Chat transcript - IM (acid base disorders, renal)

[Anonymous]

19:57:57 Step2 enters this room

19:57:58 >[Step2] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

20:01:12 GucciMD enters this room

20:01:31 [Step2] hi gucci

20:01:40 [GucciMD] hi

20:02:07 [GucciMD] is there a meeting here or in the step 1 group

20:02:21 GucciMD exits from this room

20:02:23 [Step2] both i think

20:02:36 GucciMD enters this room

20:02:50 kidoo enters this room

20:03:07 [Step2] hi kidoo

20:03:20 [GucciMD] hi kidoo

20:03:29 [kidoo] Hi step 2

20:03:42 [kidoo] Hi gucci MD

20:04:06 [GucciMD] what are you guys using to prepare for step 2

20:04:21 [Step2] did anyone post an announcement on other sites?

20:04:48 [GucciMD] i am not sure

20:05:22 [Step2] i'm using crush, 1st aid step 2, and hilights as main stuff

20:05:29 [Step2] how about you

20:05:38 [kidoo] i think we shud first make a final schedule and then pos it..people are having confusions abt timings and all

20:05:47 [GucciMD] i am also using crush mainly

20:05:50 mang0tang0 enters this room

20:05:58 [Step2] hi mango

20:06:12 [kidoo] i m using &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3 &subid=0 >Kaplan&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&sub id=0 > ,step2 secrets

20:06:26 [mang0tang0] hey

20:07:21 [Step2] oh yeah, forgot to mention, cant type stuff like k@plan, first aid, q bank, amaxon, crush step 2, etc or else you will get a link

20:07:42 [kidoo] is site a little slow...??

20:08:05 [GucciMD] ok

20:08:36 [Step2] i think its because the step 1 group decided to chat at the same time.....but its working fine for me

20:09:05 [Step2] so lets get some housekeeping stuff out of the way first and then we can start

20:09:07 [kidoo] ok...shud we start too??

20:09:31 [mang0tang0] what books do u recomend to start off with?

20:09:36 [kidoo]

20:09:45 [Step2] probably wont be too busy tonight because we didnt post announcements, but 4 of us is a good start and we will get more as we go

20:09:48 [mang0tang0] &lt;A target=new HREF=http://www.amazon.com/exec/obidos/external-search?tag=valuetheplace-20&keyword=blueprints&mode=books>BluePrints&lt;/A>?

20:09:54 [mang0tang0] oops

20:10:03 [mang0tang0] bluprints?

20:10:11 [Step2] blue prints is another one

20:10:23 [GucciMD] i read all the bp series

20:10:43 [GucciMD] i have found nothing that is really good for IM

20:10:44 [kidoo] i think...whatever books we are using the idea is to grab the concepts

20:10:50 [Step2] crush is equivalent to first aid for step 1....very concise and very high yield

20:11:05 [kidoo] and doing a lot of questions

20:11:17 [GucciMD] i started to study with crush and doing questions

20:11:39 [GucciMD] peds and ob/gyn are good with bp

20:11:40 [Step2] yes....lots and lots of questions.....q bank i think is best for questions

20:11:40 [mang0tang0] thats true cause in the exam the questions r so twisted that only concepts can save u

20:12:03 [Step2] longer questions than step 1

20:12:19 [Step2] were any of you in step 1 chats?

20:12:28 [mang0tang0] i heard q bank is nt all that good for step 2 .. mle world is better

20:12:32 [GucciMD] i did ccssa form 1 and they are not that long

20:12:37 [kidoo] yes i was there

20:12:53 [mang0tang0] i came once or twice i found out about the chats a lil b4 my exam

20:13:03 [GucciMD] mle is better than kap &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000206&type=2 &subid=0>QBank&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491&type=2&subid=0 >

20:13:09 [GucciMD] sorry

20:13:21 [GucciMD] mle better than k

20:13:45 [kidoo] this time ..we shud discuss more of clinical scenarios

20:13:51 [Step2] so the format is basically that we study hard for the upcoming chats on our own on whatever subjects and try to come up with short questions and answers for the group based on that material.

20:14:14 [GucciMD] i know the topic is acid base.......but this is my worse area and I was not sure how to write questions

20:14:27 [kidoo] i agree

20:14:29 [Step2] in betweeen chats, we can post more complex questions in the step 2 forum for more lengthy discussions

20:15:02 [mang0tang0] for a week or so ill just observe till i get the books and start studying

20:15:23 [Step2] today we will start of easy to get the hang of things.

20:15:43 [GucciMD] What disease has markely elevated alkaline phosphatase?

20:16:02 [Step2] but i have another problem in that i cant make it next week ....but i'll probably be a regular the rest of the time

20:17:03 [kidoo] i m sorry

20:17:28 [kidoo] i tried to ans both of u

20:17:54 [mang0tang0] pagets disease

20:18:01 [GucciMD] well, I do not have any acid base ques

20:18:10 [GucciMD] pagets ds.......yes

20:18:29 [GucciMD] but what about if you have a PSA of 8

20:19:14 [GucciMD] pros. cancer with bone mets

20:19:19 [kidoo] sec of prostrate ca in bone??

20:19:59 [GucciMD] What is the most specific test for sjogrens syndrome?

20:19:59 [kidoo] tell me the lab scenario in reanal artery stenosis?

20:20:28 [mang0tang0] prostate ca with spinal mets

20:20:42 [GucciMD] yes

20:21:05 [kidoo] i mean BUN/Creatinine ratio,urine sodium etc.?????

20:21:46 [GucciMD] i think you have increased renin with RAS

20:21:49 [mang0tang0] Anti ribonucleoprotein in sjogrens

20:22:10 [GucciMD] no mango

20:22:26 [GucciMD] lip biopsy is most specific test

20:22:45 [kidoo] ????

20:22:59 [mang0tang0] oo ok

20:23:25 [mang0tang0] lip biopsy of minor salivary gland

20:23:46 [mang0tang0] or'

20:23:51 [GucciMD] yes

20:24:02 [kidoo] hey guys ..what abt my question..??prerenal /renal...what???

20:24:32 [GucciMD] lymphoid foci in accessory salv gland

20:24:44 [mang0tang0] sorry didnt c ur Q kidoo.. what is it

20:24:46 [Step2] what is your question?

20:25:13 [GucciMD] prerenal is mostly dehydration

20:25:18 [kidoo] I was asking the scenario in Renal artery stenosis..

20:26:06 [kidoo] what will be BUN /creat ratio .....urinary na and why.??

20:27:08 [Step2] dehydration and heart failure are probably 2 most common for prerenal...anything that decreases cardiac output....this will give ratio of >15 to 1

20:27:22 [GucciMD] it can be anything

20:28:05 [Step2] obstruction of urine flow behind kidneys like BPH will be postrenal

20:28:23 [GucciMD] renal artery stenosis bun/cr would depend on the length of time the disease in progress

20:28:23 [kidoo] it will be prerenal problem ...thus

20:28:29 [mang0tang0] renal artery stenosis i think should be prerenal

20:28:30 [Step2] not sure about renal art stenosis....would that be like obstruction?

20:29:02 [mang0tang0] cause theres nothing wrong with the kidney right

20:29:25 [Step2] i think its also prerenal because causing decrease flow into kidneys....right?

20:29:44 [Step2] agree, nothing wrong with kidneys

20:30:00 [kidoo] thus BUN/creat ratio >20 and low urinary sodium

20:30:18 [Step2] so my guess is that the BUN to Cr would be >15 to 1

20:30:39 [kidoo] how will u differentiate prerenal from post renal??

20:31:01 [kidoo]>[Step2] right in some books it is 20

20:31:07 [mang0tang0] we can differentiate by the BUN/ creatinine ration

20:31:10 [mang0tang0] ratio

20:31:17 [GucciMD] ratio

20:31:28 [Step2] initially you have ratio of >15 to 1 (some books say 20 to 1), then it may become &lt;15 to 1

20:31:30 [kidoo] it is same >20 in both

20:32:15 [kidoo] ,20 will be in renal causes as kidneys can't compensate

20:32:31 [Step2] i think 20 is more common number used, but golijan got it stuck in my head to use 15

20:32:37 [mang0tang0] no itll b increased in renal

20:32:53 [mang0tang0] right?

20:33:51 [mang0tang0] sorry im weak in kidney

20:34:01 [Step2] according to gol jan, post renal will be high at first, but can become low if obstuction is not relieved and tubular damage occurs

20:34:53 [Step2] does that sound right?

20:34:54 [GucciMD] agree with > 20 for prerenal

20:35:40 [Step2] what are causes of increased anion gap metabolic acidosis?

20:36:02 kidoo exits from this room

20:36:24 kidoo enters this room

20:36:36 [GucciMD] ELM PARK

20:36:48 [kidoo] sorry guys i was logged off

20:37:52 [Step2] no problem, at least you made it back

20:38:26 [GucciMD] Ethy., lactic acid, meth, ASA, Keto,

20:38:30 [Step2] what does ELM PARK stand for? I learned it using LA MUDPIES

20:38:46 [kidoo] me too

20:38:47 [Step2] mneumonic is LA MUDPIE.....Lactic acidosis, Aspirin, Methanol, Uremia/renal failure, Diabetic ketoacidosis, Polyethelene glycol, Inh, Ethylene glyclol poisoning

20:39:16 [GucciMD] same stuff just different mneumonic

20:39:32 [Step2] whatever works

20:40:01 [Step2] what is the formula for AG?

20:40:39 [kidoo] Na -(hco3 +cl)

20:40:44 [GucciMD] Na - ( HCO3 + cl)

20:40:51 [GucciMD] i think

20:40:55 [kidoo] 8-12 meq normal

20:41:11 [Step2] AG=Na- (Cl+HCO3) .....thats right....excellent

20:41:42 [Step2] btw, know the labs cold so you wont need to look them up during exam

20:41:47 [kidoo] in type 4 RTA why there is hyporeninnemia??

20:42:51 [kidoo] this is due to aldosterone resistance so renin shud be high not low??

20:44:27 [kidoo] does any bidy know..i had this cinfusion when i read this

20:45:18 [Step2] i'm reading up on it right now

20:45:40 [Step2] sorry wasnt prepared tonight

20:45:42 [GucciMD] high potassium with RTA 4

20:46:10 [kidoo] that's right but why hyporenin??

20:46:56 [GucciMD] mineralocorticoid defic

20:49:43 [Step2] i'm reading it and it doesnt seem very clear.....i will need to absorb this a bit, but here is an article about it in emedicine http://www.emedicine.com/med/byname/...osteronism.htm

20:49:53 [kidoo] leave it ...tell me the ABG in chronic lung conditions

20:49:55 [GucciMD] hypoaldosteronism

20:50:37 [kidoo] hey that's good

20:50:52 [GucciMD] well if you have the answer please give it

20:52:26 [GucciMD] emphysema resp. acid

20:53:01 [kidoo] it says..mechanism is not precise and confusion is due to nomenclature

20:55:03 [Step2] agree, emphysema will show hypoxemia with acute resp acidosis in acute exacerbation

20:55:40 [GucciMD] Barters syndrome...Which acid base disorder?

20:56:26 [kidoo] alkalosis??

20:56:54 [GucciMD] met. alka

20:58:24 [Step2] Hypokalemic Alkalosis

20:58:48 [GucciMD] Conns Syndrome

20:59:03 [kidoo] yess due to hyperaldosteronism

20:59:17 [GucciMD] yes

21:00:14 [kidoo] u r giving to the pt iv K still symptoms of hypokalemia what shud u do??

21:00:18 [Step2] metabolic alkalosis

21:01:05 [Step2] Spironolactone

21:01:08 [GucciMD] D5W

21:01:24 [GucciMD] lol

21:01:33 [kidoo] plz explain ur ans

21:01:57 [kidoo] u r giving to the pt iv K still symptoms of hypokalemia what shud u do??

21:02:04 [mang0tang0] sorry im back

21:02:33 [mang0tang0] doesnt K need glucose to enter the cells

21:02:47 [GucciMD] IVF with glucose is what I was thinking but not sure....

21:03:04 [GucciMD] agree with mango

21:04:43 [Step2] also must make sure you've corrected hypomagnessemia if present

21:05:20 [kidoo] right step2..

21:05:44 [Step2] if you don't correct the low Mg, the hypokalemia will be difficult to correct

21:05:56 [kidoo] glucose is needed for entru into cells...so how does it help in hypok??

21:06:00 [mang0tang0] ok

21:06:14 [GucciMD] check the mag

21:06:39 [GucciMD] if mag is low....hypokalemia can not be corrected

21:06:52 [kidoo] yes without Mg body can

21:07:10 [kidoo] not retain k

21:07:29 [GucciMD] so give Mag

21:08:16 [GucciMD] especially alcoholic patients

21:08:44 [GucciMD] of course we want to give them thiamine....

21:08:48 [kidoo] more prone to hypoMg

21:11:13 [Step2] asthmatic pt blood gas goes from alkalotic to normal.....what might be next step?

21:11:37 [GucciMD] intubation

21:11:45 [kidoo] pt might be crashing...

21:12:21 [Step2] if an asthmatic pt goes from alkalotic to normal, might mean they are too tired to breath and about to crash....get ready to intubate....great job!

21:12:54 [mang0tang0] this is from secrets right?

21:13:17 [Step2] got that one from crush

21:13:26 [Step2] which is the same author

21:14:09 [mang0tang0] it says u cant treat hypocalcemia either if there is hypomagnessemia

21:15:42 [Step2] pt presents with confusion, lethargy, mental status changes, anorexia, siezures, disorientation, cramps, coma. diagnosis? treatment?

21:16:45 [Step2] that seems to general, so let me point you in the right direction....they're very dehydrated as well

21:16:50 [kidoo] DD of delirium..

21:17:02 [GucciMD] hyponatr

21:17:37 [kidoo] in electrolyte imbalance it can be both hypo and hyperNa

21:18:00 [mang0tang0] yes its hypo nat

21:19:21 [Step2] thats the reason i threw in the dehydration part is because that could be many things including DD ....i was looking for hypovolumeic hyponatremia, but i see now that it was very general.....either way, how would you treat....what type of fluids i mean?

21:19:54 [mang0tang0] normal saline?

21:20:00 [kidoo] iv NS

21:20:03 [Step2] hypertonic saline, or normal saline?

21:20:46 [kidoo] if hypoNa is profound &lt;110 then only hypertonic saline

21:21:02 [Step2] on exam, the answer will almost always be normal saline. the only exception is when the patient is having seizures...but even then, normal saline is likely better choice....why?

21:21:20 [kidoo] also

21:21:38 [Step2] good point kidoo

21:22:03 [kidoo] yep this is b'cos fast corection can furher cause damage

21:22:28 [Step2] good, but what kind of damage?

21:22:31 [mang0tang0] u could damage the brainstem if u give hyper due to fast correction

21:22:38 [GucciMD] pontine

21:23:21 [Step2] if correct hyponatremia too fast with hypertonic saline, you can cause brainstem damage (central pontine myelinolysis) very high yield point. good job!

21:25:40 [Step2] another important point is that an increase in glucose can cause a decrease in sodium (Na decreases by for each 100mg/dl of glucose over 200.

21:26:25 [GucciMD] yes

21:26:32 [kidoo] 1.6mg%

21:26:33 [Step2] oops, Na decreases by 1.6 mEq/L for every 100 mg/dl of glucose once past 200

21:26:53 [mang0tang0] hmmm

21:27:15 [GucciMD] so you can correct glucose

21:28:34 [Step2] yes, correct glucose, but also correct the hyponatremia with normal saline

21:29:10 [Step2] pregnant pt develops hyponatremia....what pain meds was she likely given?

21:30:21 [Step2] oxytocin administration may cause hyponatremia (ADH-like effect) in pregnant women

21:30:30 [kidoo] oxytocin in pregnant

21:30:43 [mang0tang0] oxytocin

21:30:44 [kidoo] even any narcotics

21:30:50 [mang0tang0] yea

21:30:50 [Step2] good job, i think i answered too quickly

21:31:09 [kidoo] it's okay

21:31:21 [kidoo] u are doing good job

21:31:28 [Step2] what about a surgical patient who develops hyponatremia....what is most likely cause?

21:32:11 [kidoo] that is bcos of narcotics and overaggresive iv fluids

21:33:17 [Step2] inappropriate or excessive fluid administration is most common cause for surgical patients. your right, narcs can probably cause it too

21:35:04 [Step2] otherwise healthy looking 18 yo female patients with hypotension and hypokalemic alkalosis.....what might have caused this?

21:36:10 [kidoo] adrenal insufficiency??

21:36:39 [GucciMD] sorry I had to help my child

21:37:08 [kidoo] sorry ...hyperaldosterone leads to hypoK

21:37:28 [GucciMD] yes

21:38:12 [Step2] vomitting and diarrhea often can cause hypokalemic alkalosis. the low K can lead to musclular weakness and hypotension. but why would a healthy looking female be vomitting or have excessive diarrhea?

21:38:12 [kidoo] is it renal artert stenosis due to fibromuscular dysplasia

21:38:28 [GucciMD] can be in the young

21:39:01 [mang0tang0] bulimic?

21:39:27 [Step2] yep, you got it mango!!!

21:40:05 [kidoo] malabsorption syndrome??

21:40:42 [GucciMD] lactose intolerance

21:41:11 [Step2] whenever you see a young healthy female with hypokalemic alk and hypotension, think of bulemia from forced vomitting and/or laxative abuse.....whereas anorexics are below weight and restrict food completely, bulemics bing and then get rid of the food (and potassium)

21:41:40 [GucciMD] ok

21:41:47 [kidoo] ok

21:42:00 [mang0tang0] yea i remembered gol.jan saying bulemics didnt have a distorted body image

21:42:12 [Step2] the other guesses were good for a differential also and good to rule out

21:43:12 [Step2] exactly, that is the givaway because malabsorption and other things would have a thin unhealthy presentation, but not bulemics...they look normal....sometimes even a little obese

21:43:24 [kidoo] renal artery stenosis will have hypertension not hypotension but will have hypok alkalosis

21:44:13 [kidoo]>[Step2] u r right

21:45:02 [Step2] good point, the kidney will think that the blood pressure is low because less blood entering the kidney, so it will increase renin, etc and result in HTN....good point

21:45:58 [Step2] so in this hypokalemic pt, what is the buzz word for the EKG finding?

21:46:17 [kidoo] u waves

21:46:20 [GucciMD] inverted t waves

21:46:39 [GucciMD] u waves

21:47:12 [Step2] you will see loss of T waves, premature vent contractions, cent and atrial tachy....but buzz word is U waves

21:47:31 [kidoo] what type of anamia will occur in infant when switched from cow's milk to goat milk

21:47:32 [Step2] excellent!

21:47:39 [mang0tang0] hyper k has tall t waves and presence of u waves in hypo k

21:47:41 [GucciMD] ok

21:47:46 [Step2] you're all pretty good at this stuff

21:47:49 [GucciMD] b6

21:48:16 [kidoo] right also iron

21:48:35 [GucciMD] iron with whole milk

21:48:46 [GucciMD] loss from GI

21:49:09 [GucciMD] infants should not start milk until after 1 year old

21:49:19 [Step2] it might be dumb, but i picture the T as an arrow pointing up to remember hyper (up) T waves ....maybe it will help you too

21:49:27 [GucciMD] need formula or breast milk

21:50:03 [kidoo] hey step2 u have great imagination

21:50:05 [Step2] meaning hyperkalemia for peaked T waves

21:50:38 [mang0tang0] thats akewl way to remember

21:50:41 [Step2] i'm a visual learner....you should see the stuff that goes thru my mind during an exam

21:51:26 [kidoo] that's really a good approach

21:52:35 [Step2] patient presents with "bones, stones, groans, and psychiatirc overtones". what is this in reference to?

21:52:44 [GucciMD] pth

21:52:58 [kidoo] hyper ca

21:54:02 [mang0tang0] agree with kidoo

21:54:06 [Step2] this is hypercalcemia....bone changes such as osteopenia or pathologic fractures, kidney stones and polyuria, abdominal pain, anorexia, constipation, ileusn nausea, comitting, depression, psychosis, delirium, confuion

21:54:23 [Step2] what is the buzz word for the EKG?

21:54:53 [kidoo] prolong QR

21:55:14 [mang0tang0] short QT interval

21:55:31 [kidoo] oops

21:55:49 [Step2] btw, gucci, you were correct also because HyperPTH is a common cause of hyper Ca

21:56:06 [Step2] QT interval shortening

21:56:09 [kidoo] i m sorry again

21:56:34 [kidoo] agreed

21:56:46 [Step2] lots of cacium means HR is increasing so the QT shortens

21:57:04 [GucciMD] yes

21:57:05 [Step2] no prob....we're all learning from each other

21:57:29 [Step2] so what diuretic might have caused this state?

21:57:39 [mang0tang0] u learn better with mistakes in a discussion then just readin it

21:58:03 [mang0tang0] thiazide

21:58:09 [Step2] i agree mango....also better to learn it now than in the test

21:58:21 [kidoo] thiazide

21:58:38 [kidoo] i agree with both of u

21:58:44 [kidoo]

21:59:06 [mang0tang0] the test is the worst time to learn

21:59:52 [Step2] LOOps LOOse calcium....as golijan would say...."the other is the other"...so thiazides retain calcium

22:00:14 [Step2] so thiazides is correct

22:00:25 [kidoo] good one

22:00:49 [Step2] so how would you treat this patient in the hospital setting?

22:01:07 [kidoo] didn't u guys got tired??

22:02:06 [Step2] i rounded on pts at 6:45 this morning and have not had a break since then....believe me....i'm tired

22:02:18 [mang0tang0] if i remember right thiazide was the one with the increases in everything

22:02:35 [Step2] thats why i was unprepared....it will be like this for the rest of the month unfortunately

22:02:44 [kidoo] oh..

22:02:46 [GucciMD] tx hypercal with IV hydration and loop diuretic

22:03:08 [mang0tang0] hyper calcemia hyper lipidemia hyper glycemia hyperurecemia

22:03:17 [kidoo] what rotation u are having currently??

22:03:22 [GucciMD] if severe calcitonin bisphos, dialysis, glucocord

22:03:33 [mang0tang0] that must b very hectic for u

22:04:29 [Step2] exactly gucci. you know that LOOps LOOse Ca, but you want to hydrate them first before giving the diuretics....so basically give IV fluids, then drain those fluids with loops which will take the Ca with it

22:05:02 [GucciMD] yes thanks

22:05:27 [GucciMD] i should have typed follow with loops

22:05:42 [Step2] like i said, next week, i will not be able to attend because i will be on call. but remainder of month i just wont be able to be as prepared as i would like.....the rest of time, i should be ok

22:06:00 [GucciMD] when is the next meeting and topic

22:06:09 [Step2] i'm on internal medicine right now

22:06:58 [Step2] i promise i will try to have things a little more organized next month....i just haven't had the time lately....sorry

22:07:11 [kidoo] doesn't matter...sth rotations will teach u and sth we will teach u

22:07:18 [mang0tang0] ure doin very well while ure not prepared

22:07:42 [GucciMD] thats fine .... i am trying to take exam this month if possible

22:08:09 [kidoo] hey gucci GOOD LUCK

22:08:28 [mang0tang0] best of luck for ur exam

22:08:36 [GucciMD] there is so much material

22:08:46 [mang0tang0] i just gave step 1.. havent even bought the step 2 books yet

22:08:50 [Step2] thats the reason i started a month earlier than i would have normally...i saw the interest and thought it was better to get started now. hopefully we can all help you to get prepared on time gucci

22:09:00 [GucciMD] the ccssa questions were not even in the review books

22:10:06 [kidoo] yeah i have heard they even give new topics related to reseaches and all

22:10:09 [GucciMD] are you at a teaching hospital for IM

22:10:33 [Step2] i listened to a little bit of kapl@an hilights and thought they were pretty good...have you tried that?

22:11:10 [kidoo] but u shud revise the topic from ccsa they are important

22:11:28 [GucciMD] yes but the best thing so far has been usworld

22:11:45 [Step2] yes, its long hours, but you learn alot.

22:12:06 [GucciMD] i scored 480 on form 1

22:12:28 [Step2] you mean the questions from usworld...or do they have lectures or what?

22:12:32 [GucciMD] but I need to improve in IM....everything else was good

22:12:45 [kidoo]>[Step2] u are talking abt video &lt;a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000209&type=2 &subid=0" >Highlights&lt;/a>??

22:12:50 [mang0tang0] is there something like gol.jan high yield notes for step 2?

22:12:53 [GucciMD] the questions on usworld are excellent

22:13:00 [mang0tang0] like the 100 pages notes he had?

22:13:07 [GucciMD] i have been taking notes

22:13:37 [kidoo]>[Step2] are u talking abt video &lt;a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000209&type=2 &subid=0" >Highlights&lt;/a>??

22:13:51 [GucciMD] i have not found anything like gol.jan

22:14:02 [Step2]>[kidoo] yes kidoo, the video hilights and notes. p.s. you cant type the word or else you will get a link

22:14:34 [kidoo] sorry again

22:14:41 [Step2] golijan has step 2 notes also like the step 1, but i dont know about the high yield notes from him?

22:14:47 [GucciMD] so when do you meet again?

22:15:14 [Step2] we are supposed to meet thurs at 8 pm again to discuss GI (upper & lower gi dzs and bleeds, liver, biliary tract and pancreas)

22:15:21 [GucciMD] yes...but they are old...and many things like test of choice has changed

22:15:25 [kidoo] oops.

22:15:35 [Step2] i'm not sure yet if i can make it, but i will try really hard

22:15:54 [GucciMD] ok

22:15:55 [kidoo] fine...what abt hemat..??

22:16:05 [GucciMD] this thursday

22:16:30 [kidoo] can we can discuss hemat too with GIT??

22:16:53 [GucciMD] alright

22:16:59 [Step2] we can discuss some now or tomorrow or when ever....or we can push it to thurs day since today was the first day and we took a little while to get started

22:17:33 [GucciMD] ok

22:17:51 [GucciMD] i am going to go now.....see you later

22:17:53 [GucciMD] thanks

22:18:01 [Step2] now we have a better idea of format.....basically it will be quick recall from the stuff we just studied.....when we get stuck we can discuss further.....and then things in between in the forum

22:18:01 [GucciMD] bye

22:18:01 [kidoo] as everybody says

22:18:23 [kidoo] byeee Gucci take care

22:18:29 [Step2] please try to post something on other sites so that more participation until people find out about it....the bigger the better

22:18:44 [Step2] good night everyone and thanks for great chat

22:19:04 [mang0tang0] take care everyone

22:19:06 [mang0tang0] bye!

22:19:10 [kidoo] good night and thanx every body

22:19:26 [Step2] bye

22:19:58 [Step2]