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dua_frank
03-06-2005, 08:11 PM
Welcome
dua_frank has joined the chat.
[namelessobscure] chicago here
[jmuzuma] hi
[jmuzuma] chicago
[jmuzuma] anyone there?
[a2z] hello everyone
[a2z] is there anyone from AUC?
[a2z] any one here???
[wakejefe] chicago as well
[wakejefe] greetings
[jmuzuma] hello
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[lanny] hello all
[megs] hi dua, lanny
[dua_frank] hi
[megs] dua wanted to ask something to u
[dua_frank] sure megs
[megs] where r u planning to take cs??
[dua_frank] before aug
[dua_frank] hopefully
[dua_frank] the dates are available right?
[megs] but wjhere
[dua_frank] i need to check on that
[dua_frank] houston
[dua_frank] you?
[megs] i too houston
[dua_frank] great megs :)
[dua_frank] maybe we can give the exam on the same day and prepare together
[megs] have u done with the application
[dua_frank] not yet, you?
[megs] sure dua
[dua_frank] i will do that tomorrow
[megs] same
[dua_frank] what date shall we take?
[megs] most probably aug dates
[dua_frank] aug first week should be sufficient
[megs] i think so
[dua_frank] ok then lets take the same date tomorrow
[megs] now a days site is showing houston qota for may
[dua_frank] i'll write you a mail about this tonight
[megs] no dua
[dua_frank] thats good, meaning we have time to decide the date
[megs] i mean
[megs] i have to apply online
[dua_frank] ok but let me know the date
[megs] tjen confirmation of cs will come and then i can take date
[dua_frank] oh
[dua_frank] i guess i have to do the same too megs
[megs] have u done with online applic for cs
[dua_frank] i never really looked into that before
[samantha] hi everyone
[dua_frank] no megs
[dua_frank] hi sammy
[megs] ok then within a week or 10 days we will do that procedure will take same date then
[dua_frank] ok that sounds good megs
[megs] ok dua
[megs] hi sammy
[dua_frank] cardiology today
[megs] i will let u know subsequently dua
[dua_frank] ok megs, i'll be waiting for you to let me know
[megs] cardio today
FERO has left the chat.
[samantha] How long do u need to study for cs?
[megs] hi FERO, CAPITAL TODAY
[lanny] can we start
[dua_frank] i heard about a month and a half sammy or 2 weeks of really good prep should be enough
[megs] I REALLY DONT KNOW BUT THEY SAY 1 MONTH ENOUGH
[dua_frank] i'm going for the one month plan too
[fero] hi everyone
[megs] fero welcome back
[dua_frank] hi fero
[fero] hi megs , dua
[dua_frank] fero you got two ids here, don't you:P
[dua_frank] :P
[samantha] are u taking it after ck dua and megs?
[dua_frank] yes sammy
[fero] no dua..when u type in caps, it will let u in in caps like FERO and fero same
[dua_frank] ohhhhhhhhhh
[megs] yes sammy
[megs] diffise ST ELAVATION IN ALL LEADS HISTORY OF CHEST PAIN DX???
[samantha] pericarditis
[fero] pericarditix
[megs] yup
[megs] what are the causes???
[megs] most common??
[uniteus] hi everyone
[lanny] uremia
[megs] hi uni
[megs] nope lanny
[lanny] dresslers sd
[samantha] MI?
[megs] which is the commonest cause first tell that
[lanny] yes uremia can cause pericard megs
[lanny] oh ok
[megs] true lanny
[uniteus] infections
[samantha] alcohol
[megs] idiopathic is most common
[megs] sammy how alcohol causes pericarditis??
[megs] didnt know that
[fero] viral is next most comm megs?
[megs] yeah fero
[samantha] sorry it is for pancretitis megs
[megs] ok sammy
[lanny] stress test is done in?
[fero] unstable angi?
[megs] angina lanny
[samantha] chest pain
[lanny] also post MI
[megs] IT IS DONE TO CONFERM DIAGNOSIS OF ANGINA AND DETERMINE SEVERITY
[fero] o no sorry stress test in contra indiv in unstable angio,,soryyyyyy
[lanny] yes fero
[lanny] indic in stable
[fero] rt rt
[lanny] so if pt has unstable how do you confirm?
[megs] clinically on EKG LANNY
[lanny] right
[fero] ekg is does not show st elev in unstable
[lanny] if you cant read EKG
[lanny] what next?
[samantha] thallium
fero has left the chat.
[lanny] yes sam
[lanny] or stress echo
[fero] angip
[fero] angiography?
[megs] I WAS THINKING THAT TOO FERO
[megs] why not angiography lanny
[dua_frank] MC congenital valvular abnor?
[lanny] not sure think you do angio in printzmetal angina
[dua_frank] you diagnose printzmetal after angio
[samantha] angio is done before surgery to look for vessel disease
[dua_frank] its a diagnosis of exclusion when cor atrs are clear
[megs] vsd dua
[dua_frank] MVP
[megs] ohhh
[lanny] VSD
[samantha] i think
[fero] becks triad of pericar temponade?
[uniteus] hypotension, muffled heart sounds, n increase jvp
[fero] good uni....wats kassmal sign?
[dua_frank] fall in BP on inspiration?
[lanny] rapid breathing
[megs] agree dua
[fero] thats pulsas paradox
[lanny] right dua thats pulsus p
[dua_frank] oh
[megs] rapid breathing is kaussumaus breathing lanny seen inDM
[lanny] thats what i said
[dua_frank] i hate these breathing types
[dua_frank] kussmalls
[dua_frank] biots
[dua_frank] cheyne stokes
[lanny] kussmauls
[fero] kassmal sign is inc in JVP on inspiration but rt kassmal resp is rapid resp
[dua_frank] there has to be an easy way to remember this
[lanny] fero theres only one kussmaul
[lanny] rapid breathing
[megs] NOT INCREASE FERO I THINK ITS FALL IN JVP ON INSPIRATION
[dua_frank] lanny no actually fero's right, there ar two of those bloody things
[fero] let me check
[lanny] never heard that
[dua_frank] megs its rise in JVP
[dua_frank] pericarditis back pressure
[samantha] i thought it was inc in pulse with inspi
[dua_frank] more seen in tamponade i think
[fero] its JVDISTENTION SO INC
[dua_frank] both pulsus paradox as well as kussmall's sign
[dua_frank] and kussmalls resp in some lung condition
[dua_frank] COPD?
[dua_frank] dunno
[fero] kussmauls sign > JVD on inspi
[megs] yeah fero u r right
uniteus has left the chat.
[fero] its also given well in first aid lanny
[dua_frank] if a patient with MVP present with lightheadedness, syncope, chest pain what does it mean?
[lanny] thx fero will chk it
[lanny] emboli
[megs] pt need medical treatment dua
[megs] b blocker
[dua_frank] means arrythmias
[lanny] dua you know the mechanism
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[dua_frank] two conditions improving with squatting
[megs] which arrythmia dua??/
[fero] a fib i think
[dua_frank] yeah fero
[lanny] tetralogy
[uniteus] MVP?
[dua_frank] yes uni and the other is that hypertrophic outlet of the aorta
[dua_frank] whats that called?
[dua_frank] all other conditions get better with valsalva lanny not squatting
[megs] HOCM???
[lanny] a fib is seen in M stenosis is it seen also in MVP?
[dua_frank] MVP gets bad with valsalva
[dua_frank] yes megs
[lanny] dua you aasked about squatting right?
[dua_frank] lanny i am not sure but yes they do have arrythmias sometimes, not sure exactly of what kind
[dua_frank] yes i did
[lanny] dont tetralogy pts squat to feel better?
[dua_frank] no
[dua_frank] you hear their murmurs better in squatting
[dua_frank] i think
[dua_frank] but anything that increases venous return should worsen tof
[dua_frank] right?
[megs] lanny u are right
[dua_frank] rx of MVP?
[lanny] sure mega
[lanny] dua is confusing
[fero] b blockers
[dua_frank] yes
[megs] if asymptomatic no treatment just reassure
[dua_frank] and rx for endocarditis
[megs] if palpitations..then b blockers
[dua_frank] these only in case of symptoms
[dua_frank] otherwise no treatment like megs said
[megs] MVP WITHOUT MR IS LOW RISK FOR IE..NO PHROPHYLAXIS
[megs] but mvp with mr needs prophylaxis
[lanny] true megs
[dua_frank] yeah so in an MVP where you hear the murmur
[dua_frank] give prophylaxis
[dua_frank] i thought i was clear
[dua_frank] MC cause of AS?
[uniteus] elderly clacification
[lanny] bicuspid valves
[megs] calcification
[dua_frank] yes uni
[lanny] calcify
[lanny] its actually calcification ona a bicuspid valve
[lanny] in elderly its clacif on a normal valve
[megs] lanny ..in young pt thats the common cause as u said
[lanny] yes generally
[megs] in olds...calcification of normal valve
[uniteus] what is AS classic presentation?
[lanny] yes megs
[dua_frank] syncope?
[fero] dysnea, syncope, angina
[dua_frank] no angina
[megs] SYNCOPE TRUE
[lanny] systolic eject muruur
[uniteus] rt fero...angina is also included
[megs] DUA ANGINA IS INCLUDED
[dua_frank] yeah but CP is most common
[dua_frank] among those symptoms
[megs] what about endocarditis prophylaxis in AS??
[dua_frank] yes megs
[uniteus] yes u give antibiotic
[megs] pt with AS must recive IE prophylaxis
[dua_frank] whats pulsus tardes et parvus?
[megs] seen in aortic stenosis dua
[dua_frank] yeah but what is it?
[fero] delay in fem pulses?
[dua_frank] dunno fero
[lanny] dua you mean where is it seen?
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[dua_frank] no
[dua_frank] i know its seen in AS
[lanny] pulse slow and faxt??
[dua_frank] i want to know what that sign means coz i don't know myself
[lanny] fast
[dua_frank] conditions causing split s2?
[lanny] could be short and long???
[uniteus] dictionary says pulsus tardus is an abnorm slwo pulse due to prolong of the systole
[megs] ok thanx uni
[dua_frank] thanks uni
[lanny] yea tardus is slow and parvus is fast?//
[uniteus] n pulsus parvus is slow pulse
[uniteus] :( dunno
[uniteus] anyone stil there?
[dua_frank] large septal q waves on ECG, no coronary cause, dx?
[lanny] what can cause the greatest reduction in incid of IHD
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[megs] CESSATION OF SMOKING LANNY
[fero] quit smok?
[lanny] right megs fero
[dua_frank] HOCP
[dua_frank] HOCM
[lanny] agree dua
[uniteus] cool dua
[uniteus] commonest cause of AR?
[dua_frank] RF
[lanny] rheum fever
[uniteus] rt dua n lanny
[megs] rh fever dua
[lanny] 2nd most common?
[fero] hypertension uni?
[uniteus] what murmur u hear?
[uniteus] commonest is RF for AR
[dua_frank] EDM
[megs] earlydiastolo
[samantha] AF murmur
[uniteus] what it means dua?
[lanny] 2nd MC is congenital
[dua_frank] early diastolic
[dua_frank] murmur
[lanny] whats EDM
[uniteus] oh..
[lanny] oh
[samantha] Austin Flint murmur
[uniteus] rtrt
[dua_frank] where does AS murmur radiate tO?
[uniteus] neck- carotid
[dua_frank] ESM due to MS
[lanny] carotids
[dua_frank] yes uni
[dua_frank] MR?
[uniteus] axilla radiation for MR
[dua_frank] yes uni
[dua_frank] how can you diff PS from AS?
[uniteus] what is water-hammer pulse?
[dua_frank] AR
[megs] water hammer in AR
[uniteus] rt...dua n megs
[uniteus] but what it means?
[megs] COLLAPSING PULSE IT IS
[uniteus] rt megs
[dua_frank] seen also in PDA
[uniteus] true dua
[uniteus] is dat y pda get wide pulse pressure? dunno plz tell
[dua_frank] PS murmur will not radiate to neck, loud at left sternal border and inc on inspiration
[samantha] PDA what murmur?
[dua_frank] yes uni
[uniteus] thx
[dua_frank] welcome
[lanny] machinery murmur
[dua_frank] its like a back leak too in diastole
[lanny] to and fro murmur
[uniteus] n PS is on left upper sternal while AS is on rt
[samantha] rt lanny
[dua_frank] yes
[uniteus] treatment of AR?
[fero] valve replacement
[lanny] positive ionotropes
[lanny] ACE inhib
[dua_frank] vasodialators
[lanny] pre load red
[dua_frank] endo prophylaxis
[dua_frank] or AVR
[uniteus] meds first = ACE I and vasodilators eg. hydralzine for AR then Surgery
[uniteus] when symptoms worsen or eje fraction decrease
[lanny] whats initila diag test in AS
[dua_frank] CXR?
[dua_frank] or EKC
[dua_frank] EKG
[lanny] echo dua
[samantha] transesophageal echo
[lanny] whats the best test in AS?
[dua_frank] that holds true to all val lesions
[lanny] yes
[dua_frank] ok
[dua_frank] best is cath?
[uniteus] echo
[lanny] trans esophageal echo is best
[lanny] sam youre right before but i asked initial test
[dua_frank] why not cath?
[lanny] invasive
[dua_frank] ok
[samantha] so xray is initial test rt lanny
[lanny] no trans thoracid echo is initial
[lanny] thoracic
[lanny] which is the usu regular echo we do
[samantha] ok
[lanny] trans esophageal is best you see behind heart
[uniteus] MVP is associated to what connective tissue dz?
[fero] marfans
[samantha] marphan
[megs] BUT HOW CAN U DIRECTLY SAY ECHO LANNY INITIAL TEST..I AGREE THAT THIS IS THE BEST TEST
[uniteus] rt fero, sammy
[megs] BUT X RAY AND EKG SHOULD BE INITIAL TESTS
[uniteus] agree to megs
[samantha] echo has replaced all others these days
[lanny] megs i assume you have done basics like EKG x ray... just wanted to highlight diff of trans thorax and trans esoph
[megs] ok thanx lanny
[lanny] sure with any chest pain or angina you do ekg and x rays
[lanny] sam is right too in many centers they go straitht for echo
[lanny] but for ausamle do the EKG X ray first of course
[lanny] USMLE
[megs] ok
[samantha] thx lanny
[lanny] welome sam
[dua_frank] how does chronic AR have low diastolic pressure?
[uniteus] because of the increase wide pulse pressure dua?
[dua_frank] close
[dua_frank] why does PP inc in AR?
[megs] due to both reasons...backward flow of bld and and vascular resistsnce also decrease
[dua_frank] good megs
[samantha] due to large stroke vol
[dua_frank] yes good sammy
[samantha] thx dua
[dua_frank] welcome
[dua_frank] you guys are good
[dua_frank] when is s3 and s4 seen in aortic lesions and why
[megs] s3 due to volume overload
[uniteus] n left vent dysfunction
[dua_frank] AS has s4 and Ar has s3
[megs] s4 when heart need to contracts against high pressure
[lanny] all valvular have S3 gallop though
[dua_frank] name three conditions which can present as deep q waves
[lanny] MI
[dua_frank] one
[uniteus] Transmural MI
[lanny] yes
[uniteus] HOCM
[megs] hocm
[dua_frank] two
[uniteus] any hint?
[dua_frank] AR is three
[uniteus] thx
[samantha] nice q dua
[dua_frank] thanks
[dua_frank] which MI can present as ST depression?
[megs] INITIAL CHANGES DUA...CAN show st depression in mi??
[uniteus] ah..st depression occurs in MI that is opposite the affected area....while the affected will have the st elevation...
[megs] IMEAN SUBENDOCARDIAL INFARCT
[dua_frank] post wall MI guys
[dua_frank] uni you were close
[uniteus] :(
[dua_frank] megs initial presentation is peaked t wave i think
[uniteus] agree dua
[dua_frank] and then you have st depression conversion to elevation
[dua_frank] its called as hyperacute MI
[megs] I THOUT ISCHEMIA OF SUBENDOCARDIUN CAUSES ST DEPRESSION...SO :(
[dua_frank] awww megs :(
[dua_frank] the only difference is no q waves in subendocardial MI megs
[dua_frank] the rest of the picture is same as transmural
[dua_frank] what does giving amyl nitrate do to murmurs of AS, MS and AR (austin flint)
[megs] OK...BUT I HAVE read somewhere that if its onset of ischemia we may see st depression ...
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[dua_frank] yeah but not infarcts megs
[dua_frank] ischemia, sure you will have st depression
[megs] ok dua u r right
[megs] its ischemia not infarct
[dua_frank] right
[dua_frank] only kind of ischemia that can present as ST elevation? :)
[samantha] prinzmetal dua
[dua_frank] good sammy
[fero] unstable
[dua_frank] amyl nitrate is a vasodialator
[dua_frank] so AR murmur that is austin flint will decrease
[dua_frank] MS remains unchanged
[dua_frank] AS murmur will inc
[dua_frank] any confusion? *)
[dua_frank] MS might remain unchanged or inc
[dua_frank] we know vasodilators are bad for stenotic lesions
[dua_frank] so they will inc murmur
[dua_frank] why is everybody so quiet? :(
[samantha] ok dua
[uniteus] its cardiology :gun :( dua
[dua_frank] awwwww
[samantha] :?
[dua_frank] lanny i still think you need to do cath in AS
[dua_frank] or any valvular lesion for that matter
[fero] dua regarding , that pulsus parvus et tardus, i came accross,,its weak delayed caraotid upstroke wat ever that is
[dua_frank] as best test
[dua_frank] thanks fero
[lanny] dua what was the q?
[dua_frank] lol lanny
[dua_frank] like i would remember now :P
[megs] *evil*
[fero] i hate cardio...
[lanny] whats that sound?
[uniteus] do it again
[uniteus] plx
[dua_frank] evil megs laughing
[megs] its evil cardio lanny *evil*
[dua_frank] lol
[uniteus] oh ...:)
[lanny] lol
[uniteus] :)
[megs] dua..not me
[megs] its cardio
[lanny] it looks like we all hate cardio!!!
[uniteus] i strongly believe so megs
[uniteus] what should we do??
[dua_frank] do we have a choice here uni? :( we still got to study it
[fero] wat i paln to do is i will do rheuma tonight and again will have full day for cardio tomorrow
[lanny] yep
[megs] agree fero
[uniteus] ok...
[lanny] why dont we come bk refreshed tom and do the arrythmias
[lanny] and cont cardio
[fero] agree lanny
[lanny] dua whats your thinking
[lanny] guys cardio is imp!!!!
[dua_frank] forget rheuma
[dua_frank] we covered enough in peds for that
[lanny] we have 15 more mins guys WAKE UP !!!
[dua_frank] do we give dig in all valves?
[lanny] no
[dua_frank] explain lanny
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[lanny] im explaining dua
[lanny] cause more contract will cause more obstruct
[dua_frank] ok
[dua_frank] i learnt that you have to give dig in all
[megs] in case of acute MI..which is to be done first..trombolytics or PTCA???
[lanny] no dua in MS and AS they dont work
[lanny] can give in reg valves
[dua_frank] thrombolytics
[uniteus] thrombo
[megs] WHY NOT PTCA???
[dua_frank] MS and AS are most prone to AF, so dig should work best in them
[dua_frank] invasive? mortality risk
[dua_frank] dunno
[megs] THEY SAY THAT IF NO CAONTAINDICATION FOR THROMBOLYTICS..THEN THROMBO FIRST
[megs] if thrombolytics contraindicated then PTCA FIRST]]
[fero] agree megs
[megs] which one has best prognosis???
[lanny] dua in MS wont you want to keep blood in the vent to perfuse the heart?
[dua_frank] PTCA
[samantha] to prevent muscle damage thrombo is the earliest
[dua_frank] yeah but dig controls AF
[samantha] PTCA takes time
[dua_frank] and AF is more dangerous
[megs] PTCA..has better prognosis over thrombolytics
[lanny] if you give dig you are inc contractility and greater blood will leave the heart and due to the stenosis blood will not be in the vent for next systole
[megs] do we do cardiac enzymes in angina???
[dua_frank] no megs
[uniteus] in unstable yes
[megs] yeah uni
[dua_frank] why?
[uniteus] to diff from MI
[dua_frank] ahhhhhhhhhh :P tricky :P
[megs] GOOD UNI
[lanny] dua i will read this pt but that was what i thought i learnt about the stenotic lesions and digoxin
[dua_frank] ok lanny, so will i
[uniteus] :)
[dua_frank] we'll get back on this topic again tomorrow
[lanny] your argument is valid though
[dua_frank] MC cause of heart transplantS?
[lanny] but i like when we disagree makes me chk it immed and remember whose right lol
[lanny] congenital
[lanny] rhabdo
[lanny] myoma
[lanny] atrial myxoma
[dua_frank] congestive or dilated CMP
[megs] ok dua
[dua_frank] MC cause of dialated CMP?
[fero] idiopathic, alchol
[uniteus] alcohol
[dua_frank] idiopathic
[dua_frank] alcohol second
[samantha] idiopathic
[samantha] heart transplant is cardiomyopathy?
[samantha] ok got it
[fero] ok guys.. longgggg 2 hrs for me,,lol got to go
[fero] thx everyone bye
[dua_frank] i think cardio will go slow
[dua_frank] theres just too much of it
[megs] ok guys i am too leaving...
[megs] bye all
[uniteus] ok..bye all
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[uniteus] thx
[dua_frank] bye
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[samantha] bye bye then
[lanny] ok dua
[lanny] bye sam
[samantha] bye lanny and dua
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