Chat transcript - Behavioral Science (Ethic-legal Issues, Ph

[Anonymous]

14:47:05 [Roxanita] Hi Guys, today friday sept 10 the chat will be, as always, at 8pm (Eastern time, N.Y. time) and will cover the last chapters of Behavioral Science from K-aplan notes. Ethic-legal Issues, Physician-pt relationship, Child development, DSM. See you there guys

20:10:21 [Roxanita] CHILD DEVELOPMENT

20:10:22 [Step_1] that is very kind of you Rox.....great attitude

20:10:32 [calender] ok.so,lets start...cause of anaclitic depression?

20:10:52 [Roxanita] Tell me what are the capabilities of children at birth?

20:11:08 [Step_1] severe and progressive depression in infants who lose their mother and do not get a suitable substitute

20:11:39 [calender] right step1

20:12:20 [Roxanita] what are the symptoms of that?

20:12:27 [Step_1] sucking, rooting, babinski, grasp, moro

20:12:53 [calender] these are reflexes present at birth..

20:13:26 [Roxanita] anaclitic depression that's a good one they can even lead them to severe impairment

20:13:58 [calender] capabilities are..reaching and grasping behav,imitate facial expression,crying,coupling and clinging...

20:14:57 [Roxanita] About smiles, what is the Exogenous Smile in the baby? and when do you see that?

20:15:12 [Roxanita] you are right calender

20:15:20 [calender] ty

20:15:38 [Roxanita] when do you see the SOCIAL SMILE?

20:15:39 [madalasa] Exogenous smile ...12 to 16 weeks

20:15:43 [calender] exogenous smile.3-4mths.?

20:15:50 [Step_1] exogenous means its elicited externally

20:15:57 [calender] social...6 mths

20:16:19 [madalasa] elicited with preference to mother, father etc

20:16:19 [kiranadi] 3 months

20:16:33 [Roxanita] ok. let's review. At birth the baby have the smile as an innate REFLEX "endogenous Smile"

20:16:33 [calender] sorry..exo...at 2 mths

20:16:40 [calender] and social at 4-6mths

20:17:04 [Roxanita] later at 8 weeks the Exogenous Smile appear in response to some known face

20:17:26 [calender] at birth.endo. smile...nice

20:17:37 [Roxanita] SOCIAL SMILE is from 12-16weeks right

20:17:46 [calender] ok

20:18:06 [madalasa] I think I was mixed up. Thanx Rox for summerising

20:18:29 [Roxanita] what is the order of the appeareance to copy shapes?

20:18:56 [calender] what is the order of development?

20:19:01 [madalasa] 3 yrs circle

20:19:11 [madalasa] 4 yrs cross

20:19:15 [calender] physical

20:19:22 [Roxanita] remember is in alphabetical order for shapes... CC RST D

20:19:27 [madalasa] 4 1/2 Rectangle

20:19:40 [madalasa] 5 yrs square

20:19:58 [madalasa] 6 triangle

20:20:00 [Roxanita] remember the "S" as a "5"

20:20:24 [madalasa] yeah they come in alphabetic order except Diamong which is at 7 yrs

20:20:34 [madalasa] sorry Diamond

20:20:48 [Step_1] good one

20:21:12 [Roxanita] who can explain what is Brain-Growth Spurt?

20:22:16 [Roxanita] this period run from the 3rd trimester to the 14 months

20:22:38 [calender] ?

20:22:42 [madalasa] period during which brain development vulnarable to environemnt

20:23:10 [madalasa] its from Last trimester to 14 postnatal months

20:24:06 [Roxanita] and is just the time when we should stimulate the baby to get the maximal brain development, in a rich environment with lots of stimulus the baby will make more synapsis, more myelinated, because the brain is more responsive and sensitive to the external stimulus

20:24:16 [calender] ok.Adolescent growth spurt?

20:24:37 [Roxanita] that's why some mom's to be make their children listen classic music at the end of pregnancy

20:24:48 [Roxanita] that's on puberty

20:24:54 [madalasa] cool

20:25:04 [hutals] i'm experience brain growth spurt with every chat lol

20:25:18 [Roxanita] :0

20:25:20 [Roxanita]

20:25:29 [calender] 12+ yrs

20:26:00 [calender] girls befor boys.onset of sexual maturity

20:26:12 [Roxanita] A child can hold his head up, has a palmar and rooting reflex as well as social smile, is not afraid of strangers? what age?

20:26:14 [calender] identity is crucial issue

20:26:56 [Roxanita] I don't know guys if you have &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3 &subid=0 >Kaplan&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&sub id=0 > notes from 2003 or 2004 but they made some changes

20:27:01 [Roxanita] gosh

20:27:10 [hutals] 3-4 months??

20:27:38 [Roxanita] I don't know guys if you have k-aplan notes from 2003 or 2004 but they made some changes

20:27:48 [kiranadi] 3-4 months

20:28:10 [Step_1] mine are a bit older than that

20:28:23 [hutals] me too

20:28:32 [calender] stacks 3 blocks,throws a ball,climbs stair with one foot..age?

20:29:16 [madalasa] 2 yrs

20:29:30 [Roxanita] 3y

20:29:41 [calender] 18mths

20:29:46 [Roxanita] climbs stairs upstairs is 3y and downstairs is 4y

20:30:10 [calender] at age 2.a child can stacks 6 blocks..

20:30:14 [calender]

20:30:24 [kiranadi] ooops i read all these stuff ...but i dont remember them now

20:30:25 [hutals] What are the development milestones at about 3 years old in preschool?

20:30:50 [Step_1] rides TRIcycle at 3

20:31:06 [calender] stacks 9 blocks,ride a tricycle,copies a circle

20:31:12 [madalasa] When does separation anxiety appears and disappears?

20:31:12 [Roxanita] oops the cubes

20:31:24 [calender] stairs.using alternate feet

20:31:28 [Step_1] 3 word sentences

20:31:40 [kiranadi] 4-6 m onths

20:31:50 [hutals] yep, and group play- rides tricycle- copies line or circle drawing

20:32:03 [calender] 10 words sentenvces?

20:32:13 [calender] sorry.not senten..

20:32:28 [calender] 10 words

20:33:18 [madalasa] Best disciplinary action for childeren?

20:33:21 [hutals] not sure, maybe 4 yrs?

20:33:30 [calender] 10 words..at the age of 18 mths

20:33:47 [Roxanita] unbuttons buttons, name colors, imaginary friends?

20:33:59 [kiranadi] 4 years

20:34:00 [hutals] you mean can understand 10 words or use 10 word sentences?

20:34:20 [calender] can say 10 words

20:34:24 [calender] bulary

20:34:33 [calender] vocabulary

20:34:44 [hutals] cooperative play- simple drawings (stick figure)- hops on 1 foot at 4 yrs

20:34:50 [Roxanita] Step_1> 3 word sentence? I have 2 w.s at 2y

20:35:14 [Roxanita] kiranadi> good kiran 4y

20:35:29 [hutals] the 3 word sentences was meant for the 3 yr old question

20:35:46 [hutals] i think

20:35:47 [Roxanita] ok

20:36:29 [Roxanita] Electra and edipol complex, at what age?

20:36:39 [Step_1] yes, sorry ....was looking up something....correct, 3 words at three yo....easy to remember

20:36:53 [calender] pincer grasp..age?

20:37:03 [kiranadi] 2 months

20:38:04 lijun enters this room

20:38:06 [calender] 7-11 mths

20:38:23 [Step_1] hi lijun

20:38:31 [lijun] hi

20:38:33 [kiranadi] ok

20:38:33 [Roxanita] Electra and Edipo complex, at what age?

20:38:34 [hutals] hey lijun

20:38:48 [madalasa] Complete sphinctor control???

20:38:48 [Roxanita] Hi Lijun

20:39:04 [kiranadi] hi lijun

20:39:14 [calender] at 2 yrs.

20:39:33 [Step_1] oedipal complex at 3-6 yrs

20:39:36 [calender] 2-3 yrs

20:39:55 [madalasa] Sphinctor control at 5yrs'

20:40:05 [Roxanita] well in the new table of &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3 &subid=0 >Kaplan&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&sub id=0 > is at 5y

20:40:10 [Roxanita] gosh again

20:40:35 doer enters this room

20:40:41 [Roxanita] In the new table of k-aplan is at 5y...OEDIPAL PHASE

20:40:48 [calender] ty madalasa

20:40:48 [madalasa] Parallel play???

20:41:02 [Step_1] agree, 5 yrs for complete sphincter control

20:41:11 [Roxanita] Hi Doer

20:41:24 [doer] hi

20:41:25 [Step_1] hi doer

20:41:36 [Roxanita] Gender identity at what age?

20:41:36 [hutals] hey Doer

20:41:51 [kiranadi] 3 yrs

20:41:58 [madalasa] Gender identity 3yrs

20:41:59 [doer] you guys discussing milestones?!

20:42:06 [Roxanita] yes

20:42:07 *****laine enters this room

20:42:21 [Roxanita] Egocentric?

20:42:26 [Step_1] hi *****laine

20:42:34 [calender] walk unassisted...age?

20:42:34 [hutals] hey *****

20:42:51 *****laine exits from this room

20:42:55 [Step_1] 12 months

20:42:58 [Roxanita] this table is very important, know it by heart

20:43:08 [kiranadi] 13 months

20:43:17 [calender] rt.12-15mths

20:44:25 [Roxanita] the question I remember was... they describe the language, motor and social milestone

20:44:53 [hutals] for parallel play question, Toddler, 24-48 months old

20:45:39 [hutals] When does a child achieve object permanence?

20:45:46 [Roxanita] at what age they understand the death?

20:45:56 [Step_1] 1-2 yrs old

20:46:07 [Step_1] for object permanence

20:46:25 [madalasa] Parallel play and Object permanance at 2yrs

20:46:37 [Roxanita] hutals> yes 2y

20:46:53 [hutals] yep, Toddler, 12-24 months old

20:47:25 [Roxanita] strong egocentrism at 3y

20:47:25 [hutals] When does a child become toilet trained?

20:47:30 *****laine enters this room

20:47:33 [calender] if a specific goal is not achieved at a specific age,the indivi. will never achieve that goal.....whose theory is that?

20:47:34 [kiranadi] 3yrs

20:47:36 [Roxanita] 3y

20:47:47 [Step_1] 3 yrs

20:48:13 [hutals] yep, Preschool, 30-36 months old

20:49:19 *****laine exits from this room

20:49:49 [hutals] not sure calendar. i'd like to guess erikson???

20:49:50 [Roxanita] calender> what is the answer?

20:49:57 [kiranadi] whats the answer?

20:50:04 [kiranadi] calender

20:50:33 [hutals] When is adolescence for boys and for girls?

20:50:51 [calender] Erik Erikson described development in terms of critical periods for the achievement of social goals

20:51:01 [Step_1] girls younger than boys....11 for girls and 13 for boys i think

20:51:05 [kiranadi] 13 and 12 yrs respectively

20:51:24 [kiranadi] i dont know exactly....this is my guess

20:51:51 [hutals] Boys: 13 years old Girls: 11 years old

20:52:05 [kiranadi] ok

20:52:25 [calender] develop. in terms of learning capabilities of the child at each age ...described by Jean Piaget...i think what we r discussing

20:53:16 [Roxanita] ok, thanks calender

20:53:51 [Step_1] should we move on....lots to cover

20:54:14 [calender] curiosity about sex..age?

20:54:14 [Roxanita] yes

20:54:31 [kiranadi] yes

20:54:40 [madalasa] 4 yrs

20:54:43 [calender] ok

20:55:14 [Step_1] we can finish up the question first

20:55:17 [Roxanita] If you have a child pt in the surgery unit and he claims for his mom to stay with him, what do you do?

20:55:55 [calender] what is the age of child?

20:55:58 Hmmmmmm enters this room

20:55:59 [Step_1] during the actual surgery?

20:56:06 [Step_1] hi hmmmmm

20:56:16 [hutals] hey Hmmmmmm

20:56:27 [Hmmmmmm] hey step1 hutals

20:56:34 [Roxanita] 2 days previous to the surgery in the hospital and even after the surgery, what do you do?

20:56:42 [Hmmmmmm] did i miss lots?

20:56:43 [kiranadi] hi hmmmmmm

20:56:46 [Roxanita] Hi Hmmmmmmmmmmmmm

20:57:00 [calender] can talk about age appropriate talk to child

20:57:02 [Hmmmmmm] hey kiran and roxy

20:57:09 [Step_1] not too much, just child development

20:57:19 [Hmmmmmm] kool

20:57:19 [calender] hi hmmmmmmmmm

20:57:26 [Hmmmmmm] hey calendar

20:57:34 [Hmmmmmm]

20:57:39 [calender] your name is easiest to write

20:57:41 [Roxanita] ok what is your answer to the little patient?

20:57:50 [madalasa] Let her mom to stay as long as its not interupting the treatment ?????

20:58:00 [Roxanita] why?

20:58:14 [calender] i gave the ans. rox

20:58:34 [Step_1] let mom stay because reduces anxiety??

20:58:35 [Hmmmmmm] dont let her mom stay

20:58:37 [kiranadi] till the anesthesia is given.......if this question pertains to the case in operation theatre

20:58:42 [calender] talk age appropriate.to the child..he has overconcern about illness

20:58:46 [madalasa] Pt is the first priority

20:59:08 [calender] that is normal...

20:59:20 [Hmmmmmm] calendar and kiran make good pointws

20:59:22 [Roxanita] it is related with the PROLONGED SEPARATION OF CHILDREN

20:59:25 [calender] to 4 yrs old

20:59:35 [calender] so, whats the ans rox?

21:00:47 [Roxanita] which has 3 phases: Protest, Despair, and Detachment. Not in this case but in others when the children are not in contact with their parents can lose affection and become with not responsiveness when they see them again

21:01:12 [calender] hmm.

21:01:34 [calender] so,what will u do in this case?

21:01:44 [calender] stay mom or not?

21:01:55 [Roxanita] The answer for Daughm is... Let the parent sleep in the same room because the child will be happy and the treatment will end up with even better results, that's is called GOOD MEDICAL PRACTICE

21:02:15 [calender] GOOD

21:02:18 [madalasa] cool

21:02:25 [kiranadi] ok

21:02:27 [calender] tricky Q and Ans

21:02:28 [Roxanita] yeah I like it

21:02:36 [Hmmmmmm]

21:02:54 [kiranadi] thats nice

21:03:17 [Step_1] Real question decribed a friend from med school (both now docs) who calls to tell you about new practice he opened and wants you to send him referrals. What to say? "OK, no problem", call state med boards to report, ask to see facilities, can't remember others...?

21:03:19 [Roxanita] What happen if an adult after loss a relative keep in grief for more than 1 year

21:04:08 [Hmmmmmm] "ok no problem"

21:04:15 [Step_1] >1 yr of grief is not normal

21:04:30 [Roxanita] I saw that one before...I think it was ...ask to see facilities

21:04:32 [Hmmmmmm] agree

21:04:44 [madalasa] end up in Depression

21:05:06 [Hmmmmmm] is it greater than >6months or >1 year?

21:05:26 [Step_1] i had brought it up before, i think we decided that it was best to ask to see facilities, but not sure

21:05:29 [madalasa] > 1yr

21:05:40 [Roxanita] What is the difference between Normal Grief and Depression after losing a relative

21:05:48 [Hmmmmmm] ty madalasa

21:06:25 [kiranadi] denial

21:07:12 [madalasa] suicidal ideation in depression, rare in grief

21:07:27 calender enters this room

21:07:51 [Hmmmmmm] agree with kiran

21:07:57 [Hmmmmmm] wb calendar

21:08:09 [Roxanita] Normal Grief you don't give medication. But also in Normal Grief you are very sad b/c you LOSS SOMEONE but in Depression you feel that you LOSE YOURSELF with suicidal ideation right.

21:08:10 [madalasa] antidepressents helpful in depression, not in grief

21:08:15 [kiranadi] what is wb hmmmmmmmmm

21:08:19 [calender] sorry...bad connection

21:08:21 [Step_1] normal up to 1 yr. also normal to have an illusion or hallucination about deceased, but normal people knows its an illusion or hallucination, whereas depressed person believes its real.

21:08:26 [Hmmmmmm] welcome back

21:08:38 [calender]

21:08:48 [Roxanita] Step_1> correct

21:09:02 [kiranadi] ok

21:09:07 [Hmmmmmm] kiranadi> wb = welcome back

21:09:11 [Step_1] anti depressants i believe only for depression and not useful in grief

21:09:17 [Roxanita] what is the first reaction of a patiient that know is dying?

21:09:26 [kiranadi] got it hmmmmmmm

21:09:29 [Step_1] denial

21:09:29 [madalasa] Denial

21:09:32 [calender] deniel

21:09:38 [hutals] denial

21:09:44 [calender] Denial

21:09:50 [Roxanita] Great guys, then?....

21:09:51 [kiranadi] denial

21:09:56 [Hmmmmmm] agree

21:10:13 [madalasa] Anger, bargaining, depression..Acceptance

21:10:53 [Step_1] 5 stages, denial, anger, bargain, depression, acceptance

21:10:57 [Roxanita] Take the time to talk to your patient about it...

21:11:36 medfan enters this room

21:12:09 [Roxanita] If a doctor says " I don't talk more with the patient about his problem because he doesn't want to talk to me" what defense mechanism is that?

21:12:11 [hutals] What is beneficence?

21:12:21 [Step_1] hi medfan

21:12:34 [madalasa] conter transference

21:12:40 [Roxanita] Hi medfan

21:12:48 [madalasa] sorry Counter Transference

21:12:49 [Hmmmmmm] howdy med

21:13:02 [calender] children's conception of Illness and Death....at what age?

21:13:03 [medfan] hi step_1, hello all, just joined in and will follow if it's ok.

21:13:14 [Step_1] i had a real question about that. can't remember right now, but probably in old behavioral transcript

21:13:24 [kiranadi] hi medfan

21:13:38 [madalasa] calender 8-9yrs

21:13:39 [Roxanita] I thought it was Projection ?

21:13:42 [medfan] hi Hmmmm, Hi Kirandi

21:13:49 rozyaurora enters this room

21:13:52 [Step_1] yes, welcome. jump in whenever comfortable or sit back and relax....whatever works for you

21:13:54 [calender] universality,inevitability, and irreversibility of Death.....ONLY after age 8 or 9

21:14:04 [Step_1] hi rozy

21:14:06 [Roxanita] Step_1> Isn't it projection?

21:14:21 [calender] rt madalasa

21:14:22 [Roxanita] Hi Rozyaurora

21:14:26 [hutals] Dr. have special ethical responsibility to act in the pt's best interest. Pt. autonomy may conflict with beneficience

21:14:38 [calender] hi rozy

21:14:45 [kiranadi] hi rozy

21:14:58 kmonica26 enters this room

21:15:09 [hutals] thats the answer for beneficence

21:15:22 [calender] ok

21:15:24 [Step_1] rox, isn't what projection?

21:15:38 [Roxanita] they understand death from 6-12y

21:16:14 [madalasa] If a doctor says " I don't talk more with the patient about his problem because he doesn't want to talk to me" what defense mechanism is that? Step-1 thats Rox Question

21:16:43 [Roxanita] If you have a patient who is dying and you don't feel like talking to him but you say to the nurse that he is the one who doesn't want to talk to you?

21:16:48 [Roxanita]

21:16:55 [Step_1] ok, i see it. that can be projection if he feels like he doesn't want to talk to the pt (pt is rude, etc) and he projects it to seem as though the patient doesn't want to talk to him

21:17:20 [calender] yes.....it is projection

21:17:35 [calender] g own feelings in someone else

21:17:45 [madalasa] just curious how do you differentiate with counter transference

21:18:12 [Step_1] often used with schizophrenics who say "you can't trust anyone"....be aware that they mean " you can't trust me"

21:18:33 [Roxanita] only after 6y children understand about death. Remember the case of that little boy 4y Elian who came from Cuba in a Boat and his mother died, he thought she would wake up anytime.

21:18:57 [madalasa] ty Rox

21:19:10 [Step_1] projection will have a hint saying that the person actually feels the way he views the other as feeling....that should be in the stem of question

21:19:41 [madalasa] ty Step-1

21:20:03 rozyaurora exits from this room

21:20:24 [Roxanita] about ELDERLY. What is the fastes growing age population in US?

21:20:50 crusher enters this room

21:20:58 [Step_1] another example is the husband who is mad at wife and comes home and says to wife "are you mad....you look mad....are you sure you're not mad". another example is anyone watching a movie....story is from projector, but you see it on the screen....easier to remember that way

21:21:01 [Hmmmmmm] 60

21:21:10 [calender] >85yrs

21:21:11 [Hmmmmmm] hey crush

21:21:12 [crusher] hi everyone

21:21:21 [madalasa] Thx Step-1

21:21:30 [calender]>[Step_1]

21:21:33 [Step_1] >85

21:21:43 [Roxanita] what are the clinical signs of child abuse?

21:21:53 [Step_1] no problem madalsa

21:22:04 [Step_1] hi crusher

21:22:10 [Roxanita] Hi monica

21:22:11 [hutals] hey crush

21:22:16 [kmonica26] hi

21:22:18 [hutals] hey mon

21:22:18 [calender] how about that...when a husb. sees some hot woman and comes home and have sex with his wife?

21:22:20 [Roxanita] hi crusher

21:22:31 [Step_1] hi monica....didnt see you come in

21:22:35 [madalasa] Best predictor of hospital admissions in Elderly?

21:22:55 [Roxanita] Clinical Signs of Child abuse?

21:22:59 [kmonica26] i was wacthing

21:23:06 [Roxanita] Falls

21:23:28 [kmonica26] hi all

21:23:34 [madalasa] Reaction formation ...Calender

21:23:34 rozyaurora enters this room

21:23:39 [crusher] burn mark on buTTOCKS..healing fractures

21:23:42 [madalasa] Yes its falls

21:23:48 [Step_1] sublimation??

21:23:51 [Roxanita] in elderly...falls. But that is for Nursing home

21:24:14 [Roxanita] again........ Clinical Signs of Child abuse?

21:24:36 [kmonica26] std

21:24:42 [crusher] healig fracture...roxzi

21:24:46 [kmonica26] RIB FRACTURES

21:24:57 [kmonica26] retinal hage

21:25:23 [madalasa] Broken bones, STD, Soft tissue injuries, non accidental burn mainly on arms

21:25:23 [Hmmmmmm] calender for u question was the ans..UnDOING?

21:25:42 [Roxanita] What do you do if a mother brings her daughter 4yo with an upper respiratory problem and when you are gonna examinee her she has bruises all over. TELL ME what do you do immediately as first step?

21:25:42 [kiranadi] kmonica do you mind picking up some other color...i'm using the same

21:25:49 [Roxanita]

21:25:56 [kmonica26] ok

21:26:07 [kiranadi] report it to welfare society

21:26:20 [madalasa] Take child to safer place and report child abuse

21:26:20 [Roxanita] Nope

21:26:27 [Roxanita] Right!!!

21:26:37 [kiranadi] thank you

21:26:49 [kmonica26] np

21:26:51 calender enters this room

21:27:26 [kiranadi] am i wrong roxy....plz be m,ore clear

21:27:29 [Step_1] welcome back calendar....i thought you were just building more suspense for your question

21:27:38 [Roxanita] "PROTECT THE CHILD FIRST". You carry the baby, walk away with no explanation and after that when the child is safe you go and report it to

21:27:47 [madalasa] Yesssssssssssssssssssss

21:27:56 [calender] so which ch we are discussing now?

21:28:02 [Roxanita] Local Child Welfare Society and the Social worker from your hospital.

21:28:08 [kiranadi] ok got it

21:28:20 [calender] no.my comp. is so bad today

21:28:24 [Roxanita] I got a question similar but with an elderly patient

21:28:52 [Step_1] wondering what the ans to your question was about husband who saw hot girl then goes home and has sex with wife

21:28:52 [Roxanita] almost finish child developm

21:28:55 [madalasa] calender what is answer for ur previous uestion aboue having sex with wife?

21:29:00 [calender] ok

21:29:13 [Roxanita] Which abuse do you report because they are mandatory?

21:29:20 [calender] its a transference

21:29:37 [kmonica26] child and elderly

21:29:45 [calender] d to hmm.....undoing is when he buys flowers for his wife : )

21:29:51 [madalasa] what about reaction formation

21:29:53 rozyaurora enters this room

21:30:00 [kiranadi] child and elderly

21:30:10 [Step_1] i thought we were done with child development?

21:30:53 [Step_1] transference is pt to doc....not a defense mech...right?

21:31:08 [Hmmmmmm] oh ty calender

21:31:19 [Roxanita] ok, don't forget that cause you are gonna see that in your exam

21:31:46 [Step_1] mandatory are child and elder

21:32:02 [Hmmmmmm] child elder

21:32:19 [calender]>[Step_1] rt step1

21:32:21 [Step_1] because they cannot take care of themselves....spousal is not reportable because assumed to be indepedent

21:32:33 rozyaurora exits from this room

21:32:51 [Roxanita] PHYSICIAN PATIENT - RELATIONSHIPS

21:33:08 [calender]

21:33:19 [Hmmmmmm] lol

21:33:24 [Roxanita] Rule #1 PATIENT IS ALWAYS NUMBER 1

21:33:25 [calender] holly zolly.Rox

21:33:36 [Hmmmmmm] poor step1 gunna have troble copy-pasting now

21:34:07 [Roxanita] this rule means that at the exam don't look for the option that protects you legally, cause that will be wrong

21:34:23 [Step_1] i can never get the smilies

21:34:45 [Hmmmmmm] good point roxy

21:35:02 [calender] but in reality..do the revrse

21:35:23 [Roxanita] Always pick the answer that gives your patient the comfort and safe over anybody else, even over the relatives.

21:35:23 [calender] this is only for exam point of view

21:35:30 [Roxanita] calender> hey

21:35:36 [hutals] Define Autonomy.

21:35:52 [calender] HOW TO DEAL WITH A DYING PATIENT ?

21:36:06 [Roxanita] Like Daugherty says. When you meet this questions think..... WHAT THE MOTHER TERESA WOULD DO IN THIS CASE ?

21:36:17 [Step_1] pts get to decide medical treatment

21:36:23 [calender] should u tell EVERYTHING?

21:36:54 [Hmmmmmm] calender> see if teh patinet is competent..(notunder depreession etc.) then ask the relatives

21:36:55 [crusher] yes everything donot hide anything if pat like to know

21:36:57 [hutals] Obligation to respect pts as individuals and to honor their preferences in medical care

21:37:01 [madalasa] Yes, unless Pt doesn't want to

21:37:05 [Roxanita] tell the patient everything, don't give them false hopes

21:37:29 [Roxanita] RULE #2 ALWAYS RESPOND TO THE PATIENT

21:37:32 [hutals] Legally, what does informed consent require?

21:38:00 [calender] when a patient cannot make a decision....then what will u do?

21:38:16 [Roxanita] Anything you know about the case, good or bad news. If you explain him better, the chances of being sued are less

21:38:23 [Step_1] pt must understand and agree to treatment given all options

21:39:00 [hutals] discussion of pertinent information- obtaining the patient's agreement to the plan of care- freedom from coercion

21:39:16 [Roxanita] Even if the pt say "doc I don't want to know...your job is to find out why they don't want to know.

21:39:57 [Roxanita] RULE #3 WORK ON LONG -TERM RELATIONSHIPS WITH PATIENTS

21:40:05 [calender] when a patient cannot make a decision, the decision is made based on what is thought WOULD BE that person’s choice. The decision is finally made by who is most likely to represent the patient’s own wishes

21:40:39 [madalasa] Agree

21:40:49 [Roxanita] where does your patient sit at your office? to your right, to your left, in front of you? beside to your right? beside to your left?

21:41:06 [Roxanita] calender> very good

21:41:06 [calender] When you are not clear about the patient’s wishes......in this case what will u do?

21:41:20 [hutals] in front

21:41:35 [Roxanita] ok, who else?

21:41:39 [Hmmmmmm] beside u to the left

21:41:42 [Roxanita] answers?

21:42:08 [kiranadi] towards right

21:42:16 [calender] beside u to the rt

21:42:17 [madalasa] front

21:42:20 [kiranadi]

21:42:25 [Roxanita] you mean this? doc------- patient

21:43:23 [Roxanita] yeah is close to you, beside to your right. So different that they way I learned.

21:43:28 [calender] whats the ans?

21:43:56 [hutals] more like patient = if waiting for important test

21:43:58 [kiranadi] ok guys i'll leave now...have to go now

21:43:59 [Roxanita] if you have a rectangle desk, the patient goes in the same side of the desk to your right

21:44:14 [Roxanita] in your same side, really close

21:44:52 [Step_1] ok kiranadi, thanks for chat....see you next time

21:45:02 [madalasa] calender whats ans for your Q?

21:45:05 [Hmmmmmm] hehe i always get the sides mixed up

21:45:07 [kiranadi] see you all in the next chat

21:45:07 [hutals] nite kiran

21:45:11 [kiranadi] bye

21:45:14 [kiranadi] g'nite

21:45:17 [Roxanita] Step_1> in the forum there is a question about this chapter and nobody is sure about the answer

21:45:19 [medfan] bye kiranadi

21:45:23 [Hmmmmmm] latez kiran, take is easy

21:45:23 [Roxanita] bye Kiran

21:46:03 [Step_1] is it one of your questions?

21:46:28 [Roxanita] yeah, the lady with rheumatoid arthritis

21:46:54 [madalasa] whats ans for you question/TO calender

21:47:07 rozyaurora enters this room

21:47:25 [Step_1] i'll need to take a look at it

21:47:35 [Roxanita] a question for the exam... IF YOU MAKE A MISTAKE, DO YOU TELL IT TO YOUR PATIENT?

21:47:49 [Step_1] yes tell pt everything

21:47:53 [madalasa] Yes

21:48:38 [Roxanita] If the nurses did a mistake, what do you do?

21:48:54 [Roxanita] Do you assume the mistake?

21:48:58 [madalasa] Take responcibility

21:49:01 [Hmmmmmm] for the exam "u tell everything" in real life "think bout it "

21:49:15 [Roxanita] Ja Ja

21:49:15 [medfan] you also have to explain it b/c ultimately the Dr is responsible

21:49:23 [Roxanita] good medfan

21:49:45 [Roxanita] RULE #8 ADMIT TO THE PATIENT WHEN YOU MAKE A MISTAKE

21:49:48 [medfan] thanks

21:49:51 [hutals] in real life.....you run....fast....and dont look back....

21:50:14 [Step_1] LOL

21:50:19 [Roxanita] If a patient with Depression comes to your office, do you transfer him to a Psychiatrist?

21:50:39 [crusher] not at alll

21:50:48 [Roxanita] RULE #9 NEVER PASS OFF

21:50:51 [medfan] no, for usmle you try to take care of everything yourself

21:50:54 [Step_1] referrals are rarely the right ans on exam

21:51:20 [Roxanita] Unless is an Ophthalmology case, that's the exception to the rule

21:51:51 [Roxanita] Is that ok?

21:52:03 [Step_1] agree

21:52:09 [madalasa] yup

21:52:38 calender enters this room

21:52:40 [medfan] so anything with the eye you refer?

21:52:51 [Roxanita] If you tell your patient of 30y that he has DBM and he reacts very angry, and don't want to talk to you. Do you discharge him off?

21:53:17 [Roxanita] that's what daugh say

21:53:18 [madalasa] No

21:53:50 [madalasa] Rox can you please change color to something brighter

21:53:52 [calender] hey Rox.pl. change the color purple

21:53:56 [hutals] DBM??

21:54:28 rozyaurora enters this room

21:54:38 [Roxanita] RULE #10 Express EMPATHY, THEN GIVE CONTROL

21:54:43 [Roxanita]

21:54:56 [calender] Is schizophrenic pt has right to refuse med. treatment?

21:55:15 [madalasa] choose the color you used in the beginning

21:55:38 [Roxanita] ok, the answer to that angry pt would be. "I am sorry, what would you like to do?"

21:55:48 [Step_1] yes, so long as they comprehend

21:55:55 [madalasa] Yes calender

21:56:15 [Roxanita] You have a pt. Dx is clear for you. What do you do next?

21:56:31 [Step_1] assume competent unless something clearly shows otherwise

21:56:45 [Roxanita] I would say give the treatment but no

21:56:53 [calender] how about Alzhiemer?

21:57:04 [Step_1] discuss with pt

21:57:08 [madalasa] explain everything to pt, take consent and treat

21:57:21 [calender] already diagnosed..then?

21:57:29 [Roxanita] next, you get the pt understand the problem and discuss with him the options and treatment

21:57:36 [calender] can he refuse treatment?

21:57:45 [Roxanita] yes

21:58:04 [madalasa] Yes I guess

21:58:21 [Step_1] depends at what stage of alzeihmers. again, check if competant....if question doesn't indicate that pt is incompetant, assume they are

21:58:25 [calender] so.what is the definition of COMPETENT PATIENT?

21:58:27 [Roxanita] calender> can he?

21:59:02 [Roxanita] but try to understand why he doesn't want to get the treatment, then you can work on that

21:59:16 [calender] if he is alcoholic,has alzhiemer,or mentally retarded.in all cases..he has right to refuse treatment??//

21:59:51 [calender] how will you decide that pt is compitent ?

21:59:55 ash enters this room

21:59:55 [Step_1] competent is a legal and not medical term which implies that the patient can comprehend the treatment and options and can make an informed decision based on that

22:00:06 [ash] sorry i am late

22:00:46 [Roxanita] in this exam we are suppose to be the ideal doctors

22:00:50 [calender]>[Step_1] here is the point..legal term..but really i am confused on this?

22:00:53 [madalasa] Hi Ash

22:01:01 [ash] hi

22:01:23 [Step_1] hi ash

22:01:30 [Roxanita] Hi Ash

22:01:31 [hutals] hey ash

22:01:39 [ash] hi all

22:01:47 [calender] ok Rox .move on

22:02:06 [Roxanita] You have a long term patient who now is in coma. What to do next?

22:02:42 [calender] know the wishes of pt??

22:02:44 [ash] is it about DNR?

22:02:55 [Roxanita] here we talk about the LIVING WILL and POWER OF ATTORNEY

22:03:14 [calender] yes

22:03:46 [Step_1] ok, here is from kap lan, competence is legal, not medical issue. diagnosis by itself tells you little about pts competence. clear behavior must be present including suicide attempt, pt grossly psychotic and dysfunctional, pts physical or mental state prevents simple communication. if you're...

22:04:03 [Roxanita] A 34 yo woman with SLE gives instruction to her attorney about how her care should be in the event that she becomes incompetent. This is an example of?

22:04:27 [Step_1] unsure, assume pt is competent. the pt doesn't have to prove to you they are competent. you have to have clear evidence to assume they are not

22:04:29 [ash] power of attorney

22:04:48 [madalasa] Power of Attormey

22:04:57 [Roxanita] no

22:05:04 [calender]>[Step_1] Thanks step 1.doubdts clear

22:05:10 [Step_1] i had a couple of questions on the DNR, power of attny stuff

22:05:56 [Roxanita] because she gave exact instructions to the attorney about what does she want when the time comes, she made her LIVING WILL

22:05:57 [calender]>[Step_1] are you going to post it in forum?

22:06:04 [Roxanita] let' see that Step 1

22:06:08 [ash] health power of attorney or surrogate decision maker

22:06:17 [ash] oh

22:07:04 [Step_1] one said that a pt arrived without vitals and you gave CPR and now on mech vent. Daughter arrives with power of attorney and DNR order. What to do? Turn off vent, seek ethics committee advice, continue vent, seek court order?

22:07:14 [Roxanita] A 75y. man with Chronic renal disease designates his wife of 45y to make decisions about his case in the event that he becomes incompetent. This is an example of?

22:07:41 [calender] For decision making ..when u have to go to court?

22:07:53 [ash] turn off vent

22:08:14 [hutals] turn off vent

22:08:17 [calender]>[Step_1] go to court

22:08:21 [madalasa] If daughter is the best representative of her wishes turn off vent

22:08:26 [ash] surrogate decision maker

22:08:37 [calender] ec. here the daughter( care taker).is not taking care !!

22:08:49 [crusher] donot resusitate as by power of attory

22:09:23 [Step_1] forgot to mention that pt was elderly man living in a nursing home

22:09:37 [crusher] its not daughter but she hasnpower of attorney

22:10:22 [Step_1] i guessed turn off vent because those are the pts wishes expressed thru daughter. you don't assist in killing, but do not do anything heroic to save life....such as mech vent

22:10:55 [calender] have to decide what is in the best interest of pt.?...where r the pt's wishes here?

22:11:04 [Roxanita] I think because she has the POWER OF ATTORNEY she can decide

22:11:30 [ash] go to court if 1)if there is intractable disagreement about a patients competence,who should surrogate or make a decision on life support. 2)you percieve a serious conflict between interest of surrogate and patient.

22:11:43 [calender]>[Step_1] pts wishes expressed thru daughter.can be right..but are they mentioned?

22:11:45 [Step_1] his wishes are in the power of attorney. He wants his daughter to represent his wishes legally.

22:12:10 [calender] ok..then fine : )

22:12:21 [Roxanita] ash> surrogate decision maker, explain please

22:12:30 jwalitm enters this room

22:13:27 [Step_1] i probably didn't express it the same as in question, but i got the impression that the DNR and power of atty were filled by pt previously. i guess it would depend on details of question which i can't recall now

22:14:12 [calender]>[Step_1] this is tricky one

22:14:28 [ash] surrogate decision maker is the one who is given the health power of attorney

22:14:58 [Step_1] they had quite a few of those tricky ethics questions.

22:15:16 [calender] thanks ash

22:15:40 [calender] and step1

22:16:14 [Roxanita] All of these cases are situations where the Pt-phys confidentiality can be breached except? a) STD's b) Elderly or Child abuse c) Suicidal or homicidal pt d) An adult wishing to have abortion

22:16:19 [ash] in case there is any conflict about the patients competence when a substitute decision maker is not available or there is a fight over who will make the decision for the patient

22:17:03 [Roxanita]

22:17:07 [ash] adult wishing to have abortion

22:17:10 [calender] how will u diff. between Substituted judgment and Best interest Standard?

22:18:58 [Roxanita] ash> ?

22:19:08 [Roxanita] yeah that's the answer

22:19:28 [Step_1] another question had pt eating lunch with family in cafeteria and you're passing by. You got her positive cancer results back and she asks you, "Did you get the results?". what to say? Standing, you say "yes, you have cancer", sit and tell her " you have cancer", tell her that results are in....

22:19:31 [Roxanita] ok you were explaining

22:19:42 [ash] say for eg if you know your patient for a long time and you think that he wouldnt refuse dnr but the substitute is saying dnr although you may have never heard the patients wishes you can give it a benefit of doubt and go to court

22:20:06 [Roxanita] Step_1> in the cafeteria?

22:20:07 [Step_1] but you would like to speak in a quiet place about them, can't remember other choices

22:20:31 [ash] tell her the results are in but dont reveal the result itself

22:20:55 [calender] Substituted judgment .....what would pt want and Best interest Stand....what would most people wants

22:21:24 [calender]>[Step_1] whats the rt ans?

22:22:22 [Roxanita] I would go for that . Yes I have your results, come to my office.

22:22:23 [Step_1] I picked the one about telling her results are back, but want to speak in quiet place. Reason being that you should not lie, but patient has right to privacy and it should take place in appropriate setting where it is quiet and private.

22:23:05 [Roxanita] good questions step 1 thanks

22:23:12 [calender] u will tell her in front of family member..or call her in office?

22:23:34 [calender] thanks step1

22:23:47 [madalasa] office

22:23:53 [ash] call her in the office

22:24:07 [calender] ok

22:24:26 [Step_1] that would be a different question calendar, but i would try to tell her privately unless she expressed that she wanted someone present....some pts prefer this

22:25:04 [ash] 16 yrs old pregnant girl .who has the right to make a decision about her baby?

22:25:38 [Roxanita] Which one is not a Criteria for malpractice: a) negligence & deviation from nornal standards b) Fail to determine nature of disease c) fail to establich Phys-Pt relationship d) pt not informed of potential risks of a procedure e) Harm cause by physician negligence

22:25:58 [calender] the brother of 60 yrs old competent woman who has terminal lung CA asks you her diagnosis and prognosis ...what will u say?

22:25:59 [madalasa] Pregnant girl

22:26:22 [Roxanita] ash> hey that's a good one

22:26:26 [ash] fail to determine the nature of disease

22:26:37 [Roxanita] hey my question

22:26:46 [madalasa] fail to determine nature of disease

22:26:47 [ash] thanks you all are doing a great job too

22:26:53 [crusher] donot tell without 60 year consent

22:27:02 [Roxanita] ash> great answer

22:27:08 [madalasa] ash whats ans for your Q?

22:27:19 [Roxanita] is that the answer The pregnant girl

22:27:19 [ash]

22:27:44 [Step_1] fail to determine nature of disease

22:27:50 [ash] th e pregnant girl but i am not a 100% sure

22:28:31 [ash] hispanic lady with depression and interpreter.who do you talk to?

22:28:52 [madalasa] ty ash

22:29:08 [ash]

22:29:36 [hutals] Dr. breach of duty to patient- pt. suffers harm- breach of duty causes harm Note--beyond reasonable doubt not needed, just more likely than not

22:29:47 [crusher] hispanic lady

22:30:06 [hutals] those are the 3 proofs are required for a sucessful malpractice civil suit for neglegence

22:30:20 [ash] oh

22:30:38 [Step_1] what was ans rox?

22:31:04 [Roxanita] Parental consent is not required in : a) a child accompanied by friends to ER who needs a surgery b)16yo needs Rx for 1st trimester bleeding c) 16yo needs med attention b/c herpes lesion in penis e)14yo seeks assistance b/c heroin addiction

22:31:30 [Roxanita] yes that was the answer "fail to determine nature of disease"

22:32:01 [calender] a) a child accompanied by friends to ER who needs a surgery

22:32:12 [Roxanita] [ash] hispanic lady with depression and interpreter.who do you talk to?

22:32:14 [ash] b)

22:32:19 [medfan] b

22:32:35 [Roxanita] you can call me ...........just kidding

22:33:16 [calender] The parent of 15 yr old girl want u to tell her to give up her new born for adoption..what will u do?

22:33:27 [ash] talk to the hispanic lady and listen to the interpreter while looking at the hispanic lady.remember rapport needs to be maintained with the lady.

22:34:21 [ash] calender see what the girl wishes

22:34:22 [Roxanita] ash> ok Rapport

22:34:28 [Step_1] agree with ash....good one

22:34:39 [crusher] donot listen to parent...calender

22:34:51 [Roxanita] Hey Ash you got great questions

22:34:55 [ash] if she is staying with her parents and is still dependent on them then parents can decide

22:35:05 [Step_1] ok, we're down to less than 30 mins left.....should we move on?

22:35:24 [ash] ty roxanita so do you

22:36:10 kiranadi enters this room

22:36:14 [Step_1] what was the answer to the consent question?

22:36:19 [ash] ty calender

22:36:45 [ash] yeah roxanita is b) right?

22:37:09 [kiranadi] what's the topic thats going on?

22:37:26 [Roxanita] the last option was

22:37:37 [ash] hi!!! dr patient relationship

22:37:43 [kiranadi] is the pt-doc relationship over

22:37:48 [Roxanita] all options don't need parent aproval

22:37:48 [kiranadi] hi ash

22:38:05 [Roxanita] sorry guys

22:38:12 [calender] You have relegious and moral prohibition gainst abortion..a lady comes and requests a first trimester abortion...what will u do?

22:38:24 [ash] roxanita what about 16 yrs with 1trimester bleeding?

22:38:53 [Roxanita] it's an emg case it doesn't need parent aproval

22:38:56 [calender] with friend

22:39:02 [Roxanita] any emg case

22:39:03 [calender] parent approval?

22:39:13 [ash] 1 trimester should be performed on her request

22:39:20 [Roxanita]

22:40:31 [Roxanita] In general: EMG SITUATIONS, CARE IN PREGNANCY, RX of STD's, DRUGS/OH DEPENDENCE...all are situations were parental consent is waived

22:40:42 [ash] so what if the doctor has it if it is allowed legally in that state it should be done .your duty as a doctor comes before your religion

22:40:44 [calender] ....you are not required to do any procedure on pt's request.u can refer to some other doc?

22:41:05 [ash] sure

22:41:10 [Roxanita] yeah about the girl who wants to do the abortion,

22:41:34 [Roxanita] you can pass off that pt?

22:41:40 [ash] oh so you were giving examples now i get it

22:42:55 [Roxanita] What if previous to an important surgery your patient who is not from your same religion ask you to get on your knees and pray with him for God to guide you throught he surgery?

22:43:15 [ash] pray with him

22:43:21 [Roxanita] what would you do?

22:43:30 [ash] the way he wants you to

22:43:43 [ash] i know i have done it

22:43:47 [Step_1] ok, i have an excercise for everyone.....i will privately distribute defense mechs to each one of you and you will provide and example where the rest of us will try to guess what it is.....sound good? whoever wants to try this reply yes and i'll send them a defense mech.

22:43:59 [Roxanita] I guess you paid good attention to Daugherty

22:44:12 [calender] a couple with 5 kids want birth control.comes to u...they ask u whether they should choose tubal ligation or vasectomy..what will u suggest?

22:44:14 [ash] sure step_1

22:44:21 [ash]

22:44:23 [Step_1] daugherty is good

22:44:29 [kiranadi] mee too step1

22:44:29 [Roxanita]

22:44:43 [Step_1]>[ash] introjection

22:44:50 [Roxanita] ok

22:44:55 [Step_1]>[kiranadi] acting out

22:45:06 [Step_1]>[Roxanita] passive agressive

22:45:08 [calender] ready step1

22:45:18 [ash] calender say that if i were given those options i would have done vasectomy but dont force them to do anything

22:45:25 [Step_1]>[calender] altruism

22:45:31 [hutals] count me in

22:45:31 [Roxanita] calender> that's a tough one

22:45:55 [kiranadi] acting like a famous personality

22:45:57 [Step_1]>[hutals] supression

22:45:58 [medfan] ok

22:46:24 [Step_1]>[medfan] blocking

22:46:35 [ash] a drill sargent shouts at his scouts the way his mother shouted at him in childhood.identify

22:46:36 [Step_1] did i miss anyone?

22:47:33 [ash] ok calender what is the answer?

22:47:40 [calender]>[Step_1] u r going to write examlples of defens mech?

22:48:01 [hutals] introjection or is it displacment ash?

22:48:16 [ash] introjection

22:48:22 [calender] do not involve in the issue of which partner will have the procedure..just tell them pros and cons of each procedure

22:48:42 [ash] displacement wouldbe if it occured in a short span of time

22:48:51 [ash] oh thanx

22:49:03 [hutals] ok, i have my exam coming up, but I'm going out tonight and going to have a great time and forget about the anxiety...tomorrow, back to studying. what defense mech?

22:49:54 [Step_1]>[calender] i'm giveing them out privately to each person and they will give example where we all try to guess them

22:50:20 [hutals] well then my guess is introjection for ashes

22:50:25 [ash] suppression

22:50:50 [ash] hutals introjection is right

22:51:02 [ash] hutals supression

22:51:05 [hutals] kiranadi, that sounds like intojection too

22:51:19 [kiranadi] ok

22:51:29 [medfan] ok, i forgot the answers to the question on USMLE but I remember it after i sit in my car on the way home, what mechanism? (hope that doesn't occur btw!)

22:51:32 [ash] kiranadi identification

22:51:35 [calender]>[Step_1] u r not including me?

22:51:50 [ash] blocking

22:52:02 [ash] medfan blocking

22:52:04 [kiranadi] block

22:52:14 [hutals] thats gotta be blocking medfan....happens to all of us

22:52:25 [medfan] blocking is correct

22:52:42 [Roxanita] ok

22:52:44 [kiranadi] i'll better drop out.....i'm not able to answer

22:52:51 [Step_1]>[calender] yours was altruism

22:53:16 [calender]

22:53:26 [ash] hey i have 2 good ones-odipal complex is an example of?le belle indifference is an eg. of?

22:53:50 [Roxanita] ok I am back

22:53:52 [ash] tell me the defence mechs

22:54:18 [Step_1]>[kiranadi] i'll help you out. acting out is when someone has massive emotional or behavioral outbusts to cover up underlying feeling or idea. like a temper tantrum, whistling in dark to hide fear, etc

22:54:43 [hutals] supression was correct for mine

22:55:32 [calender] a child abused by her mother.treated for abuse.now has no memry of any mistreatment by her mom.?

22:55:58 [ash] ok i didnt find an answer to this one .what is altruism?

22:55:58 [Step_1] if anyone needs help with theirs, let me know and i'll help out or you can use your own example

22:56:24 [ash] calender repression

22:56:44 [Roxanita] kiranadi> this is a very weak point for me

22:56:48 [medfan] repression

22:57:21 [Step_1] altruism is helping others with no apparent return. doing good balances out the bad we may do and eases anxiety of living in bad world.....we all have that i think

22:57:57 [calender] good one

22:57:59 [Step_1] repression calendar?

22:58:01 [ash] calender if you put an arrow like you just did only i will be able to read it and noone else

22:58:42 [ash] oh i remember isnt it what the underworld dons do?donate a lot of money?

22:59:01 [calender] oh.

22:59:36 [Roxanita] Well guys, we are almost 3 hours. and being lost on this, I will study this chapter better

22:59:54 [ash] i had it in my medschool.saw no mention here

23:00:04 [Step_1] this is an excercise we had in med school and it really helped them stick for me....was hoping it would help you all too

23:00:15 [calender] looks soo easy but, really lost in terminology

23:00:22 [Roxanita] I am happy cause we did ethics and pt-phys relation, that is always hard to answer but you all put so many examples

23:00:24 [medfan] thanks everyone for great quality questions, much helpful.

23:00:33 [ash] someone answer the odipal complex and le belle indifference

23:00:46 [Step_1] thanks for leading another great chat rox....great work!

23:01:02 [Roxanita] I will read the transcript my hubby has the dinner served so I better go now

23:01:08 [calender] yes thanks Rox..

23:01:19 [ash] yeah thanks a lot.is someone posting the transcript?

23:01:23 [Step_1] someone else should attempt to post the transcript because I probably won't always be able to make it to chats...that was someone will know how

23:01:42 [Roxanita] Thanks to all of you. Next chat is Anatomy

23:01:42 [ash] bye roxanita

23:01:59 [medfan] bye roxanita

23:02:06 [ash] step_1 i dont know how to do it

23:02:12 [Roxanita] I have netscape and I tried but can't save the chat

23:02:17 [ash] i still cant post my messages

23:02:47 [Step_1] all you need to do is right click on chat text, click select all, then Ctrl + c and it will copy all the text. then open a new topic in step 1 forum and hit Ctrl + v which will paste it.

23:02:58 [Roxanita] Bye ash,calender,crusher, hmmmmmmmmmm, hutals, madalasa, medfan, and Step 1

23:03:18 [ash] bye

23:03:20 [calender] I can try..but my comp. connection is so bad...but can post if emergency

23:03:21 [Step_1] bye rox....thanks again

23:03:38 [calender] good night Rox

23:04:06 [Roxanita] I will try next chat but I can only paste the last page visible

23:04:09 [Step_1] maybe a few of you should try so a couple of us will know how in case i'm not here

23:04:32 [Step_1] oh yes, you will need to have been here from the beginning

23:04:32 [Roxanita] ok guys, See you on Tuesday. Will try to put more nbme quest for anato

23:04:37 [ash] step_1 i dont have all the chat on my screen as i came very late is there any other way?

23:04:39 [calender] sure

23:04:47 [Roxanita] Buenas Noches

23:04:50 [Roxanita] Bye.

23:05:04 [ash] bye

23:05:11 [calender] Buenas Noches

23:05:13 [Step_1] one more thing, try to help hutals spread the word about chat....he's the only one letting others know. great job hutals

23:05:26 [Step_1] good night all!

23:05:28 [calender]

23:05:34 [hutals] nite everyone

23:05:37 [medfan] good night everyone.

23:06:09 [ash] yeah good work i see your post on other sites .thats how i was hooked on to it in the begining

23:06:25 [ash] goodnight all

23:06:42 rozyaurora enters this room