chat transcript goljans path (environmental, genetics)

[Anonymous]

20:20:26 [Lorena] roofer for 25 years and smoker for 10 years....he i at risk for???

20:20:46 [jwls29] lung cancer

20:21:07 [jwls29] also mesothelioma

20:21:13 [Lorena] yes

20:21:30 [Lorena] lung cancer more than mesothelioma

20:21:50 [jwls29] ok


20:23:25 [Lorena] in pneumoconiosis ...how big or small has to be the particle?

20:23:26 [jwls29] what state are you in? I'm trying to figure out if you are near me


20:25:03 [jwls29] 1-5 microns

20:25:27 [hutals] which subject? is this environmental path?

20:25:37 [jwls29] yes

20:26:08 [Lorena] yes, very good....if it is bigge rthan that it just reaches the upper airway and if it is smaller you inhale it and exhale it

20:27:09 [Lorena] what are ferroginous bodies?

20:27:12 [hutals] in above question, lung cancer is more common because the pt will develop it sooner (10 yrs) than mesothelioma (25 yrs)

20:27:25 [jwls29] what layers of skin are affected in a third degree burns?

20:27:45 [jwls29] ty hutals

20:28:02 [Lorena] ok

20:28:45 [jwls29] they are seen in asbestosis, look like dumbells

20:29:00 [hutals] asbestos exposure

20:29:23 [Lorena] yes, asbesto coated with iron..very good

20:29:49 [hutals] full thickness burns for 3rd degree

20:30:03 [Lorena] third degree are deeper than dermis reticularis....no pain

20:30:08 [hutals] epidermis, adnexa

20:30:50 [jwls29] yes and sometimes require skin grafts

20:31:26 [Lorena] what are the layers?

20:31:35 [jwls29] what is a curling ulcer?

20:31:50 [jwls29] epidermis, dermis and dermal appendages

20:32:11 [Lorena] thanx

20:33:05 [Lorena] i dont know

20:33:15 [hutals] te gastroduodenal ulceration following severe skin burns

20:33:20 [hutals] acute

20:33:28 [jwls29] yes

20:33:37 [jwls29] very good, hutals

20:33:46 [Lorena] ok

20:34:16 [jwls29] is an exit wound from a gun bigger or smaller than an entrance wound?

20:34:28 [hutals] AD disease with defect in calcium release channels in the muscle sacroplasmic reticulum. presents with massive muscle contractions. what disease and what treatment?

20:34:38 [Lorena] smaller

20:34:44 [hutals] i think bigger

20:35:04 123456 enters this room

20:35:19 [hutals] well, i've been watching too many violent movies with "hallow point" bullets

20:35:23 [123456] hi

20:35:38 [hutals] hey 123456

20:35:39 [jwls29] exit wound may be significantly larger than the bullet and are usually irregular or stellate rather than round

20:35:41 [Lorena] hi 123456

20:35:56 [jwls29] hi 123456

20:36:01 [123456] where can I download previos chat sessions from or look at them

20:36:05 [jwls29] so bigger than the entrance wound

20:37:25 [hutals] you can do a search on the website and enter step 1 forum and term "transcript" will bring lots of them up

20:37:53 [123456] thx

20:38:32 [hutals] here is the link to the search feature http://www.valuemd.com/search.php

20:38:56 [jwls29] hutals, what's the answer to your question

20:39:17 [hutals] the answer to my question was malignant hyperthermia

20:39:30 [hutals] the treatment would be dantrolene

20:39:35 [jwls29] oh...didn't know that was AD

20:39:55 [jwls29] thanks

20:40:30 [hutals] the question would probably be about a pt who was undergoing surgery with anesthesia with halothane or succinylchoine and developed very high temp

20:41:35 [hutals] which ultraviolet light is for woods lamp and which is the one that causes cancer?

20:42:03 [Lorena] ok, but hopefully they say the opatient was given this drugs otherwise it is hard to tell, it doesnt happen spontaneously

20:42:25 [jwls29] UVB causes cancer so I would say UVA is the wood's light

20:42:31 [Lorena] UVB causes cancer

20:43:11 [hutals] uv-B is very "B-ad" and causes cancer.....the other is the other as papi always says

20:43:45 [hutals] very good

20:45:23 [jwls29] B-naphthylamine and vinyl chloride cause cancer of where?

20:45:52 [Lorena] bladder and liver

20:46:23 [jwls29] yup

20:46:27 [hutals] i agree with liver....didnt know about bladder

20:46:46 [hutals] interesting....both in bladder or just the first?

20:46:56 [jwls29] actually in this book it's just bladder

20:47:04 [jwls29] but i had read somewhere else that it was liver too

20:47:18 [jwls29] transitional cell carcinoma of the bladder

20:47:19 [Lorena] in my book the first in bladder and second liver

20:47:40 [jwls29] complications of ethylene glycol?

20:47:52 [hutals] ok, thanks

20:47:54 [jwls29] that's where i must've read the liver then in kap

20:48:09 [hutals] increased AG met acidosis

20:49:27 [jwls29] my book only says acute tubular necrosis and Precipitation of Calcium oxalate crystals

20:49:34 [jwls29] you are probably right

20:50:32 [jwls29] 5 complications of lead poisoning?

20:51:48 [Lorena] lethargy, somnolence, mental retardation, cerebral edema, coma , renal failure sideroblastic anemia

20:51:55 [hutals] i remembered the inc AG met acidosis from the MUDPILES mneumonic

20:52:13 [jwls29] so then u are right

20:52:23 [jwls29] good Lorena

20:52:41 [Lorena] what is that mneumonic hutals?

20:52:54 [jwls29] RBC changes like basophilic stippling,hypochromic microcytic anmeia

20:53:13 [jwls29] encephalopathy (seizures and coma)

20:53:17 [hutals] let me look it up to make sure i get it right

20:53:33 [Lorena] ok

20:53:34 [jwls29] neuropathy (wrist drop and foot drop)

20:55:06 [jwls29] Fanconi syndrome (impaired proximal renal tubular reabsorption of phosphate, glucose and amino acids

20:55:12 [jwls29] Lead line

20:55:26 [Lorena] lead colic

20:55:30 [jwls29] increased radiodensity of the epiphyses of the long bones

20:56:32 [Lorena] excellent

20:56:48 [jwls29] what causes a bitter almond smell?

20:56:55 [hutals] MUD PILES for inc anion gap metabolic acidosis. Methanol, Uremia (chronic renal failure), Diabetic ketoacidosis, Paraldehyde or Phrenformin, Iron tablets or Inh, Lactic acidosis (CN, CO, shock), Ethanol or Ethylene glycol, Salicylates

20:57:09 [Lorena] cyanide

20:57:39 [jwls29] good lorena

20:57:47 [Lorena] thanks hutals

20:57:59 [Lorena] and a garlic breath?

20:58:16 [hutals] apparently it will cause a bitter almond smell AND inc AG met acidosis

20:58:19 [jwls29] arsenic?

20:58:37 [Lorena] yes, arsenic

20:58:57 [hutals] i person is on a ski trip and develops headache, lethargy, insomnia, dyspnea. what is probable diagnosis. what is treatment?

20:59:37 [Lorena] probable cyanide poisoning?

21:01:06 [hutals] well, let me help a little, this ski trip was in denver where the ski slope are very high in the mountains

21:01:29 [jwls29] high altitude sickness?

21:01:30 [Lorena] ok

21:01:36 [Lorena] agree with jwls

21:02:46 [hutals] acute mountain sickness occurs within first 24 to 36 hrs of an ascent above 8,000 to 10,000 ft (like in mountains from skiing). the treatment is descent, increase fluid intake (flying causes dehydration), oxygen. prevention includes acclimatize before ascending, acetazolamide....

21:03:51 [Lorena] thank you

21:03:54 [hutals] acetazolamide is very high yield and previous real question. it works by producing metabolic acidosis which compensates for the expected respi alkalosis

21:05:06 [jwls29] ty...head start on pharm

21:05:47 [hutals] no prob.....its also in the environ notes because golijan loves to integrate

21:06:14 [jwls29] i don't have notes for that from him

21:06:20 [jwls29] i only have up to cns and skin

21:06:35 [Lorena] same here, so i read k a pl an

21:07:27 [hutals] the environmental was not in his audio lectures because he skipped it, but he put it in his lecture notes between nutrition and neoplasia

21:08:15 [hutals] he basically talks about drugs of abuse in that section

21:08:21 [Lorena] i dont think i have them , i will have to look

21:08:42 [hutals] i can go over some of the high points if you want

21:08:52 [Lorena] yes

21:08:58 [jwls29] ok

21:10:25 [hutals] a patient walks into ER with mydriasis, tachycardia, hyperthermia, psychosis/demetia, sweating......what drug did this patient likely take prior?

21:10:54 [hutals] this is a tricky one because it can possibly be two different drug classes

21:11:13 [jwls29] cocaine?

21:11:37 [Lorena] amphetamines ?

21:12:13 [hutals] everything is sped up (HR, temp, mydriasis....sounds sypathetic. so it can be something like cocaine (sypathometic) or an anticholinergic (opposite of DUMBELS)

21:12:42 [hutals] the way to tell is that there is sweating with sympathomimetics but not with anticholinergics

21:12:48 [Lorena] not cocaine because it would have myosis

21:12:58 [hutals] he has sweating, so you are both correct

21:13:32 [hutals] nope, opiods have miosis. cocaine has mydriasis

21:13:49 [jwls29] yes

21:14:03 [hutals] think about your body in fight/flight....it would want your pupils open wide to be aware of everything around

21:14:27 [Lorena] "MorPHINE: Fine. AmPHETamine: Fat":

21:15:08 [Lorena] i am confused now, let me look

21:15:52 [hutals] morphine is the opiod that would have fine, pinpoint pupils (miosis), and amphetamines would have "fat" open and dialated pupils which is mydriasis

21:16:08 [Lorena] ok, yes, you guys are right...i was confusing with opiates

21:16:25 [Lorena] i havent studied pharma in a long time

21:16:45 [Lorena] thanks

21:16:54 [jwls29] next week

21:17:01 [hutals] triad for opiods is miosis, resp depression, and coma if i remember correctly

21:18:06 [hutals] another high yield is the IV drug user endocardidtis vs regular endocarditis

21:18:42 [Lorena] s. aureus for drug users

21:18:43 [hutals] one is staph aureus and the other is strep viridans (i think)....which one is which?

21:19:02 [hutals] and which valve?

21:19:13 [Lorena] mitral

21:19:24 [jwls29] iv drug user is strep viridans

21:19:38 [jwls29] and i think it's the tricuspid valve most affected

21:19:51 [hutals] its staph aureus for drug users and the tricuspid valve

21:19:57 [jwls29] and staph aureus is regular

21:20:02 [jwls29] ok

21:20:08 [jwls29] i get them confused

21:20:24 [Lorena] ok

21:20:45 [hutals] its strep viridans for regular people and mitral valve (regular not positive because my path notes only have the drug user

21:21:41 [Lorena] which one after a dental procedure and which one after an abdominal surgery?

21:22:20 [hutals] yep, just confirmed it from golijans cardio notes

21:22:35 [hutals] strep viridans after dental i think

21:22:58 [hutals] the group E i think for abdominal

21:23:07 [Lorena] yes and strep. faecalis after abdominal

21:23:16 [hutals] group E strep i mean

21:24:02 [hutals] what drug to give for patient on bezo overdose?

21:24:20 [jwls29] flumazenil

21:24:25 [Lorena] flumazenil

21:24:32 [hutals] i know that its pharm stuff, but golijan mentions it

21:24:38 [hutals] yep, both right

21:24:40 [hutals] very good

21:24:52 [Lorena] yes, i like to try to remember things

21:25:15 [hutals] superhuman behavior is buzz word for which drug overdose?

21:25:27 [jwls29] pcp

21:25:38 [Lorena] pcp

21:25:56 [hutals] superhuman meaning violent/agitation....pcp....very good

21:26:49 [hutals] pt is in hospital for whatever procedure and 2nd day post op is having illusions and other signs of psychosis....what probable diag?

21:27:03 [hutals] oops, make that 3rd day post op

21:27:32 [hutals] and not illusions, but hallucinations....sorry

21:28:04 [jwls29] drug-induced delirium

21:28:16 [Lorena] agree

21:28:30 [hutals] the distractor for this will always be the anesthesia.....but it will not occur in this time frame

21:29:04 [hutals] the person is an alcoholic who is going threw withdrawal symptoms and having hallucinations

21:29:30 [hutals] treatment is IV diazepam and thiamine

21:29:34 [jwls29] delirium tremens

21:29:42 [Lorena] oh very good

21:29:49 [hutals] yep, exactly

21:29:50 [Lorena] yep

21:30:38 [hutals] they wont always give you "seizures" in the question stem because that might give it away

21:30:48 [jwls29] yup

21:31:06 [hutals] cancers where smoking is the leading cause?

21:31:41 [jwls29] lung, esophageal,mouth,

21:31:43 [Lorena] lung, pharynx,larynx

21:31:45 [jwls29] bladder

21:32:30 [Lorena] esophagus and stomach bladder

21:32:47 [hutals] sorry, i meant what type like squamous, adeno, etc

21:33:03 [jwls29] squamous and small cell

21:33:06 [hutals] but you're probably right

21:33:15 [Lorena] squamous and small cell ca of the lung

21:33:17 [hutals] squamous, small cell are top two, adenocarcinoma to lesser extent

21:33:22 [hutals] very good

21:34:12 [hutals] in order of death causing.....most common deadly cancers in men (top 3)

21:34:40 [Lorena] lung prostate colon

21:34:42 [jwls29] lung.prostate,colon

21:34:55 [hutals] lung, prostate, colon. ...very good. what about women?

21:35:05 [Lorena] and women?

21:35:13 [jwls29] lung, breast,colon

21:35:46 [hutals] yep, very good. lung, breast colon. what about without causing death, just incidence.

21:36:04 [hutals] in men, then in women

21:36:47 [jwls29] prostate,lung, colon?

21:37:08 [hutals] prostate, lung, colon for men. breat, lung, colon for women. the trick question will ask the 2nd most common cancer in men and women is what?

21:37:26 [jwls29] colon

21:37:59 [hutals] the second MC in men AND women is colon because you would eliminate the breast and prostate.....very good

21:38:48 [hutals] what drug dont you give to a child with chick pox

21:39:02 [hutals] of course with the vaccine, we dont really see this much anymore

21:39:10 [jwls29] aspirin

21:39:23 [Lorena] aspirin cauze reye s sx

21:39:28 [jwls29] Reye's sdme

21:39:32 [hutals] yep, stay away from aspirin because of reyes...very good

21:39:58 [hutals] what kind of acid base disorder seen with aspirin tox?

21:40:23 [jwls29] respiratory acidosis with metabolic alkalosis?

21:40:36 [Lorena] respiratory alkalosis metabolic acidosis?

21:40:44 [hutals] mixed respir alk with met acid.

21:40:56 [jwls29] mixed them up

21:40:58 [jwls29] ok

21:41:11 [hutals] think of the ulcers it causes because of acidic environment (met acid).....then the other is the other

21:41:34 [Lorena] good one

21:41:35 [jwls29] ty

21:41:51 [hutals] just a couple more....

21:42:31 [hutals] treatment for pt who presents with organophosphate poisoning (question will give exposure to insectisides)

21:42:53 [Lorena] atropin

21:43:13 [jwls29] agree

21:43:18 [hutals] atropine is treatment of choice and pralidoxime (2 PAM) is next.....very good

21:43:59 123456 enters this room

21:44:01 [hutals] the other stuff on there is not as high yield....i think i covered all the points that he stressed in that chapter

21:44:24 [hutals] so you didnt miss a thing

21:44:39 [jwls29] ty hutals

21:44:52 [Lorena] great! thank you hutals

21:45:13 [hutals] no prob.....but papi gets all the credit

21:45:47 [jwls29] where do we see Brushfield spots?

21:46:35 [hutals] downs??

21:46:49 [jwls29] yes

21:47:03 [jwls29] they are small white spots on the periphery of the iris

21:47:19 [hutals] pic of brushfield spots http://www.medsteps.com/Assets/Image...lds_spotsi.jpg

21:47:25 [jwls29] what is the mc congenital heart disease in downs?

21:47:33 [Lorena] cushion defects

21:47:47 [hutals] endocardial cushions

21:48:00 [jwls29] yes...very good

21:48:19 [jwls29] how is the AFP in down's?

21:48:42 [Lorena] decreased

21:48:49 [jwls29] yes

21:49:00 [Lorena] where is it high?

21:49:05 [jwls29] what is the chromosomal abnormality in Cri du chat?

21:49:13 [hutals] neural tube defects

21:49:24 [Lorena] delteion in short arm of chromosome 5

21:49:26 [jwls29] AFP is high in yolk sac tumors, hepatocel carcinomas, and neural tube defects

21:49:37 [hutals] is it 5?

21:49:47 [jwls29] yes

21:50:08 [jwls29] what chromosome is DiGeorge sdme associated with?

21:50:10 [Lorena] very good, also in gastroschisis and omphalocele

21:50:22 [Lorena] 22

21:50:37 [jwls29] yes, good

21:50:42 [hutals] 3rd and 4th pharyngeal pouches

21:50:45 [jwls29] rocker bottom feet

21:50:51 [jwls29] yes hutals

21:50:54 [hutals] i guess thats not a chromosome

21:51:27 [jwls29] not the chromosome but what causes the defect, so good answer

21:51:36 [Lorena] good to remember hutals

21:52:11 [jwls29] where do we see rocker bottom feet?

21:52:18 [hutals] well, good to know that its chrom 22. i forgot about that.

21:52:35 [hutals] trisomy 18?

21:52:45 [hutals] edwards

21:52:52 [jwls29] yes

21:53:06 [Lorena] agree i didnt see the q's

21:53:09 [hutals] which has polydactayl?

21:53:13 [jwls29] name three diseases with nucleotide repeats?

21:53:29 [jwls29] Patau sdme

21:53:31 [hutals] huntingtons, fragile x

21:53:49 [Lorena] huntington , x fragile syndrome, friedreichs ataxia

21:54:09 [hutals] yes, friedreichs i could remember

21:54:12 [jwls29] yes

21:54:16 [hutals] couldnt

21:54:34 [jwls29] CGG in Huntington's

21:54:53 [hutals] trisomy "13" has "13 fingers" which is patau

21:54:58 [jwls29] no

21:55:18 [Lorena] CGG is in fragile X

21:55:18 [jwls29] scratch that...CGG is in Fragile X

21:55:42 [Lorena] CAG in huntingtons

21:56:09 [jwls29] yup

21:56:50 [jwls29] what chromosome associated with APKD?

21:57:33 [hutals] 16

21:57:42 [jwls29] good

21:57:47 [Lorena] yes

21:58:07 [jwls29] enzyme deficiency in Tay-Sachs?

21:58:31 [Lorena] hexosaminidase

21:59:17 [hutals] sorry, i agree

21:59:18 [jwls29] yes

21:59:34 [hutals] was writing next question...sorry for taking long

21:59:40 [hutals] real question asked what can be given to klinefelters pt to improve development of secondary sex charactieristics. given beginning of puberty for life?

21:59:53 [jwls29] AR dx with accumulation of heparan sulfate, dermatan sulfate?

22:00:08 [Lorena] mucopolysacharidosis

22:00:25 [Lorena] testosterone?

22:00:50 [hutals] yep, that good, i had to look that one up

22:00:56 [jwls29] Hurler sdme

22:01:33 [jwls29] enz def in Alkaptonuria?

22:02:12 [Lorena] homogentisic oxidase

22:02:24 [jwls29] good

22:03:39 [hutals] my memory is failing because these all look familiar AFTER i see them

22:03:58 [jwls29] happens to me too

22:04:10 [jwls29] guess we just have to read them over and over

22:04:36 [hutals] i'm counting on multiple choice recognition

22:04:49 [Lorena] yes, and also the exam is multiple option, so you will recognize the enzyme ...it is harder to remeber it from zero

22:04:52 [jwls29] yeah me too

22:05:14 [jwls29] well lorena and hutals

22:05:19 [jwls29] i have to go

22:05:23 [jwls29] time for bed

22:05:28 [jwls29] thanks for the chat

22:05:28 [Lorena] yes, time to go for me too

22:05:39 [jwls29] so we'll meet on sunday at what time?

22:05:47 [Lorena] i will see you on sunday?

22:05:48 [hutals] thanks for the excellent chat....as usual ....i learned ALOT

22:05:57 [Lorena] same time?

22:06:07 [hutals] sounds good to me

22:06:08 [jwls29] ok

22:06:16 [jwls29] see u on sunday

22:06:16 [hutals] good nite

22:06:18 [Lorena] thanks you hutals!! i learnt a lot from yuo today

22:06:20 [jwls29] goodnite

22:06:31 [Lorena] and jwls, thank you for all the questions

22:06:39 [jwls29] yw

22:06:50 [jwls29] bye

22:06:50 [hutals] who is posting transcript?

22:07:05 [Lorena] i dont have it all, i had to refresh the page

22:07:24 [jwls29] me too

22:07:25 [hutals] i'll post it....i think i have it all

22:07:34 [jwls29] my screen went white

22:07:38 [Lorena] ok, byeee

22:07:41 [jwls29] ok bye

22:07:51 [hutals] bye