Chat transcript - resp physiology

[Anonymous]

In case anyone is wondering, no you did not miss a scheduled chat session. One of the members had the date mixed up and showed up on Tues night instead of Wed night at 9 pm eastern (which will cover physio subjects in endo, resp, cardio, and muscle). Since a few of us were already there, we decided to get a head start. I figured someone else might benefit from some of the questions we went over, so I'm posting the short transcript here. But we're officially scheduled to chat every Wed and sat and 9pm. See ya all in the chat




11:34:49 [ash] hey vandan there is a chat on physiology in 10 hours from now .join us if you are interested.

14:48:06 shazia enters this room

16:10:49 ash enters this room

16:25:30 al*****i enters this room

16:49:27 drsasmd enters this room

16:51:19 [drsasmd] Hello everybody

17:20:09 ash enters this room

20:07:26 shazia enters this room

21:10:52 ash enters this room

21:15:35 Step_1 enters this room

21:15:36 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

21:15:53 [Step_1] hi ash

21:16:55 [ash] hi

21:17:11 [ash] do you know the topics for todays discussion

21:17:26 [Step_1] i noticed that it says there is supposed to be a physiology chat in tonight, but it is really scheduled for tomorrow night at 9 pm eastern

21:17:54 [Step_1] i just saw that you were in here, so thought i'd let you know

21:17:57 [ash] hey i read your post.congrats for passing stap 1

21:18:09 [ash] oh!!!

21:18:29 [ash] but what are the chapters?

21:18:30 [Step_1] thanks ask....i hope to be saying the same congrats to you soon enough

21:18:49 [ash] amen

21:19:08 [ash] i didnt know you had already given step 1

21:19:18 [Step_1] i cant remember what exactly was decided, but i think it was endocrinology, muscle physiology, and cardiac....i think

21:19:44 [ash] ooopps i didnt read endocrino.

21:19:53 [Step_1] yes, about a month ago. i was sticking around just in case....and to help the others too

21:20:11 [ash] thanks

21:20:19 [ash] how was it?

21:20:29 [Step_1] endocrine is probably the most important part of physiology

21:20:49 [ash] i have read it earlier but not today

21:20:54 [Step_1] i wont lie....i was tough.....but definitely doable if you prepare correctly

21:21:15 [ash] which books did you read?

21:21:29 [ash] i hope i am not boring you

21:21:56 [Step_1] i used mainly kap lan notes, but also web prep, gol.jan, first aid, q.bank

21:22:17 [ash] did you do B S S?

21:22:20 [Step_1] not boring me at all. i had same questions for others not long ago

21:22:39 [ash] thanx

21:22:56 [Step_1] i did some, but didn't get through enough of it because i decided to redo q.bank instead

21:23:08 [ash] was k a p l a n genetics and molecular biology enough?

21:24:36 [Step_1] biochem is not my best subject, but i used kap lan and felt it was pretty good. also gol jan has a good chapter on genetics. i also used lipencotts biochem as a reference for some things not well explained in kap lan

21:25:11 [ash] what about transgenic mice?

21:25:42 [ash] i didnt have it in my syllabus in detail in my med school.

21:25:59 [Step_1] there is a pretty good post (long and detailed) about that subject on the step 1 forum here. have you taken a look at that yet?

21:26:13 [ash] what country are you from?

21:26:28 [ash] ok i will

21:27:03 [Step_1] i'm from the u.s. but went to school in carib

21:27:08 [ash] have you given step2 too?

21:27:11 [Step_1] how about you?

21:27:19 [ash] oh.

21:27:25 [Step_1] nope, just started studying for it now

21:27:38 [ash] i am in the usa but basically from india

21:28:11 [ash] all the best for your step 2 then.i am sure you will do well

21:28:48 [Step_1] i hope so. and best of luck to you with step 1

21:28:54 [ash] how long did you study for step 1?

21:29:01 [ash] thanx

21:29:25 [Step_1] i found the post here http://www.valuemd.com/viewtopic.php...ransgenic+mice

21:29:56 [ash] it is very sweet of you to help others even after you are done with step1

21:30:47 [Step_1] i studied for quite some time because i did some during rotations, so not full time studying. but i hit the full time study hours during the last couple of weeks before the exam

21:31:54 [ash] wow!!!you were studying during rotations?it must be so tough and exhausting!!!

21:32:15 [Step_1] i remember a guy named tommyk (have you read his 1200 + questions?) who did the same thing and i thought he was crazy. but now i find myself doing the same thing. so who knows, maybe you will do the same once your done?

21:32:39 [ash] so have you finished rotations now?

21:33:23 [ash] i have read about this guy.i dont have the questions though.are they good?

21:33:26 [Step_1] no, still in rotations, but i took some time off to study for step 1 and hopefully will do the same for step 2.

21:34:04 [ash] are your rotations for 1 year?

21:34:28 [Step_1] i think they're excellent. he is an excellent teacher who has a great way of explaining the high yield concepts for questions. take a look at a few of his questions and see if you like them.

21:34:38 shazia enters this room

21:35:03 [ash] i am assuming they are at valu e m d too.

21:35:15 [ash] hi shazia

21:35:35 [Step_1] we have about 1.5 yrs of rotations if you do them straight, but i'm taking some time off to study, so will take me 2 yrs total and i'm almost half done.

21:35:51 [Step_1] yes, let me find the post

21:36:11 [ash] ok

21:36:31 [ash] isnt it in the downloads section?

21:36:42 [Step_1] its one of the announcements in the step 1 forum, but also available in free download area in word format. here it is http://www.valuemd.com/viewtopic.php?t=14286

21:37:38 [ash] i dont know how to thank you

21:37:45 [shazia] hi

21:37:48 [Step_1] tommy is my inspiration and has helped many of us. hopefully his questions can help you too

21:38:25 [Step_1] hi shazia. you know that the chat is tomorrow and not today...right?

21:38:33 [shazia] oh i see

21:38:49 [shazia] you are talking about physi,right

21:38:50 [ash] are you guys coming for the chat tomorrow?

21:39:18 butter enters this room

21:39:21 [Step_1] i stopped by because i saw ash here.....i'll be here tomorrow night at 9 sharp

21:39:24 [ash]>[Step_1] where is the list of the topics for discussion?

21:39:53 [Step_1] http://www.valuemd.com/viewtopic.php?t=18530

21:40:01 [Step_1] hi butter

21:40:03 [ash] hey thrre are 4 of us .why not do it today itself?

21:40:11 [shazia] ok

21:40:24 [Step_1] hmmmm.....was there supposed to be a chat tonight....seems like lots of people showing up?

21:41:01 [ash] hi butter

21:41:18 [shazia] i read this message in the chat room this mesage that there would be physi chat tonight

21:41:24 [shazia] but i was not sure

21:41:26 [ash] so what do you say should we start?

21:42:32 [Step_1] i saw that too, so i thought i'd show up just in case. but the actual chat is supposed to be every wed and sat and 9 pm eastern. its up to you all, i'm just here to help if i can.

21:42:57 [shazia] would it eb okay if ijust observe it coz i have not done phsio since a while

21:43:12 [shazia] no

21:43:27 [ash] butter are you there?

21:44:15 [Step_1] like i said, its up to you all. usually given a couple of days for everyone to prepare, but if you got through the same parts of whatever material, we can discuss it if you want

21:44:25 [ash]>[Step_1] do you have some questions on general physio,cardiac and respiratory?

21:44:48 [ash] thtas what i read today

21:45:46 [Step_1] i hadn't prepared them yet, but i have a bunch of physio mixed up....i would just need to separate them.

21:46:36 [ash] let me try some

21:46:44 [shazia] butter has left too

21:46:55 [shazia] now ash do you still want

21:47:00 [shazia] plz

21:47:33 [Step_1] ok, i found some on resp physio if you want to do a couple?

21:47:44 [ash] ok

21:47:56 [ash] we will do the rest tomorrow

21:48:03 [ash]>[Step_1] shoot

21:48:09 [shazia] ok

21:48:14 [Step_1] Neonatal respiratory distress syndrome is due to a deficiency of what?

21:48:34 [ash] surfactant

21:48:54 [Step_1] yep, its Surfactant (dipalmitoyl phosphatidylcholine, lecithin)

21:49:06 [Step_1] Perfusion is greatest in what part of the lung?

21:49:07 [ash] especially before 34 wks

21:49:22 [ash] ratio should be>2

21:49:35 [ash] base

21:50:08 [Step_1] Both ventilation and perfusion are greater at the base than at the apex....great job ash!

21:50:26 [ash]

21:50:27 [Step_1] Recurrent TB grows best in what part of the lung? Why?

21:50:44 [ash] normal ratio is 0.8

21:50:49 [ash] apex

21:51:03 [shazia] sorry guys i can't recall anything

21:51:04 [ash] high v?p ratio

21:51:33 [ash] thats ok it would happen to anyone.

21:51:57 [Step_1] yep....Apex because of high O2. a real question had something about this concept

21:52:33 [ash] what part of the lung behaves like dead space and which is like shunt?

21:53:19 [ash] anything about tb will be well known by an indian cos it is very common there

21:54:13 [Step_1] its pretty high yield for the boards too....not so much because its common, but because it is so contagious and relatively resistant to most drugs

21:54:56 [ash] thats a relief.tb is better than genetics anytime

21:55:16 [Step_1] ok, i have a T/F question so that it's 50-50 chance

21:55:19 [Step_1] T/F - The pulmorary circulation is a high resistance, low compliance system.

21:55:26 [ash] ok

21:55:36 [ash] false

21:55:47 [ash] low resistance

21:55:54 [ash] high compliance

21:56:10 [Step_1] you really know your physio!!! thats correct its F. It has low resistance and high compliance.

21:56:22 [Step_1] wow....i'm impressed!

21:56:39 [ash] i just read it today.

21:56:59 [ash] i dont know anything out of k a p l a n

21:57:51 [Step_1] some of these questions cover material in kap lan too, but you know enough to get those too

21:58:08 [ash] now u r making me blush

21:58:16 [Step_1] Surfactant role in the lungs is to do what?

21:58:31 [ash] reduce surface tension

21:58:34 [shazia] dec surface tension

21:59:02 [Step_1] Decrease alceolar surface tension....excellent.....i knew i'd get shazia involved on at least one of these

21:59:14 [ash] and also reduce capillary filtration forces

21:59:28 [ash] preventing pulmonary edema

21:59:38 [ash] good shazia

21:59:45 [Step_1] yep.....very good point ash

21:59:55 [shazia] thanks

22:00:02 [Step_1] ok, this is a bit tougher, but important concept. Dissociation of CO2 from Hb upon oxygenation in the lungs is known as?

22:00:19 [ash] and also increase compliance

22:00:49 [ash] haldane effect?

22:00:53 [Step_1] The Haldane effect

22:01:10 [Step_1] wow....wasnt expecting you to get that one

22:01:29 [ash]

22:01:48 [Step_1] i'm looking for the post with a pic describing that concept because important concept. but the pics make it seem easy to remember

22:01:56 [ash] stop making me blush

22:02:20 [ash] i know this effect

22:02:32 [Step_1] ok, it doesnt have a pic (i'll need to keep looking later) but here is what i found

22:02:38 [Step_1] http://www.valuemd.com/viewtopic.php...haldane+effect

22:02:44 [ash] it causes the bicarbonates to form

22:02:58 [ash] and they then leave the rbcs

22:03:16 [ash] in exchange the chlorides enter the rbcs

22:03:28 [ash] this is the chloride shift

22:03:49 [Step_1] exactly, very cool concept

22:04:48 [ash] rbcs produce the bicarbonates found in plasma

22:05:12 [Step_1] i cant find too many others in the group of physio questions dealing with resp because theyre all mixed up. do you want some cardio, or should we leave it for tomorrow?

22:05:33 [ash] are you tired?

22:06:14 [ash] i dont mind cardio

22:06:27 [Step_1] not tired yet, just not too prepared to answer the physio questions for tonight, but i can keep asking instead of answering if you want

22:06:36 [ash] but if you are tired we will leave it for tomorrow

22:06:59 [ash] ok if you dont mind then ask on cardio

22:07:16 [Step_1] we can go on for a little while longer....maybe 15 to 20 mins....what do you think?

22:07:53 [ash] alright!!thanks

22:07:59 [Step_1] i'l ltry to find some more resp too. heres one. Exercise (increased cardiac output) will have what effect on V/Q to the apex?

22:08:13 [ash] increases

22:08:47 [Step_1] The V/Q will approach 1 (from 3) as a result of dilation of vessels in the apex.

22:09:28 [ash]>[Step_1] i dont undrestand

22:09:43 [ash] will the ratio increase or decrease?

22:10:09 [ash] i thought it increases as both v and p increase in exercise

22:10:26 [Step_1] i think it is saying that the ventilation will increase more than the perfusion so that the ratio actually decreases to 1:1 (from 3:1), but both go up overall

22:11:02 [ash] oh!ok!

22:11:48 [Step_1] picture a person in excercise who breath deep and heavy and also has vasodialation. afterwards, they get "soar" because not enough perfusion despite the increased ventilation.

22:12:06 [ash] perfusion increases to 3 and hence it is 1:1

22:12:39 smb enters this room

22:12:46 [ash] thanks. got it.

22:12:56 [ash] hi smb

22:13:12 [Step_1] hi smb

22:13:41 [Step_1] In the perpheral tissue what factor helps unload oxygen by shifting the curve to the right?

22:13:56 [shazia] oh thanks for the example step_1

22:14:21 [ash] increased co2 in the tissue

22:15:00 [ash] and also the low o2 content

22:15:35 [Step_1] this is true, but those lead to something that actually has the effect on the o2 curve

22:15:47 [shazia] dec ph

22:16:08 [smb] hi

22:16:13 [ash] no idea

22:16:18 [Step_1] very good , Increased H+ (decreased pH) a.k.a. the Bohr effect.

22:16:37 [ash] oh yes!!!

22:17:22 [ash] hey but bohr effect is increased co2

22:17:37 [Step_1] the right shift (think excercising muscle) is caused by dec pH from lactic acid and inc PCO2, inc 2, 3 bisP from inc glycolysis, and inc temp

22:18:36 [ash] smb can you change your color it is hard to read

22:19:11 [smb] ok

22:19:17 [ash]>[Step_1] you are good at giving examples

22:20:09 [Step_1] yes, i meant to say that the increase CO2 will effect the pH which is what actually causes the shift. but you are correct that it was because of the CO2 to begin with

22:20:41 [ash] ok

22:21:12 [Step_1] The right shifted curve will have what effect on the dissociation of O2? inc or dec?

22:21:26 [ash] increase

22:21:47 [ash] tissues can extract o2 more easily

22:22:22 [Step_1] yes, exactly. so then you can think about what situation would want more O2 and it will help you remember

22:22:43 [ash]

22:23:17 [Step_1] notice that increased temp (fever) will help release more O2, so fever is our bodies defense mech....and the first thing we always do is give tylenol

22:23:56 [ash] right

22:24:04 [ash]

22:24:06 [Step_1] A ZERO value for V/Q indicates?

22:24:12 [shazia] wow

22:24:30 [ash] ventillation is absent

22:25:05 [Step_1] exactly, Airway obstruction

22:25:06 [ash] eg. foreign body in a bronchus

22:25:30 [Step_1] what about the opposite, A value of infinity for V/Q indicates?

22:25:49 [ash] perfusion absent

22:25:56 [ash] block in vessel

22:26:09 [Step_1] yep again, Blood flow obstruction

22:26:40 [Step_1] A decrease in PA O2 will have what effect on the pulmonary vasculature?

22:26:50 [ash] constriction

22:27:03 [ash] only one of its kind

22:27:16 [Step_1] Causes hypoxic vasoconstriction that shifts blood awayfrom poorly ventilated regions

22:27:41 [Step_1] you are really good at this stuff ash....i'm truely impressed

22:27:44 [ash] right

22:27:51 [ash] thanks

22:28:38 [ash] should we continue tomorrow ?i havent had dinner.

22:28:47 [ash]

22:29:22 [Step_1] sure, we can continue tomorrow. you're well on your way to passing. i'll need to come up with better questions for you

22:29:54 [ash] thankyou so much for bearing with me today

22:30:06 [shazia] step_1 could you plz tell me the topics for tomorrow

22:30:12 [Step_1] shazia, i'm sure you will be just as good at answering these once you get through the material because i've seen you answering lots of questions before

22:30:23 [ash] i will try to bring some good questions tomorrow too

22:30:38 [shazia] thanks guys

22:31:00 [ash] to tell you the truth i dont know the topics for tomorrow

22:31:06 [Step_1] for tomorrow, we are supposed to go over endocrine, mucle, cardio, resp....i think thats what we decided.

22:31:18 [ash] i am assuming it is the initial chapters

22:31:42 [Step_1] we did some resp today, so the 2 of you are already ahead of the game

22:32:16 [ash] i need to go through endo.the arrows are bothersome

22:32:23 [Step_1] yes, the initial chapters of kap lan physio, and the remainder of physio on sat

22:32:54 [ash] ok guys thanks a lot for todays session

22:33:00 [Step_1] endo is tough, but if you try understanding the reasons why the arrows go one way or the other, it gets easier

22:33:12 [ash] agree

22:33:18 [ash] but its boring

22:33:28 [shazia] step_1 and ash ! you guys are really helpful

22:33:48 [shazia] stp1 i am very bad in some concepts in phsio

22:33:57 [Step_1] true. i recommend gol jan for some of these as supplements to understanding the concepts...it helps alot

22:34:23 [ash] i agree g o l j a n is a very good book

22:34:48 [ash] ok goodnite guys .see you tomorrow.

22:34:50 [Step_1] shazia, it is all about repetition. the first time is slow and painful, but its gets easier with the next time around (assuming not too much time has passed)

22:34:50 [shazia] you mean lecture or the book?

22:35:07 [ash] both

22:35:21 [Step_1] the lecture notes with audios, or the book....everything from him is great

22:35:24 [shazia] i see

22:35:30 [shazia] ok guys thanks

22:35:43 [Step_1] ok, see you tomorrow...good night

22:35:46 [shazia] see you tomorrow then

22:35:56 [ash] bye

22:36:02 [shazia] bye

22:36:14 [Step_1] bye