01/21/05 10:52:24 pqqian Logs in
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01/21/05 12:02:43 fouzia Logs in
01/21/05 12:02:43 fouzia Joins Subroom USMLE_Step_2
01/21/05 12:02:50 fouzia Logs Out
01/21/05 12:16:23 journey Logs in
01/21/05 12:16:51 journey Joins Subroom USMLE_Step_1
01/21/05 12:17:03 journey Logs Out
01/21/05 13:00:21 strug Logs in
01/21/05 13:00:53 strug Joins Subroom USMLE_Step_2
01/21/05 13:01:10 [USMLE_Step_2] strug: Hi,
01/21/05 13:01:39 [USMLE_Step_2] strug: is anyone preparing for step 2 ck?
01/21/05 13:03:35 shreya Logs in
01/21/05 13:03:44 strug Logs Out
01/21/05 13:04:24 shreya: hai...
01/21/05 13:04:31 shreya: any1 for step 2 chat
01/21/05 13:06:59 shreya: ding!
01/21/05 13:07:15 shreya: *beep*
01/21/05 13:08:42 shreya Logs Out
01/21/05 13:14:50 doctorchamita Logs in
01/21/05 13:14:50 doctorchamita Joins Subroom USMLE_Step_2
01/21/05 13:15:37 [USMLE_Step_2] doctorchamita: Hi to all
01/21/05 13:21:20 doctorchamita Logs Out
01/21/05 13:23:42 doctorchamita Logs in
01/21/05 13:24:05 doctorchamita Logs Out
01/21/05 13:25:30 shreya Logs in
01/21/05 13:25:57 shreya Joins Subroom USMLE_Step_2
01/21/05 13:26:09 [USMLE_Step_2] shreya: hai
01/21/05 13:26:23 [USMLE_Step_2] shreya: any 1 in step2 chat
01/21/05 13:26:37 [USMLE_Step_2] shreya: strug is this the site?
01/21/05 13:27:21 shreya Logs Out
01/21/05 15:59:19 annie Logs in
01/21/05 15:59:19 annie Joins Subroom USMLE_Step_2
01/21/05 16:00:49 annie Logs Out
01/21/05 17:20:16 ash Logs in
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01/21/05 17:30:26 ayesh Logs in
01/21/05 17:31:21 ayesh Disconnects
01/21/05 17:33:06 ayesh Logs in
01/21/05 17:33:06 ayesh Joins Subroom USMLE_Step_2
01/21/05 17:33:33 ayesh Leaves Subroom
01/21/05 17:33:47 ayesh Joins Subroom Clinical_Skills
01/21/05 17:34:01 ayesh Leaves Subroom
01/21/05 17:34:05 ayesh: hi
01/21/05 17:34:21 ayesh: is any one doing a discussionat 6 pm
01/21/05 17:34:26 ayesh: with pulmonology
01/21/05 17:34:35 ayesh: i just wanna know about the chat room
01/21/05 17:35:06 ayesh Logs Out
01/21/05 17:35:13 sanz Logs in
01/21/05 17:35:20 sanz Joins Subroom USMLE_Step_2
01/21/05 17:35:32 sanz Logs Out
01/21/05 17:53:57 kmk Logs in
01/21/05 17:55:20 kmk: yeah it at 6
01/21/05 17:55:38 kmk Logs Out
01/21/05 18:03:57 medico24 Logs in
01/21/05 18:04:00 medico24 Joins Subroom USMLE_Step_2
01/21/05 18:04:47 [USMLE_Step_2] medico24: hi
01/21/05 18:06:20 medico24 Logs Out
01/21/05 18:07:00 medico24 Logs in
01/21/05 18:08:50 medico24 Joins Subroom USMLE_Step_2
01/21/05 18:08:58 medico24 Joins Subroom USMLE_Step_1
01/21/05 18:09:04 medico24 Joins Subroom USMLE_Step_2
01/21/05 18:09:26 medico24 Joins Subroom USMLE_Step_2
01/21/05 18:09:31 medico24 Logs Out
01/21/05 18:10:16 medico24 Logs in
01/21/05 18:10:47 medico24: hi
01/21/05 18:11:19 medico24: let me know when will you start the discussion.
01/21/05 18:11:48 medico24: anybody there??
01/21/05 18:12:14 medico24 Joins Subroom USMLE_Step_2
01/21/05 18:12:22 [USMLE_Step_2] medico24: hi
01/21/05 18:12:42 [USMLE_Step_2] medico24: anybody there?????
01/21/05 18:21:47 crengy Logs in
01/21/05 18:21:47 crengy Joins Subroom USMLE_Step_2
01/21/05 18:23:19 [USMLE_Step_2] crengy: hi
01/21/05 18:24:03 [USMLE_Step_2] crengy: i'm here preparing for pneumo chat
01/21/05 18:24:57 [USMLE_Step_2] medico24: Hi do you know the exact time of discussion?
01/21/05 18:25:16 [USMLE_Step_2] crengy: 6pm central
01/21/05 18:25:58 [USMLE_Step_2] crengy: i'm at pacific hour so...i suppose at 5pm?!
01/21/05 18:26:06 [USMLE_Step_2] medico24: I am in eastern time zone means it is 7pm eastern?Right
01/21/05 18:26:18 [USMLE_Step_2] crengy: yep
01/21/05 18:26:24 [USMLE_Step_2] medico24: thanks
01/21/05 18:26:29 [USMLE_Step_2] crengy: welcome
01/21/05 18:27:35 medico24 Logs Out
01/21/05 18:29:31 crengy Logs Out
01/21/05 18:31:35 iamzuhair Logs in
01/21/05 18:31:46 iamzuhair: hi
01/21/05 18:32:13 iamzuhair: heard on cnn that there is a step 2 chat forum here--- can i join
01/21/05 18:33:02 iamzuhair Joins Subroom USMLE_Step_2
01/21/05 18:33:31 iamzuhair Leaves Subroom
01/21/05 18:34:26 iamzuhair Logs Out
01/21/05 18:35:00 iamzuhair Logs in
01/21/05 18:38:00 ayesh Logs in
01/21/05 18:38:16 ayesh: sure its at 6 pm
01/21/05 18:38:24 ayesh: and topic today is pulmonology
01/21/05 18:38:36 ayesh: but i have no idea in which chat room we will be
01/21/05 18:39:53 ayesh Disconnects
01/21/05 18:42:50 spice Logs in
01/21/05 18:42:53 spice Joins Subroom USMLE_Step_2
01/21/05 18:43:21 spice Joins Subroom USMLE_Step_1
01/21/05 18:43:58 iamzuhair Joins Subroom USMLE_Step_2
01/21/05 18:44:03 [USMLE_Step_2] iamzuhair: hi
01/21/05 18:44:20 spice Joins Subroom USMLE_Step_2
01/21/05 18:44:33 [USMLE_Step_2] iamzuhair:
01/21/05 18:45:05 spice Logs Out
01/21/05 18:48:57 iamzuhair Leaves Subroom
01/21/05 18:49:22 iamzuhair: hello --- is there going to be any discussion at all
01/21/05 18:51:20 iamzuhair Logs Out
01/21/05 18:54:24 sanz Logs in
01/21/05 18:54:56 sanz Joins Subroom USMLE_Step_2
01/21/05 18:55:47 sanz Logs Out
01/21/05 19:01:06 medico24 Logs in
01/21/05 19:01:47 medico24 Joins Subroom USMLE_Step_2
01/21/05 19:01:59 medico24 Logs Out
01/21/05 19:02:01 nalini Logs in
01/21/05 19:02:04 nalini Joins Subroom USMLE_Step_2
01/21/05 19:02:06 sanz Logs in
01/21/05 19:02:17 sanz Joins Subroom USMLE_Step_2
01/21/05 19:02:24 [USMLE_Step_2] sanz: hey there!
01/21/05 19:02:32 [USMLE_Step_2] nalini: hi
01/21/05 19:02:42 lenhoxung Logs in
01/21/05 19:02:43 [USMLE_Step_2] nalini: is this for step 2
01/21/05 19:02:44 lenhoxung Joins Subroom USMLE_Step_1
01/21/05 19:02:56 [USMLE_Step_2] sanz: yup, i think so
01/21/05 19:03:33 [USMLE_Step_2] sanz: how are you guys doing to night?
01/21/05 19:03:44 lenhoxung Logs Out
01/21/05 19:07:46 [USMLE_Step_2] nalini: hi,how is ur preparation going
01/21/05 19:08:19 [USMLE_Step_2] nalini: .
01/21/05 19:08:45 [USMLE_Step_2] sanz: it's slow but going somewhere, i hope! hehe
01/21/05 19:08:58 [USMLE_Step_2] sanz: when's yr exam?
01/21/05 19:09:06 medico24 Logs in
01/21/05 19:09:14 [USMLE_Step_2] nalini: feb
01/21/05 19:09:20 medico24 Joins Subroom USMLE_Step_2
01/21/05 19:09:26 [USMLE_Step_2] nalini: how about u?
01/21/05 19:10:03 [USMLE_Step_2] sanz: march
01/21/05 19:10:12 [USMLE_Step_2] sanz: hey medico
01/21/05 19:10:22 [USMLE_Step_2] medico24: hi
01/21/05 19:10:29 strug Logs in
01/21/05 19:10:31 strug Joins Subroom USMLE_Step_2
01/21/05 19:10:38 [USMLE_Step_2] sanz: hey strug
01/21/05 19:10:46 [USMLE_Step_2] nalini: hi guys
01/21/05 19:10:47 [USMLE_Step_2] sanz: we made it here finally!
01/21/05 19:11:11 [USMLE_Step_2] strug: welcome to the discussion
01/21/05 19:11:34 [USMLE_Step_2] sanz: shall we start?
01/21/05 19:11:43 [USMLE_Step_2] medico24: yup
01/21/05 19:11:53 [USMLE_Step_2] strug: Ready ok so has anyone any doubts??/
01/21/05 19:12:29 [USMLE_Step_2] nalini: nope
01/21/05 19:12:45 [USMLE_Step_2] sanz: how do you guys wann do it? take turn to ask a question and the rest of us answer... and try to cover all impt topics in pulm tonight?
01/21/05 19:13:00 samsung68 Logs in
01/21/05 19:13:01 samsung68 Disconnects
01/21/05 19:13:40 [USMLE_Step_2] strug: yes thats seems a good idea..after each q complete discusison of whole topic
01/21/05 19:14:13 [USMLE_Step_2] strug: here comes a q.....The primary pathophysiology in idiopathic plumonary fibrosis is?
01/21/05 19:14:17 [USMLE_Step_2] sanz: yup, so all of us should come arm with questions that're high yield to ask the group... and then we can discuss them
01/21/05 19:14:20 samsung68 Logs in
01/21/05 19:14:36 samsung68 Joins Subroom USMLE_Step_2
01/21/05 19:14:51 [USMLE_Step_2] strug: 1]micro org mediated activation of pul neurtrophils
01/21/05 19:15:28 crengy Logs in
01/21/05 19:15:28 crengy Joins Subroom USMLE_Step_2
01/21/05 19:15:35 [USMLE_Step_2] strug: 2 immune comples mediated activation of alveoloar macrophages
01/21/05 19:15:55 ayesh Logs in
01/21/05 19:15:56 [USMLE_Step_2] strug: 3]direct immune compled mediated pulmonary instestial damage
01/21/05 19:16:11 [USMLE_Step_2] strug: 4 pulmonary fibroblast proliferation
01/21/05 19:16:44 ayesh Joins Subroom USMLE_Step_2
01/21/05 19:16:47 [USMLE_Step_2] sanz: 4 sounds right
01/21/05 19:17:04 [USMLE_Step_2] sanz: it will give a restrictive picture
01/21/05 19:17:14 [USMLE_Step_2] medico24: great explanation
01/21/05 19:17:34 [USMLE_Step_2] sanz: wuz the ans strug?
01/21/05 19:18:48 [USMLE_Step_2] nalini: is it 4
01/21/05 19:19:34 [USMLE_Step_2] sanz: oke, anyone with more qs?
01/21/05 19:20:08 [USMLE_Step_2] crengy: sorry, i don't know what was the Q...
01/21/05 19:20:22 [USMLE_Step_2] sanz: here's one... how do you dx bronchiectasis?
01/21/05 19:20:34 [USMLE_Step_2] strug: its the immune complex mediated activation of alverolar macrophages .....probably related to locally generated immune comples, alveolar macrogphages become activated and the produce several mediatores that recruite and induce fibroblast proliferationand ca
01/21/05 19:20:44 [USMLE_Step_2] sanz: crengy, sturg's questions was what is the pathophys of idiopathic pulm fibrosis...
01/21/05 19:20:52 [USMLE_Step_2] crengy: thank you
01/21/05 19:20:52 [USMLE_Step_2] strug: cause secondadry damage
01/21/05 19:21:51 [USMLE_Step_2] sanz: oh.. so the ans is 2
01/21/05 19:22:10 [USMLE_Step_2] strug: chest xray as the first initial test and ct best test for broncieactasis
01/21/05 19:22:34 [USMLE_Step_2] crengy: CT-best, agree
01/21/05 19:23:03 [USMLE_Step_2] sanz: it's also non invasive and better than CXR
01/21/05 19:23:24 [USMLE_Step_2] medico24: how will you diff between epiglottitis and croup?
01/21/05 19:23:30 [USMLE_Step_2] crengy: but the 1 step remains Xr
01/21/05 19:23:47 [USMLE_Step_2] sanz: yup
01/21/05 19:24:02 [USMLE_Step_2] crengy: clinic, Xr
01/21/05 19:24:06 [USMLE_Step_2] strug: for idiopathic pulmonary fibrosis....clues which are imp are chest auscultation reveals coarse dry crackes and on chest x *** retucilar or reticulonodular disease..ct ground glass apperarance....pft's restrictive pattern
01/21/05 19:24:45 [USMLE_Step_2] crengy: dry crackes are durind inspiration?
01/21/05 19:25:04 [USMLE_Step_2] sanz: epiglottis - drooling, soft stridor
01/21/05 19:25:06 [USMLE_Step_2] strug: bronchalveolar laveage shows increade macrophages....one of the few restrictive diseases where steriods give response
01/21/05 19:25:14 [USMLE_Step_2] sanz: croup marked stridor
01/21/05 19:25:31 [USMLE_Step_2] sanz: with barking cough
01/21/05 19:26:21 [USMLE_Step_2] sanz: thanx strug... i didnt know that!
01/21/05 19:26:32 [USMLE_Step_2] strug: croup with history of upper respir tract infection.not that sudden. epiglottits is very sudden child in marked distress
01/21/05 19:26:58 [USMLE_Step_2] sanz: CXR steeple sign for croup
01/21/05 19:27:01 [USMLE_Step_2] medico24: yup intubation is required
01/21/05 19:27:04 [USMLE_Step_2] crengy: Tx for epiglotitis?
01/21/05 19:27:06 [USMLE_Step_2] sanz: thumb print for epiglot
01/21/05 19:27:52 [USMLE_Step_2] sanz: ET intubation and IV Ab
01/21/05 19:27:55 [USMLE_Step_2] strug: muffled voice for epiglotties..if intubation reqrd doin an O. R. not er
01/21/05 19:28:30 [USMLE_Step_2] medico24: also in epi there is high fever and dysphagia.drooling
01/21/05 19:28:47 [USMLE_Step_2] medico24: while in croup mild fever
01/21/05 19:28:50 [USMLE_Step_2] strug: airway secured then bl cultures taken start antibiotics ivceftriazone
01/21/05 19:28:53 [USMLE_Step_2] sanz: i have a question - the dx is clinical right? and we dont do direct fibroptic first
01/21/05 19:29:03 Roxanita Logs in
01/21/05 19:29:48 [USMLE_Step_2] strug: direct laryngoscope
01/21/05 19:30:47 huli72 Logs in
01/21/05 19:30:48 huli72 Logs Out
01/21/05 19:31:06 Roxanita Joins Subroom USMLE_Step_2
01/21/05 19:31:17 Roxanita Joins Subroom USMLE_Step_1
01/21/05 19:31:25 [USMLE_Step_2] strug: d/d includes spasmodic cough....there is no family histrory of infectionand triggers like allergy pscychological factors and gastrointes reflux present
01/21/05 19:31:33 Roxanita Joins Subroom Clinical_Skills
01/21/05 19:31:38 Roxanita Joins Subroom USMLE_Step_3
01/21/05 19:31:41 Roxanita Joins Subroom USMLE_Step_1
01/21/05 19:31:57 huli72 Logs in
01/21/05 19:32:55 [USMLE_Step_2] strug: also bacterial tracheatis which begins as viral laryngotreacheobronchites which becomes a bacterial complication of viral disease....common org is stap aureus
01/21/05 19:33:08 huli72: Hi
01/21/05 19:33:31 [USMLE_Step_2] sanz: what is the CXR finding of Sarcoidosis? What are the lab findings?
01/21/05 19:33:53 [USMLE_Step_2] nalini: hilar lymphadenopathy
01/21/05 19:34:05 [USMLE_Step_2] crengy: Hca
01/21/05 19:34:05 [USMLE_Step_2] nalini: inc CA,inc ACE
01/21/05 19:34:07 [USMLE_Step_2] samsung68: cxr-hilar l,adenopathy
01/21/05 19:34:09 spice Logs in
01/21/05 19:34:24 [USMLE_Step_2] strug: hilar lymphadenopathy reticulonodular parenchyma
01/21/05 19:34:31 huli72: hi, spice
01/21/05 19:34:37 [USMLE_Step_2] strug: lab hypercalcemia [imp]
01/21/05 19:34:37 spice: hi
01/21/05 19:34:38 huli72: where are the other guys?
01/21/05 19:34:43 spice: waiting
01/21/05 19:34:45 Roxanita Logs Out
01/21/05 19:34:45 [USMLE_Step_2] sanz: lymphocytes ct? and alk phos?
01/21/05 19:34:50 [USMLE_Step_2] samsung68: common in blacks
01/21/05 19:34:55 [USMLE_Step_2] sanz: PFT pattern?
01/21/05 19:35:02 [USMLE_Step_2] samsung68: restrictive
01/21/05 19:35:21 [USMLE_Step_2] sanz: yup
01/21/05 19:35:21 roxanita Logs in
01/21/05 19:35:27 [USMLE_Step_2] strug: in which conditions we give steroids imm in sarcoidosis
01/21/05 19:35:30 roxanita Joins Subroom USMLE_Step_1
01/21/05 19:35:32 [USMLE_Step_2] crengy: alk phos-normal
01/21/05 19:35:34 [USMLE_Step_2] sanz: uveitis
01/21/05 19:35:42 huli72 Joins Subroom USMLE_Step_2
01/21/05 19:35:46 [USMLE_Step_2] crengy: neuro
01/21/05 19:35:46 [USMLE_Step_2] sanz: CNS involvement
01/21/05 19:36:02 [USMLE_Step_2] strug: also hypercalcemia
01/21/05 19:36:06 huli72 Leaves Subroom
01/21/05 19:36:11 spice Joins Subroom USMLE_Step_2
01/21/05 19:36:18 huli72 Joins Subroom USMLE_Step_2
01/21/05 19:36:21 [USMLE_Step_2] samsung68: whats cns?s[s
01/21/05 19:36:35 [USMLE_Step_2] strug: central nervous system
01/21/05 19:36:37 roxanita Joins Subroom USMLE_Step_2
01/21/05 19:36:38 spice Logs Out
01/21/05 19:36:38 [USMLE_Step_2] crengy: mecanism for hypersens pneumonitis?
01/21/05 19:37:01 roxanita Joins Subroom USMLE_Step_1
01/21/05 19:37:07 medico24 Logs Out
01/21/05 19:37:16 [USMLE_Step_2] sanz: lymphopenia and elevated alk phos are common cuz of liver involvement
01/21/05 19:37:32 [USMLE_Step_2] crengy: good point
01/21/05 19:37:58 [USMLE_Step_2] strug: what if lofgren syndrome
01/21/05 19:39:10 [USMLE_Step_2] strug: whats alveolar protenoisi?
01/21/05 19:39:18 [USMLE_Step_2] crengy: fever, eryth nodosum, cough, arthritis
01/21/05 19:39:47 [USMLE_Step_2] crengy: accumulation of phospholip in alveolar space
01/21/05 19:40:05 [USMLE_Step_2] strug: erythema nodosum, arthithis and hilar adenopathy is lofgren
01/21/05 19:40:12 [USMLE_Step_2] crengy: dry cough+ dyspnee

01/21/05 19:41:10 [USMLE_Step_2] sanz: hypersen pneumonitis is type III hypersentsitivity
01/21/05 19:41:26 [USMLE_Step_2] sanz: due to some inhaled organic material
01/21/05 19:41:32 [USMLE_Step_2] crengy: hilar adenop. has any clinical presentation?
01/21/05 19:41:52 [USMLE_Step_2] strug: x-***. billateral alveolar pul infiltrates....PFT restrictive pattern....diagonoisi by biposy.pas +ve material present..treatment is bronchoalveiolar lavage
01/21/05 19:42:36 [USMLE_Step_2] crengy: right, type 3
01/21/05 19:42:37 bharathk Logs in
01/21/05 19:42:39 bharathk Joins Subroom USMLE_Step_2
01/21/05 19:42:53 [USMLE_Step_2] sanz: strug, is that for alv protenosis?
01/21/05 19:42:59 [USMLE_Step_2] strug: yes
01/21/05 19:43:45 [USMLE_Step_2] huli72: Is hypersensitive pneumonitis type III?
01/21/05 19:43:48 [USMLE_Step_2] sanz: yes
01/21/05 19:43:52 bharathk Logs Out
01/21/05 19:43:59 [USMLE_Step_2] crengy: dx for hypersens, pneumonitis?
01/21/05 19:44:13 [USMLE_Step_2] sanz: CXR?
01/21/05 19:44:23 [USMLE_Step_2] huli72: avoid the organic material.
01/21/05 19:44:45 [USMLE_Step_2] crengy: Xr is alv. infiltrates
01/21/05 19:44:51 [USMLE_Step_2] huli72: or steroids?
01/21/05 19:44:59 [USMLE_Step_2] sanz: i dont know much abt alv proteinosis... who gets them?
01/21/05 19:45:33 [USMLE_Step_2] huli72: fire fighters?
01/21/05 19:45:36 [USMLE_Step_2] crengy: hmm, don't know
01/21/05 19:45:57 [USMLE_Step_2] crengy: don't think firefighters
01/21/05 19:46:05 [USMLE_Step_2] sanz: hehe.. i mean alv proteinosis, huli
01/21/05 19:46:12 [USMLE_Step_2] crengy: it's accumulation of phospholipids
01/21/05 19:46:52 [USMLE_Step_2] crengy: Strug review v well the characteristics
01/21/05 19:47:22 [USMLE_Step_2] huli72: CHF pts?
01/21/05 19:47:38 [USMLE_Step_2] crengy: what does it mean?
01/21/05 19:47:49 [USMLE_Step_2] sanz: oke... thanx.. i found an article abt it on emedicine
01/21/05 19:47:56 [USMLE_Step_2] strug: cause is unknown ....i dont know who gets them
01/21/05 19:48:32 bharathk Logs in
01/21/05 19:48:40 [USMLE_Step_2] sanz: http://www.emedicine.com/radio/topic21.htm
01/21/05 19:49:37 bharathk Logs Out
01/21/05 19:49:48 bharathk Logs in
01/21/05 19:49:55 [USMLE_Step_2] huli72: which lung ca show cavaty in early stages?
01/21/05 19:50:18 bharathk Joins Subroom USMLE_Step_2
01/21/05 19:50:40 [USMLE_Step_2] crengy: squamous?
01/21/05 19:50:44 [USMLE_Step_2] sanz: dont know!
01/21/05 19:50:58 [USMLE_Step_2] sanz:
01/21/05 19:51:01 [USMLE_Step_2] strug: squamous cell
01/21/05 19:51:02 [USMLE_Step_2] huli72: will you tell us who get alv proteinosis?
01/21/05 19:51:12 [USMLE_Step_2] strug: i dont know
01/21/05 19:51:13 [USMLE_Step_2] sanz: it's idiopathic
01/21/05 19:51:13 [USMLE_Step_2] huli72: large cell ca.
01/21/05 19:51:34 [USMLE_Step_2] sanz: PAP may be associated with hematologic malignancies, particularly chronic myeloid leukemia and lymphomas.
01/21/05 19:51:44 [USMLE_Step_2] sanz: that's according to the emedicine article
01/21/05 19:51:56 [USMLE_Step_2] huli72: what is PAP?
01/21/05 19:52:09 [USMLE_Step_2] crengy: are u sure about large cell ca and early cavity?
01/21/05 19:52:15 [USMLE_Step_2] sanz: pulm alv proteinosis
01/21/05 19:52:38 [USMLE_Step_2] huli72: thanks, sanz
01/21/05 19:53:06 [USMLE_Step_2] sanz: ur welcome
01/21/05 19:53:07 [USMLE_Step_2] huli72: lung ca with hoarseness, what does it mean?
01/21/05 19:53:24 [USMLE_Step_2] sanz: pancoat tumor
01/21/05 19:53:34 [USMLE_Step_2] crengy: reccurent laryng affected
01/21/05 19:53:36 [USMLE_Step_2] strug: supeior vena cave syndrom...compression of laryngeal nerve
01/21/05 19:53:51 [USMLE_Step_2] crengy: pancoast
01/21/05 19:53:51 [USMLE_Step_2] huli72: resectable or nonresectable
01/21/05 19:53:55 [USMLE_Step_2] crengy: non
01/21/05 19:53:59 [USMLE_Step_2] ayesh: nonresectable
01/21/05 19:54:12 [USMLE_Step_2] huli72: yeah, very hi yield
01/21/05 19:54:34 [USMLE_Step_2] sanz: thanx
01/21/05 19:54:36 [USMLE_Step_2] strug: what is most commmon sym of initial symptom of bysssinosis?
01/21/05 19:54:45 mjl1717 Logs in
01/21/05 19:54:49 [USMLE_Step_2] crengy: hm, what's that?
01/21/05 19:54:57 [USMLE_Step_2] samsung68: SOB?
01/21/05 19:55:14 [USMLE_Step_2] huli72: dry cough?
01/21/05 19:55:28 [USMLE_Step_2] crengy: heiii, what's that?
01/21/05 19:55:39 [USMLE_Step_2] strug: chest tightnss
01/21/05 19:55:44 mjl1717: Hi
01/21/05 19:55:50 [USMLE_Step_2] strug: its a occupational disease because of cotton dust
01/21/05 19:55:54 [USMLE_Step_2] samsung68: WHATS PATHOPHYS
01/21/05 19:55:59 [USMLE_Step_2] crengy: thank you!
01/21/05 19:56:18 [USMLE_Step_2] strug: bronchospasm
01/21/05 19:56:38 [USMLE_Step_2] crengy: is it like an allergy?
01/21/05 19:57:03 [USMLE_Step_2] samsung68: any extrapulm. manifest?
01/21/05 19:57:11 [USMLE_Step_2] sanz: hypersen pneumonitis right?
01/21/05 19:57:25 [USMLE_Step_2] crengy: i don't know
01/21/05 19:57:35 [USMLE_Step_2] strug: no..hmm never heard
01/21/05 19:57:45 [USMLE_Step_2] crengy: is anybody how can make a short presentation?
01/21/05 19:57:54 [USMLE_Step_2] sanz: oke, let's get on with more high yield topics
01/21/05 19:58:14 [USMLE_Step_2] sanz: DLCO in COPD and emphy
01/21/05 19:58:25 [USMLE_Step_2] ayesh: ok
01/21/05 19:58:28 [USMLE_Step_2] crengy: copd-normal
01/21/05 19:58:36 [USMLE_Step_2] samsung68: dec in emphysema
01/21/05 19:58:40 [USMLE_Step_2] crengy: emphy-decresed
01/21/05 19:58:44 [USMLE_Step_2] strug: imparired in empy normal in brochin
01/21/05 19:58:53 [USMLE_Step_2] sanz: 1st line Rx for COPD exacerbation
01/21/05 19:59:06 [USMLE_Step_2] ayesh: oxygen
01/21/05 19:59:06 [USMLE_Step_2] strug: abg in copd?
01/21/05 19:59:13 [USMLE_Step_2] huli72: B agonist
01/21/05 19:59:14 [USMLE_Step_2] ayesh: almost normal
01/21/05 19:59:24 [USMLE_Step_2] samsung68: Bagonist
01/21/05 19:59:48 [USMLE_Step_2] samsung68: respi. alkalosis
01/21/05 19:59:51 [USMLE_Step_2] crengy: Rx is diagnosis or treatm?
01/21/05 20:00:00 [USMLE_Step_2] ayesh: in exacerbation u give oxygen
01/21/05 20:00:01 [USMLE_Step_2] strug: oxygen antibiotics and cortico in acute exacer
01/21/05 20:00:10 [USMLE_Step_2] ayesh: yeah
01/21/05 20:00:16 [USMLE_Step_2] ayesh: kaplan says that too
01/21/05 20:00:35 [USMLE_Step_2] strug: when do we give home oxygen?
01/21/05 20:00:43 [USMLE_Step_2] ayesh: other wise anticholib=nergis then b agonist
01/21/05 20:00:46 [USMLE_Step_2] sanz: Dx is diagnosis
01/21/05 20:00:48 [USMLE_Step_2] samsung68: po2 less than55
01/21/05 20:00:54 [USMLE_Step_2] sanz: Rx is treatment... sorry for the confusion
01/21/05 20:01:25 [USMLE_Step_2] crengy: it's ok
01/21/05 20:02:14 [USMLE_Step_2] crengy: o2 at home for pCO2 more than 60?
01/21/05 20:02:23 [USMLE_Step_2] strug: also when sat < 85..pt with corp Pao2 < 59..home oxy also in patients with pul hypertension, erythrocystosis
01/21/05 20:02:51 [USMLE_Step_2] ayesh: Pao2 less then 55
01/21/05 20:02:59 [USMLE_Step_2] crengy: erythrocytosis-but all of them have
01/21/05 20:03:14 [USMLE_Step_2] crengy: bz of hypoxia
01/21/05 20:03:32 [USMLE_Step_2] strug: hct > 55 give home oxy
01/21/05 20:03:42 [USMLE_Step_2] crengy: thanks
01/21/05 20:04:06 [USMLE_Step_2] strug: in acute exacerbation of copd whats the blood gas?
01/21/05 20:04:24 [USMLE_Step_2] samsung68: respi acidos
01/21/05 20:04:36 usmle_guy Logs in
01/21/05 20:04:39 usmle_guy Joins Subroom USMLE_Step_1
01/21/05 20:04:40 [USMLE_Step_2] strug: right
01/21/05 20:04:43 [USMLE_Step_2] samsung68: co2 retention
01/21/05 20:04:44 [USMLE_Step_2] sanz: yup ... they already have baseline incr PCo2
01/21/05 20:04:48 usmle_guy Leaves Subroom
01/21/05 20:04:49 [USMLE_Step_2] strug: what about asthams

Welcome
mick has joined the chat.
[ayesh] sure its at 6 pm
[ayesh] and topic today is pulmonology
[ayesh] but i have no idea in which chat room we will be
[iamzuhair] hello --- is there going to be any discussion at all
[huli72] Hi
[huli72] hi, spice
[spice] hi
[huli72] where are the other guys?
[spice] waiting
[mjl1717] Hi
Now entering USMLE_Step_2 subroom.
mick has joined subroom: USMLE_Step_2
[crengy] what's the INR in its tx?
[sanz] A-a gradient?
[crengy] increa
[sanz] aim 2-3
[crengy] when you put a filter?
[samsung68] recurrent pe
[sanz] recurrent PE and haemo dyn unstable
[strug] pt unstable and thrombolytic contrain or when in major vessel
[samsung68] thanks
[strug] sorry i thought embolectomy
[crengy] major vessels means surgery
[strug] if pt on cumadin and bleding and inr increased what to do
[nalini] ffp
[crengy] stop + frozen plasma
[strug] correct if only inr incr no bleeding?
[crengy] only vit k
[nalini] vit k
[strug] perfect
[strug] if pt get a new PE when on anticoagulant what to do
[sanz] embolectomy
[strug] no
[crengy] heparin plus trombopeny in 3 days-what to do?
[samsung68] filter
[crengy] first-increased inr
[crengy] not enough-filter
[strug] crengy stop heparin give another group of anticoag..ifo rgt the name of drug
[sanz] tPA?
[nalini] tpa
[strug] when pt on PE who is on anticoagu gets another Pe put ivc filter and continue to anticoagulate
[strug] no its a new one i just read today
[crengy] ?
[crengy] thrombin inh?
[sanz] let's talk abt pleural effusion
[strug] i will let u know tomorrw
[sanz] define transudate
[crengy] ok
[sanz] and exudate
[crengy] exud-at least 1 criteria from:
[crengy] ldh>200
[crengy] ldhpl/ldhser>0.6
[strug] Ldh < 200...ldh e/s <0.6..proten e/s,0.5 transudate
[crengy] prot.pl/prot.ser>0.6
[strug] if patient has transudate and no apprent cause found what should u consider?
[crengy] what's the normal amount of glucose in pleural l?
[crengy] let it trans and no further tests
[sanz] gluc less than 40
[crengy] normally?
[strug] crengy consider Pulmonary embolism
[crengy] really?!
[sanz] oh no... sorry
[sanz] that's when emphyema kicks in
[strug] crengy yes
[crengy] so pacient with just transudate and no clinical pres is considered PE?
[sanz] but with transudate, pt will also have chest paina dn dyspnea etc
[crengy] so, norm. pleural glucose?????????
[sanz] tell us
[crengy] yep, good point...
[crengy] i don't know the level
[crengy] i was thinking about 60?!
[sanz] hehe... i know if it's less than 40, we have to think abt empyema
[strug] in a patient with pl eff 1st find out wherther transudat or exudate...2nd meausere glu if < 60 could be empyems , rheumatoid pleurits or malignancy..next meausere amylase if increased it could be esophageal rupture pancreatiits
[strug] still no cause found..occult pulmonary embolism
[crengy] ahaaaa
[sanz] but empyema would be exudate
[strug] is still no diagnosis tuberculosi or carcinoma ...perform needle biopsy
[crengy] pancreatitis is also with incresed amylase in pl.lic?!
[huli72] pleuro biopsy?
[crengy] where u find low glucose in pl.l?
[crengy] what's the finding in rheum. arthr. pleur. lic?
[crengy] come on, guys!!!
[sanz] what is pl.l?
[samsung68] exudate??
[crengy] pleural fluid
[crengy] sorry, zombi
[sanz] hehe
[huli72] what is the pathologic lesion in silica?
[crengy] so low glu: TB, empiem, pneu
[sanz] low gluc in transudate
[crengy] usually is normal in transudate
[sanz] ok
[sanz] silica cause pneumoconiosis
[huli72] what kind of nodules?
[sanz] it has egg sehll calcification on CXR
[sanz] small nodule upp lung lobe
[strug] hyaline nodule
[huli72] yeah, strug
[huli72] what kind of sputum in bronchietasis?
spice has left the chat.
[crengy] large amount
[strug] foul smelling
[sanz] foul smelling!!!
[huli72] yeah
[samsung68] mucopurulent
[crengy] as in abscess
[huli72] no
[crengy] no?
[huli72] 1st line Rx for COPD exacerbation?
[crengy] again?
[sanz] what genetic disorder is prone to bronchietasis?
[crengy] CF
[strug] cystic fibrosis
[strug] what is caplan syndrome
[sanz] what's the pathophys?
[crengy] RA+ pneumoconiosis
[sanz] coal pneu
[strug] also rh nodules
[crengy] any treatment?
[strug] dunno
[huli72] steroids?
[crengy] may be only for RA and no exposure for pneumocon
[strug] associated immumological abnormal in coal worker pneun
8:33 PM huli72 has left the chat.
8:34 PM [crengy] we're getting small...
8:35 PM [sanz] can you guys summarise for me again abt home oxygen plz?
8:35 PM [sanz] we give it when Po2 is <55mg
8:35 PM [sanz] to maintain sats abv 85%
8:35 PM [strug] antinucler antibody, rheumatoid factor, inc IgA, IgG, C3
8:36 PM [sanz] oh, osrry sturg... i didnt se your q! I didnt mean to ignore...
8:36 PM [strug] sanz if pt has corp we give with po2<59 ,
8:36 PM [strug] thats ok
8:37 PM [strug] also if patient had hematocrit>55 or has pul ht we give home O2
8:37 PM [sanz] oke.. but kaplan book says <55mmHg (pg 283)
8:38 PM [crengy] in my notes for home O2: pO2<60, saO2<90%, nocturnal desatur, air travel, right heat fail, cor pulm
8:38 PM [strug] both usmleworld and kaplan agreee with <55
8:38 PM [strug] as far as sat is concerned kaplan says 85
8:39 PM [strug] usmle world says 88
8:39 PM [sanz] ok... thanks guys!
8:39 PM [strug] nocturanal desarureation and cor p kaplan agrees...
8:39 PM [crengy] no comment
8:40 PM [strug] can u tell a condition in which there is hypoxemia but no increase in AA gradient
8:41 PM [sanz] shunt?
8:41 PM [samsung68] shunt
8:41 PM [strug] as far as i know its hypoventilation and high altitute kaplan page 276
8:41 PM [crengy] sedation
8:42 PM [crengy] all causes of hypovent
8:42 PM [crengy] shunt is with incresed AA
8:43 PM [crengy] as PE, pneum, pulm edema
8:43 PM [sanz] what's the ABG is ARDS?
8:43 PM [crengy] hypoxia with no correction with o2
8:43 PM [strug] hypoxemaia and hypercarbia
8:43 PM [crengy] pco2 increased
8:44 PM [sanz] PCWP?
8:44 PM [crengy] increased
8:44 PM [strug] normal
8:44 PM [sanz] normal
8:44 PM [sanz] cuz it doesnt involve the heart
8:44 PM [sanz] Rx?
8:44 PM [strug] undrlying disorder
8:44 PM [strug] also PEEP
8:45 PM [sanz] yup and maintain adeq perfusion
8:45 PM [strug] watch for pneumothorax and hypotension when u give PEEP
8:45 PM [sanz] whenever PEEP is used, what shall we monitor?
8:46 PM [crengy] tension?
8:46 PM [strug] Cardiac output
8:46 PM [sanz] yeah
8:46 PM [sanz] strug, you know your UW well!
8:46 PM [strug] thanx
8:46 PM [samsung68] could u explain strug?
8:47 PM [strug] yeap because of increased intrathoracis pr the venous return to heart decreases and so does cardiac output
8:47 PM [samsung68] thanks
8:48 PM [sanz] what big topics have we not covered in pulm tonight?
8:48 PM [sanz] we've got 10 mins left...
8:48 PM [strug] i didnt realise it that times over....we can continue?
8:49 PM [sanz] cancer... what types are central and what are peripheral?
8:49 PM [strug] alll s are central sq call and small ceell
8:50 PM [strug] onlyone which cannot be treated with surgery is small cell so go for chemo directly
8:50 PM [crengy] yes
8:50 PM [samsung68] which is asso with paraneoplastic synd?
8:50 PM [sanz] it's also neuroendocr origin
8:50 PM [crengy] small+squ
8:51 PM [strug] when do we give pressure contro ventilation
8:52 PM [sanz] no clue
8:52 PM [sanz] to avoid pneumothorax?
8:53 PM strug has left the chat.
8:54 PM [strug] i lost everything....whre are u guys?
8:54 PM [crengy] sorry, i really don't know about pres. control vent
8:54 PM [crengy] what did u lost?
8:55 PM [crengy] we are here!!!
8:55 PM [strug] everything what we discussed today vanished and its still not there
8:55 PM [crengy] or may be not
8:55 PM [crengy] sorry
8:55 PM [strug] not ur fault
8:56 PM [crengy] do u want to send you all the disc?
8:56 PM [strug] is that possible?
8:56 PM [crengy] i suppose so
8:56 PM [sanz] what r u guys talking abt?
8:56 PM [crengy] i'll do it a zip
8:56 PM [strug] doc_123mrn@yahoo.com is my email id
8:56 PM [crengy] let me try
8:57 PM [strug] i was lost sanz everything we discussed has vanished from my screen i dunno why
8:57 PM [sanz] cuz i think you logged off the chat room by mistake...
8:58 PM [nalini] i shall send to ur mai l id dont worry
8:58 PM [strug] anyway we give pr control ventilation in ARDS patient aalso to post op thoracic surgery patients ...it requires heavey sedation
8:58 PM [strug] nalini thanks
8:59 PM mehr has joined subroom: USMLE_Step_2
8:59 PM [strug] what is chronic eosinophilic pneaumonea?
9:00 PM [strug] common guys have u logged off?
9:00 PM [sanz] no...
9:00 PM [sanz] i just dont know the ans!
9:00 PM [sanz] hehe
9:00 PM [strug] s/s fever malaise weight loss
9:01 PM [strug] diagnosi eosinophilic infiltrate involving intestituum and alv space
9:02 PM [sanz] thnx
9:02 PM [strug] photo negative pul edema with central sparing and nonsegmental patchy infiltrates in lung periphrey
9:02 PM [strug] Treatment glucocorticoids
9:03 PM [sanz] how do you know all these?
9:03 PM [strug] Is that all for today? tomorrow nephrology.....same time....if any doubts remaining can discuss them tomorrow
9:04 PM [nalini] did u receive the mail
9:04 PM [strug] i didnt see it wait i shall check
9:04 PM [nalini] stru did u receive the mail?
9:04 PM mehr has left the chat.
9:05 PM [strug] yes i did thanks alot
9:05 PM [lanny] are we in step 2 room
9:05 PM [strug] lanny we are almost done....
9:06 PM [sanz] oke... c u guys tmrw! the TV is calling me
9:06 PM [strug] the time was 6-8 central time....we are leaving
9:06 PM [strug] bye everybody see u tomorrow
9:06 PM [nalini] bye
9:06 PM sanz has left the chat.
9:06 PM [crengy] bye
9:06 PM nalini has left the chat.
9:06 PM [crengy] see u tom.
9:07 PM [samsung68] bye
9:07 PM huli72 has joined subroom: USMLE_Step_3
9:07 PM [lanny] what do you mean,is 6-8 central time not 9-11 eastern time
9:08 PM samsung68 has joined subroom: USMLE_Step_3
9:08 PM strug has left the chat.
9:08 PM huli72 has left the chat.
9:08 PM samsung68 has left the chat.
9:09 PM crengy has left the chat.