Chat transcript - Anatomy (Neuro and Gross)

[Anonymous]

20:14:39 [Step_1] i guess we can start with neuro and then move onto gross anatomy

20:14:54 [docak] great

20:15:11 [Step_1] by the way, there are a bunch of great questions posted in the forum by rox that you should all look at if you get the chance

20:15:15 Hmmmmmm enters this room

20:15:27 [Step_1] hi hmmmmmm

20:15:51 [Hmmmmmm] hy

20:15:53 [Hmmmmmm] hey

20:16:01 [Hmmmmmm] sorry got d/c

20:16:03 [Step_1] you're gonna kill me, but i haven't had the chance to look at those questions yet....i've been very busy last couple of days (

20:17:07 [Hmmmmmm] kill u why????

20:17:23 [Step_1] ok, real question described a pt who stumbles in the dark but is ok in daylight. what is possible cause of this? cerebellar defect, dorsal column defect, eye problems, and some others

20:17:59 [Step_1] because i said i would look at them and i didn't get the chance....i'm very sorry about that....but i will get to them this weekend for sure

20:18:00 [Hmmmmmm] negative rhombergs...so i would say cerebellar

20:18:40 [hutals] i would say dorsal column because pos rhomberg

20:18:45 [Hmmmmmm] dont worry man...take ur time

20:19:03 [usmle_exam] i got d/c

20:19:21 [docak] i think its cerebellar too

20:19:32 [Step_1] if eyes closed and fall over....+Rhomberg so dorsal column. if eyes open and fall over than cerebellar

20:19:38 [Brams] how do we differentiate it from Night blindness???

20:19:41 [Hmmmmmm] oh where are my manners...hi step1, hutals, docak, brams tsm and usmleexam

20:20:00 [docak] hi Hmmmmmm

20:20:03 [Hmmmmmm] brams i guess they give u history of vit A defeciency....

20:20:16 [Brams] hi everybody again..

20:20:27 [tsm] hi hmmmmmmm , hope enuf mmm

20:20:28 [Brams] okie hmmm..

20:20:41 [Hmmmmmm] haha tsm

20:21:10 [docak] being in the dark is similar to eyes closed?

20:21:12 [Hmmmmmm] so step1 in this case its +ve rite?

20:21:39 [Step_1] the exam was clever to put this in a practical way by saying that he stumbles in dark (similar to closing eyes) but is ok in daylight (similar to eyes open). so it is a + rhombergs and dorsal column. pt is falling over in dark because bad sensory. but ok in light because the cerebellar is ok.

20:21:58 [Hmmmmmm] wow

20:22:02 [Hmmmmmm] good question

20:22:09 [docak] k

20:22:21 [Brams] good explanation Step1

20:22:38 [tsm] good Q

20:23:13 [Step_1] provide some signs of UMN vs LMN lesions

20:23:50 [docak] umn : hypertonia, hyperreflexia

20:24:15 [Hmmmmmm] UMN - atropy, spastic paralysis, hypertonic, LMN - disuse atropy, flaccid para, hypotonic

20:24:18 [docak] lmn: hypotonia,

20:24:29 [Brams] UMN; spastic Paralysis, LMN: Flaccid

20:24:36 [Hmmmmmm] UMN -hyperreflexia LMN - hyporerefllexxia

20:24:45 [hutals] UMN has spastic paralysis, pos babinski, inc muscle tone, hyperreflex. LMN has flaccid paralysis, areflexia, no babinski, dec muscle ton

20:24:49 [usmle_exam] umn:spastic paralysis.babiniski sign + muscle weakness

20:24:50 [docak] good hmmmmm

20:24:55 [Step_1] UMN has everything increased while LMN has them decreased....excellent everyone

20:25:26 [usmle_exam] LMN:muscle faculation,flacidity

20:25:30 [Brams] babinski sign + UMN, -ve LMN

20:26:05 [Step_1] which tract provides voluntary refined movements of the distal extremities?

20:26:24 [Brams] UMN: Ipsilateral/cpntralateral always below the lesion, LMN: Ipsilateral and always below the lesion

20:26:25 [hutals] corticospinal tract

20:26:31 [Hmmmmmm] corticospinal

20:26:39 [usmle_exam] agree

20:26:48 [Brams] sorry LMN at the level ,of the lesion

20:27:01 [Step_1] very good.....corticospinal

20:27:10 [Brams] yes, corticospinal

20:27:18 [hutals] A rupture of the middle menigeal artery causes what type of hematoma? (epidural or subdural)

20:27:31 [Brams] epidural

20:27:34 [Step_1] epidural

20:27:37 [usmle_exam] epi

20:27:40 [docak] epidural

20:27:51 [hutals] yep, epidural hematoma

20:28:06 [hutals] A rupture of the superior cerebral veins causes what type of hematoma? (epidural or subdural)

20:28:07 [Hmmmmmm] a patient has trouble speaking....moving around......an injection of edrophonium fixed him rite up.....what do u find in his blood?

20:28:10 [Brams] YEAH..I know something..

20:28:17 [Hmmmmmm] hutals subdural

20:28:30 [Brams] Subdural..yes

20:28:33 [Step_1] subdural for hutals question

20:28:37 [docak] sorry guys i don't have questions, since i just saw the schedule

20:28:58 [docak] so i am not well prepared

20:29:00 [Hmmmmmm] docak as long as ur with us

20:29:09 [Step_1] thats ok docak.....you''re doing great answering them

20:29:18 [docak] thanks

20:29:57 [Brams] even I guys..feeling very guilty but tahts okie I really do not want to miss this chatt.: (

20:30:20 [Hmmmmmm] a pateint has trouble speaking ....moving around..hypohyperreflexia, fasciulatinons and spasticity.....where is the lesino in the spinal cord?

20:30:24 [Brams] hmm..wut is the ans

20:30:51 [Hmmmmmm] any one venture a guess???its useless if no one guesses

20:30:59 kmonica26 enters this room

20:31:12 [Step_1] cholinergics found in blood?

20:31:27 [Brams] myasthenia gravis??

20:31:35 [Step_1] organophosphates

20:31:48 [Hmmmmmm] MG (myasthenia gravis.......)...and u see Ach receptors autoantibodies in his blood

20:32:25 [docak] so where's the lesion in spinal cord?

20:32:36 [Hmmmmmm] i guess edrophonium u have to relate to MG step1 cuz its very short acting....so not used in organophosphates (its primarily used for dx of MG rite?)

20:32:46 [kmonica26] Hi everyone\

20:32:50 [Hmmmmmm] hey monica

20:32:51 [Step_1] edrophorium used to distinguish between MG and colinergic crisis....just couldnt remember which one

20:32:56 [Step_1] hi monica

20:33:02 [hutals] hey mon

20:33:08 [docak] hey monica

20:33:10 [tsm] hi monica

20:33:14 [Brams] Hi monica

20:33:32 [Hmmmmmm] i think colinergic crisis is not fixed rite step1?

20:33:32 [hutals] good question hmmmm

20:33:48 [Hmmmmmm] anyone to guess for the second one?

20:34:10 [Step_1] yes, thats how you distinguish the two since they both cause similar symptoms...good one

20:34:12 [docak] cholinergic crisis gets worse with edrophonium

20:34:26 [docak] but myasthenia gets better

20:34:51 [Brams] hmm any clue for the 2nd question??

20:35:15 [Hmmmmmm] ok its ALS...(upper and low motor lesion)

20:35:42 [docak] i was thinking ALS

20:35:48 [docak] but wasn't sure

20:36:18 [Hmmmmmm] i guess my q's wording confused u...sorry i make thses on the go..and sometimes make mistakes

20:36:29 [docak] its ok

20:36:41 [Step_1] ALS is the only one where you will see both UMN and LMN....very high yield

20:37:16 [Brams] yeah..thats correct, step1 remembered now..

20:37:23 [hutals] An aneurysm of what artery may cause CN III palsy?

20:37:38 [Hmmmmmm] a pateint was born with ED and always has heart problems with hypertension......he died one day while running around in a soccer field.......where can the lesion be (in what aretery)

20:37:51 [Step_1] posterior communicating art for hutals

20:38:06 [Hmmmmmm] hutals PICA

20:38:18 [Brams] what is ED hmm??

20:38:31 [docak] ehler danlos?

20:38:42 [Hmmmmmm] sorry ehler danlos yes docak

20:39:06 [Hmmmmmm] its a disease of weakness in collagen

20:39:23 [Hmmmmmm] (generally speaking)

20:39:23 [Brams] posterior cerebral Artery hutals

20:39:51 [Step_1] any large artery i think

20:40:06 [hutals] yep post cerebral artery

20:40:27 kmonica26 exits from this room

20:40:38 [Hmmmmmm] yes but i was thinkigng most common is Anterior communicating....but i should have given more detail

20:40:44 [Step_1] splenic artery, aorta, etc

20:40:51 kmonica26 enters this room

20:41:11 [kmonica26] dissection of aaorta

20:41:46 [docak] dissection of aorta is in Marfans, i think

20:42:17 [Step_1] with ED, they have problems with ruptures of any large arteries including aorta.

20:42:48 [Step_1] but you are correct that marfans has dissection aorta more frequently

20:42:49 [Hmmmmmm] sorry step1, wasnt with detail nvm bout that q ppl

20:43:03 [docak] not only arteries, also they can rupture the gut

20:44:04 [Step_1] you have very good questions hmmmmm, they give us things to discuss

20:44:11 [hutals] Bell's Palsy is seen as a complication in what 5 things?

20:44:49 [kmonica26] facial nerve palsy, lyme ds, herpes

20:44:53 [docak] lesion of facial nerve/

20:45:00 [Brams] lyme disease , hepes, Fn palsy..

20:45:10 [kmonica26] Vit A intoxication

20:45:18 [Step_1] AIDS, Lyme disease, Sarcoidosis, Tumors, Diabetes ... mneumonic is "ALexander Bell with STD"

20:45:22 [Hmmmmmm] a patient with severe thalessemia was put under repeated blood transfusion....some time later his blood test was takes and revealed elevated glucose, lipase, amylase, andthe doctor suggests phelebotomy to run from the feared complication??? what complication is that?

20:45:25 [Hmmmmmm] ty step1

20:45:52 [docak] hemochromatosis

20:45:58 [kmonica26] Iron overload

20:46:05 [hutals] yep, that was more than 5 so even better

20:46:46 [Hmmmmmm] good.... (it was already starting to affect the pancrease as u can see)

20:47:04 [docak] how does the pnuemonic work, step 1?

20:47:26 [docak] hey i got it

20:47:30 [Hmmmmmm]

20:47:36 [docak] took some time duh!!!!!!!!

20:48:18 [Brams] clincal symps of Facial N lesion

20:48:24 [Step_1] thats ok, as long as you got it....i have some strange mneumonics....but they work for me...hopefully can work for you too

20:48:36 [docak] thanks

20:48:59 [Hmmmmmm] a newborn child with torticollis, doctor couldnt check the joints by movign his muscles...and child seemed to be getting infections all the time what is the dx?

20:49:40 [Step_1] loss of serous secretion, submandibular, sublingual, paralysis of facial muscles and stapedius muscle

20:50:02 [Hmmmmmm] a 8 yochild with torticollis on right side......what nerve?

20:50:08 [docak] facial nerve makes u spit and cry

20:50:24 [docak] so the lesion is opp

20:50:32 [usmle_exam] also lost of test sensation of the tongue 2/3 rd

20:50:37 [kmonica26] Accesorry?

20:51:08 [Hmmmmmm] yes good accessory for the second q

20:51:17 [kmonica26] digeorge?

20:51:21 [Hmmmmmm] good

20:51:22 [Hmmmmmm]

20:51:34 [Brams] yep..also Hyperacusis..as Step 1 mentiones paralysis of Stapedius mus

20:51:35 [kmonica26]

20:51:59 [Hmmmmmm] yes hyperacusis

20:52:32 [Hmmmmmm] ant 2/3 is facial?

20:53:07 [Brams] disturbed lacrimataion and salivation - due to injury of..???

20:53:25 [Hmmmmmm] trigeminal

20:53:27 [docak] facial nerve?

20:53:38 [usmle_exam] facial nerve

20:54:02 [hutals] facial

20:54:07 [Brams] ..Nervus Intermedius..

20:54:25 [docak] whats that brams?

20:54:28 [Hmmmmmm] step1 whats parotid gland innervation?

20:54:29 [hutals] From which 3 spinal roots does long thoracic nerve arises?

20:54:54 [Brams] remembered some where I read this..so my Q is ..is wut branch is it???

20:55:01 [Hmmmmmm] hutals is it c6 7 8?

20:55:46 [docak] c5, 6 7

20:55:47 mika enters this room

20:56:23 [Brams] long thoracic N..c567 supplies Serratous anterior

20:56:34 [docak] otic ganglion, but i don't remember the nerve

20:56:52 [hutals] C5, C6, C7 is the answer

20:57:04 [hutals] hey mika

20:57:13 [mika] hi

20:57:13 [docak] long thorasic nerve injured during mastectomy, leads to winged scapula

20:57:35 [hutals] General sensory/motor dysfunction and aphasia are caused by stroke of the? (ant. circle or post. circle)

20:57:44 [mika] and commnly occurs during ligation of laterl thoracic artery

20:57:48 [Hmmmmmm] otic = gloos pharyngeal docak for which q?

20:58:10 [Brams] post circle???

20:58:17 [docak] for parotid gland innervation

20:58:32 [Hmmmmmm] hutals posterterior

20:58:40 [Hmmmmmm] ok thanks docak i think ur rite

20:58:47 [docak] post synaptic thru otic ganglion

20:58:57 crusher enters this room

20:58:58 [docak] i think its vagus nerve

20:59:12 [crusher] hi everybody

20:59:27 [docak] hi crusher

20:59:30 [docak] hi mika

20:59:30 [Hmmmmmm] otic is glossopharyngeal docka

20:59:33 [Hmmmmmm] hey crush

20:59:46 [Step_1] sorry my connection was slow

20:59:54 [Step_1] hi crusher and mika

20:59:55 [docak] yes

21:00:09 [docak] its glossopharyngeal, sorry

21:00:17 [Step_1] ant for hutals question. CN 9 for hmmmm's question

21:00:34 [usmle_exam] my internet connection is also bad today

21:00:53 [mika] hi guys this is the first time i have come to this chat session just about to finish my center prep acess so thought i might join

21:00:53 [hutals] anterior circle is right

21:01:36 [Step_1] welcome mika, you might want to pick a brighter color from rainbow on right so we can read the text better.

21:01:52 [mika] ok

21:01:57 [Hmmmmmm] hey hutals can u exam man?

21:02:00 [hutals] Give 3 charateristics of internuclear ophthalmoplegia (INO)

21:02:01 [mika] thanx

21:02:06 [Hmmmmmm] hey hutals can u explain man?

21:02:20 [Step_1] thanks mika, much better

21:02:40 [mika] paralysis of the eye ie injured eye if medial rectus

21:02:56 [mika] and nystag mus ion the other eye

21:03:12 [mika] and commny occur in MS

21:03:49 [mika] MULTIPLE SCLEROSIS

21:04:30 [Hmmmmmm] mika is INO the same as optic neuritis cuz i thought MS has optic neuritis?

21:05:03 [mika] THAT I AM NOT SURE ABOUT

21:05:22 [Hmmmmmm] o

21:05:26 [Step_1] nystagmus, medial rectus palsy

21:05:38 [Brams] lesion of MLF Medial Longitudinal fasiculus INO

21:06:11 [hutals] great job mika

21:06:20 [hutals] medial rectus palsy on lateral gaze, nystagmus in abducted eye, normal convergence.

21:06:27 [Brams] MLF lesion Convergence is intact i sthat right??

21:06:27 [mika] BUT I KNOW THAT OPTIC NUERITIS OCCURS IN MS AS THE OPTIC NERVE BEING DERIVED FROM CNS IS SUPPLIED BY OLIGODENDROCYTES IN WHICH IS SITE OF MS LESION

21:06:46 [Hmmmmmm] convergence is lost with CN 3 rite?

21:07:02 [Hmmmmmm] ty mika

21:08:47 ggg enters this room

21:08:58 [hutals] Horner's Syndrome is present if the lesion in Brown-Sequard is above what level?

21:09:08 [Step_1] hi ggg

21:09:28 [docak] t2

21:09:31 Perudoc enters this room

21:09:37 [mika] ABOVE LEVEL OF C7

21:09:37 [kmonica26] t1

21:09:38 [usmle_exam] T1 and 2

21:09:43 [ggg] hi every one

21:09:45 [kmonica26] Above T1

21:09:49 [mika] SORRY T1 I AGREE

21:09:53 [Step_1] > T1

21:10:09 [tsm] hi ggg

21:10:13 [hutals] yep, t1

21:10:26 [docak] t1, yes

21:10:34 [ggg] hi tsm

21:10:43 [hutals] How are the fibers of the corticospinal tract laminated? (legs/arms medial or lateral?)

21:10:59 [mika] MEDIAL LEGS LATERAL ARMS

21:11:11 [Brams] yes..agree

21:11:55 [Step_1] with dorsal column its legs medial and arms lateral....is it the same for corticospinal?

21:11:59 [Hmmmmmm] a patient with dilated pupil....loss of accomodation....right eye moving laterally, left side of face, left upper limb has spastic hemiparesis... lesion?

21:12:10 [mika] THEN AS AFTER THE INTERNAL CAPSULE THE ORIENTATION BECOMES VERTICAL

21:12:47 [hutals] i actually meant to say dorsal column, sorry. yes, both correct

21:12:54 [mika] AT THE LEVEL OF CEREBRAL PEUNCLE

21:13:08 [Hmmmmmm] step1 its not the same....cotricospinal has medical UL and lateral LL

21:13:58 [Step_1] thats what i thought.....its opposite for the two tracts

21:15:17 [Brams] Upper homonumous quadrantonopia..location of the lesion....???

21:15:26 [Step_1] is it lateral pontine

21:15:35 [mika] MEYERS LOOP

21:15:41 [usmle_exam] parietal lobe

21:15:44 [mika] IF MACULAR SPARING

21:15:53 [Hmmmmmm] for whose q???

21:15:54 [usmle_exam] sorry temporal

21:16:06 [Brams] central scotoma..

21:16:08 [usmle_exam] brams

21:16:24 [Brams] yes usmle-exam it is Temporal optic radiation

21:16:32 [Hmmmmmm] brams can u explain?

21:16:49 [Step_1] never mind.....it has 3rd CN damage if loss of accom. maybe vertral midbrain??

21:16:56 [Hmmmmmm] oh wait i figured it out thanks

21:17:19 [Hmmmmmm] step1 ur corrects is webers syndrome (medial midbrain)

21:17:39 [Brams] okie..then Lower Homonymous Quadrantonopia..???

21:18:07 [kmonica26] parietal lesion

21:18:24 [Brams] lets complete the list.., Homonymous Hemianopia, Bitemporal Hemianopia..

21:18:25 [Step_1] Lower Homonymous Quadrantonopia would be parietal lobe lesion

21:18:36 [Hmmmmmm] agree

21:18:36 [Brams] correct kmonica26

21:18:48 [Brams] agree..

21:19:14 [mika] OPTIC NERVE , OPTIC CHAISMA CENTRALLY

21:19:21 [usmle_exam] Bitemporal Hemianopia..optic tract

21:19:48 [Brams] Optic Nerve Ispsilateral blindness mika

21:20:02 [Step_1] bitemp hemianopia would be a pit tumor possibly....right in the middle

21:20:16 [mika] WOULDNT CRANIPHARYNGIOMA CAUZE THE SAME LESION

21:20:26 [Step_1] that was actually another real quesiton

21:20:32 [Brams] Optic tract is Homonymous hemianopia..

21:21:11 [usmle_exam] Homonymous Hemianopia:all other lessions be;ow the optic tract

21:21:39 [Brams] correct usmle-exam..agree

21:21:41 [Hmmmmmm] a pateint is sent for research.........he has hyperthermia and the doctors check his TSH normal.check his levels of epinephire and ne ..normal.....check his cortisol levels normal.....then they do a CAT scan and it reveals a small infarct in the vicitiny of hypothalamus....where is the lesion???

21:22:46 [usmle_exam] ventral hypothalamus

21:22:48 [Brams] posterior hypothalamus??

21:22:59 [mika] POSTERIOR HYPOTHALAMUS

21:23:00 [docak] VML

21:23:00 [kmonica26] posterior hypothalamus

21:23:18 [Hmmmmmm] good usmle, its anterior hypothalamus (cuz we're talking lesions)

21:23:28 [Brams] yeah..wait is it Anterior hypothalamus..??

21:23:42 [Hmmmmmm] docak VML is for satiety center i think

21:23:44 [usmle_exam] yes thats right

21:23:46 [Brams] because it is responsible to cool out when it is hot..

21:23:47 [docak] ant is same as ventral

21:23:51 [mika] ANT CUSES DISSIPATION OF HEAT

21:24:20 [Brams] supra optic nucleus..

21:24:33 [mika] OH YA SO ITS LEASION WOULD CAUSE HYPERTHERMIA

21:24:42 [Hmmmmmm] ADH and oxy

21:24:53 [mika] BRAMS I THINK U ARE RIGHT

21:25:16 [crusher] sipraoptic n paraventricular nucleus of pist pit

21:25:35 [Hmmmmmm] yep

21:25:55 [Brams] yes mika..

21:26:13 [mika] NO VENTRAL REFERS TO STRUCTURES IN BASAL GANGLIA I THINK DOCAK

21:26:14 [hutals] If the radial nerve is lesioned, what 2 reflexes are lost?

21:26:20 [crusher] Anterior hypoth=AC -assocoated with =cooling..its lesion will result in hyperthermia

21:26:23 [Brams] septate nucleus for sex and emotions right??

21:26:35 [Step_1] triceps reflex

21:27:08 [Hmmmmmm] ok a lady has lactation even thought shes not pregnant.....she has coarse pubic and axillary hair, her labs show increse in prolactin but decrease in ACTH, TSH, FSH, LH etc dx?

21:27:26 [crusher] radial causes extensin of forearm and supination

21:27:49 [mika] PITUIARY ADENOMA

21:27:53 [Brams] radial n..great extensor Nerve..

21:28:00 [Hmmmmmm] agree with step1 triceps and brachioradialis reflex i think

21:28:19 [Brams] also supinator..

21:28:45 [mika] WHY SUPINATOR?

21:29:12 [Brams] radial N innervates supinator right???

21:29:15 [Hmmmmmm] mika i think it innervates brachioradilis thats why

21:29:26 [mika] IS THAT MAINLY BY MUSCULOCUTANEOUS

21:29:42 [Hmmmmmm] hutals what the ans ?

21:29:43 [hutals] yes, but it asked about reflexes....not movements....so ans is triceps reflex and brachioradialis reflex

21:30:06 [Hmmmmmm] ty

21:30:29 [hutals] If you break your humerus mid-shaft, which nerve would likely injure?

21:30:30 [Brams] Oh okie I was remembering about all that Radial N innervates sorry abouit taht..

21:30:46 [Brams] RADIAL

21:30:47 [Hmmmmmm] hutals its radial

21:30:51 [kmonica26] radial

21:30:56 [usmle_exam] redial nerve

21:30:59 [Step_1] radial

21:31:00 [Hmmmmmm] ok a lady has lactation even thought shes not pregnant.....she has coarse pubic and axillary hair, her labs show increse in prolactin but decrease in ACTH, TSH, FSH, LH etc dx?

21:31:05 [mika] I THINK SUPINATION MAINLY DONE BY BICEPS BRACHII

21:31:09 [hutals] yep radial

21:31:21 [crusher] hypothalamus lesion in low prolactin...reason cos PIF is release from hypothlamus..which inhibit prolactin release

21:31:23 [mika] IS IT PITUITARY ADENOMA?

21:31:27 [Hmmmmmm] mika ur rite but also done by brachioradilalis

21:31:30 [tsm] damage to pit stalk?

21:31:43 [mika] OK

21:31:43 [Hmmmmmm] very good tsm

21:31:47 [mika] THNX

21:31:56 [Step_1] supination by both radial and musculocutaneous

21:32:00 [Hmmmmmm] yes crush ur rite but pituitary stalk is the lesion

21:32:06 [Step_1] nerves

21:32:12 [crusher] i mean high prolaction..cos inhibitory effect gone by dec PIF

21:32:14 [mika] THANX STEP 1

21:32:35 [Hmmmmmm] good crush

21:33:05 [hutals] If you break your supracondyle of the humerus, which nerve would likely injure?

21:33:17 [mika] RADIAL

21:33:27 [usmle_exam] median nerve

21:33:30 [Hmmmmmm] hutals is it radiaL?

21:33:30 [tsm] radial?

21:33:31 [kmonica26] median

21:33:34 [Brams] Radial again..

21:33:47 [Step_1] median

21:33:47 [mika] YEP RADIAL IN SHAT INJURIES

21:33:53 [mika] SHAFT

21:33:57 [crusher] radial

21:34:07 [tsm] No it hink Brachial?

21:34:17 [hutals] correct ans is median nerve

21:34:54 [hutals] the medial epicondyle of the humerus would be the ulnar

21:35:00 [mika] SURGICAL NECK- AXILLARY

21:35:09 [hutals] If you break your surgical neck of the humerus, which nerve would likely injure?

21:35:14 [Hmmmmmm] a drug addict was taken to a hospitall..there they discovered he has a very familiar set of symtoms, masked facies, pill rolling tremors, shuffling gait etc..what is the dx? and cause?

21:35:16 [mika] MID SHAFT - RADIAL

21:35:28 [hutals] oops, you read my mind

21:35:32 [Hmmmmmm] hutals axillary for surgican nect?

21:35:42 [docak] parkinsonism

21:35:54 [Brams] pARKINSONISM

21:35:54 [Hmmmmmm] medial epicondyle for what???

21:35:56 [docak] drug induced

21:36:04 [Brams] ULNAR Hmm

21:36:10 [Hmmmmmm] good brams

21:36:11 [mika] YES HULTALS

21:36:13 [Hmmmmmm] docak what drug?

21:36:32 [hutals] yep axillary for surg neck and the next question was going to be midshaft humerus which is radial

21:36:39 [usmle_exam] medial epicondyle for ulnar nerve

21:36:42 [crusher] musculocutaneos

21:36:45 [mika] COMMNEST OF THE CARPAL BONES TO BE FRACTURED?

21:36:48 [Hmmmmmm] the drug is MPTP

21:37:06 [Hmmmmmm] MPTP is used to cut illicit drugs (cut is a slang term here)

21:37:15 [hutals] medial epicondyle of humerous was ulnar

21:37:26 [Brams] ARM -Axiallary, Radial, Arm...<a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A> says

21:37:28 [mika] I THINK ITS AN ANTI EMETIC?

21:37:29 [Hmmmmmm] mika skaphiod?

21:37:29 [docak] MPTP?

21:37:31 [hutals] ectasy??

21:37:35 [Hmmmmmm] yes docak very good

21:37:40 [Brams] ooops sorry,,

21:37:42 [mika] DOMPERIDOME?

21:37:49 [usmle_exam] scaphoid

21:37:52 [crusher] commonest is scaphoid

21:37:56 [Brams] scaphoid..yes

21:38:01 [mika] RIGHT

21:38:01 [Hmmmmmm] the drug is MPTP

21:38:14 [Hmmmmmm] why is scaphoid fracture important?

21:38:28 [kmonica26] avascular necrosis

21:38:52 [mika] COZ ITS BLOOD SUPPLY IS PERIPHERAL SO THE DISATAL PART CAN BECOME NECROSED

21:38:55 [usmle_exam] agree

21:39:00 [Hmmmmmm] very good

21:39:08 [Hmmmmmm] also doesnt show in xray for a week

21:39:09 [hutals] In a lesion of the radial nerve, what muscle is associated with wrist drop?

21:39:16 [Hmmmmmm] so u cant dx it right away

21:39:30 [Hmmmmmm] and when u do , its already undergone avascular necrosis

21:39:36 [kmonica26] extensor carpi radialis

21:39:37 [Step_1] extensor something

21:39:49 [Hmmmmmm] agree with monica

21:39:52 [Brams] extensor..???

21:39:54 [Step_1] yes extensor carpi radialis sounds right

21:40:05 [crusher] brachiradilalis???

21:40:09 [mika] ALL MUSCLES OF THE EXTENSOR COMPARTMENT

21:40:15 [hutals] extensor carpi radialis longus

21:40:31 [Hmmmmmm] ty hutals

21:40:49 [mika] THANX HULTAS

21:41:26 [hutals] Name 7 functions of the hypothalamus?

21:42:24 [mika] SECRETION OF THE STIMULATING HORMONES

21:42:39 [Hmmmmmm] a 60 yo pateint doesnt have heart disease( is healthy as a fiddle ) but suddenly he has trouble standing up and going up stairs..he tells the doctor he eats garlic everyday and ginseng...also his bp is 129/79, his ekg is normal. what is the probable dx?

21:42:54 [mika] REGULATION OF TEMPRATURE

21:42:57 [crusher] seitity and hunger cebters

21:43:06 [usmle_exam] control tem,part of lymbic system,control of food intake

21:43:14 [crusher] control of temp.

21:43:24 [Step_1] the hypothalamus wears TAN HATS....Thirst and water balance, Adenohypophysis releases hormones, Hunger, Autonomic reg and circardian rythym, Temp reg, Sexual urges and emotions

21:43:41 [mika] INJURY TO THE GLUTEI MUSCLES

21:43:59 [mika] I MEANT THE SUPERIOR GLUTEAL NERVE

21:44:21 [Hmmmmmm] very close mika but its inferior gluteal nerve

21:44:22 [Brams] Glutus maximus is Inferior Gluteal Nerve

21:44:26 [usmle_exam] inferior gluteal nevre

21:44:35 [usmle_exam] ingury

21:44:39 [Hmmmmmm] good ppl

21:44:47 [Brams] Gluteus medius and minimus Sup Gluteal Nerve

21:44:55 [mika] THANX

21:45:08 [docak] sorrp step 1, didn't get the pnemonic this time

21:45:12 [Step_1] The other mneumonic is the r F's....Food, Fear, Fight, and sex

21:45:13 [Hmmmmmm] gag reflex by what?

21:45:19 [Hmmmmmm] cought reflex by what?

21:45:20 [docak] please can u explain

21:45:26 [mika] VAGUS

21:45:38 [usmle_exam] cough vagus

21:45:50 [Brams] Gag Glosspharyngeal

21:45:57 [usmle_exam] gag also vagus

21:45:58 [Hmmmmmm] both vagus

21:46:12 [Brams] Ohhh...: (

21:46:14 [Hmmmmmm] but affrent is glosso for gag

21:46:19 [Hmmmmmm] ur rite brams

21:46:40 [Step_1] the mneumonic is TAN HATS....each capital letter stands for each of the following....Thirst and water balance, Adenohypophysis releases hormones, Hunger, Autonomic reg and circardian rythym, Temp reg, Sexual urges and emotions. But I think the 4 F's is an easier way to remember it

21:47:11 [Brams] Thanks Hmm

21:47:29 [usmle_exam] afferent means output comes from brain

21:47:34 [Hmmmmmm] np brams

21:47:51 [Hmmmmmm] affreent mean sensory (carry away from the organ)

21:48:13 [Brams] efferent is output usmle exam..

21:48:22 [usmle_exam] ok thanks

21:48:45 [docak] thanks step1

21:49:00 [Brams] Klumpkes Palsy???

21:49:09 [mika] LOWER TRUNK

21:49:13 [Step_1] Actually, I think its the 5 F's and thats for the Limbic system....Feeding, Fighting, Feeling, Flight, sex

21:49:15 [usmle_exam] i don't know why i can't remember those things

21:49:21 [mika] C8 T1

21:49:38 [Brams] yep..then what else can we remember??

21:49:48 [Hmmmmmm] ty step1

21:49:52 [mika] HORNERS

21:50:06 [mika] ASSOCIATED WITH KLUMPKES

21:50:06 [Hmmmmmm] very helpful ones expecially the TAn HATS

21:50:22 [Brams] atrophy of interosseus mus, thenar and hypothenar

21:50:42 [hutals] Name the type of movement with slow writhing movements (esp. the fingers)?

21:50:44 [usmle_exam] hypo

21:50:48 [kmonica26] Medain

21:50:48 [Brams] also called Thoracic outlet syn..

21:50:52 [mika] TY BRAMS

21:51:10 [Hmmmmmm] hutals is tis chorea?

21:51:27 [Step_1] Athetosis

21:51:43 [mika] ATHETOSIS

21:51:52 [Step_1] chorea would be sudden, jerky, purposeless movements

21:52:09 [mika] AND HEMIBALISMUS IS FLINGING

21:52:10 [Hmmmmmm] oh thanks step1...was confused bout that

21:52:14 [Brams] agree..

21:52:22 [hutals] Athetosis is right

21:52:33 [hutals] Name the type of movement with sudden, wild flailing of one arm?

21:52:44 [kmonica26] hemiballismus

21:52:47 [Hmmmmmm] what is the function of golgi tendon organ?

21:52:51 [Brams] Hemiballismus

21:52:51 [Step_1] hemiballism

21:53:00 [docak] hemiballismus

21:53:14 [hutals] yep, Hemiballismus

21:53:14 [Brams] deep reflex Hmmm

21:53:22 [docak] maintains tone at rest

21:53:27 [mika] DTECTION OF MUSCLE STRETCH

21:53:32 [docak] when muscle is not stretched

21:53:39 [mika] FOR MUSCLE REFLEX ARC

21:54:12 [Hmmmmmm] good also proprioception

21:54:13 [mika] WHERE IS THE LESION IN HEMIBALISMUS

21:54:32 [kmonica26] subthalamic nucleus

21:54:42 [Hmmmmmm] wait wait

21:54:42 [docak] subthalmic nucleus

21:54:45 [Brams] yep..

21:54:45 [mika] RIGHT MONICA

21:54:52 [Hmmmmmm] muscle spindle is muscle length

21:55:21 [Hmmmmmm] golgi tendon = muscle tension and proprioceptoin page 52 (b . r. s . physio)(

21:55:24 [hutals] contral subthal nucleus

21:55:35 [Brams] where do you palpate for dorsalis pedis pulse??

21:56:04 [mika] OVER THE NAVICULAR BONE

21:56:04 [Hmmmmmm] i think its ipsilateral sub thal nucleus hutals not sure...

21:56:25 [Step_1] dorsum of the foot in the first intermetatarsal space just lateral to the extensor tendon of the great toe.

21:56:53 [Brams] located between..two tendons??

21:57:00 [mika] NO HMMMM I CHECKD ITS CONTRALLATERAL

21:57:05 [Hmmmmmm] agree with step1

21:57:42 [hutals] i got that one from kap lan neuro. it says hemorrhagic destruction of contralat subthal nucleus. HTN pts. can have hemiballismus

21:57:47 [mika] TIBIALIS ANTERIOR AND EXTENSOR HALUSIS LONGUS

21:57:54 [Brams] between Ext. Hallucis longus and Ext Didgitorum longus..

21:58:13 [Hmmmmmm] oh ok thanks mika

21:58:29 [Hmmmmmm] thanks hutals

21:58:37 [Brams] No tinialis anterior mika..

21:58:59 [mika] ok ty brams

21:59:03 [hutals] The fasciculus gracilis contains fibers from the upper or lower body?

21:59:16 [Brams] Lower body

21:59:20 [mika] lower body

21:59:24 [Step_1] gracilis is lower body....medial

21:59:43 [Brams] Cuneatus is Upper body arms..

21:59:48 [hutals] yep, lower extremities

21:59:54 [Brams] lateral..

21:59:55 [Hmmmmmm] spacial neglect syndrom in patient with right dominant lobe...where is teh lesion?

22:00:22 [mika] right mca

22:00:49 [hutals] right temporal lobe dysfunction ??

22:00:53 [Brams] ???

22:01:24 [kmonica26] right parietal?

22:01:35 [mika] pariteal right

22:01:42 [Brams] Guess kmonica is correct

22:02:00 [hutals] The hippocampal formation is connected to the mammillary body and septal area via what structure?

22:02:09 [Hmmmmmm] left parietal

22:02:18 [Hmmmmmm] cuz right pareitn is dominant in that case

22:02:26 [mika] enterorinal cortex?

22:02:36 [kmonica26] oh yes correct

22:02:42 [Hmmmmmm]

22:02:44 [Brams] interpeduncular fossa..????

22:02:48 [Step_1] fornix

22:03:09 [kmonica26]

22:03:31 [hutals] yep, its the Fornix

22:03:54 [mika] yep fornix

22:04:03 [Brams] okie..I understand..Thanks

22:04:08 [hutals] Traction or tear of the superior trunk of the brachial plexus causes what syndrome?

22:04:16 [mika] me too

22:04:29 [mika] erbd paralysis

22:04:34 [mika] erbs

22:04:39 [Hmmmmmm] erbs

22:04:43 [Hmmmmmm] waiter's tip

22:04:48 [mika] with waiter tip

22:04:51 [Step_1] upper is erbs

22:04:52 [mika] sign

22:05:01 [Step_1] waiters tip

22:05:03 [Brams] Erb Duchanne..c 5 6

22:05:15 [hutals] Erb-Duchenne palsy (waiter's tip)

22:05:19 [Brams] upper trunk C5 C6

22:05:43 [docak] sorry guys, i gotta go. my husband is home. i have to make dinner.

22:06:08 [docak] please let me know the link to view the transcript

22:06:14 [Hmmmmmm] bye docak was great having u here

22:06:14 [docak] thanks

22:06:16 [mika] mine is loitering aroung getting bored

22:06:23 [Brams] Bye docak..yeah, I make dinner early on Tuesday and Friday..

22:06:44 [Step_1] ok docak. thanks for chatting. hope to see you next time

22:06:47 [docak] yeah i think i'll do the same from next time

22:06:59 [mika] bye docak

22:07:08 [Brams] yep..see you next time..: )

22:07:09 [hutals] bye docak

22:07:13 [docak] please post the link so i can view the transcripts

22:07:28 [kmonica26] bye docak

22:07:31 [docak] thanks guys, always a pleasure, happy studying

22:07:37 [tsm] bye docak

22:07:47 [mika] u too .

22:07:48 [Hmmmmmm] u 2

22:07:54 [Step_1] the transcript will be posted in the step 1 forum of this site at http://www.valuemd.com/forum12.html

22:08:15 [mika] what time do u guys chat till?

22:08:16 [Brams] Grown Sequard syndrome..??

22:08:45 [Step_1] we go 3 hours at the very most, so 11pm eastern time at most

22:08:46 [Hmmmmmm] hemisection of the spinal cord rite brams (brown sequard )

22:08:51 [mika] hemisection of spinal cord with contralateral loss of

22:08:59 [Brams] Sorry Hmmm you are right..

22:09:05 [mika] pain temprature

22:09:19 [mika] ty step1

22:09:41 [Step_1] we

22:10:02 [Step_1] we've been moving along well tonight, so maybe we'll go until 10:30

22:10:05 [Brams] Ipsilateral loss of tactile, proprioception,tactile..Dorsal column..

22:10:18 [Hmmmmmm] ok step1

22:10:20 [Step_1] anything specific anyone want to cover for next 20 mins?

22:10:23 [Hmmmmmm] i guess we'er almost done

22:10:27 [mika] horners above level of t1

22:10:47 [Hmmmmmm] step1 we havent covered pelvis and abdomnet

22:10:48 [Brams] pain and temp is contralateral -spino thalamic tract right??

22:10:51 [hutals] What 1 nerve root is assoc. with the achilles reflex?

22:10:57 [mika] yep

22:11:05 [mika] s1

22:11:13 [Brams] Achillis tendon..S1

22:11:15 [Step_1] s1

22:11:36 [hutals] yep, S1. What 1 nerve root is assoc. with the biceps reflex?

22:11:48 [Hmmmmmm] agree

22:11:56 [mika] c5

22:11:59 [Hmmmmmm] c6

22:11:59 [Step_1] C5 and some of 6

22:12:00 [Brams] C5 right

22:12:12 [Hmmmmmm] (thanks to step1's q he posted )

22:12:26 [Brams] which one should we pick up..C5 right??

22:12:35 [hutals] yep, C5 mostly

22:13:06 [hutals] thats where i got most of these questions....thanks to step 1

22:13:15 [Brams] fall on the outstretched hand..may #..???

22:13:36 [mika] scaphoin

22:13:42 [Brams] Yep..thanks step1 also for the nice graphic Illustration..

22:13:45 [mika] colles#

22:13:50 [Hmmmmmm] http://www.valuemd.com/viewtopic.php?t=8987

22:13:55 [Hmmmmmm] but this says c6

22:13:55 [Brams] No mika..

22:14:34 [mika] thats what the lecture in &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 > said

22:14:42 [Step_1] it goes in order from bottom to top....so S1 is ankle, L2, 3 4(mostly 4) is the knee, C 5-6 is biceps, C 7 and 8 is tricep

22:15:01 [Brams] Scaphoid is most frequesntly fractured bone..

22:15:29 [Brams] Thanks Step1..good to remember..

22:15:32 [mika] here it is fall on oyt strecthed hand in elderly- radius

22:15:37 [Hmmmmmm] step 1 im confused

22:15:48 [mika] middle aged scaphoid

22:15:50 [Hmmmmmm] u posted c6 in this post...http://www.valuemd.com/viewtopic.php?t=8987

22:15:56 [Step_1] good point, I guess both C 5 and 6 contibute, so probably won't ask you to differentiate

22:16:00 [mika] teenage clavicle

22:16:13 [Hmmmmmm] ok ty step1

22:16:20 [Brams] answer is hook of the hamate..kplan

22:16:56 [Brams] most commonly dislocated carpal bone..???

22:17:13 [Hmmmmmm] lunate?

22:17:23 [mika] lunate

22:17:25 [Brams] CORRECT..

22:18:00 [Hmmmmmm] step 1 we havent done pelivs and abdomen

22:18:10 [Hmmmmmm] and im bad in those

22:18:21 [Brams] yeah..right Hmm..

22:18:39 [Step_1] ok, we can do some questions on that

22:18:54 [Brams] lunate compresses which nerve..???

22:19:17 [Hmmmmmm] median?

22:19:36 [Brams] Correct..hmm

22:19:45 [mika] median

22:20:12 [Hmmmmmm] where does the splenic vein drain?

22:20:17 [Step_1] the cecum is supplied by which artery? (real question, but in simpler terms here)

22:20:18 [Hmmmmmm] what makes up the portal vein?

22:20:33 [mika] splenic and superor mesentric

22:20:47 [Hmmmmmm] i would guess SMA step1

22:20:55 [Brams] inferior mesentric Aretry

22:21:01 [Hmmmmmm] good mika

22:21:07 [Step_1] portal vien is made up of proper hepatic art, portal vien, common bile duct

22:21:38 [Hmmmmmm] u mean portal triad

22:21:53 [mika] thats the portal trid

22:21:53 [Step_1] yes, its sup mesenteric art because this vessel supplies all embryonic midgut derivatives...including cecum

22:22:23 [Hmmmmmm] what artery supplies appendix?

22:22:33 [Step_1] ooops....got twisted on my words there....now i know its getting late

22:22:38 [Brams] Appendicular aretery???

22:22:39 [Hmmmmmm] and its a branch of what?

22:23:02 [Brams] SMA..

22:23:05 [Hmmmmmm] good brams

22:23:06 [mika] ileocolic

22:23:08 [Hmmmmmm] good

22:23:16 [Step_1] appendix is supplied by SMA

22:23:24 [Brams] Thanks..hmm

22:23:30 [Hmmmmmm] mika ur absolutely rite to

22:23:44 [Hmmmmmm] what is the head of pancrease supplied by?

22:23:51 [mika] thamx

22:23:53 [Hmmmmmm] what bout the tail?

22:24:05 [Brams] Gastroduodenal..head

22:24:12 [mika] pancreaticoduodenal -head

22:24:14 [Brams] tail..I guess splenic..

22:24:14 [Hmmmmmm] step 1 a few more mintues than we can rest

22:24:18 [mika] splenic art

22:24:22 [mika] tail

22:24:31 [Step_1] sounds good to me

22:24:47 [mika] soory guys i have to leave

22:25:07 [Hmmmmmm] ok bye mika

22:25:08 [mika] had a great time today though it was my first time

22:25:17 [Hmmmmmm] pleasure to have to discuss with u

22:25:18 [Hmmmmmm] us

22:25:26 [Brams] Bye mika see you on Tuesday...

22:25:26 [mika] see you next time

22:25:50 [Brams] Bye mika see you on Tuesday..

22:25:51 [mika] bye dont say any bye continue ur chat i wont disturb you

22:26:05 [Step_1] bye mika, thanks for chatting

22:26:09 [Hmmmmmm] step1 i read somewhere that in biilateral renal thromobiss u dont have left renal problem why?

22:27:05 [Hmmmmmm] and please tell me what that disease is called where pregannt lady has bilat.. renal thromobosis????i cant remember the name

22:27:15 [Step_1] probably because the left renal vien has 3 branches while the right drains directly into IVC

22:27:42 [Brams] what r those branches Step 1??

22:27:50 [Hmmmmmm] isnt it also becuase left gonadal.drains it?

22:28:16 [Brams] Yes, Hmm..i remember somthing like taht..

22:28:37 [Hmmmmmm] but i cant remembr the reason why this helps

22:29:09 [Hmmmmmm] sorry step1 i know ur tired..ill write this down..ill ask u later

22:29:12 [Step_1] on the left you have the left suprarenal vein and left gonadal vein going into left renal vien which drains into into the IVC

22:29:50 [Step_1] on the right side, they all drain directly into IVC

22:30:24 [Hmmmmmm] then why would u get problems with only rite side?

22:30:58 [Brams] guess IVC is right side of teh abdomen right?? Dont know..

22:31:30 [Hmmmmmm] yes brams

22:31:36 [Brams] most common site for abdominal anerysm???

22:31:42 [Hmmmmmm] but how does that make a diffrence?

22:31:50 [Hmmmmmm] hehe AAA

22:33:10 [Step_1] i cant think of the reason off the top of my head....i will need to look that up

22:33:14 [Hmmmmmm] its ok step1..ill bug u again bout this later

22:33:34 [Hmmmmmm] ty u for everything

22:33:58 [Step_1] but i'm pretty sure it has something to do with that drainage difference....cant make the connection right now....but i will think about it some more tomorrow and try to come up with something

22:34:16 [Brams] thanks step1 r we done with this fro today??

22:34:37 [Step_1] unless you all want to continue, but i have to go??

22:35:18 [Hmmmmmm] hurrrah to step1 the bringer and solver of hard questions

22:35:20 [Brams] I think this should be enough can't think anymore..; (

22:35:46 [Hmmmmmm] hehe brams im getting stupid now...so lets call it a day

22:36:00 [tsm] it was great to be with u guys here , hope to join u on Tuesday

22:36:11 [Step_1] thanks for the excellent chat everyone....you all did great with excellent questions and answers

22:36:20 [tsm] & hopefully with few Qs & Ans

22:36:20 [kmonica26] thanks guys

22:36:21 [Hmmmmmm] bye tsm (whats on next week? )

22:36:30 [Hmmmmmm] bye monica

22:36:33 [Step_1] see everyone on tues...or in the step 1 forum before then

22:36:42 [Brams] Yeah Thanks everybody..Biochemistry I think right???

22:36:43 [kmonica26] bye all

22:36:45 [Step_1] next week is biochem i think

22:36:54 [Hmmmmmm] ok cool

22:36:56 [Hmmmmmm] thanks

22:36:59 [hutals] nite all

22:37:13 [Hmmmmmm] gnite hutals

22:37:13 [tsm] Bye everyone, u guys are great

22:37:27 [Brams] Ok then Good night..May God bless all with great study amd memory. Bye.

22:37:58 [Hmmmmmm] bye brams......was fun cracking qs together man