pATHOLOGY ON OCT 19

[Anonymous]

22:40:21 [hutals] i was hoping that lorena would post it, but i'll post it if she doesn't.

22:40:34 [dr_yasir] tell me how to post i will do it

22:40:40 [jwls29] ok...she's gone

22:40:47 [jwls29] i don't know how

22:40:55 [jwls29] goodnite

22:41:11 [hutals] yep, i was just checking to see if she posted it.....i dont see it so i will post it.....nite

22:43:39 hutals exits from this room

22:43:45 [dr_yasir] ok i am leaving to so bye every one

23:35:38 malumed007 enters this room

23:38:57 crusher exits from this room

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04:55:49 soni_pande enters this room

16:16:26 emmanueljoshua enters this room

16:17:05 [emmanueljoshua] hello

16:17:25 [emmanueljoshua] anybody here?

19:59:32 hutals enters this room

20:03:04 jwls29 enters this room

20:03:25 [hutals] hey jwls

20:03:26 ninadnashua enters this room

20:03:27 >[ninadnashua] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

20:03:37 [jwls29] hi hutals

20:03:48 [hutals] hey nina

20:04:01 [jwls29] hi nina

20:04:29 [ninadnashua] hi

20:05:14 Lorena enters this room

20:05:35 [Lorena] hi everyone

20:05:51 [jwls29] hi lore

20:07:28 [hutals] hey lor

20:08:07 [Lorena] hi jwls hutals ninad

20:08:37 [hutals] i guess ppl will show up late again tonight. i didnt get a chance to post an announcement on other site, so i hope that wont affect attendance tonight

20:09:24 [ninadnashua] hi lorena

20:10:12 [Lorena] we can start if you want

20:11:07 [jwls29] we should start

20:11:31 [hutals] ok, i'm sure other will join later

20:11:57 [hutals] so we're starting with nutrition and then moving to neoplasia....right?

20:12:30 [Lorena] right

20:12:30 [hutals] top 3 causes of death in u.s.?

20:12:56 [Lorena] MI, cancer, stroke

20:13:32 [jwls29] agree

20:13:35 [hutals] heart dz, cancer, stroke is right....good job lor. high fat, low fiber diets contribute to this

20:14:11 [hutals] what is main difference between anorexia nervosa and bulemia?

20:14:32 [jwls29] in anorexia they are underweight

20:14:43 [jwls29] in bulimia they are not necessarily underweight

20:14:48 [Lorena] body weight , in anorexia nervossa is less 15% and bulimia they can be normal or overweight

20:14:53 [jwls29] in anorexia they have distorted body image

20:15:08 [jwls29] not necessarily so in bulimia

20:15:09 [Lorena] agree

20:15:22 [hutals] body image is the main difference where anorexics have disrorted image of themselves regardless of how little they weight. bulemics can have normal body weight and even a little increased

20:15:28 [hutals] good job

20:16:02 [hutals] which one will have osteoporosis? what causes it?

20:16:24 [Lorena] anorexia

20:16:36 [jwls29] anorexia...lack of estrogen

20:16:42 [Lorena] they have decreased strogen

20:17:07 [hutals] anorexics have osteoporosis from the estrogen lack. they will also have secondary amenorrhea from this

20:17:22 [hutals] very good again

20:17:37 [Lorena] how does strogen regulates this? just to remember

20:17:45 [hutals] what is most common cause of death in anorexics?

20:18:02 [jwls29] arrhythmias

20:18:09 [Lorena] cardiac arrythmias

20:18:28 [hutals] yep, cardiac arrythmias

20:18:54 [jwls29] b/c of the loss of body fat there is a decrease in GnRh secretion which leads to low FSH/LH causing low estrogen levels

20:19:22 [hutals] agree with jwls

20:19:34 [Lorena] strogen regulates IL1 (inhibitory) which is the osteoclast activating factor

20:19:45 [Lorena] yes very good

20:20:12 [hutals] same reasoning behind osteoporosis in post menopausal women i think

20:20:31 [Lorena] yes

20:20:31 [jwls29] yes

20:20:43 [hutals] what type of electolyte disturbances seen in bulemics?

20:21:14 [jwls29] hypokalemic metabolic alkalosis

20:21:17 [Lorena] hypokalemia with metabolic acidosis

20:21:29 [jwls29] b/c of the vomiting

20:21:32 [ninadnashua] hypokalemic metabolic alkalosis

20:21:41 [Lorena] sorry alkalosis

20:21:50 [hutals] yep, all correct

20:22:27 [hutals] just one more tid bit on this.....don't give buproprion to bulemics because it can cause seizures

20:22:29 [Lorena] what does alkalosys causes in the Oxygen Hb curve?

20:22:54 [ninadnashua] left sift

20:22:57 [hutals] left shift

20:23:09 [Lorena] thank you huts, didnt know that

20:23:11 [jwls29] agree

20:23:33 [Lorena] yes good

20:23:47 [hutals] i didnt either until i got it wrong on q bank

20:24:39 [hutals] what is considered obese as far as BMI? what about morbidly obese?

20:24:58 [jwls29] >30 bmi

20:25:09 [jwls29] and for morbidly >40

20:25:09 [Lorena] more than 30BMI obese, morbidity is more than 40

20:25:22 [Lorena] how to calculate BMI?

20:25:29 [hutals] yep, both right

20:25:56 [hutals] kg / m squared

20:26:04 [Lorena] yes

20:26:05 [jwls29] weight in kg/height in meters squared

20:26:13 [Lorena]

20:26:50 [hutals] most common complication in obesity?

20:27:07 [jwls29] hypertension

20:27:07 [Lorena] hypertension

20:27:28 [hutals] yep, HTN

20:27:50 [hutals] first treatment of choice for obesity?

20:28:07 [hutals] think cheap as papi says....hint

20:28:15 [jwls29] behavior modification

20:28:27 [Lorena] behavior modification

20:28:33 [jwls29] low calorie diet and exercise

20:28:44 [hutals] yep, behavior modifications like diet and excercise

20:29:15 [hutals] difference between kwashiorkor and marasmus?

20:29:46 [jwls29] kwarshiorkor is decreased protein intake,diet mostly cbh

20:29:58 [Lorena] kwashiorkov decreaed proteins in diet

20:30:00 [jwls29] marasmus is decreased caloric intake

20:30:20 [hutals] kwash is dec protein and marasmus is dec total calories.....good.....which is worse? which has pitting edema?

20:30:21 [Lorena] agree

20:30:46 [Lorena] kwarshiorkov is worse, it has pitting edema for hypoalbuminemia

20:31:06 [jwls29] kwarshiorkor has pitting edema b/c of hypoalbuminemia

20:31:14 [Lorena] why do they have fatty liver?

20:31:32 crusher enters this room

20:31:34 [hutals] if you have dec albumin (protein), you will have pitting edema.....very good......kwash is worse

20:31:38 [jwls29] decreased synthesis of apolipoproteins

20:31:51 [crusher] hello everybody

20:31:55 [jwls29] hi crusher

20:31:58 [hutals] dec apolipoprotens

20:32:03 [Lorena] hi crush

20:32:03 [hutals] hey crush

20:32:15 [crusher] he lorena

20:32:21 [crusher] hey hutal

20:32:27 [Lorena] explain why they have red hair

20:32:41 [jwls29] copper deficiency

20:32:52 [hutals] copper deficiency

20:33:05 [crusher] lack of copper

20:33:21 [Lorena] yes, what does copper do?

20:33:42 [crusher] coper is a co factor

20:34:17 [crusher] for the synthesis of collagen

20:34:32 [hutals] tyrosinase relationship

20:34:49 [Lorena] yes, copper is cofactor for lysil oxidase, it stabilizes collagen

20:35:26 [hutals] i guess tyrosinase relationship would be for the skin depigmentation....oops

20:35:38 [hutals] what vits are likely to be dec in pt with cystic fibrosis? why?

20:36:00 [crusher] allfat soluble vit

20:36:01 [jwls29] a,d,e,k

20:36:08 [jwls29] fat soluble vitamins

20:36:14 [Lorena] fat soluble proteins because cystic fibrosis causes malabsorption

20:36:29 [hutals] pancreatic malabsorption of fat sol vits.....ADEK....very good

20:36:38 [jwls29] yes

20:37:33 [crusher] cos in where these vitamins absorb???

20:37:50 [Lorena] what vit defficiency may be defficient in a ptient with Chron's disease?

20:38:20 [hutals] B12 i think

20:38:42 [Lorena] yes very good hutals

20:38:43 [crusher] where does fat solu vit reabsorb

20:38:54 [hutals] reabsorp of vits are in prox small intest

20:38:57 [crusher] b12 absorb in terminal ileum

20:39:05 [hutals] b12 is in term ilieum

20:39:22 [jwls29] agree

20:39:28 [Lorena] small intestine except vit B12 in terminakl ileum-the most common affected site in Chrons

20:39:48 [hutals] what is the leading cause of blindness worldwide? 2nd? what about in u.s.?

20:39:50 [crusher] what is basic differnec of anorexia and Bulemin by definition

20:40:11 [crusher] us is Dibetes.

20:40:23 [hutals] body image

20:40:42 [jwls29] worlwide it's trachomata

20:41:10 [hutals] us is diabetes. worldwide 1. trichomonis 2. vit A def

20:41:27 [Lorena] thanks hutals

20:41:51 [hutals] isnt that crazy, we can prevent millions of blindness cases with a simple vit pill???

20:42:01 [crusher] its body weight and distorted body image ..anorexia= less than 15% ideal wt n distored image while bulemia both normal

20:43:16 [Lorena] do you remember the serotypes hutals for trachoma?

20:43:18 [hutals] which vit can cause birth defects

20:43:21 [hutals] ?

20:43:41 [Lorena] def folic acid

20:43:46 [crusher] i think vit A overdose

20:44:09 [jwls29] vit a overdose is cerebral edema and papilledema

20:44:17 [jwls29] agree with lorena

20:44:49 [hutals] the answer i was looking for, i think step 1 provided it as a real question, was vit a in the form of retinoic acid given for treatment of acne

20:45:08 [crusher] folate def gluteal with neural tube defect

20:45:10 [jwls29] ah ok

20:45:10 acestep1 enters this room

20:45:39 [jwls29] hi ace

20:45:43 [acestep1] hi guys

20:45:54 [hutals] hey ace

20:45:55 [acestep1] hi jwls

20:46:00 [crusher] hello ace

20:46:09 [Lorena] hi ace

20:46:09 [acestep1] hey hutals

20:46:21 [acestep1] hi lor

20:46:33 [acestep1] hi crush

20:46:42 [Lorena] ok, but in that case they would specify if an overdose or a defficiency in a vitamin

20:46:51 [hutals] i cant remember the serotypes of the top of my head

20:47:34 [acestep1] agree . 1 more pt it treats a wbc cancer as well

20:48:04 [acestep1] i think a-l

20:48:10 [jwls29] ace, can you change your color,please?

20:48:13 [Lorena] serotypes a to C for trachoma

20:48:14 [hutals] i cant remember the question that was given to us, but it said something like which vitamin can cause birth defects? i guess both could depending on choices given and wording

20:48:18 [crusher] follicular hyperkeratosis secondry to squamous metaplasia inhair follicles linked to which vit def

20:48:26 [Lorena] i just looked

20:48:38 [acestep1] oops im really sorry

20:48:51 [hutals] i was way off....i was thinking it was a number instead of letters

20:48:54 [jwls29] vit c

20:48:54 [Lorena] vit A

20:48:56 [acestep1] is it ok now?

20:49:04 [hutals] thanks lor

20:49:13 [acestep1] oh ok

20:49:15 [jwls29] lorena is right

20:49:21 [crusher] lorena ur rite its VIT A def

20:49:21 [Lorena] thank you for bringing that up, now we know

20:49:31 [jwls29] i was thinking of perifollicular hemorrhage which is vit c

20:49:40 [jwls29] better ace, thanks

20:49:54 [acestep1] k:0

20:50:05 [acestep1]

20:50:33 [hutals] what is the most imp source of vit D?

20:50:47 [acestep1] sunlight?

20:51:00 [jwls29] agree with ace

20:51:10 [ninadnashua] ya

20:51:10 [Lorena] sun, UBV

20:51:11 [crusher] squmous metaplasia of straitified columnar epith of of bronchiloes linked to which vit def

20:51:20 [jwls29] vit a

20:51:24 [hutals] yep, sunlight. what about colostrum.....is this a good source of vit D?

20:51:29 [crusher] agree sun light

20:51:33 [acestep1] vit a

20:51:35 [Lorena] agree with jwls

20:52:07 [crusher] i thinlk not its lack vitD.

20:52:10 [hutals] is that vit a crush?

20:52:17 [acestep1] i think yes- hutals

20:52:28 [crusher] yes u all right its vit A

20:52:33 [Lorena] no, not a good sourse of vit D

20:52:43 [jwls29] agree with crusher and lorena

20:53:13 [Lorena] thats hy they recommedn to expose the baby to the sunlight

20:53:21 [hutals] believe it or not, vit D is absent in colostrum of milk. in fact, it is not even in cows milk normally, but is added

20:53:55 [jwls29] where are vitamin d receptors located

20:53:55 [acestep1] ok 1 pt i think if vitA def then u get all kinds of resp d/s like colds ( recurrent) , pneumonitis n lung ca

20:54:46 [crusher] which two reactions in vit D synthesis require Ohlation

20:55:05 [Lorena] small intestine, kidney , osteoblasts

20:55:25 [crusher] agree with lorena

20:55:36 [jwls29] yes

20:55:49 [hutals] crush...is that hydroxylation?

20:56:03 [crusher] yes hyroxylation

20:56:19 [hutals] took me a while to get that one

20:56:36 [Lorena] hepatic and renal hydroxilations before it is 1,25 dihydrocholecalciferol

20:56:51 [hutals] 25 OD D3

20:57:02 [jwls29] 25 hydroxylation occurs in the liver and 1,25 hydroxylation occurs in the kidney

20:57:03 [crusher] one in the live by 25 oHlase and other in kidney by alpha 1 hyroxylase

20:57:06 [acestep1] chol- 25oh chol ( liver) n 1,25 chol- kiney

20:57:13 [hutals] oops thats 25-OH-D3

20:58:25 [Lorena] so in apatient with renal failure, is it effective to give over the counter vit D?

20:58:29 [hutals] what is the most common cause of vit D deficiency?

20:58:56 [acestep1] nosunlite

20:59:02 [hutals] nope lor, because they cant convert it without functioning kidney

20:59:13 [crusher] lack of sunlight

20:59:14 [acestep1] no sunlight imean

20:59:33 [Lorena] yes hutals

20:59:36 [acestep1] agree with hutals

21:00:10 [hutals] that is a cause of vit D deficiency, but MCC according to golijan is chronic renal failure

21:00:15 [Lorena] the same happens with patient with liver insufficiency or cirrhosis

21:00:43 [hutals] other causes?

21:00:44 [acestep1] colostrum is def in which other vit?

21:01:32 [crusher] lab value dec ca inc P inc,,patient patient on renal dialysis what could be the cause

21:01:45 [hutals] vit k??

21:01:50 [Lorena] vit K ace

21:02:31 [crusher] lab value dec ca inc P inc PTH ,, patient on renal dialysis what could be the cause

21:02:48 [crusher] yes dec vit k

21:03:19 [Lorena] renal insufficiency , high phosphate because parathormone is trying to compensate the hypocalcemia

21:03:24 [hutals] chronic renal failure

21:04:39 [acestep1] sorry guys my comp froze. yes v good vita k

21:05:00 [crusher] its cos of lack of alpha 1 Oh lase def cos of renal failure..sec Hpterparthyroism

21:05:00 [hutals] other causes of vit D def include poor diet, malabsorption, liver dz, drugs enhancing p450, hypoPTH, genetic dzs

21:05:10 [acestep1] vit k imean

21:05:40 [hutals] ace, i thought u were just building the suspense

21:05:46 [Lorena] thanks crush

21:06:05 [acestep1] lol . no hutals .

21:06:17 [acestep1]

21:06:19 [hutals] big game hunter presents with headaches....what might be the cause?

21:06:52 [Lorena] ate bear liver-overdose of vit A

21:07:00 [crusher] agree

21:07:33 [acestep1] agree

21:07:33 [jwls29] agree

21:07:37 [hutals] rule out papilledema from inc cranial pressure due to hypervit A tox from eating bear liver.....very good

21:07:47 [crusher] in bone on which cells does pth receptors located

21:08:15 [hutals] osteoblasts

21:08:39 [Lorena] agree

21:09:21 [hutals] what are vit K dependent factors?

21:09:27 sweta_med enters this room

21:09:30 [crusher] yes osteoblast which secrete interleukin 1 which then linked it to osteoclast ,,result in CALCIUM release by activation of PTH

21:09:46 [sweta_med] hi everyone

21:09:46 [hutals] hey sweta

21:09:47 [crusher] 2 7 9 10

21:10:01 [Lorena] hi sweta

21:10:03 [jwls29] protein c and protein s

21:10:07 [sweta_med] are u discussind nutrition

21:10:22 [crusher] yes sweta

21:10:34 [Lorena] what vitamin overdose can cause the deff of another vitamin?

21:10:34 [hutals] yep sweta

21:10:37 [hutals] 2,7,9,10, prot c/s

21:11:06 [hutals] vit E can dec vit k

21:11:22 [crusher] wht will happen to bone reabsorption with inc or dec vit D

21:11:39 [Lorena] good hutals

21:11:46 [acestep1] wow i didnt know tht

21:12:05 [sweta_med] it will increase

21:12:07 [crusher] and osteocalcien another factor form in liver

21:12:22 [sweta_med] with decrease vit d

21:12:40 [acestep1] agree with sweta

21:13:01 [crusher] there is inc bone reabsorption in both inc or dec vit D

21:13:03 [Lorena] bothj decreased or increased will result in loss of bone

21:13:41 [hutals] lor, correct me if i'm wrong, but i think that vit E tox causes bleeding which will basically use up vit k factors and that is how it will have an effect....am i understanding that correctly?

21:13:55 [sweta_med] what would be the cause

21:14:53 [acestep1] ok .yes cuz vit d also cuzes bone resorption by activating osteoclasts in addition to inc the s. intestine absp n kidney absp

21:14:59 [hutals] child presents to ER after eating rat poison. what is intial treatment? why?

21:15:05 [crusher] most common cause of vit D def?

21:15:21 [Lorena] vit E toxicity decreases synthesis of vit K factors, and will result in bleeding but after some days because you still have some coagulation factors around

21:15:22 [hutals] the cause of what sweta?

21:15:37 [hutals] crush, chronic renal failure

21:15:53 [acestep1] vit k - hutals?

21:16:02 [hutals] ok, thanks lor

21:16:03 [Lorena] vitamin K

21:16:07 [sweta_med] the bone resorption in vit d deficiency would be due to PTH

21:16:16 [crusher] yes good hutal renal failure n dc alpha i ohlase def

21:16:16 [Lorena] you are welcome

21:16:34 [jwls29] vitamin k

21:16:57 [hutals] yes, its vit k given IM

21:17:06 [crusher] other cause of vitD def are.....alcolism..liver damage...celiac dis

21:17:17 [hutals] because rat poison contains warfarin

21:17:42 [sweta_med] should heparin be given

21:18:48 [crusher] what would be valus of ca ,P and alk Phosphatse in rickets and osteomalacia????

21:18:50 [hutals] heparin would cause further bleeding, so i dont think it would be good to give it

21:19:13 [hutals] no, i am wrong...sorry

21:19:42 [crusher] rat poision conatin warfarin...anticoagulat so >>>>>>bleeding

21:20:12 [sweta_med] CA and p is lowand alkaline phos is high

21:20:18 [crusher] no donot give heparin............another anticoagiulant

21:20:40 [Lorena] when you want to anticoagulate a patient (post MI for example) you give heparin and warfarin, but not in a warfarin overdose in a normal patient

21:21:00 [hutals] sweta, i'm confused by your question....should hep be given in case of child with rat poison (warfarin).....if that is the question than no because it can cause further bleeding

21:21:33 acestep1 enters this room

21:21:37 [sweta_med] ok but its in the <a target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=Goljan&mode=books>Goljan</A> notes that heparin and warfarin shoould be given together

21:21:39 [hutals] but if you mean why give hep with warfarin normally it is because hep will work right away whereas warfarin will take longer

21:22:07 [crusher] sweta u r right in osteomalcia n oricj=ket its deminerlization so dec ca and P. n inc alk phosphate

21:22:49 [sweta_med] i got that thanks

21:23:20 [hutals] yes sweta, they can be given together if you want to prevent clots, but not if you have warfarin toxicity like with child taking rat poinson

21:24:10 [Lorena] in what other disorders is alkaline phosphatase increased?

21:24:31 [sweta_med] tumors of the bone

21:24:45 [crusher] what are the level of Ca.P and alk P in osteoporosis

21:25:18 [ninadnashua] normal

21:25:22 [acestep1] any bone forming patho - lor

21:25:40 [Lorena] yes

21:25:52 [crusher] osteochonroma..sarcoma etc lor

21:25:53 [acestep1] agree with nina

21:26:09 [crusher] yes all normal in osteoporosis

21:26:21 [Lorena] good question crush

21:26:27 [hutals] liver dz, kid normal to be elevated

21:27:21 [hutals] what vit supplement should be given to TB pt be treated?

21:27:31 [acestep1] b6

21:27:39 [Lorena] agree

21:27:41 [sweta_med] pyridoxine

21:27:41 [crusher] b6

21:27:58 [hutals] why B6.....which drug causing deficiency?

21:28:14 [crusher] isoniazid i think lower down b6

21:28:21 [acestep1] otherwise b6 is amde by n. flora i think

21:28:36 [acestep1] made by n.flora

21:28:49 [hutals] Isonizaid (INH) used to treat TB can cause deficiency of B6.....good job

21:28:51 [acestep1] agree with crusher

21:28:52 [Lorena] yes isoniazid

21:28:53 [sweta_med] birth contol pills also

21:29:30 [hutals] yes sweta....also alcoholism and pregnancy

21:29:37 [sweta_med] what are the ymotoms

21:29:45 [sweta_med] ji mean symptoms

21:29:59 [Lorena] sideroblastic anemia, cheilosis, stomatitis

21:30:22 [sweta_med] peripheral neuropathy,

21:30:27 [hutals] sideroblastic anemia, convulsions

21:30:37 [hutals] neuropathy

21:31:19 [hutals] interesting.....convulsions seen in both B6 deficiency and toxicity

21:31:19 [ninadnashua] what is brown bowel syndrome

21:31:47 [sweta_med] the deposition of lipofuscin

21:31:52 [Lorena] what else cause sideroblastic anemia?

21:32:13 [ninadnashua] ya in cystic fibrosis

21:32:17 [jwls29] seen in CF and due an increase in liprofuscin from increased lipid peroxidation

21:32:18 [acestep1] lead

21:32:20 [Lorena] agree with sweta but dont remember secondary to what?

21:32:34 [Lorena] thanks

21:32:36 [ninadnashua] ya

21:32:40 [hutals] lead

21:32:45 [Lorena] yes ace very good

21:32:54 [ninadnashua] vit e

21:33:10 [ninadnashua] defieceincy

21:33:16 [acestep1] thanks

21:33:22 [sweta_med] yes agree

21:33:44 [hutals] eating raw eggs can cause a deficiency in what?

21:33:55 [acestep1] biotin

21:34:08 [sweta_med] biotin

21:34:14 [ninadnashua] true

21:34:16 [Lorena] yes

21:34:31 [hutals] yep biotin.....what is a sign that can be seen with this?

21:35:06 [Lorena] alopecia

21:35:07 [acestep1] dont remb

21:35:14 [ninadnashua] mcc of vitk defeieiency

21:35:15 [sweta_med] alopecia

21:35:21 [hutals] alopecia is right

21:35:40 [hutals] antibiotics

21:35:50 [acestep1] antibiotics?

21:35:57 [sweta_med] antibiotics

21:35:40 [hutals] antibiotics

21:35:50 [acestep1] antibiotics?

21:35:57 [sweta_med] antibiotics

21:36:18 [jwls29] i have to go...goodnight all....see you tomorrow

21:36:30 [ninadnashua] ya

21:36:33 [sweta_med] bye jwls

21:36:38 [Lorena] see you tomorrow jwls

21:36:46 [acestep1] bye jwls

21:36:46 [hutals] nite jwls

21:36:55 [acestep1] tc

21:36:57 [jwls29] bye

21:37:12 [sweta_med] what essential amino acid is needed for niacin formation

21:37:29 [Lorena] tryptophan

21:37:41 [acestep1] ok . 1 q y in b6 def u see neuropathy

21:37:49 [sweta_med] yes

21:37:53 [acestep1] agree with lor

21:38:03 [hutals] tryptophan

21:38:08 [hutals] patient eating lots and lots of corn can have what symprtoms?

21:38:17 [Lorena] what if the patient has phenylketonurya? what aminoacid then?

21:38:19 [sweta_med] pellagra

21:38:37 [acestep1] b6 - fits

21:38:49 [sweta_med] aspartic acid

21:38:56 [Lorena] pellagra the 5 D's

21:38:58 [acestep1] tyrosine

21:39:05 [hutals] ace, i think because B6 involved in neurotransmitter synthese

21:39:21 [crusher] tyrosine

21:39:27 [Lorena] yes ace good job

21:39:56 [Lorena] and crush

21:39:57 [hutals] hmmmm.....i only know of 4 D's.....diarrhea, dementia, dermatitis, death

21:40:00 [acestep1] no d-ALA accumulatesn it is neurotoxic i think

21:40:15 [acestep1] thanks lor

21:41:06 [Lorena] the 5 D is D-ehydrogenases for the ez that requiere niacin as cofactor

21:41:09 [crusher] in wilson disearw what level of ceruloplasin free cU and total copper,explain also plz???

21:41:21 [hutals] ok, thanks lorena

21:41:26 [acestep1] k

21:41:49 [sweta_med] i want to know the question crusher

21:42:22 [hutals] in wilsons, you will have low ceruloplasim, low total copper, and high free copper

21:42:37 [crusher] in wilson diseae wht the level of ceruloplasmin,,Free Cu+2,total cu?

21:42:48 [acestep1] dec ceruloplasm- genetic defect - inc free cu which binds 2 liver n hepatotoxic

21:43:35 [acestep1] and is hepatotoxic imean cirrhosis

21:44:14 [ninadnashua] total cu les but free more

21:44:30 [Lorena] low total copper because you only measure the bound one hutals?

21:44:59 [acestep1] dm pts lack which trace element

21:45:00 [sweta_med] whta are the symptoms of zn deficiency

21:45:07 [crusher] wilson Dz is AR diseas in which there is DEFECTIVE EXCRETION CU into BILE ..from chronic levr dz.DEc ceruloplasim(low copper level)Bcoz synthesis in liver......inc free cupper that deposit in eye give kaysers fleisher rings

21:45:35 [acestep1] agree

21:45:51 [sweta_med] yes aree

21:46:06 [Lorena] poor wpund healing, taste decreases and anosmia

21:46:10 [crusher] but i donot understand why total dec n free inc can some one explain?

21:46:31 [sweta_med] yes lor

21:46:32 [acestep1] agree - lor

21:46:53 [acestep1] dm pts lack zn

21:47:18 [sweta_med] rash around the mouth , growthn ertardation and hypogonadism

21:47:24 [acestep1] which trace element will dec hyeprglycemia

21:47:56 [Lorena] chromium

21:48:22 ggg enters this room

21:48:23 [acestep1] v good lor

21:48:42 [Lorena] chromium increases glucose uptake by insulin

21:48:55 [Lorena] thanks ace

21:48:59 [acestep1] trace element for hair colour?

21:49:12 [acestep1] yes

21:49:14 [hutals] low ceruloplasmin levels with subsequent increase in free copper in blood. But that will be less total copper (bound) which is the one that is measured. but dont be fooled because the free is the one that really matters

21:49:34 [ninadnashua] thiamine defeceiency related to what

21:49:34 [Lorena] copper?

21:50:08 [crusher] sweta zinc >>>ans

21:50:12 [acestep1] execellent lor

21:50:24 [hutals] hey ggg

21:50:29 [acestep1] excellent imean

21:50:31 [Lorena] thiamine deficiency is common in alcoholics

21:50:35 [sweta_med] copper

21:50:48 [crusher] korsakof physosis,,wernikes enceph...ninad

21:50:53 [acestep1] agree. also dry n wet berri berri

21:51:04 [crusher] cu related to hair changes

21:51:04 [ggg] hi all

21:51:06 [ninadnashua] yes also atp defeieceiency

21:51:13 [sweta_med] nystagmus, confusion, ataxia

21:51:38 [acestep1] alos memory loss

21:51:50 [ninadnashua] ya wet dry beriberi

21:51:57 [acestep1] yes - crush

21:52:11 [hutals] pt given IV glucose and develops wernicke's encephalopathy.....why?

21:52:22 [ninadnashua] ya

21:52:26 [Lorena] also seen in kwarshirokor-red hair for lack of copper

21:52:27 [acestep1] no b1

21:52:45 [acestep1] agree with lor

21:52:48 [sweta_med] glucoses uses up the thiamine

21:53:05 [Lorena] glucose precipitated thiamine deficiency because it was used in glycolysis a cofactor for pyruvate dehydrogenase

21:53:10 [sweta_med] for pyruvate formation

21:53:19 [crusher] agree

21:53:30 [acestep1] i think in alco u need b1 pyrophos

21:53:31 [hutals] always infuse IV thiamine before giving pt glucose because glucose is converted to pyr and pyr to acetyl CoA which uses up thiamine and precipitates attack.....excellent

21:53:33 [crusher] two reactions require thiamine as a co factor

21:53:58 [sweta_med] pyrvate dehydroge

21:54:19 [acestep1] 3 i think

21:54:19 [sweta_med] and alpha keto glutarate dehydro

21:54:26 [Lorena] actually 3 reactions

21:54:43 [acestep1] n transketolase?

21:54:46 [sweta_med] also alpha keto acid dehdrogenase

21:54:54 [hutals] pyr DH, alpha ketoglutarate DH, alpha keto acid DH

21:54:57 [crusher] transketolase and pyruvate to acetyl coa...(tender loving care for nancy) co factors.

21:55:00 [Lorena] also tranketolase in HMP shunt

21:55:21 [crusher] very good all

21:55:21 [hutals] RBC transketolase

21:55:32 [acestep1] agreee

21:55:34 [Lorena] excellent crush

21:55:58 [ninadnashua] ya

21:56:04 [hutals] we should probably discuss a little neoplasia....what do you think?

21:56:04 [crusher] if there is def of thiamine what will happen in reaction of pyruvate to acetyl coa..what product will form?

21:56:26 [Lorena] NADH

21:56:40 [acestep1] lactate?

21:56:43 [crusher] the reaction will divert to form DHAP.

21:56:55 [sweta_med] lactate

21:57:26 [crusher] what does DHAP gives u?

21:57:55 [sweta_med] i will be back pl continue

21:57:57 [Lorena] glycerol 3P

21:58:08 [acestep1] k

21:58:25 [acestep1] agree

21:58:37 [crusher] very good lor,,and Glycerol 3 phosphate is a back bone of???

21:58:49 [Lorena] thats wht fatty liver?

21:59:11 [crusher] excellent!!!!!

21:59:16 [Lorena] thats why...right? tryglycerides accumulate

21:59:29 [crusher] thats why alcoholic have fatty liver

21:59:51 [Lorena]

22:00:22 [Lorena] thanks crush

22:00:35 [crusher] u welcome

22:01:26 [Lorena] do you guys want to move to neoplasia?

22:01:39 [crusher] sure

22:01:51 [hutals] sure

22:01:51 [hutals] sure

22:02:10 [acestep1] wait wait wht happens in floride toxicity

22:03:17 [Lorena] teeth get mottled and calcification in ligaments and tendons which is visible in xr

22:03:22 [acestep1] u guys there

22:03:24 [ninadnashua] folate vitamin b12 defieceincy

22:03:49 [acestep1] excellent lor also ligament rupture

22:04:15 [Lorena] thanks ace

22:04:57 [Lorena] folate and B12 def cause megaloblastic anemia - and vit b12 also cause neurological symptoms

22:05:17 [ninadnashua] ya

22:05:18 [acestep1] agree

22:05:34 [crusher] agree

22:05:47 [acestep1] also heyperseg pmn n dec plts

22:05:56 [Lorena] in whci one you have methilmalonic aciduria?

22:06:04 [acestep1] causes of folate def

22:06:32 [crusher] what is the co factor in glutathione peroxidase

22:06:35 [acestep1] b6 /12

22:06:41 [crusher] lack of green veg

22:06:51 [acestep1] se- crush

22:07:00 [crusher] b12 def

22:07:09 [crusher] yes ans is selinium def

22:07:41 [Lorena] pregnancy

22:08:20 [crusher] folate are present in green vegtables

22:08:28 [acestep1] yes

22:08:38 [acestep1] v good lor

22:08:42 [crusher] and also yes pregnacy require more amount of folate

22:09:01 [acestep1] also alcoholics , elderly ppl

22:09:30 [Lorena] alcoholics but not if they drink beer

22:09:47 [crusher] where does folate reabsorb

22:10:02 [acestep1] also in malabsp d/s -folate

22:10:16 [acestep1] s.intestine?

22:10:29 [Lorena] agree

22:10:37 [crusher] jejunem

22:10:55 [acestep1] k

22:11:01 [hutals] i seem to be having computer problems.....my computer froze and i won't be able to post transript. can someone else post transcript tonight?

22:11:18 [Lorena] i will

22:12:01 [hutals] if i become silent all of a sudden, its because it froze again

22:12:07 [acestep1] hey guys i gtg

22:12:11 [hutals]

22:12:15 [acestep1] k

22:12:34 [acestep1] see u guys later

22:12:39 [hutals] nite ace....c ya tomorrow

22:12:46 [Lorena] dont worry hutals , you will read the transcript later

22:12:51 [crusher] name some reactions Cu require as a co factor

22:13:01 [crusher] good night ace

22:13:02 [Lorena] see yuo tomorrow ace

22:13:24 [acestep1] yes . sure

22:13:40 [Lorena] lysil oxiodase for collagen stabilization

22:13:43 [acestep1] gn crush

22:14:34 [crusher] lysl oxidase.......SOD.....tyrosinase...cytochrome c oxidase

22:14:41 [crusher] gn ace

22:14:44 [ninadnashua] cytochrome c in ets

22:15:02 [crusher] yes ninad

22:15:22 [Lorena] i didnt remember the rest, thanks

22:16:09 [ninadnashua] cancer cause in us

22:16:14 [hutals] i just figured out the reason for the copper levels in wilsons. the bound copper is actually bound to ceruloplasmin, so a decrease in ceruloplamin would mean a decrease in bound copper. if less is bound, that would have to mean that more is free because it has less to bind to. make sense?

22:16:44 [Lorena] thank you hutals

22:16:58 [crusher] thanks hutal

22:17:04 [ninadnashua] cause is relate to smoking

22:17:12 [Lorena] lung cancer

22:17:28 [ninadnashua] ya

22:17:36 [hutals] no prob....it finally makes sense to me

22:17:55 [sweta_med] age related cancers?

22:18:09 [Lorena] kids Leukemia

22:18:20 [crusher] proste Ca.....old age

22:18:21 [hutals] prostate

22:18:29 [sweta_med] breast,prostrayte

22:18:58 [sweta_med] which leukemia inkids?

22:19:14 [crusher] ALL

22:19:20 [hutals] ALL my children

22:19:26 [sweta_med] yes

22:19:31 [Lorena] agree

22:19:41 [ninadnashua] what is seen in picture of sq ca

22:19:46 [sweta_med] CLL in adults

22:19:51 [hutals] mneumonic is the soap opera "ALL my children"

22:19:56 [sweta_med] keratin pearls

22:20:26 [Lorena] ok

22:20:32 [ninadnashua] ya

22:20:54 [Lorena] guys i have to go, i will post transcript until here , can someone post the rest?

22:21:22 [sweta_med] what ate the oncogenes for breast cancer

22:21:23 [hutals] i have to go to.

22:21:24 [Lorena] hutals? hopefully if you dont have more computer problems?

22:21:31 [crusher] i got to leave too

22:21:37 [Lorena] oh ok

22:22:01 [Lorena] see you tomorrow , take care

22:22:09 [crusher] i think most of us leaving

22:22:09 [sweta_med] ok bye lorena and crusher

22:22:17 [crusher] bye lorena

22:22:23 [crusher] see ya t,m

22:22:27 [hutals] ok lorena, you will post transcript up to now?

22:22:28 [sweta_med] and hutals

22:22:41 [crusher] bye all

22:22:51 [hutals] nite all, c ya tomorrow

22:22:52 crusher exits from this room

22:23:16 hutals exits from this room

22:23:16 [Lorena] yes, but now that i am checking i had to refresh the page so i lost the beginning

22:23:29 [Lorena] oh no

22:23:39 [Lorena] ninad?? are you there?

22:24:08 [Lorena] ninadnashua>

22:24:29 [ninadnashua] 454546

22:24:34 [ninadnashua] ya

22:24:49 [Lorena] do you have the beginning of this chat?

22:24:56 [ninadnashua] what

22:25:05 [ninadnashua] ya

22:25:22 [Lorena] do you know how to post the transcript?

22:25:46 [ninadnashua] please tell me

22:26:31 [ninadnashua] u tell me i will do it