Welcome
dua_frank has joined the chat.
[chandra] i never see anyone in these chat rooms...dont know abt schedules
[annvrghs] where are you from in india?no i haven't joined.
[chandra] i am originally south indian...andhra...but lived in karnataka as well
[annvrghs] am from kerala.are u currently in U.S?
[chandra] no in europe
[annvrghs] do u used to take any tests for practice?
[chandra] yeah
[chandra] PLAB
[chandra] and now i passed FRCS...so mhave registration with medical council
[chandra] i took off now for these step 1 exam
Now entering USMLE_Step_2 subroom.
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[ash] hi dua
[ash] hi dua are you there?
[lanny] hi all
[megs] hi dua,ash,lanny
[lanny] hi megs
[ash] hi megs and lanny
[megs] where is dua??
[ash] yeah she isnt responding
[dua_frank] hi
[ash] i tried since 6.55
[megs] hi dear
[lanny] dua i was asking you about incontinence somet imee like i said the q i have been seeing refer to dioabetic cystopathy as incontine even though the bladder cant empty
[ash] welcome back dua
[dua_frank] yeah thats peripheral neuropathy
[dua_frank] autonomic neuropathy lanny
[lanny] yes dua but they refer to it ia overflow incontinence
[lanny] paradox
[dua_frank] so the brain now depends on the sensations from the anterior abdominal wall
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[dua_frank] yes anything that leaks is incontinence
[dua_frank] leak due to overflow, leak due to irritation
[dua_frank] meaning you cant hold when you want to
[megs] that is urge isnt it dua???
[dua_frank] no no
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[ash] ok shall we begin todays discussion?
[dua_frank] urge is when you have the sensation to go
[dua_frank] due to irritation
[dua_frank] yes please ash
[megs] ok got u dua
[megs] lets start
[dua_frank] i will be back in 15 minutes
[dua_frank] cooking
[dua_frank] not done yet
[megs] 5 yr old male child came with fever epitaxis....whats dx???
[ash] male infant presents with a reddish brown skin lesion that progresses to a violaceous bulging mass.painful and ulcerates.he also has gum bleeding and petechiae.later the lesion regresses leaving behind a reddish brown discoloration and the bleeding episodes stop.what is this condition?
[lanny] megs more clues
[ash] megs what is the blood picture?
[megs] anemia abd blast cells 30%
[ash] ALL
[lanny] ALL
[megs] yes
[ash] treatment?
[megs] whats is ans to u r q ash???
[megs] what is the skin lesion u talked about
[ash] it is Kasabach Merritt syndrome
[ash] it is called consumptive thrombocytopenia
[ash] platelets are consumed in the vascular lesion
[megs] oh thanx ash
[megs] is it given in kaplan???
[ash] so chemotherapy of ALL in a child?
[megs] yes i got it
[ash] megs the syndrome is mentioned in kaplan
[ash] so i checked it online
[megs] vincristine predni and l asparginase
[ash] good
[ash] for AML?
[megs] for all induction phase
[ash] RIGHT
[megs] when we give intrathecal methotrexate in ALL>>
[ash] cns involvement
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[megs] YES
[ash] what type of AML mets to the CNS?
[megs] AML TX IS CYTOCIN ARABINOCIDE
[ash] and?
[megs] m5 ...???
[megs] not sure thought
[ash] yes
[ash] very good
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[ash] what type has DIC?
[megs] m3
[ash] close
[ash] it is m2
[megs] my book says its m3 sure ash
[megs] gum infilteration in what???
[megs] m5
[ash] sorry wqas on the phone
[ash] megs the book that i asked it from was blue prints
[megs] i said whats given in kaplan
[ash] what book is your sourse?if it is kaplan then i will change the writing in mine
[ash] ok then i will change it.thanks
[ash] EVEN THE NET SAYS m3.
[ash] thanks
[megs] newborn with bleeding episode after circumcision...no family history of bledding disorder what is dx???
[ash] dont know megs?
[ash] itp?
[megs] its hemophilia ash
[ash] ok thanks
[ash] why not itp
[ash] ?
[megs] itp will not be present in newborn
[ash] megs did they give lab findings in this pt?'
[megs] no ash no lab findings given
[ash] ok
[megs] itp usually occurs after viral infection
[megs] some immune trigger is needed for that
[ash] right thanks
[megs] if bleeding in newborn...u must think about some congenital bleeding disorder
[dua_frank] back
[megs] wb dua
[dua_frank] thanks megs
[dua_frank] nice qs
[ash] this child has cleft lip +shield chest+triphalangeal thumb.what blood disorder will you see most likely?
[ash] yeah thanks megs
[megs] what is most common cause of thrombocytopenia in children???
[dua_frank] thanks ash too
[dua_frank] ALL ash?
[megs] aITP DUA
[megs] ITP
[dua_frank] oh
[dua_frank] is that child with some particular syndrome?
[ash] yes dua
[dua_frank] whats the syndrome?
[ash] not ALL
[dua_frank] is there a name to it?
[ash] well thats the answer
[ash] yes
[megs] DIAMOND BLCKPHAN
[megs] ASH
[ash] very good megs
[megs] APLASTIC ANEMIA
[ash] you are ready for step 2
[dua_frank] where are these qs from?
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[megs] not really ash
[ash] it is pure red cell aplasia
[dua_frank] oh ok
[dua_frank] so there is extramedullary erythropiosus
[ash] how would you differentiate it from transient erythroblastopenia?
[ash] donno about that dua
[dua_frank] no shield chest and all that?
[dua_frank] these qs are hard
[ash] i agree
[dua_frank] but its good you guys are brining them up, thats how they would stick in our brains
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[megs] erythropetien levels ash???
[ash] TECdoesnt have the extrahemopoietic manifestations as diamond blackfan also it has
[ash] raised HbF and iantigen which is absent in diamond
[ash] how are the rbcs in diamond blackfan anemia?
[dua_frank] small
[megs] didnt get u ash
[megs] rbc are macrocytes in db
[ash] on the contrary they are macrocytic
[dua_frank] how come?
[ash] yes megs
[dua_frank] its a chronic process isn't it?
[ash] it is a congenital anomaly dua
[dua_frank] ok thanks
[megs] 2yr old child with aplastic anemia and absebt radii??
[megs] whats dx???
[ash] 3 metabolic conditions causing macrocytic anemia?
[ash] fanconis
[megs] yes ash
[dua_frank] whipples
[dua_frank] crohns
[dua_frank] oh metabolic
[ash] ok i meant enzyme deficiencies
[dua_frank] folate dehydrogenase maybe
[dua_frank] dunno
[ash]
[dua_frank] :P
[megs] hehe tell us ash
[ash] orotic aciduria
[ash] lesch nyhan syndrome
[dua_frank] whats the enzyme there?
[dua_frank] yikes
[dua_frank] good q
[ash] methylmalonyl aciduria
[megs] goods one and rarae one ash
[dua_frank] the last one i knew
[dua_frank] but i can't tell the names of the enzymes
[ash] LNS has HGPRT deficiency
[dua_frank] ok
[ash] orotic aciduria is carbomoyl phosphatase
[ash] not sure
[dua_frank] yes you're right
[dua_frank] and MMA?
[ash] it is synthatase not phosphorylase
[ash] i hatebiochemistryo
[dua_frank] i don't hate it anymore, i passed step 1 :P
[dua_frank] i just fogive and forget it :P
[ash] well so did i but it seems we need it here too
[ash]
[dua_frank] awww
[dua_frank] yeah we do
[ash] MMA is b12 def
[dua_frank] no easy way around it
[ash] yep
[dua_frank] yes but b 12 is with some enzyme right?
[ash] dont remember that one
[dua_frank] i wonder how LNS causes anemia
[dua_frank] never read that in step 1
[ash] yeah i read it in step 2 not step 1
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[dua_frank] well i guess kaplan teachers aren't as good as they claim they are then :P
[ash] what is the treatment for hereditary spherocytosis?
[ash]
[dua_frank] splenectomy
[dua_frank] if symptomatic
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[ash] at what age is it advisable?
[dua_frank] 8 yrs?
[dua_frank] dunno
[ash] beyond 6 years
[megs] A 4 YR OLD CHILD PREVIOUSLY HEALTHY PRESENT WITH PETECHIAE PURPURA AFTER FALLING FROM BYCYCLE...HE HAS past history of recurrent respiratory tract infcetions...and he said he noticed a itchy lesions over both lower extrimities...???what is dx???
[dua_frank] ok
[ash] wiscott aldrich!!!!
[megs] any reason for 6 yrs ash???
[ash]
[dua_frank] ash beat me to it
[megs] right ash
[dua_frank] ig e high ig m low
[ash] yes megs by 6 years the immune system develops sufficiently
[dua_frank] i mean esino high
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[megs] ok
[ash] what is waring blender syndrome?
[ash] so many syndromes today!!!
[megs] is in G6 PD deficiency u reat with splenectomy???
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[megs] never heard ash
[dua_frank] no megs
[dua_frank] just avoid
[dua_frank] whatever you are sensitive to
[ash] i think g6pd treatment is generally supportive megs
[megs] if g6 pd deficiency is chronic...disese then think of spenectomy
[dua_frank] ok
[megs] otherwise no need
[ash] it is hemolytic anemia in a patient with artificial heart valve
[ash] the syndrome i mean
[dua_frank] oh thanks
[megs] ok thanx ash this was new for me
[ash] yeah me too
[dua_frank] i knew that but just not by name
[ash] well me too dua
[dua_frank] the rbcs because fragile for some reason
[dua_frank] going against the heart valves
[dua_frank] right?
[ash] right
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[ash] a histologic sample of wilms tumor will show what?
[dua_frank] owls eye
[dua_frank] no wait thats rs cells
[ash] dua thats hodgkins
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[megs] immature embryonic cells ash
[dua_frank] embryonal tissue
[ash] it has triphesic pattern-tubule formation,spindle cells,blastemal elements
[dua_frank] teeth and hair
[dua_frank] sort of like a teratoma
[ash] on extremely rare occasions yes dua
[megs] wilms tumour is associated with which leukemia..???ALL OT AML??
[ash] 2 syndromes associated with wilms tumor?
[dua_frank] retinoblastoma
[dua_frank] osteosarcoma
[dua_frank] oh syndromes
[ash] all?
[megs] HEMIHYPERTROPHY AND ANIRIA
[dua_frank] VHL
[megs] ahree dua
[megs] its AML
[ash] oh thanks megs
[ash] what is VHL?
[megs] VON HIPPLE LINDUE
[dua_frank] WAGR
[ash] right dua what you are saying is WAGR syndrome
[dua_frank] there are two more
[ash] wont you get hemangioblastoma in von hipple?
[ash] yes the other is beckwith wideman-wilms +organomegaly
[ash] drash syndrome-wilms+ambiguus genitalia+nephropathy
[dua_frank] i think VHL has bilateral wilms
[dua_frank] or maybe bilateral renal cas
[megs] VHL has renal cell carcinoma
[ash] agree megs
[ash] i dont think it is wilms
[dua_frank] yeah its clear cell renal cancers
[dua_frank] sorry not wilms
[dua_frank] WAGR and the others you said for wilms
[ash] dua return my 100 bucks
[ash]
[dua_frank] ah i spend them :O
[ash] oh no
[dua_frank] can give you an IOU :P
[ash] :an
[dua_frank] lol
[ash]
[dua_frank] remember dumb and the dumber and the IOUs for a million dollars? lol
[megs] 14 YR BOY WITH short stature on ct calcified sella tursica what is dx???
[megs] ON CT
[dua_frank] i bet this is a new syndrome
[dua_frank] dunno megs
[megs] craniopharyngioma...is ans
[ash] a 4 y/o girl with sickle cell anemia presents with temp 103f,irritable.lab-wbcs 18000/mm3,88%pmns,10%lymphocytesmegs craniopharyngioma
[dua_frank] hehe not new
[megs] what is the q ash..??
[dua_frank] sickle crisis
[ash] hb-7.6 most appropriate next step?1)observe,pending bld culture.2)amox.3)ceftriaxone4)ceftazidime+genta %)vanco+genta
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[megs] ceftriaxone
[dua_frank] 4
[ash] in a hurry to write craniopharyngioma i left the question halfway
[megs] thats ok ash
[ash] right girls
[ash] why?
[dua_frank] prevents sepsis
[megs] pneumococcal and h influenza prophylaxis is needed
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[ash] ye s better than all the examples against s.pneumoniae and h.inf
[megs] so ceftriaxone is enough
[ash] right megs
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[megs] sudden fall in retic count in sickel cell anemia suggest what???
[ash] parvo
[dua_frank] aplastic crisis
[megs] aplastic crisis due to folate deficiency or parvovirus infection....good ash dua
[ash] virus inf causing aplastic
[dua_frank] yes
[dua_frank] parvo
[ash] at what age should you start checking visual acuity?
[ash] and fundus examination?
[dua_frank] 6 months
[megs] IN PNH...WHAT TYPE OF U SEE..??/1.hemolytic 2. rbc mem defect3.enzyme defect4. aplastic
[ash] 3.5 years
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[ash] hemolytic
[dua_frank] why 3.5 years only ash?
[megs] nope the ans is RBC MEMRANE DEFECT
[ash] i dont know dua.i was hoping you girls would know
[dua_frank] see vasoocculusive crisis in SCD starts after 6 months
[ash] oh yes due to the complement activation?
[dua_frank] so technically the predisposition is after 6 months
[megs] yes ash...
[dua_frank] why wait for 3/5 yrs for checking then?
[ash] agree dua.but i really dont know whay
[dua_frank] dunno either
[ash]
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[ash] vulnerability period of developing amblyopia is?
[dua_frank] what age does hand foot syndrome develop?
[dua_frank] in scd
[megs] 2yrs to 4
[ash] 6 mths
[ash] to 2 yrs?
[dua_frank] 5-6 months yes
[dua_frank] 2-4 months its hemolytic anemias
[dua_frank] after 6 months vasoocclusive crisis events
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[dua_frank] nothing at birth
[ash] ok everyone i have to go now.thanks for the great chat
[dua_frank] bye ash, thanks for the qs
[ash] yrw dua
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[dua_frank] megs why did you say that bleeding in young kids
[dua_frank] after circumcision was not ITP?
[megs] itp is not seen in new born dua
[dua_frank] oh was it a newborn?
[megs] its not a congenital disorder
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[dua_frank] rx of ITP?
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[megs] prednisolone
[dua_frank] and?
[dua_frank] rhogam
[megs] imglobulins
[megs] but in children it is need not be treated
[megs] as self limiting...most of the time
[dua_frank] ys
[dua_frank] resolves by 6 yrs
[megs] its not by yrs dua
[dua_frank] then?
[megs] it will resolves after 8 weeks of the initial episode
[dua_frank] oh
[dua_frank] so one time is all that happens?
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[megs] yes...usually self limiting
[megs] if not then needs treatment
[dua_frank] mc of acquired renal failure in kids?
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[megs] poststreptococcal gn??
[dua_frank] HUS
[megs] ohhhhhhh
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[dua_frank] how is the level of haptoglobin here?
[megs] decresed...
[dua_frank] yes
[dua_frank] rash, arthritis, GI bleed, hematuria dx?
[dua_frank] preceeding viral infection
[megs] 2 yr child with blue skin nodules+ periorbital proptosis and ecchymosis on examination abdominal smooth mass present..whats dx???
[dua_frank] tuberous sclerosis?
[megs] ITP DUA??/
[dua_frank] HSP
[dua_frank] mycoplasma or viral predisposition
[megs] ITS NEUROBLASTOMA FOIR MY Q
[dua_frank] oh
[dua_frank] is it with NF?
[megs] NOPE DUA
[dua_frank] oh oh
[dua_frank] got it
[dua_frank] thanks
[megs] its neuroblastoma alone
[dua_frank] adrenal medulla tumor
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[dua_frank] what are the blue skin nodules called megs?
[megs] i dont know their name if they have any
[dua_frank] the rest are due to metastasis
[dua_frank] the retrobulbar metastasis causes proptosis
[dua_frank] abdominal mass can be liver
[dua_frank] dunno what the skin signs are due to
[dua_frank] stage 4 of neuroblastoma
[megs] i too dunno
[dua_frank] HUS and HSP looks like the same to me
[dua_frank] except arthritis is absent in HUS
[dua_frank] and no anemia in HSP
[megs] ok dua
[dua_frank] is there any way to tell them apart?
[megs] but i guess ttp and hus are similer
[megs] i mean both have trombotic pathology
[dua_frank] yes right
[dua_frank] no anemia in TTP though right?
[megs] dont think so dua
[megs] but will cq
[dua_frank] no diarrhea either
[dua_frank] or azotemia
[dua_frank] none of those abdominal and renal manifestations
[dua_frank] in TTP
[dua_frank] only bleeding
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[megs] yes dua agree with u
[megs] just checked
[dua_frank] HUS and HSP look too much alike
[dua_frank] except for joint arthritis in HSP
[megs] ok
[dua_frank] and no anemia in HSP
[dua_frank] how about bergers now?
[dua_frank] how does that present as?
[megs] boy with pure red cell aplasia and mediastinal mass whats is that mediastinal mass???
[dua_frank] thymoma?
[megs] yes dua
[megs] right
[dua_frank] blood pictures give away HUS and HSP easily anyway
[dua_frank] but if they give us only clinical presentation, we're dead
[megs] lol
[dua_frank] hemolytic anemia and thrombocytopenia in hus and ig a elevevation in hsp
[dua_frank] megs i'm finding peds tougher than im
[megs] yes lots of syndromes dua
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[megs] dua actually i am running short of time...with next 15 days i want to finish uw
[dua_frank] deaf, mutism, MR, spastic and rigid neuromotor disorders, dx?
[dua_frank] how much have you done till now?
[megs] less than half
[dua_frank] how many tests are you doing every day?
[megs] i am doing one timed 46 q ...s
[dua_frank] increased tsh too
[dua_frank] so one test per day
[megs] and rest 24 untimed each day
[dua_frank] ok
[dua_frank] sanz was telling to do atleast 2 tests per day
[dua_frank] 100 per day
[megs] so total 70...but took much time to read explanations
[dua_frank] are you doing anything else besides uw right now?
[dua_frank] i feel like q banks take up a lot of time
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[dua_frank] that was neurocretin
[dua_frank] the regular cretin you see is the myxoedematous cretin
[megs] why dretin will have spasticity dua
[megs] creitin i mean
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[dua_frank] dunno megs, it affects neuro
[dua_frank] its one of the manifestations
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[megs] its hypothyroidism so...should be hypotonia
[dua_frank] yes thats the myxoedematous type
[megs] ok
[megs] ok dua i will leave now got to go
[megs] bye
[dua_frank] ok megs bye
[megs] see u tomorrow
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[dua_frank] see you

Hi everyone