chat transcript - Golijan path (heme, cardio, resp, renal, g

[Anonymous]

21:08:30 [Step_1] ok, lets take it by section, we're covering the 2nd part of goljan...

21:08:58 [kmonica26] Hey Step 1 do you have your exam experience posted somewhere?

21:09:23 [Step_1] we can go in order and start with heme and cardio then take it from there....or just bring up questions if you dont have them in order

21:09:25 [acestep1]

21:09:37 [acestep1] sure step1

21:09:42 [Step_1] yes, let me find the thread.....its a long one

21:09:46 [Hmmmmmm] anyway u like man

21:10:00 [kmonica26] Thanks


21:10:55 [Step_1] http://www.valuemd.com/viewtopic.php?t=20954

21:11:09 [kmonica26] thanks


21:11:42 springone enters this room

21:11:54 [Step_1] ok, so if you see howell jolly bodies, what can this mean?

21:12:00 [Hmmmmmm] howdy spring

21:12:15 [Step_1] hi spring

21:12:22 [springone] pretty good ,thanks

21:12:44 [Hmmmmmm] autosplenectomy?

21:12:48 [Step_1] spring, you might want to pick brighter color from the right

21:13:11 [hutals] no spleen

21:13:40 [Step_1] howell jolly bodies can be spleen surgially removed or dysfunctional from sickle cell

21:13:40 [Hmmmmmm] whoops ur rite hutals

21:13:42 [acestep1] agree

21:13:53 [Step_1] both correct

21:14:40 [Step_1] in iron def anemia, what type of anemia is this?

21:15:00 [kmonica26] Micro hypo

21:15:10 [hutals] micromicrocytic

21:15:31 [hutals] oops, just one micro....not that small

21:16:01 [Step_1] lol

21:16:09 [Hmmmmmm] a 10 yo child from a poor country has fatty liver what is the most probable etiology? the minimum age for alcohol consumption is 10 there? dx?

21:16:34 [Step_1] yes, its micro....very good

21:16:48 [Hmmmmmm] agree with hutals

21:18:22 [hutals] even if started drinking at 10, the pt would probably not develop fatty liver so quick, right?

21:19:11 [Hmmmmmm] hutals the most probable etiology would be protein deficieny or kwasiorkor(sorry for the spelling)

21:19:58 [Hmmmmmm] what is the main diffrence between vit B12 and folate deficency?

21:20:29 [Step_1] B12 will cause neuro problems which can be permanent

21:20:37 [Hmmmmmm] yes

21:20:43 [kmonica26] A previously well 17-year-old girl complains of weakness, weight loss, canker sores on her tongue, and loss of sensation and positional sense in her feet over the past few months. Her family reports that she has become pale. Laboratory findings include: hemoglobin, 73 g/L (7.3 g/dL); mean corpuscul

21:21:07 [kmonica26] mean corpuscular volume, 108 fL; white blood cell count, 3.1 x 109/L (3,100/mm3); platelets, 116 x 109/L (110,000/mm3); and reticulocyte count, 1%. Examination of a peripheral blood smear reveals marked anisocytosis, many large ovalocytes, and an average of six lobes per neutrophil.

21:21:22 [kmonica26] diagnosis?

21:22:06 [Hmmmmmm] macrocytic anemia due to vit b12 def

21:22:30 [hutals] agree

21:22:36 [acestep1] b12 def

21:22:46 [kmonica26] answer was pernicious

21:23:01 [kmonica26] though I am trying to think why not Vit B12

21:23:10 [Hmmmmmm] pernicious is vit b12

21:23:25 [Hmmmmmm] its because of auto antibodies ot intrinsic factor

21:23:42 [Hmmmmmm] which carrier b12 into blodd

21:23:47 [acestep1] yes agree iwth hmm

21:23:48 [Step_1] pernicious anemia will lead to vit b 12 def

21:24:04 [Hmmmmmm] (haha my english is degenerating)

21:24:33 [kmonica26] oh yes!!

21:24:47 [kmonica26]

21:25:15 [acestep1] intrinsic factor

21:25:28 [Step_1] so everyone was correct, just depends on the answer choices given. good question

21:25:42 [acestep1] k

21:25:50 [Hmmmmmm] a child from a poor country get mental and behavioral changes! u see a black gingival line?

21:25:55 [kmonica26] A newborn is recognized clinically to have Down syndrome. The parents are very concerned about the disorder and its manifestations.

21:26:20 [acestep1] lead oisioning

21:26:34 [Hmmmmmm] very good ace

21:26:39 [acestep1] hye monica whst teh q

21:26:47 [Hmmmmmm] alzimers monica

21:27:14 [Hmmmmmm] (kaplan notes eh!!! )

21:27:23 [acestep1] thnx

21:27:32 [kmonica26] I guess as Anewborn you will be more worreid abou the baby having Leukemia

21:27:53 [kmonica26] yes they do develop alzimers too

21:28:09 [Hmmmmmm] its the ALL kind rite?

21:28:27 [acestep1] ic

21:28:39 [Step_1] and endocardial cushion defects (20% have congenital cardiovasc dz)

21:28:44 [kmonica26] they could have either ALL or AML as far as I am aware

21:28:50 [acestep1] k

21:28:54 [kmonica26] yep step 1

21:29:03 [Hmmmmmm] thx step2

21:29:10 [acestep1] lol

21:29:16 [Step_1] according to goljan, any person under 40 with alzheimers has down syndrome

21:29:20 [kmonica26] and if I remeber correctly they are more prone to get hypothyroidism

21:29:29 [Step_1] lol....i need to change my name

21:29:54 [Hmmmmmm] they also have pyloric stenosis adn hirshprungs

21:29:58 [acestep1] yes- step1

21:30:09 [acestep1] :0

21:30:25 [acestep1]

21:30:57 [Step_1] another big correlation is duodenal atresia with a double bubble sign and vomits bile at birth....oops, just gave away the answer to one of my GI question

21:31:06 [acestep1] hey guys listen ill log off now

21:31:07 [Hmmmmmm] a lady has cramps during menses...she has pain during intercourse....the doctor thinks PID but ultrasound u see some dark cysts dx?

21:31:27 [acestep1] if i cant sleep ill log on again

21:31:34 [kmonica26] endometriosis

21:31:36 [acestep1] u guys take care

21:31:38 [Hmmmmmm] awww already ace? well take care it was a pleasure

21:31:49 [Step_1] ik ace, hope to see you later

21:31:52 [kmonica26] bye ace

21:31:54 [Hmmmmmm] very good monica

21:32:01 [acestep1] yes

21:32:09 [Hmmmmmm] latez ace(sleep tight)

21:32:11 [kmonica26] I think this is a nice question to clear B/T vit b!2 and pernicious anemia............

21:32:12 [acestep1] definitely step1

21:32:24 [acestep1]

21:32:29 [kmonica26] A 4-week-old exclusively breastfed boy undergoing preoperative screening prior to elective surgery is found to have macrocytic anemia. The mother is a strict vegan who emigrated from India 1 year ago. Laboratory findings include: hemoglobin, 103 g/L (10.3 g/dL); mean corpuscular volume, 135 fL; whi

21:32:36 [acestep1] byee

21:32:47 [kmonica26] white blood cell count, 4.1 x 109/L (4,100/mm3); platelets, 110 x 109/L (110,000/mm3); and reticulocyte count, 10 x 10-3 (1%). The peripheral blood smear reveals marked anisocytosis, many large ovalocytes, and hypersegmentation of the neutrophils.

21:33:09 [kmonica26] the MOST likely diagnosis is

21:33:25 [Hmmmmmm] folate?

21:33:51 [hutals] b12 def

21:34:02 [Hmmmmmm] whoops no no its pernicous cuz hes only 4 weeks

21:34:08 [kmonica26] b12

21:34:21 [kmonica26] this is dietary as mom is vegan

21:35:05 [Hmmmmmm] ok i get it now thx nice question

21:35:09 [Step_1] pure vegan gives away the b12 part because b12 cannot be obtained except from animal products

21:35:50 [kmonica26] yep

21:35:54 [Hmmmmmm] thx step1 i ignored that word!

21:36:16 [Step_1] also look for the fish tapeworm as another cause of b12 deficiency...another buzz word

21:36:33 [Hmmmmmm] a pregnant mom gets nutmegs liver and doctor sees thrombosis in hepatic veins dx?

21:38:37 [Step_1] here is a pic of a nutmeg liver

21:38:38 [Step_1] http://www-medlib.med.utah.edu/WebPa.../LIVER041.html

21:38:57 [Hmmmmmm] a 50 yo patient with left lower lobe consolidation and productive cough. sputum sample taken to lab. what is teh most likely diagnosis? give ddx if u can!

21:39:27 [kmonica26] strep pneumo?

21:39:34 [Hmmmmmm] the answer to my first one is budd-chiari i think

21:40:06 [Step_1] strep pneumo is my guess too

21:40:14 [hutals] agree

21:40:25 [Hmmmmmm] yeah monica and step 1 great

21:40:31 [Hmmmmmm] very good hutals

21:40:58 [Hmmmmmm] ddx could include H. flu, leginoella etc

21:41:11 [Hmmmmmm] but usually consolidation in strep pneumo

21:41:24 [kmonica26] agree

21:41:54 [Step_1] not sure about that, you mentioned productive cough....isnt legionella atypical?

21:42:14 [Hmmmmmm] whoosp im sorry ur rite step1

21:43:04 [Step_1] actually, i think they might have boody sputum, so i guess that can be considered productive

21:43:36 [Hmmmmmm] no ur rite its non-productive!

21:44:19 [Step_1] but you're right, the most common cause of lobar pneuomonia in someone that age, assuming no other factors such as immunocompromised, etc, would be strep pneuomo....good question

21:45:03 [Hmmmmmm] a 40 yo male was sexually promicus (sheesh wheres my dictionary) and develops non-productive cough and diffuse pulm. inflitrate in xray dx?

21:45:16 [Hmmmmmm] ty step1

21:45:39 [kmonica26] chymidial pneumonia?

21:45:48 [Hmmmmmm] very good

21:45:52 [Step_1] chylamida

21:46:13 [kmonica26] sorry for th etypo

21:46:22 [Hmmmmmm] most imp atypical pneumo... mycoplasma, chlamydia and legionelal(thx to step1)

21:46:47 [kmonica26] A 6-year-old boy is brought to your office for evaluation of a palpable purpuric rash on his arms, legs, and trunk. He has a fever of 39.4°C (102.9°F), appears ill, and complains of headache, arthralgias, and abdominal pain.

21:46:54 [kmonica26] diagnosis

21:46:54 [Hmmmmmm] yes its chylamidal pneumo

21:47:09 [Step_1] oh, i wasnt correcting your spelling ( i mispell all the time when i type fast)....i was just answering late

21:47:38 [kmonica26]

21:47:41 [Step_1] HS

21:48:08 [kmonica26] I thought that too....but he is ill appearing..

21:48:12 [Step_1] henoch ....here comes my mispelling...nevermind....i'll just say HS

21:48:15 [Hmmmmmm] varicella?

21:48:40 [kmonica26] no

21:48:43 [Step_1] palpable rash....hold on....let me think this one thru

21:49:07 [kmonica26] remember what goljan says

21:49:21 [kmonica26] ill appearing with purpura

21:49:41 [Step_1] palpable has to be small vessel vasculitis

21:49:50 [Step_1] rmsf??

21:50:02 [kmonica26] no

21:50:09 [Hmmmmmm] thats what i thought

21:50:10 [kmonica26] fever, headache

21:50:17 [kmonica26] meni

21:50:32 [kmonica26] minigococcseamia

21:50:53 [Hmmmmmm] but meningitis has mood and behavioral changes too rite?

21:51:02 [Step_1] really, i would not have guessed that....

21:51:18 [Hmmmmmm] what bout septic shock?

21:51:49 [Step_1] where is the rash coming from ?

21:51:56 [Hmmmmmm] sorry monica its just that im confused!

21:52:08 [kmonica26] I guess septis shock is not a bad thought

21:52:39 [Hmmmmmm] step1 usually systemic infection can produce rash

21:53:02 [Hmmmmmm] rite?

21:53:15 [kmonica26] Meningococcemia is a rapidly fatal disease that may be associated with disseminated intravascular coagulation and widespread bleeding in the skin (purpura fulminans). Palpable purpura and leukocytoclasis (fragmentation and necrosis of leukocytes) are associated with an immune complex-mediated host

21:53:39 [kmonica26] response that develops in response to this bacterium over several days and is associated with a better prognosis than rapid fulminant disease. Affected patients typically develop high fever, symptoms of meningitis, and small hemorrhagic, necrotic papules in the skin, as described in the patient in

21:53:43 [Step_1] yes, it makes sense now. from neiseria meningitidis causing a small vessel vasculitis.....very good question....it got me

21:53:59 [Hmmmmmm] ooohhhhhhh i see great

21:54:14 [Hmmmmmm] ty monica

21:54:26 [kmonica26] yep

21:54:37 [Step_1] yes, thanks monica.

21:55:16 [kmonica26] u welcome

21:55:45 [Hmmmmmm] a 3 weeks old child has cataracts whats the ddx?

21:56:28 [hutals] RB?

21:56:36 [kmonica26] congenital rubella

21:57:34 [Hmmmmmm] im thinking more of galactosemia and diabetes type I but yeah congenital rub is also there thankx

21:57:56 [Step_1] a 50 yr old obese african american pt comes to your office with HTN. would she most likely have high or low renin?

21:58:16 [Step_1] sorry, i couldnt answer cause i was typing the next question

21:58:44 [Hmmmmmm] its ok

21:59:09 [Hmmmmmm] if its primary htn then low renin if sec then high renin

21:59:14 [hutals] low?

21:59:38 [Hmmmmmm] my guess is low cuz its primary htn

21:59:52 [Hmmmmmm] agre with hutals

22:00:11 dgrosen enters this room

22:00:14 [kmonica26] not sure

22:00:31 [Step_1] african americans usually retain soduim which raises plasma vol. the incr plasma vol will result in lower renin because the body is responding to the high plama vol

22:00:39 [Hmmmmmm] hi dgrosen

22:00:50 [Step_1] hi dgrosen

22:00:55 [dgrosen] hi Hmmmmmm

22:01:01 [hutals] hey drrosen

22:01:03 [dgrosen] hi everybody

22:01:10 [Hmmmmmm] ty step

22:01:51 [dgrosen] By the way, thanks for the questions you post in your briefcase Hmmmm!

22:02:20 [Hmmmmmm] a patient has ADplycystic kidney disease? what other manifestations?

22:02:25 [Step_1] yes, that was very kind of you to share your files with everyone hmmmm

22:02:31 [Hmmmmmm] ty dgrosen

22:03:09 [Hmmmmmm] ty step1 *just following ur lead step1

22:03:45 [Step_1] subarach hemorage

22:04:17 [Step_1] and i'm just following tommyk's lead....i guess the pay it forward concept really works

22:04:38 [Step_1] HTN

22:04:49 [Hmmmmmm] yup its is associated with liver cysts...berry aneurysms (its a tango line step1)

22:05:01 [Step_1] berry aneurysm

22:05:28 [dgrosen] liver cysts, berry aneurisms, mitral prolapse and diverticula

22:05:56 [Hmmmmmm] wow dgrosen thx

22:06:27 [Hmmmmmm] hey dont we also see fistulas in this???

22:06:30 [dgrosen] the berry aneurisms are in the willis

22:07:04 [hutals] How can Isoniazid (INH)-induced neurotoxicity be prevented?

22:07:22 [Step_1] B6

22:07:44 [kmonica26] b6

22:07:58 [hutals] yep B6

22:08:18 [Hmmmmmm] and tylenol induced hepatotoxicity?

22:09:16 [Step_1] whats the question hmmmm?

22:09:50 [Hmmmmmm] what do u do for tylenol indudced hepatotoxicity?

22:10:25 [Step_1] give mucomyst

22:10:36 [Step_1] n-acetylcystiene

22:10:40 [kmonica26] Mucomyst? could maybe prevent the progression

22:10:54 [Hmmmmmm] yup u told us the other day remember?

22:11:06 [kmonica26] or else the patient would go into liver failure

22:11:23 [Hmmmmmm] yup monica

22:11:53 [Step_1] yep, once it reaches failure, mucomyst won't really do anything, so best to give it asap

22:12:07 [hutals] A patent ductus arteriosus is maintained by what ?

22:12:10 [dgrosen] Hmmmmmm> sorry Hmmmm, did you take step 1 already?

22:12:25 [dgrosen] PGE2

22:12:49 [Step_1] PG

22:12:59 [Hmmmmmm] no dgrosen not yet (i still till septem end)

22:13:00 [kmonica26] and closed by indomethacin

22:13:28 [hutals] yep PGE synthesis

22:13:31 [Hmmmmmm] agree with dgrosen pge2 and low 02 tension

22:13:53 jwls29 enters this room

22:13:57 [Hmmmmmm] my question is why woudl we want to keep PDAopen?

22:14:15 [Hmmmmmm] hi jwls

22:14:16 [Step_1] mneumonic is the "PGA Open" (golf tournament) to show that PG opens it

22:14:22 [kmonica26] wehn we want mixing of blood

22:14:24 [jwls29] hi. what's today's subject?

22:14:50 [Step_1] hi jwls

22:14:51 [Step_1] we

22:15:01 [Step_1] we're discussing goljan path

22:15:11 [jwls29] ok

22:15:16 [jwls29] thanx

22:15:17 springone enters this room

22:15:17 [Hmmmmmm] give me a diease where we want mixing monica?

22:15:35 [Step_1] the 2nd part which includes cardi, heme, resp, gi, renal and whatever else

22:15:42 [dgrosen] your might mean "mnemonic" not neumonic!

22:15:45 [Hmmmmmm] jwls29> did u get ur &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000206&type=2 &subid=0>QBank&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491&type=2&subid=0 > yet?!

22:16:08 [Hmmmmmm] doh whoops

22:16:35 [kmonica26] like in hypoplastic L hrt,

22:16:54 [kmonica26] I would assum ein critical coarc

22:16:56 [dgrosen] taken, what?

22:16:57 [kmonica26] too

22:17:00 [Step_1] dgrosen, bad spelling in here is understood since we're all typing fast

22:17:08 [Hmmmmmm] we want mixing of blood in tranposition of great arteries

22:17:24 [dgrosen]

22:17:33 [Hmmmmmm] im sorry jwls29 q.....bank

22:17:45 [jwls29] yes

22:17:52 [jwls29] thanx

22:17:59 [dgrosen] actually my wife is taking q....bank.

22:18:04 [jwls29] got the regular one

22:18:33 [dgrosen] how much you think is a good score to consider you are going to pass the actual exam?

22:18:38 [Hmmmmmm] monica im not sure bout coarac if we need mixing cuz itll shunt blodd to pulm( can anyone comment on this)

22:19:03 [Step_1] in tetralogy of fallot, the presence of an asd and pda are cardioprotective, so maybe in that case

22:19:10 [Hmmmmmm] im getting it too jwls so was it worth it?

22:19:26 [jwls29] yes

22:19:29 [jwls29] i think so

22:19:30 [dgrosen] fallot needs blood mix

22:19:39 [jwls29] i did 50 questions this morning...did really really bad

22:19:41 [dgrosen] I dont think coart needs one to survive

22:19:56 [Hmmmmmm] sorry step1 we're discussing when we should keep the PDA open!

22:19:56 [jwls29] so i have to make a new plan of attack b/c apparently what i'm doing is not enough

22:20:28 [dgrosen] how much is "really, really bad" jwls29?

22:20:38 [Hmmmmmm] haha attack the borads nice analogy( but have u done everything?)

22:20:45 [jwls29] really bad

22:20:52 [jwls29] oh no

22:20:55 [dgrosen] which is the prognostic factor of fallot?

22:20:57 [jwls29] not yet

22:21:13 [jwls29] i've only read path,**,micro and pharm

22:21:47 [jwls29] but still, makes me nervous. gonna take my exam in nov

22:22:03 [kmonica26] I was thinking in critical coarc if it tis preductal then a patent PDA would be able to supply bld diatal to obstruction

22:22:09 [Hmmmmmm] hey usually survive long enuf to surgically correct the main probem

22:22:31 [dgrosen] my wife did 56%, do you consider this really really bad?

22:22:55 dkochanik enters this room

22:22:57 [jwls29] is that her final cumulative score?

22:23:04 [dgrosen] If it is preductal, and really really bad, a ductus might help...I think

22:23:08 [Step_1] right, in tetralogy of fallot i think it you would want to keep it open because its cardioprotective by adding oxygenated blood into RA and step up right SaO2, while the left to right shunt of PDA takes unoxygenated blood in aorta and dumps the blood into pulm artery for oxygenation in lungs

22:23:10 [Hmmmmmm] but monica the preductal would miss the PDA entirely and the post ductal will shunt blod to pulmonary

22:23:13 [jwls29] i got less than that on my 50 questions today

22:23:15 [Step_1] at least according to goljan

22:23:25 [Step_1] hi dkochanik

22:23:40 [dgrosen] No, just in one block. Overall she has 62% so far

22:23:59 [jwls29] that's not bad

22:24:08 [jwls29] when does she take her exam?

22:24:23 [Hmmmmmm] jwls29> u have it good i have done the same subjects u have and im giving it sept end

22:24:56 [Step_1] i think that most say that betwwn 55 and 65% is considered a passing score

22:25:06 [jwls29] i feel like i'm doing something wrong. I'm not absorbing what Im reading, it seems.

22:25:36 [dkochanik] hello

22:25:46 [dkochanik] im just easeeeee droppin

22:26:01 [dgrosen] Talking about tetralogy of fallot...which component marks the prognosis?

22:26:03 [Hmmmmmm] hey we all feel like that every day of the month!

22:26:14 [Step_1] jwls....repetition is key. go over material again in a short time and it should seem better.

22:26:24 [Hmmmmmm] hey dkochanik

22:26:37 [jwls29] thanks step 1

22:26:47 [Step_1] dkochanik, welcome. you might want to pick brighter color from right b/c hard to read text

22:26:51 [jwls29] i read your exam experience and it was pretty good

22:26:55 [jwls29] advice

22:27:08 [Hmmmmmm] dgrosen i guess it would be the right ventricle (cuz its due to fail anytime)

22:27:09 [dgrosen] After I heard G.O.L.J.A.N's my score improved a lot!

22:27:09 [dkochanik] well does this help

22:27:13 [dkochanik] Much better

22:27:36 [dgrosen] Very, close Hmmmmm

22:27:40 [dkochanik] Usmle1 looks to be the topic

22:27:49 [dgrosen] here are some options

22:27:58 [kmonica26] I would say the intensity of the murmur

22:28:02 [Step_1] ToF gives cyanostic heart disease. overriding aorta, VSA, pulm stenosis and Rt vent hypertrophy

22:28:05 [jwls29] is it the degree of hypertrophy of the left ventricle?

22:28:10 [dkochanik] d

22:28:27 [kmonica26] worst the PS worst would be the prognosis

22:28:34 [Step_1] thanks dk, much better

22:28:56 [Hmmmmmm] agree with monica

22:29:01 [dgrosen] A) VSD, B)ASD, C) ventricular hypertrophy, D) pulmonar artery stenosis

22:29:23 [Hmmmmmm] PAS!?

22:29:28 [kmonica26] whats the answer?

22:29:35 [Step_1] the cyanosis depends on degree of pulm valve stenosis

22:29:42 [dgrosen] pulm stenosis

22:29:43 [springone] hey guys, can you plz tell me when you guys would meet up for the anatomy chat

22:30:09 [dgrosen] pulm stenosis will be the cause of the RV hypertrophy

22:30:21 [kmonica26] Ok guys have to go good night..

22:30:32 [springone] hope i'm not interrupting you

22:30:34 [Hmmmmmm] springone next week is pharma and then ppl want the next week for patho so i guess in 2 weeks!

22:30:48 [dgrosen] good night monica,

22:30:56 [kmonica26] bye

22:30:58 [dkochanik] g-night monica

22:30:58 [kmonica26] thanks

22:31:09 [kmonica26] for the questions everybody

22:31:26 [Step_1] good nigh monica....thanks for great chat

22:31:29 [Hmmmmmm] but if u want u can show up tomorow springone and i chat bout anatomy (im forgetting it)

22:31:32 [hutals] bye monica

22:31:45 [kmonica26] bye

22:31:46 [Hmmmmmm] gnite monica was a pleasure

22:31:51 [springone] Hmmmmm,can youplz tell mewhat are the topics in pharmac for next week?

22:31:59 [dgrosen] what time tomorrow?

22:32:17 [Step_1] spingone, the schedule is posted on the announcement in step 1 forum. it renews itself every two months. next scheduled anatomy is in about a month, but we can always meet before then or you can read over some of the older transcripts if you want

22:32:33 [Step_1] spring, next week is pharm

22:32:33 [Hmmmmmm] all of phrama in the week spring (we meet wed and sat for the group discussion)

22:32:46 [springone] o.k, Thanks.

22:33:04 [Hmmmmmm] dgrosen aorund 20:00:00 server time or around this time (its 10:32 in my place)

22:33:08 [Step_1] you can also see the schedule posted on the calendar. i've already submitted the new schedule to value md, they should have it up soon

22:33:12 [dgrosen] more questions, more questions!

22:33:37 [Hmmmmmm]

22:33:41 [jwls29] did we say what determines the px of tetralogy of fallot?

22:34:00 dkochanik exits from this room

22:34:03 dkochanik enters this room

22:34:08 [Hmmmmmm] jwls is defree of pulmonary artery stenosis

22:34:10 [dgrosen] the degree of pulmonary stenosis jwls29

22:34:34 crusher enters this room

22:34:41 [jwls29] thx

22:34:46 [hutals] Becker's muscular dystrophy is due to____.

22:34:53 [crusher] hello everyone

22:34:56 [Step_1] hi crusher

22:35:05 [hutals] hey crush

22:35:10 [jwls29] hi crusher

22:35:10 [Hmmmmmm] mutation in the dystrophin gene less serer

22:35:25 [Step_1] beckers is dystophin

22:35:26 [Hmmmmmm] howdy crush

22:35:45 [crusher] mutation in dystrophin gene hmmmmm

22:35:55 [crusher] i,m fine ty,,hmmm n you?

22:36:04 [hutals] yep due to dystrophin gene mutation

22:36:09 [dgrosen] mutation in dystrophin bene

22:36:31 [Hmmmmmm] same here crush

22:36:52 [Hmmmmmm] dgrosen> lol dystrophin bean

22:37:05 [hutals] What chemical carcinogen(s) are commonly associated with the liver?

22:37:28 [Step_1] vinyl choride

22:37:37 [crusher] thyro cyst,vinyl choloride?

22:37:45 [Hmmmmmm] a patient with VSD starts getting cyanosis whats sindrome?

22:38:05 [Hmmmmmm] arsenic, throrotrast, viny

22:38:45 [Step_1] Aflatoxins and vinyl chloride

22:39:41 [crusher] essinessinmegnerc synd??

22:39:49 [Step_1] eisenmengers

22:40:07 [jwls29] agree with step

22:40:29 [springone] reversal of shunts????

22:40:37 [Hmmmmmm] very good step jwls and crush (lol)

22:40:49 [dgrosen] eisenmenger S.

22:40:56 [Step_1] springone, you might want to pick a brighter color from rainbow on right

22:41:23 [springone] is this o.k?

22:41:33 vladi enters this room

22:41:40 [Step_1] much better thanks

22:41:45 [Step_1] hi vladi

22:42:01 [crusher] hi vladi

22:42:01 [dgrosen] Hi vladi

22:42:05 [springone] cool.

22:42:28 [vladi] hi everubody- nice to see you again

22:42:40 [dgrosen] how do you diagnosis sickle cell disease. A) Western blot, B)southern, C)northen D)PCR

22:42:42 [Hmmmmmm] a pateiint with recurret bloody diarrhea with H2S producing organism. and howell jolly boides in PBS dx?

22:42:55 [Hmmmmmm] howdy vladi

22:43:06 [crusher] PCR

22:43:27 [Hmmmmmm] PCR dgrosen

22:43:44 [dgrosen] Very good

22:43:56 [vladi] agree PCR

22:44:14 [Step_1] SS

22:44:58 [Hmmmmmm] what step?

22:45:36 [vladi] salmonella typhi

22:45:51 [Step_1] sorry, guess the answer...sickle cell

22:46:15 [crusher] but why is the Howel jolly body??plz explain

22:46:25 [Hmmmmmm] dx is salmonella typhi infection due to sickle cell (ur rite step1 and vladi) very good

22:46:35 [Step_1] giving samlmonella

22:46:49 [Step_1] oops salmonella

22:47:41 [Hmmmmmm] crusher sicke cel cuases autosplenectomy so spleen can no longer clean out hte bad rbcs (example those with intracellular accumulations(they are not normal))

22:47:48 [dgrosen] Howell jolly bodies indicates and absent or dysfunctional spleen

22:47:52 [Step_1] the howell jolly bodies are from the autospenectomy cause by infarction from sickle cells. shows a dusfunctional spleen

22:48:14 [dgrosen] Is acumulation of chromatin within the RBC

22:48:35 [Hmmmmmm] np vladi

22:48:52 [Step_1] IV drug abuser with chronic hep B, nodular inflammed mass on lower extremity, hematuria. Dx?

22:48:58 [crusher] wow..thanks everyone for explanation

22:49:28 [Hmmmmmm] ok salty baby with recurrent lung infections dx?

22:49:45 [dgrosen] CF

22:49:52 [crusher] bronchectasis cos of cystic fibrosis

22:50:04 [Hmmmmmm] good

22:50:06 [jwls29] agree with dgrosen

22:50:20 [jwls29] what's the answer to your ?,step 1

22:50:22 [hutals] polyart nodosa

22:50:24 [dgrosen] that is a hard one Step1!

22:50:31 [Step_1] this is polyarteritis nodosa. anytime you see chronic hepatitis with vasculitis....think of PAN

22:50:46 [crusher] agree with hutals....

22:50:59 [dgrosen] S$#@$!

22:51:09 [jwls29] thanks

22:51:19 [Hmmmmmm] thankx step1 i didnt see u qestion

22:51:25 [Step_1] the chronic hep plus the hematuria is the give away....straight from goljan

22:51:51 [jwls29] haven't gotten that far yet in the audio

22:52:14 [vladi] step 1- tahnks- this combination pathognomonic for PN

22:52:42 [dgrosen] I didnt know that one. Thanks for the tip!

22:53:01 [Step_1] a 4 yo child presents with an MI. what is most probably dx?

22:53:02 [Hmmmmmm] black liver dx?

22:53:10 [springone] hey step 1, thanks for the tip

22:53:11 [crusher] me either,,thanks step1

22:53:15 [vladi] what's blood marker for PNA?

22:53:24 [crusher] dubin johnson

22:53:26 [Hmmmmmm] step1 pompes?

22:53:28 [jwls29] P-anca

22:53:43 [jwls29] agree with crusher about black liver

22:53:45 [Step_1] P-anca.....PANca

22:54:20 [crusher] yes p.anca foe pAN and cANCA for wegners

22:54:27 [vladi] great jwls-it's PANCA

22:54:35 [Hmmmmmm] what bout pompe's step1?

22:54:58 [Step_1] anytime you see a child this young with a myocardial infarction, think of kawasaki disease....another tip from goljan but also saw on my exam

22:55:07 [crusher] yes i agree with pompes with this much h/o

22:55:13 [vladi] great also for step 1 and crush

22:55:35 [Hmmmmmm] black lung?dx...black joints?dx....

22:55:45 [dgrosen] what about Homocystinuria and early onset of MI?

22:56:29 [Hmmmmmm] but step1 is rite pompe's causes cardiopathy not necessarily MI crush

22:56:44 [crusher] lung...asbestoses....joint....onchonosis(coldnot rember the name ,,its in biochem

22:57:08 [Step_1] there are other causes of MI's in children, but none are common since MI's are very rarely seen in children &lt;5. the most common cause is kawasaki disease

22:57:32 [vladi] homocystinuria is associated with MI and thromembolia

22:57:53 [crusher] ok thanks step...other clue may be vasculitis with MI,

22:58:03 [dgrosen] Sorry guys, but the gol..jan audio is the one you get from coolgoose?

22:58:08 [Step_1] the other give away which I should have mentioned is that you will very likely have a rash since it has vasculitis

22:58:20 [Step_1] crusher....you read my mind

22:58:47 [dgrosen] and dont forget that Kawaski also has lymph nodes

22:59:23 [jwls29] yes, dgrosen

22:59:34 [dgrosen] and a very nice motorbike!

22:59:39 [Step_1] yes, thats true, you will have lymphadenopathy

23:00:47 [dgrosen] Name me a granulomatous vasculities that affects 1/2 to large size arteries

23:00:53 [vladi] and it seems me high fever either

23:01:11 [Step_1] 60 yo female pt presents with unlateral headache and morning stiffness in shoulders. inc ESR seen. Dx? treatment?

23:01:37 [Hmmmmmm] my 2 cents on the heart: 2yo PMPES, young child -kawasaki, around 20 hypercholestrolemia, 40 and above CAD

23:01:47 [Hmmmmmm] whoops sorry i got d/c

23:02:04 [crusher] polymylagia rhuematica

23:02:17 [Hmmmmmm] step1 temporal arteritis

23:02:37 [vladi] is it temporal arteriitis- step 1

23:02:46 [dgrosen] temporal angeitis

23:02:52 [Hmmmmmm] emprical tx with steriods

23:03:02 [dgrosen] Name me a granulomatous vasculities that affects 1/2 to large size arteries

23:03:17 [Step_1] dgrosen, i think we're asking about the same disease. the answer is temporal arteritis and tx with steroids immediately to prevent blindness

23:03:18 [crusher] wow thanks hmmmmmm

23:03:31 [Hmmmmmm] crusher> the black lung is anthracosis i think

23:03:33 [dgrosen] It more common in asian people

23:03:38 [Hmmmmmm] np crush

23:03:44 [dgrosen] is more common in asian

23:03:46 [Step_1] takayasu

23:03:55 [jwls29] Takayasu's?

23:03:56 [dgrosen] has intimal fibrosis

23:03:58 [dgrosen] GOOD

23:04:01 [crusher] what was the ans of black lung and black joints

23:04:15 [dgrosen] Takayasu's or pulseless disease

23:04:38 [Hmmmmmm] black lungs is anthracosis due to living in city or coal miner and black joints is ocronosis (alkaptonuria)

23:04:40 [Step_1] temporal arteritis is also granulomatous and effects large vessels

23:04:45 [dgrosen] alcaptonuria?

23:05:10 [crusher] ok..thanks

23:05:26 [dgrosen] I have that the temporal art. afects small to 1/2 size art

23:05:38 [Step_1] btw, the temp art question was also a real one

23:06:06 [Hmmmmmm] herion drug user gets endocarditis which side and what organism. he also gets renal insuff. what kind of glomuronephritis?

23:06:25 [Step_1] according to goljan, large vessel vasculitis includes temporal arteritis and takayasu

23:06:48 [Step_1] staph aureus on right side

23:07:05 [jwls29] agree with step

23:07:11 [dgrosen] I will never contradict Gol...jan...If he says it is

23:07:14 [Hmmmmmm] great step1 and what renal prob?

23:07:15 [crusher] staph aureus....right side involve tricuspid valve

23:07:15 [dgrosen]

23:07:35 [Step_1] focal glumerulonephritis i think

23:07:35 [Hmmmmmm] very good crush

23:08:03 [Hmmmmmm] yeah focal segemnetal glomerulosclerosis

23:08:13 [crusher] yes FSGN

23:08:34 [Hmmmmmm] MC cause of RHF?

23:08:46 [Step_1] glomerulosclerosis....sorry trying to type faster than my brain wants me too

23:08:50 [dgrosen] LHF

23:08:53 [jwls29] LHG

23:08:56 [jwls29] oops

23:08:58 [Hmmmmmm] yup

23:08:59 [jwls29] LHF

23:09:00 [Step_1] LHF

23:09:03 [Hmmmmmm]

23:09:05 [crusher] yes LHF

23:10:38 [Hmmmmmm] a patient has severe mood changes and beharioval problems. language and movement is also severly affected... ct shows a large mass in corpus callosum.... *looks like glial tissue dx?

23:11:29 [dgrosen] glioblastoma multiforme?

23:11:50 [Hmmmmmm] 50 yo woman with postural instabiltiy, urinary incontisnetce and blurrd vision dx?

23:11:55 [Hmmmmmm] very good dgrosen

23:12:09 [dgrosen]

23:12:26 [dgrosen] My grandma!

23:12:31 [dgrosen]

23:12:43 [jwls29] roflmao

23:12:50 [hutals]

23:12:51 [Hmmmmmm] lol

23:13:08 [Step_1] lol....good one

23:13:13 [dgrosen] that triggers another question

23:13:42 [Hmmmmmm] lol dgrosen ur granma is 50 so ur 10? hahaha

23:13:52 [dgrosen] She fell on her hyper extended hand. which bone did she brake?

23:13:59 [dgrosen] lol

23:14:03 [Hmmmmmm] scaphoid

23:14:10 [dgrosen] )

23:14:11 [Hmmmmmm] the answer to my question is MS

23:14:19 [crusher] i guess its tumor with compression sx

23:14:21 [jwls29] colles fracture

23:14:24 [dgrosen] Thats correct and a true story

23:14:36 sicca enters this room

23:14:44 [dgrosen] lets go back to your question Hmmmm

23:14:46 vladi enters this room

23:14:48 [Step_1] hi sicca

23:14:55 [crusher] schaphoid

23:15:07 [Step_1] welcome back vladdi

23:15:29 [jwls29] hi

23:15:49 [Step_1] child presents with headache and confusion with a history of chicken pox earlier that week. most likely dx? what caused it?

23:15:49 [dgrosen] what's the answer Hmmmmm?

23:15:52 [Hmmmmmm] crush its multiple sclerosis*there are very classical sings

23:15:54 [dgrosen] I give up

23:15:56 [vladi] sorry i've been disconnected

23:16:02 [Hmmmmmm] its MS dgrosen

23:16:18 [Hmmmmmm] thats it i need a typing tutor and a dictionary

23:16:36 [hutals] reyes

23:16:45 [dgrosen] why MS?

23:16:53 [Hmmmmmm] agree with hutals

23:17:04 [Hmmmmmm] dgrosen its the classical signs

23:17:14 [sicca] Reyes Syndrome

23:18:15 [Step_1] correct, its Reyes syndrome where the mom probably gave aspirin to child who had chicken pox

23:19:15 [dgrosen] Good night guys. Hmmmmm I will try to make it for tomorrow on Anatomy.

23:19:18 [Hmmmmmm] a woman has exoptalmus, sensitiv to heat and weight loss. what kind of hypersensitivity is it?

23:19:34 [sicca] so,never give aspirin to the child?

23:19:41 [Hmmmmmm] ok dgrosen ill be there good luck it was fun man

23:19:45 [dgrosen] thanks you all, G.O.L.J.A.N, ValueMD and God!

23:19:58 [Hmmmmmm] sicca at least not after a viral infection

23:20:09 [sicca] ok

23:20:13 [Hmmmmmm] amen to that dgrosen

23:20:15 [Step_1] by dgrosen...thanks for chat

23:20:58 [vladi] dgr- actually small vesels inc non ANCA-assos. (Henoch-Schonlein, cryoglobulinemia, cutan.vasc), medium- PN and Kawasaki and large- giant(temp.arteriitis) and Takayasu

23:21:35 [Hmmmmmm] thanks vladi that sums it up

23:21:46 [Step_1] exactly, never give aspirin to sick child ....not so bad anymore now that chickpox vaccine is out, but why take chance if we have tylenol avail

23:22:27 [Hmmmmmm] eh after goljan, im afraid of taking even tylenol hahahahaha

23:22:50 [sicca] But Gol jan says Tylenol is bad too?

23:23:07 [sicca] cause free radical inj.....??

23:23:13 [jwls29] he said it's a poison

23:23:25 [Hmmmmmm] a woman has exoptalmus, sensitiv to heat and weight loss. what kind of hypersensitivity is it?

23:23:27 [sicca] yes

23:23:32 [vladi] sorry i forgot gfor small- ANCA assosc.- Wegener, Churg-Straus and microscopic polyanginitis

23:23:36 [sicca] and should be ban

23:23:37 [Step_1] especially in that child from earlier question where drinking age was 10 in his country....shouldn't mix alcohol and tylenol

23:23:50 [Hmmmmmm] but he said its takes a long time to manifest!

23:23:55 [Hmmmmmm] haha step1

23:24:09 [vladi] type 2

23:24:36 [crusher] mysthenia graavis type2....

23:24:36 [Hmmmmmm] lol a little imagination wouldnt hurt, "where drinking age was 10 in his country"

23:24:42 [Hmmmmmm] yes vladi very good

23:25:37 [sicca] hey H..why so many mmmmmm in your name?

23:25:58 [sicca] why not Hmm....

23:26:09 [Hmmmmmm] a 30 yo women when running on day when she discovered that she has pain in her breast.. mammogram showed calicifation.. dx?

23:26:13 [Hmmmmmm] hehehe dunno sicca

23:26:41 [Step_1] fibrocystic

23:27:02 [Hmmmmmm] um i thought breast trauma

23:27:11 [crusher] pain cann never be ca...

23:27:17 [sicca] bec. of trauma c/by exercise

23:27:17 [Hmmmmmm] associated with pain and (she went running)

23:27:37 [crusher] its traumatic fat necrosis?

23:27:37 [Hmmmmmm] im not giving it away with pendulus breasts and no support

23:27:45 [Hmmmmmm] yes crusher

23:28:01 [sicca] agree with crush

23:28:11 [sicca] fat necrosis

23:28:13 [Step_1] yes, makes sense

23:28:23 [crusher] fibrocystic changes gluteal with menstrual cycle..am i right

23:28:52 [vladi] great crush

23:29:18 [Hmmmmmm] crusher can u explain a bit more (im kinda confused on fibrocystic change?)

23:29:43 [Step_1] non caseating granulomas in bilat hilar nodes, hypercalcemia, uveitis with burry vision. dx?

23:30:21 [Hmmmmmm] sarcoidosis

23:30:30 [jwls29] sarcoidosis

23:30:34 [crusher] ok..let me tell you..fibrocystic changes associated with each menstrual cycle and usually both breast involve and it has association with breast ca.

23:30:40 [sicca] sarcoidosis

23:30:47 [Step_1] its sarcoidosis. but the real question asked why hypercalcemia??

23:30:56 [vladi] sarcoidosis

23:31:41 [vladi] it's every time associated with hypercalciemia

23:31:42 [crusher] why is right upper quarderent most commonly involve in breast ca

23:32:07 [Hmmmmmm] secrete subs like PTH?

23:32:22 [Step_1] i think that the macrophages in granulomas make 1 alpha hydroxlase to inc Vit D, so hypervit D. but not sure

23:32:59 [Hmmmmmm] dunno crusher!

23:33:51 [crusher] i think most breast tissues are there....

23:33:51 [Hmmmmmm] thx step1 makes sense

23:34:57 [Hmmmmmm] intention tremors in 1 week old baby dx?

23:35:20 [sicca] When will be next Gol jan's path?

23:35:45 [Hmmmmmm] week after next sicca

23:35:56 [sicca] ok

23:36:00 [hutals] well, cant be ms that young, not 10 yrs old yet, so that rules out alcohol...

23:36:17 [Hmmmmmm] hahaah hutal hahhhahaah

23:36:50 [hutals] next week is pharm, then we have week off before schedule begins again, so we will redo goljan path again during that week

23:37:16 [Step_1] lol

23:37:36 [sicca] Bye Guys ....gotta go...and see you in next chat

23:37:45 [Hmmmmmm] its arnold chiari malfomation (heniation of the cerebellar vermis)

23:37:50 [Step_1] bye sicca, see you next chat

23:38:02 [Hmmmmmm] bye sicca take it easy glad to see ya

23:38:29 [sicca] bye step 1 and Hmmmmmm

23:38:43 [Hmmmmmm] bye

23:39:04 [crusher] bye sicca

23:39:08 [Step_1] pt presents with HTN, palpitations, sweats, anxiety, headache. what test should be done to rule out what?

23:39:23 [hutals] nite sicca

23:39:27 [Hmmmmmm] progressive demetia in 50 yo man and he keeps forgetting his wifes names (she is very angry with him)... what is the cause?

23:39:46 [jwls29] VMAl

23:39:52 [jwls29] VMA

23:39:55 [Hmmmmmm] measure the tyroid, tsh step1?

23:40:19 [jwls29] check for pheochromocytoma

23:40:24 [vladi] pick

23:40:25 [hutals] VMA

23:40:40 [Hmmmmmm] whats VMA?

23:41:41 [Step_1] VMA is correct to rule pheochromocytoma. stands for vanillylmandelic acid to chick for increased catecholamines in urine

23:41:58 [Hmmmmmm] thanks step1

23:42:27 [crusher] alzhimers diases

23:42:38 [Hmmmmmm] could it be because of hyperthyroidism too step1?

23:42:44 [Hmmmmmm] yes crush but the cause?

23:43:00 [vladi] Hm- what answer abour dementia

23:43:18 [Hmmmmmm] cause!

23:43:19 [crusher] cerebral atrophy..

23:43:46 [Hmmmmmm] amyloid BAPP deposition

23:44:07 [Step_1] i suppose that the hyperthyroidism can cause some of these symptoms, so yes. but most likely ans with these specific features would be pheochromocytoma

23:44:12 [vladi] 50n y.o- not typical for Alzheimer- more 55 y.o.

23:44:19 [Hmmmmmm] ok thanks step1

23:44:46 [Hmmmmmm] but the symtoms are typical

23:45:00 [crusher] but vladi symptoms says progressive which go more favour of alzheimers

23:46:20 [Hmmmmmm] good point though vladi

23:46:32 [hutals] hat is the most likely population to have Ewing's sarcoma?

23:46:59 [Step_1] boys

23:47:06 [vladi] i would rather go with pick

23:47:46 [jwls29] ok folks

23:47:53 [jwls29] i'm going to call it a night

23:47:58 [jwls29] so weds is pharm?

23:48:08 [hutals] yep Boys under 15 years old.

23:48:10 [crusher] young boys..ist and 2nd decade

23:48:17 [Hmmmmmm] by jwls its been a pleasure gl for u q..bank

23:48:46 [Step_1] we're just about out of time anyway, so i guess we'll call it a night

23:48:48 [jwls29] thanks

23:48:53 [springone] hey guys, sorry to disturb you all, but i was checking out the usmle forum&i couldn't find the chapters to be discussed in pharmacology next week.

23:48:56 [jwls29] weds it's pharm?

23:49:02 [Step_1] yes pharm for wed

23:49:19 [Hmmmmmm] a homosexual man comes with a purple rash in his heel. doctor give him some steriods but doesnt seems to help. its much larger next visit dx?

23:49:37 [springone] which chapters/

23:49:44 [vladi] crush- did you get my email today

23:49:49 [crusher] what is the most common location of ewing sarcoma

23:49:57 [Hmmmmmm] sprinone we're discussing 1half of pharm on wednesday and the remaining on saturday

23:49:59 [Step_1] we can do gen priciples, ANS drugs, CNS drugs...sound good?

23:50:24 [crusher] no vladi i havenot check yet.did u send it on usmleguy2002@yahoo.com

23:50:29 [Hmmmmmm] sounds great

23:50:35 [springone] o.k thanks step_1

23:50:59 [vladi] femur- diaphysis

23:51:20 [vladi] yes-crush

23:51:32 [Step_1] ok, so thats the end of the official chat. its alot of info, so we will need to cover it again in two weeks (after pharm)

23:51:37 [crusher] kaposi sarcoma???

23:51:58 [crusher] i will check it vladi ..

23:52:08 [Hmmmmmm] rite agin crush

23:52:11 [jwls29] good nite

23:52:21 [Step_1] thanks everyone for another great chat....good night

23:52:27 [Hmmmmmm] by jwls

23:52:32 [crusher] yes thats correct diaphysis of femur in case of ewing sarcoma

23:52:34 [Hmmmmmm] gn step1

23:52:44 [hutals] good nite all

23:52:47 [Hmmmmmm] ty for u help

23:52:50 [vladi] all right-good night

23:53:01 [crusher] anyone want to stay ..i .m here

23:53:09 [Hmmmmmm] ill post the announcement for teh anat chat tomorow any who wana ateend same time tomrowo

23:53:12 [Hmmmmmm] ill stay

23:53:54 [Step_1] whoever stays, please add the remainder of your chat transcipt (you all forgot last time).

23:54:06 [Step_1] i'll post up to this point

[Anonymous]

23:56:30 [Hmmmmmm] a female patient with progressive dysphagia and vitamin adek deficieny and breathing difficulty and meconium illus dx? and what do we see in teh blood

23:56:51 [Hmmmmmm] bye step 1 (as always thank you very much)

23:57:10 [Hmmmmmm] yes springone ill post the rest

23:57:34 [springone] oh, thanks hmmmm

23:58:14 [Hmmmmmm] np

23:58:35 [springone] Guys,is there anyway i can seethe previous chat trnscripts

23:59:05 [Hmmmmmm] yeah they have been posted be4 ill give u the link

23:59:16 [crusher] ...cos of fatmalabsorption lack of fat soluble vit.fatty stools.

23:59:31 [springone] Thanks again Hmmmm

23:59:48 [Hmmmmmm] http://www.valuemd.com/viewtopic.php?t=18530

00:00:28 [Hmmmmmm] just keep reading down and ull find it (there kinda old transcrpt) the more recent ones are scattered but ill try to put them under one post

00:00:53 [Hmmmmmm] so anyone with diagnosis? crush u there?

00:00:57 [springone] Great

00:01:24 [crusher] yes i,m Hmmmmmm

00:02:15 [crusher] malabsorption syndrome..especially fat

00:02:22 [hutals] the best way to find them is by doing a search at http://www.valuemd.com/search.php , then enter "chat transcript", select "search for all terms", and pick the usmle step 1 forum and a bunch will appear.

00:02:38 [Hmmmmmm] ok dx is scleroderma and u see adenosine deaminase antibodies

00:02:47 [Hmmmmmm] soryr i didnt see ur ans crush

00:03:03 [Hmmmmmm] thanks hutals

00:03:29 [hutals] no problem. saved me lots of time

00:04:50 [springone] thanks hutals

00:05:34 [hutals] ok, bye to all and thanks

00:05:55 [Hmmmmmm] by hutals are u goign too have a nice day and thanks for ur questiosn

00:06:11 [springone] bye.

00:06:19 [Hmmmmmm] ok crush get ready cuz here comes a hillslide of questions

00:06:30 [Hmmmmmm] vit a deficiency?

00:06:46 [Hmmmmmm] toxic megacolon seen in?

00:07:11 [Hmmmmmm] dialated colon proximal to lesion seen in? also associated with down's syndrome!

00:07:44 [Hmmmmmm] ketoacidosis seen in?

00:07:45 [crusher] vit a def what the q,s about it

00:08:02 [Hmmmmmm] most common cause of non-traumatic amputation is?

00:08:05 [crusher] ketoacidosiss==typ1 DM

00:08:19 [Hmmmmmm] oh im sorry what does vit a def cause?

00:08:27 [crusher] non tramuatic amputation-DM

00:08:50 [Hmmmmmm] athlete dies suddenly cause?

00:09:06 [Hmmmmmm] cl sweat test done in?

00:09:34 [crusher] athelete died cos of IHSS

00:09:44 [Hmmmmmm] tetany and no mediastinal mass seen in?

00:09:56 [Hmmmmmm] toxic megacolon is seen in ulcerative colitis

00:09:56 [crusher] cholride test in ystic fibrosis

00:10:15 [Hmmmmmm] hirshprungs u see dialated colon promixal to lesion

00:10:33 [Hmmmmmm] LES pressure >33mmHg seen in?

00:10:43 [crusher] chagas dis toxic megacolon?

00:10:45 [springone] o.k guys it was nice meeting you all.

00:10:51 [springone] good night.

00:11:04 [springone] meet you on on the next chat.

00:11:11 [Hmmmmmm] bye spring take care and attend tomorows chat if u can!

00:11:19 [Hmmmmmm] ok bye

00:11:52 [Hmmmmmm] i think ur rite crush u can also see toxic mega in chagas lemme make sure!

00:13:25 [Hmmmmmm] ok tetany and no mediastinal mass is digeorges syndrome

00:13:46 [Hmmmmmm] LES pressure >33mmHg seen in achlasia

00:13:54 [crusher] achalasia inc LES inc

00:14:14 [Hmmmmmm] very good

00:14:21 [crusher] whats the ans of toxic mega colon HMMMM

00:15:12 [Hmmmmmm] i thought ulcerative (But i think chagas is rite ) im not sure crush

00:15:32 [crusher] ok i will find about it ..later

00:15:47 [Hmmmmmm] ok

00:16:34 [Hmmmmmm] ready for more questions? jsut do this ill keep posting questiosn and u just keep typing them (dont press enter, just keep adding and paste it as an all)

00:16:49 [crusher] fire Hmmm moreQs

00:17:02 [crusher] ok

00:17:30 [Hmmmmmm] caseating granulomas in upper lobe of lung. dx?

00:18:08 [Hmmmmmm] lung manifestion due to pegion dropping. organizm?

00:18:20 [Hmmmmmm] quellung reaction? organism?

00:19:36 [Hmmmmmm] patietn with chest pain, chorei form movements, nodules under skin, joint pains in ankle then suddendly joint pain in the wrist? diagnosis

00:20:07 [Hmmmmmm] child with pharyngitis gets kopik spots in the eyes and chest pain dx?

00:20:19 [Hmmmmmm] mc cause of epiglotitis in child?

00:20:59 [Hmmmmmm] a 50 yo man has small vesicles on one side of hte face around eyes and forehead and very painful? dx?

00:21:37 [Hmmmmmm] one side of face patient cant wrinkle forehead or smile dx?

00:22:17 [Hmmmmmm] projecticle vomiting and olive-like raised lesion in abdomen dx?

00:22:32 [Hmmmmmm] double-bubble in xray dx?

00:23:18 [Hmmmmmm] child with yellow sclera and yellowish pigmentation with mood and behaviral changes and irritability dx?

00:23:48 [Hmmmmmm] ascending cystitis associated with?

00:24:00 [Hmmmmmm] hydronephrosis mc associated with?

00:24:03 [crusher] t,b non caseating,cryptococcus(pigeoan)Strep pneomonia or any capsulated organism(strep pneomonia,klebsiella,h,influenza niesseria ,)h.influenza in epiglotitis,Herpes zoster(painful vesicles),fascial nerve palsies,projectile and mass=pyrolic stenosis,,double buble-dudenal atresia......

00:24:05 [Hmmmmmm] ok im done!

00:24:59 [Hmmmmmm] remember for pegion its also clamydia psittiaci

00:25:10 [Hmmmmmm] wow crush very good very very good

00:25:29 [crusher] no hmmm i havenot answer all ur qs

00:25:39 [crusher] let me find all.

00:25:40 [Hmmmmmm] caseating granulomas in upper lobe of lung. dx? tuberculosis

00:25:57 [Hmmmmmm] lung manifestion due to pegion dropping. organizm? cryptococcus and clamydia pssittici

00:26:11 [Hmmmmmm] quellung reaction? organism? Strep pneomonia or any capsulated organism(strep pneomonia,klebsiella,h,influenza niesseria ,)like u said

00:26:18 [Hmmmmmm] h.influenza in epiglotitis like u said

00:26:34 [Hmmmmmm] patietn with chest pain, chorei form movements, nodules under skin, joint pains in ankle then suddendly joint pain in the wrist? diagnosis (rheumatic fever)

00:26:42 [Hmmmmmm] remember jones criteria

00:27:14 [crusher] ok and organ is in RF ??

00:27:22 [Hmmmmmm] child with pharyngitis gets kopik spots in the eyes and chest pain dx? (rheumatic fever due to group a Beta strep) kopik spots are micro hemmorhages in the retina

00:27:56 [Hmmmmmm] heart is the usual organ i RF but u see a lot of comlications see jones criteria

00:28:15 [Hmmmmmm] child with yellow sclera and yellowish pigmentation with mood and behaviral changes and irritability dx? kernicterus due to jaundice

00:28:36 [Hmmmmmm] ascending cystitis associated with? chron's disease

00:28:54 [crusher] ok these two i wasnot sure

00:29:06 [Hmmmmmm] hydronephrosis mc associated with? remember what goljan, said mc cause is stone in the ureter

00:29:26 [crusher] do you know which part of brain is effected in kernectirus??

00:29:29 [Hmmmmmm] very good though crush like 90 %

00:29:38 [Hmmmmmm] i think periventricular?

00:30:05 [Hmmmmmm] MS is also periventricular

00:30:21 [crusher] i,m not very sure ..

00:30:36 [Hmmmmmm] niether m i

00:30:56 [crusher] i think somewhere else is it not corpus collusm??

00:31:16 [Hmmmmmm] what is the only organ that works by hyperpolarizing?

00:31:42 [Hmmmmmm] hmmm lemme see (i always associate corpus callosum with gliobastoma multiforme)

00:32:51 [Hmmmmmm] ok kap..lan just says deposits in teh basal ganglia

00:33:34 [crusher] ohhh yaeh its right basal ganglia...now we will remember

00:34:08 [crusher] very great Qs hmmmm,really

00:34:09 [Hmmmmmm] thanks for pointing that out

00:34:20 [Hmmmmmm] what is the only organ that works by hyperpolarizing? eye

00:34:30 [Hmmmmmm] ty crush

00:34:46 [crusher] ohh i also did not knew taht

00:34:59 [Hmmmmmm] its in &lt;A HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Board%20Review%20Series&mode=books>BRS& lt;/A> physio

00:35:06 [Hmmmmmm] oops

00:35:11 [Hmmmmmm] b r s phsyio

00:35:23 [crusher] ok.

00:35:54 [crusher] meconium ileus is a potential complication in newborn with what dis?

00:36:00 [Hmmmmmm] btw did u dl the mcq program? there are some good mcqs there

00:36:08 [Hmmmmmm] CF?

00:36:39 [crusher] what is the most common invasive bact in uSa

00:36:45 [crusher] yes its CF

00:37:00 [crusher] no i havenot done it yet..

00:37:15 [Hmmmmmm] you should its very good, ECOLI?

00:38:04 [crusher] its campylobacter jeujeni...by poultry or conmtaminated milk

00:38:15 [Hmmmmmm] thanks

00:38:18 [Hmmmmmm] didnt know that

00:39:08 [crusher] last micro chat was very helpful

00:39:14 [Hmmmmmm] mc bug associated with stomach ca?

00:39:25 [Hmmmmmm] yeah i was there (but i have short mem )

00:39:29 [crusher] H,pylori

00:40:12 [Hmmmmmm] yup

00:40:38 [crusher] urease pos..which is urease pos..

00:41:09 [crusher] what is the most common cause of obstruction in Gi tract?

00:41:16 [Hmmmmmm] hmmm

00:41:42 [Hmmmmmm] hpylori si urease +ve rite?

00:42:26 [Hmmmmmm] ill guess hernia crush

00:42:38 [crusher] its adhesion cos of previous suregery

00:43:28 [crusher] do you have more Q,s

00:43:47 [crusher] these q,s i was making up myself from g ol jan

00:44:07 [Hmmmmmm] same here im making em up too

00:44:12 [Hmmmmmm] ok lemme see

00:44:30 [Hmmmmmm] hey crush i thought adhesion from previous surgery is for cancer not obstruction

00:45:15 [crusher] what is the most common site of carcinoid tumors and which site is metastasize?

00:45:16 [Hmmmmmm] lol i was just checkin my mail an someone was screaming at me bout why i sent them an email hahahahahaha (they put it there inteh post)

00:45:34 [Hmmmmmm] crush im not sure bout caricinoid what the ans?

00:45:47 [crusher] no its obstruction refer g olj ian review page 201

00:46:08 [Hmmmmmm] ok thanks crusher

00:46:52 [crusher] most coomon is appendix and its not metastasize and metasize one is terminal ileum

00:47:13 [Hmmmmmm] ok thanks

00:47:18 [Hmmmmmm] and how do u dx it?

00:47:26 [Hmmmmmm] what lab test?

00:47:35 [crusher] by testing VMA

00:47:51 [crusher] or HIAA,im sorry

00:48:03 [Hmmmmmm] urine 5HIAA

00:48:06 [Hmmmmmm] yeah ur rite

00:49:05 [Hmmmmmm] ok green-blue colored sputum. oranism?

00:49:14 [Hmmmmmm] red color. organism?

00:49:25 [Hmmmmmm] rusty colored sputum? organism/

00:49:33 [Hmmmmmm] curran jelly sputum organism?

00:49:50 [Hmmmmmm] lung abcess due to IVDA organism?

00:50:05 [Hmmmmmm] subacute endocarditis due to catherters organism?

00:50:23 [Hmmmmmm] UTI in females gram +ve cocci organism?

00:50:38 [Hmmmmmm] optochin sensitive. organism?

00:50:53 [Hmmmmmm] bacitracin sensitive organism?

00:51:11 [Hmmmmmm] hansen's disease. test to diagnosis and organism?

00:51:48 [Hmmmmmm] beta hemolysis and abcesses organism?

00:52:06 [Hmmmmmm] H2S producer and bloody diarrhea organism?

00:52:34 [Hmmmmmm] neonatal meningitis mc organism>

00:53:17 [Hmmmmmm] alcoholic patient ddx?

00:53:20 [crusher] staph aureus..blue green...red ..serratia..rusty klebsella...iv drug,staph aureus...subacute,strep pyogens,strep saprophysticus UTI.,opt sens=strep pneumonia...bacitracin sen==pyogenes,,leprosy,hensen dis,,by biopsy....beta hemolysis==pyogenes=h2s=salmonella,,,neonatal menin=agalactea..

00:53:27 [Hmmmmmm] alcoholic patient organism dxx?

00:54:22 [Hmmmmmm] rusty colored sputum? organism is strep pnemo

00:54:34 [Hmmmmmm] beta hemolysis and abcesses organism? staph aureus

00:54:55 [Hmmmmmm] everything else perfect

00:55:03 [Hmmmmmm] very well done crush

00:55:18 [crusher] ok thanks hmmm

00:55:30 [Hmmmmmm] alcoholic patient organism ddx? klebsiella and strep pneumo

00:55:39 [Hmmmmmm] burn patients? organism?

00:55:47 [crusher] pseudomnas

00:55:56 [Hmmmmmm] air conditioners? organism?

00:56:02 [crusher] which is non lactose fern and oxidase -ve

00:56:12 [Hmmmmmm] sickle cell gets with organism?

00:56:14 [crusher] legionella

00:56:36 [Hmmmmmm] salmonella, shigella and proteus

00:56:38 [crusher] sickle cell.salmonella

00:56:47 [Hmmmmmm] for non lac no oxidase

00:56:54 [Hmmmmmm] yes crush

00:57:08 [crusher] PaSS=proteus,sal,shegilla

00:57:24 [Hmmmmmm] ty

00:57:52 [Hmmmmmm] female with sicca syndrome has what antibodies in blood?

00:58:00 [crusher] lactose fast fermenters =KEE=klebselia enterobacter,Ecoli

00:58:23 [Hmmmmmm] crush first...a..i..d?

00:58:46 [crusher] i couldnot recal...if i see choices may be i can

00:58:52 [crusher] yes its f..A

00:59:00 [Hmmmmmm] what is li farumeni syndrome?

00:59:48 [Hmmmmmm] ok choices ... ANA, SS-A, dsDNA, adenosine deaminase, antiplatelet antibodies

00:59:53 [crusher] sicca syndrome,,there is think antioy to salviary glands??

01:00:07 [Hmmmmmm] yes crush

01:00:23 [crusher] SS-A?

01:00:33 [Hmmmmmm] very good

01:00:40 [Hmmmmmm] its sjogrens syndrome

01:01:00 [crusher] yep..got it

01:01:24 [Hmmmmmm] patient with hemangioblastoma of the cerebellum and spinal cord is risk of getting what? dx?

01:01:40 [Hmmmmmm] what is li farumeni syndrome?

01:02:51 [Hmmmmmm] enzyme problem with lysyl oxidase and has a tuft of hair that is white dx?

01:03:02 [Hmmmmmm] baby with blue sclera?

01:03:38 [Hmmmmmm] problem with lysyl oxidase and bone deformities dx?

01:03:57 [Hmmmmmm] most dangerous kind of Ehler Danlos syndrome?

01:04:16 [Hmmmmmm] arachnodactyly and aortic dissection dx?

01:05:05 [Hmmmmmm] overflexed fingers and microencephaly and rounded bottom of feet dx?

01:06:22 [crusher] type 4 Ehlor danlos....marfans...aortic Diss...overflex finger===i think edward

01:06:30 [Hmmmmmm] baby with wierd laffter and sezirues and ataxia diagnosis?

01:06:33 [crusher] let me ans others too.

01:07:00 [Hmmmmmm] ok crush

01:07:48 [crusher] whta time is at ur site

01:08:07 [Hmmmmmm] 1:07:48

01:08:09 [Hmmmmmm] ur?

01:08:26 [crusher] 12.07

01:08:44 [Hmmmmmm] are u sleepy?

01:08:59 [Hmmmmmm] lol i sleep during the day haha

01:09:09 [crusher] yes a bit

01:09:19 [crusher] is hutal there too?

01:09:26 [Hmmmmmm] ok done after this just answer those questions

01:09:30 [Hmmmmmm] no hes gone

01:10:02 [Hmmmmmm] ur in USA rite cuz its 1 hour less than my time

01:10:29 [crusher] menkes disease with tufts of hair and lysl oxidase def

01:10:38 [crusher] yes i,m in dallas

01:10:43 [Hmmmmmm] very good

01:11:04 [crusher] osteogenic imperfecta in blue eys

01:11:19 [Hmmmmmm] cool im int torotno

01:11:23 [Hmmmmmm] yes OI

01:11:37 [crusher] oh u in toronto,,i see

01:11:51 [Hmmmmmm] problem with lysyl oxidase and bone deformities dx? ehler danlos type 6

01:12:07 [crusher] now ans where i,m wrong

01:12:27 [Hmmmmmm] patient with hemangioblastoma of the cerebellum and spinal cord is risk of getting what? dx? risk of getting bilateral renal cell carcinoma (disease is von Hipple Lindau)

01:12:45 [Hmmmmmm] what is li farumeni syndrome? is deficincy of p53

01:13:06 [Hmmmmmm] baby with wierd laffter and sezirues and ataxia diagnosis? angelmanns syndrome

01:14:02 [crusher] oh thats very imp Question,,it means P53 def will result in upset in requlation of gene..result in carcinoma????

01:14:19 [crusher] you mean laughter??right..happy puppet

01:15:16 [Hmmmmmm] yes...p53 def mean rb gene is phosphorylated by protien kinase there lot more cell division therefore more change of cancer

01:15:30 [Hmmmmmm] so thats what i meant (sorry to miss lead u)

01:16:43 [crusher] ok thanks for explanation

01:16:51 [Hmmmmmm] ok u can sleep now dam u remember a lot

01:17:01 springone enters this room

01:17:29 [Hmmmmmm] hi springone

01:17:35 [Hmmmmmm] welcome back

01:17:44 [crusher] hmmm can u describe more about rb phosphorylation??

01:17:55 [Hmmmmmm] ok

01:18:13 [Hmmmmmm] rb gene is normally inhibiting G1 to S phase

01:18:15 [crusher] its highly tested on exam

01:18:49 [Hmmmmmm] cyclin dependant protrien kinase phosphorylates rb(to inhibit it)

01:18:53 [springone] Hi guys

01:19:05 [Hmmmmmm] therefore u go G1 to S

01:19:25 [Hmmmmmm] but now p53 makes a protein with inhibits cyclin dependant protein kinase

01:19:54 [Hmmmmmm] so in othre words u cant inhibit rb

01:20:05 [Hmmmmmm] therefore u dont go G1 to S

01:20:17 [Hmmmmmm] what brings u here springone

01:20:28 [crusher] ok got it,,if dephosphorylate ,then does it means (activation of rb gene and inhition of G1 to S phae)????/

01:21:33 [Hmmmmmm] yeah crush (but u dont dephosphrylate u just inhibit the phosphorylation)

01:22:51 [Hmmmmmm] its liek u will kill lets say mr x(mr x is rb ur protein kinase) instead of stopping u from killng mr x i will kill u so u cant kill mr x

01:22:51 [crusher] so in other words ACTIVATION (inhibition of phosphorylation)of Rb gene is GOOD and inactivation By PHOSPHORYLATION is BAD

01:23:04 [Hmmmmmm] yeah crusher u got it

01:23:12 [Hmmmmmm] u still there spring? join in

01:25:34 [crusher] very nice examole

01:25:36 [Hmmmmmm] anyone there?

01:26:28 [crusher] yep hmmm i still there

01:26:50 [Hmmmmmm] anything else crush? if u can please tell me bout fibrocystic change? i always thught it was unrelated to breast ca!

01:27:36 [crusher] i thoght too.but i recently read in golji an i was surprised to see it

01:28:02 [crusher] cos i was surprized thats why i remember it

01:28:54 [Hmmmmmm] thanks crush

01:29:11 [Hmmmmmm] lifesaver i was under teh wrong impresssion thanks

01:29:43 [crusher] if u have g o l jian review open page 250..under fibrocystic changes ,,its ductal ca

01:30:15 [crusher] other risk factor is scxlerosing adenosis

01:31:17 [crusher] actually what happen is there is directly ductal hyperplasia which is a risk factor of DUCATL CA of breast..

01:31:18 [Hmmmmmm] ill get it rite now

01:32:14 [Hmmmmmm] crush i have the review but my pages are all screwed up nvm ill read bout it thanks

01:32:43 [crusher] ok..no prob u can alays check it

01:33:17 shamim enters this room

01:33:37 [Hmmmmmm] no no i trust u i always read a little more after wards so it sticks

01:33:38 [crusher] whats is the difference b/w hirsutism and virilization?

01:33:43 [Hmmmmmm] hey shamin

01:33:53 [shamim] hi

01:34:05 [crusher] thats a best stargey to raed afterwards..

01:34:11 [crusher] hi shamim

01:34:34 [Hmmmmmm] virilization is basic loss of androgens?....hirsutism is high androgens thereby increasign hair?

01:34:47 [shamim] hi, I m new in this forum

01:35:42 [Hmmmmmm] welcome

01:35:52 [crusher] hirsutism is excess hais in wome..and virulization is male sec sex characterstic in female

01:36:03 [crusher] hi shamim..welcome to chat

01:36:14 [Hmmmmmm] thx lots crusher

01:36:19 [shamim] what r u guys discussing about?

01:36:27 [shamim] thanks

01:36:31 [Hmmmmmm] we're discussing pathology

01:36:41 [crusher] i ;lin nk hirsutism with Hair and vrrilation with Sec sex char

01:37:02 [Hmmmmmm] im not gunna forget it now

01:37:09 [shamim] ok

01:38:03 [Hmmmmmm] join in the conversation shamin ask any questions or quiz us or answer our quiz or if u want u can observe too?

01:38:07 [crusher] cos its gynecolocology so,,something abnormal in female..(male things in female)

01:38:22 [Hmmmmmm] ok high AFP in what disorders?

01:38:56 [Hmmmmmm] crusher may i venture a guess that either ur a gynecologiist or u like gynecology?

01:39:02 [crusher] yolk sac tumors,,liver cell CAcolon CA??

01:39:19 [Hmmmmmm] one more crusher

01:39:35 [crusher] the second guess is right

01:39:48 [Hmmmmmm] one more disorder, its an easy one!

01:39:53 [crusher] like gynecology

01:39:54 [Hmmmmmm]

01:40:07 [shamim] testicular tumour

01:40:29 [crusher] ok cool..like seminoma??

01:40:30 [Hmmmmmm] yes good shamin

01:40:49 [Hmmmmmm] and also neural tube defects

01:40:59 [crusher] absoultely

01:41:00 [shamim] yes

01:41:04 [Hmmmmmm] i think seminomas etc are yolk sac tumors that crusher said

01:41:25 [Hmmmmmm] what bout decrease AFP?

01:41:30 [crusher] what test u do in week 10-12 to find chromosomal abnormality?

01:41:49 [Hmmmmmm] amniocentesis?

01:41:49 [crusher] Downs syn

01:41:52 [Hmmmmmm] yes crusher

01:42:02 [crusher] very good HMM

01:42:09 [Hmmmmmm] what bout high HCG? seen in what disorders?

01:42:11 [Hmmmmmm] thanks

01:42:14 [shamim] good

01:42:26 [crusher] down things are down so the AFP too

01:42:41 [shamim] coc

01:42:43 [Hmmmmmm] sorry shamin were all around the place

01:43:04 [crusher] chorio ca,,,

01:43:12 [shamim] yes

01:43:17 [Hmmmmmm] and shamin? 2 moer things? very good shamin and crusher

01:43:24 [crusher] one more male tumor let me recall..

01:43:49 [Hmmmmmm] think normal pregnancy hydatiform mole chroicarcinoma

01:43:58 [shamim] seminoma may be

01:44:09 [shamim] i m not so sure

01:44:18 [Hmmmmmm] me niether

01:44:24 [crusher] seminoma....embromal ca

01:44:34 [Hmmmmmm] ok when do u test for HCG in pregnancy?

01:44:54 [Hmmmmmm] thanks crusher

01:44:57 [crusher] 10% with seminoma are +ve with Hcg

01:45:11 [shamim] ok

01:45:13 [crusher] ist 2-6 weeks?

01:45:59 [Hmmmmmm] ooops sorry lemme rephrase the question how do u detect pregnancy with HCG

01:46:23 [Hmmmmmm] crusher i think we keep levels of HCG handy throughout the pregnancy

01:47:01 [crusher] ys ur right ...well either by blood level or urine sample

01:47:36 [Hmmmmmm] yup 8th day in urine, 12th day in blood

01:48:11 [Hmmmmmm] thats why the pregancy test is so fast

01:48:13 [crusher] hmmm its intresting to know

01:48:25 [shamim] for metoo

01:48:34 [Hmmmmmm] for me 2

01:48:54 [Hmmmmmm] thought ull like it

01:49:21 [crusher] i sure did

01:49:26 [Hmmmmmm] here's a good one.... car accident patient loses smell except ammonia. dx and why?

01:50:18 [crusher] wow...really have no idea

01:50:40 [Hmmmmmm] dx is fracture of the cribriform plate

01:50:44 [shamim] no idea

01:50:57 [Hmmmmmm] can smell ammonia cuz sensation to that is carried by trigeminal

01:51:07 [Hmmmmmm] B.Rs Phsyio!

01:51:20 [crusher] ok

01:51:35 [shamim] ok

01:51:48 [crusher] hmmm do u Qs on Eye related pathology mixed neurology?

01:52:02 [crusher] i really m weak in it

01:52:16 [Hmmmmmm] ok lemme make up some

01:52:51 [Hmmmmmm] homonymous hemianopsia seen with?

01:53:10 [crusher] lesion in optic tract??

01:53:25 [crusher] or chiasm??

01:53:46 [Hmmmmmm] patient cannot see upper quadrant in the left temporal and rite nasal fields dx?

01:54:05 [Hmmmmmm] its optic chiasm...

01:54:19 [Hmmmmmm] homonymous hemianopsia seen with? optic chiasm

01:54:44 [crusher] pie nin the sky....optic radiations?/

01:54:49 [crusher] ok ..thanks

01:54:55 [Hmmmmmm] shamin u wana venture a guess?

01:55:11 [crusher] or myers loop

01:55:32 [Hmmmmmm] very very very good crusher (ur not weak )

01:55:32 [shamim] lesion in meyers loop

01:55:38 [Hmmmmmm] very good shamin

01:56:08 [crusher] whats the lesion if optic tract lesion??

01:56:24 [Hmmmmmm] ok patient with diabetes mellitus develops cataracts why

01:56:57 [crusher] osmotic damage to the cell.cos of aldolase reductase?

01:56:59 [shamim] may be osmolar effect

01:57:09 [Hmmmmmm] if lets say right optic tract then left temporal and right nasal field complete

01:57:51 [Hmmmmmm] very good both of u damage due to deposition of sorbitol by aldolas reductase

01:58:00 [crusher] ok..thanks

01:58:07 [Hmmmmmm] what bout is patient has galactoemia develops cataracts why?

01:58:10 [shamim] tx

01:58:40 [crusher] same mechanism..

01:58:52 [crusher] inc galctilol.. i guess

01:59:19 [shamim] dont remember

01:59:21 [Hmmmmmm] shamin we usually have more ppl than us and we chat every wed and saturday (9:00 -5 GMT) so pleaz attend ur like it

01:59:26 [Hmmmmmm] yes very good crusher

01:59:44 [Hmmmmmm] u left nothign for me 2 add

01:59:53 [shamim] sure I will

02:00:17 [Hmmmmmm] btw tomorow we're discussing anatomy (out of teh regular schedule)

02:00:43 [shamim] at what time

02:00:54 [Hmmmmmm] child with garlicky breath dx? ( no he didnt eat garlic)

02:01:06 [Hmmmmmm] shamin 9:00pm -5GMT

02:01:15 [Hmmmmmm] what time zone are u ?

02:01:26 [crusher] which is toxic ...i know its poisioning ,,is it arsenic??

02:01:31 [shamim] eater time

02:01:41 [shamim] I m in virginia

02:02:26 [Hmmmmmm] yup ur on a row crush

02:02:46 [Hmmmmmm] cool shamin see u tomorw as well then *btw im still here im not sleepy

02:04:06 [Hmmmmmm] child with asterixis, corneal deposition of something, worm like movements and behavoiral adn mood changes dx? what do u see in lab?

02:04:08 [crusher] how about MLF ,medial rectus..and other eye patholgy..?

02:04:43 [crusher] its wilson dis,,excess copper deposition..dec total copper and inc ceruloplasin

02:05:02 [Hmmmmmm] asterixis gave it away didnt it

02:05:23 [crusher] yep.. and eye deposition..

02:05:38 [Hmmmmmm] ok pateint completely ignore the left side of his body ? dx?

02:05:52 [crusher] moreb imp for exam view the level of total cu and ceruloplasin changes

02:06:03 [Hmmmmmm] patient cant comprehend but speaks clearly?

02:06:16 [crusher] rt paretial lobe involve

02:06:21 [Hmmmmmm] crush why total u decreased?

02:06:34 [Hmmmmmm] crush why total cu decreased?

02:07:00 soni_pande enters this room

02:07:52 [Hmmmmmm] patient has lesion in his right brodmans area 8 what does he get?

02:08:04 [Hmmmmmm] hi soni pande

02:08:15 [crusher] i think bcos dec ceruloplasmin will causes the free cu to dec

02:08:19 [soni_pande] hi

02:08:43 [crusher] wait i,m sorry let me strait it

02:08:52 [Hmmmmmm] no no the cerulo is increased

02:10:06 [crusher] check it out hmmmm

02:10:20 [Hmmmmmm] ok

02:10:56 [crusher] ceruloplasmin and total Cu is dec and free CU is Inc

02:11:45 [crusher] its like same TBG and Free T4

02:11:51 [Hmmmmmm] yup ur rite sorry crush

02:13:35 [Hmmmmmm] patient cant comprehend but speaks clearly? werinkes asphasia

02:13:52 [crusher] there is a defct of getting rid of cupper so it accumulate in liver and brain

02:14:32 [Hmmmmmm] patient has lesion in his right brodmans area 8 what does he get? lesion in his right visual field there fore ipsilateral nystagmus with both eyes

02:15:27 [crusher] hmm ok cool..

02:15:49 [Hmmmmmm] shamin u have any question?

02:16:10 [Hmmmmmm] hey soni join the group we're quizzing each other on pathology

02:16:13 [crusher] soni pande are u there?

02:17:15 [crusher] u there hymmmmmmmmm

02:17:41 [Hmmmmmm] im here

02:17:50 [shamim] could u plz tell me what topics u will discuss tom

02:18:01 [Hmmmmmm] just ask antyhign shamin

02:18:41 [Hmmmmmm] ok mucuz plugs and eosinophila dx?

02:18:59 [Hmmmmmm] also what arteritis associtaed with it?

02:19:10 [Hmmmmmm] what arteritis associated with smokers?

02:19:20 [Hmmmmmm] what emphysema associated with smokers?

02:19:41 [Hmmmmmm] which is cuases cancer more often chrons or UC?

02:19:44 [crusher] pan emphysema

02:19:51 [Hmmmmmm] which is transmural chrons or UC?

02:20:06 [shamim] bergers/smokers

02:20:10 [Hmmmmmm] productive cough for 3 months in 2 years dx?

02:20:45 [Hmmmmmm] what is associated with abnormal ACTH prodution?

02:20:52 [shamim] wegeners

02:21:35 [Hmmmmmm] ok mucuz plugs and eosinophila dx? asthma

02:21:45 [Hmmmmmm] also what arteritis associtaed with it? churg strauss

02:21:57 [crusher] chrus staus ,,oesinophila asthma

02:22:13 [Hmmmmmm] which is cuases cancer more often chrons or UC? UC causes it more often 5-27% of em

02:22:18 [Hmmmmmm] very go