View Full Version : Int Med chat: Preventive and Emergency Medicine

03-12-2005, 08:18 PM
dua_frank has joined the chat.
[twinpythons20] some1 whould tell me if i should start studying for the usmle's during medschool or should i wait until after the 4th semester
[twinpythons20] ?
[bantik] Hi guys.
[bantik] I am here for 6 pm chat, Am I in right place?
[mantos] hi all
[mantos] ? anybody here
[mantos] *)
[kaash110zeh] hi
[hoor] hai kassh ka exam pass ho jaya
[aprilmoe] hi
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[dua_frank] hi fero :)
[fero] hi dua
[fero] how r u?
[dua_frank] fero you urdu speaking?
[dua_frank] i'm fine, thanks. how are you?
[fero] ya,,,U?
[dua_frank] me too
[dua_frank] pak or india?
[fero] from where r u?
[fero] pak
[dua_frank] india
[dua_frank] :)
[fero] have been to india once
[fero] loved it
[dua_frank] i have yet to go visit pak, my in laws from there
[fero] o really
[wakejefe] likewise, I have been to india
[fero] which part?
[dua_frank] yeah
[dua_frank] peshawar
[fero] wat
[fero] hahaha
[dua_frank] hi wake, you from pak too?
[fero] i am from peshawar
[wakejefe] Mumbai, Pune, J&K
[dua_frank] no way!!! wow
[fero] yesss
[wakejefe] agra
[fero] am pathan
[dua_frank] nice
[wakejefe] jaipur
[dua_frank] wow nice wakejefe, nice to meet you
[wakejefe] i am not from pak or india
[fero] ,,,got a call
[dua_frank] then where are you from?
[fero] on phone..
[wakejefe] US
[dua_frank] ok fero
[wakejefe] nice to meet you as well
[dua_frank] you mean you're a total american american?
[wakejefe] indeed
[wakejefe] certainly stuck out on the subcontinent
[dua_frank] well all american are immigrants anyway :P so where are your ancestors from :P
[wakejefe] HA
[wakejefe] well said
[wakejefe] poland and norway
[dua_frank] niceeee
[samantha] hi guys will join u soon
[megs] hi hi sammy
[wakejefe] the trip was top shelf except for the constant eating of cipro
[erum] hi
[dua_frank] my husband is a total mutt, got native indian, german, india, pak all kinds of genes
[dua_frank] ok sammy
[wakejefe] the heterozygous advantage
[dua_frank] oh yeah, hybrids are always healthy creatures
[dua_frank] lol
erum has joined subroom: USMLE_Step_3
[dua_frank] megs can we start now?
[megs] yeah dua
[dua_frank] whats the subject for today?
[megs] dua emergy and preventive med
[dua_frank] oh ok
[wakejefe] sounds like a hoot....nice to meet you
[wakejefe] take care
[fero] sorry dua was on phone
[dua_frank] no problem fero, welcome back
[dua_frank] give me 5 minutes, guys, be right back. please start though
wakejefe has left the chat.
[megs] sudden hypotension tachycardia after bee sting?dx??
[fero] anayphylasis
[megs] anaphylaxis shock..yeah
[megs] what will be u r next step??/
[fero] epi
[fero] ?
[megs] and corticosteroids too
[fero] ok megs
[megs] man with acute MI WHAT WILL BE NEXT STEP?
[fero] ask for help? after checking counciousness
[megs] OK FERO
[megs] WHAT NEXT
[fero] if not in hosp settings
[dua_frank] sublingual nitrates?
[dua_frank] depends on where the patient is yeah
[uniteus] hi everyone
[fero] hi uni
[megs] WE ARE TALKING about emergency management dua
[megs] hi uni
[dua_frank] oh yeah
[megs] first step in emergency is establish airway
[megs] then breathing...
[megs] you will look for which pulse in such situation???
[fero] carotids
[megs] carotid...yup fero
[dua_frank] hi uni
[megs] man with asystole how will you proceed???
[dua_frank] epi atro
[dua_frank] PM
[uniteus] epine
[megs] yeah which route???
[uniteus] ET
[dua_frank] IV
[megs] got it uni can you tell why
[dua_frank] ET if IV does not work
[dua_frank] shortest route to heart
[uniteus] shorter route to heart..easily absorbed there in lungs
[megs] good dua as u establish airway first...intubation is already there so can give IT epi without delay
[megs] what is the rate of cpr???
[dua_frank] in reality we would never do that ofcourse :P
[fero] 15: 2
[dua_frank] stupid boards :P
[megs] how many compressions and ventilation cycle??/
[uniteus] 15:2 for 1 person n 4 cycles in 1 min
[fero] 15 compp 2 vent
[uniteus] agree dua
[megs] yup
[uniteus] cant we just shocked them all :)
[dua_frank] uni i'm with you on that one lol
[uniteus] lol
[megs] a person with ventricular fibrillation,defibrillator not available which drug will you use???
[dua_frank] lidocaine
[uniteus] epine
[fero] amoidarone?
[megs] good dua fero
[uniteus] no epine megs?
[megs] epinephrine does not work as defibrillator uni
[uniteus] oh..ok..thx
[megs] it is used in conjuction of defibrillation
[megs] what is precordial thump???
[dua_frank] small shock
[dua_frank] good when no defib around
[uniteus] using ur hand..
[dua_frank] just once though, don't beat your patient too much :(
[uniteus] used on witnessing the pt become unresp
[megs] means uni can u explain
[megs] how it works???
[dua_frank] its like a 10-20j shock
[dua_frank] stops the heart enough to fall back into its normal rythm
[megs] yeah dua
[uniteus] if u witnessed the pt as beginning to vf n no defib available ...u do hit on his sternum as small shock but only once ..then do CPR till Defri is available
[megs] ok
[uniteus] torsades de pointes, tx?
[dua_frank] whats ransons criteria?
[fero] Mg
[uniteus] rt fero
[uniteus] ransons is the one for acute pancreatitis - determines its prognosis
[dua_frank] good megs
[fero] DUA UNI ans
[fero] LOL
[uniteus] :)
[dua_frank] what kind of diet will you advise a person with chr. pancreatitis?
[megs] ????
[dua_frank] oops sorry, uni, very good *)
[uniteus] if torsades de pointes not treated what pt is prone too? complication?
[dua_frank] dunno, what uni?
[uniteus] ok dua
[megs] arrymias lifelong dua
[uniteus] VF so dat is y u tx early with Mg and of course stop the offending drugs...
[dua_frank] oh
[dua_frank] its high carb and proteins and low fat diet
[megs] what will you use for long term therapy for torsades??/
[dua_frank] how does secretin test differentiate ZES from benign disease?
[dua_frank] amiodarone?
[megs] its b blocker dua
[uniteus] bbloker
[dua_frank] oh
[fero] gastrin levels r v high
[megs] agree fero
[uniteus] ZES usually has multiple ulcers...or recurrent..despite tx
[dua_frank] yes
[megs] why we are doing pancreatitis today?
[dua_frank] whats the best test for malabsorption?
[uniteus] PAS ?
[dua_frank] its emergency med megs
[dua_frank] isn't it?
[fero] d xylose test?
[dua_frank] yes fero
[dua_frank] i'll ask cardio if you want
[fero] any questions r welcome dua megs
[uniteus] no dua please
[uniteus] :) joke
[megs] no prb guys
[dua_frank] more subjects we pick here the more diverse our study becomes
[megs] true dua
[dua_frank] i mean if each one of us took a system for emergency med and did it that way, it will give us a good variability
[fero] in which overdose, ( its an exception), we can do lavage even after 1 hr
[uniteus] oh..ok..
[dua_frank] no use being good in cardio and we get only hemato questions. thats my nightmare *)
[megs] barbiturate fero?
[fero] mine is the other way round dua
[fero] lol
[uniteus] lol
[fero] dont know barb,,megs,,its Tricyclics
[dua_frank] all sedatives i think
[fero] due to its anti cholinergic effects
[uniteus] unconscious pt ..no hx of trauma, what drugs u give 3?
[megs] thanx fero..i remember now its tca
[fero] thiamine, nalazone
[dua_frank] oh
[dua_frank] thanks
[uniteus] n?
[dua_frank] gluose
[fero] forgot
[fero] o yes
[megs] glucose iv
[uniteus] rt all
[dua_frank] o yes
[megs] or orally :)
[fero] lol
[dua_frank] lol
[dua_frank] when is shilling test used?
[uniteus] Vit b12 vs folate def
[dua_frank] vit b12 and malabsorption
[fero] to rule out diff causes of perni anemia
[megs] what is schilling test?
[fero] intrinsic factor, B12, folate
[dua_frank] its when you give radiolabelled cobalamine i think megs
[dua_frank] orally and then iv also
[uniteus] what is the main symptom difference between 2 n 3 degree burns?
[dua_frank] orally to see if it gets into your blood
[dua_frank] if it doesn't then you have some kind of malabsorption
[fero] full thinkness, burnt area looks white
[dua_frank] pain
[megs] in third degree nerve damage
[fero] agree
[dua_frank] percentage?
[megs] so no pain
[uniteus] didnt know dat dua....always thought it is for vit b12..thx dua
[uniteus] rt dua n megs..i asked for symptom not sign
[fero] :(
[fero] ok
[uniteus] how to assess the burn?
[dua_frank] awww fero
[dua_frank] percentage of burns?
[megs] rule of 9
[uniteus] what u measure roughy dat is?
[dua_frank] area?
[uniteus] rt dua n megs
[fero] % area
[dua_frank] how does one exactly measure that?
[dua_frank] i forgot
[uniteus] body surface area based on rule of 9 is the ans
[dua_frank] size of one palm is 1% right?
[uniteus] rt
[dua_frank] thanks
[dua_frank] whats rule of 9 then?
[megs] ok
[uniteus] most is 9% except like chest chest n back double each
[fero] head> 2 nines adults, 3 9 kids
[fero] rt uni..
[dua_frank] oh ok
[uniteus] n little area becomes 1% like genitalia n hand...
megs has left the chat.
[uniteus] what infection is burnt prone too what organism commonly?
[uniteus] wb megs
[fero] psudo monas arig?
[samantha] pseudomonas
[uniteus] rt fero n sammy
[uniteus] so what u monitor burnt pt to know being hydrated properly?
[dua_frank] urine output?
[fero] urinary ouput
[uniteus] rt dua, fero
[uniteus] n what is it? the rate then?
[dua_frank] forgot :)
[dua_frank] 800 ml per 12 hours? :)
[uniteus] 0.5 to 1 ml/kg/hr urine output
[dua_frank] guess :P
[uniteus] :)
megs has left the chat.
[uniteus] maybe u rt dua..but dunno the calculations lol
[dua_frank] so 50 kg man is like 50 ml/hr :)
[dua_frank] that makes it 600ml/12 hrs :)
[dua_frank] i was close :P
[uniteus] ok..cool
[dua_frank] not if it was a 300 lb man though lol
[uniteus] oh no
[uniteus] :)
[dua_frank] which conditions inc the folic acid requirements of the body/
[dua_frank] ?
[fero] pregnancy esp if its multiple
[fero] lol
[dua_frank] right
[uniteus] scd
[dua_frank] also hemolytic anemias as well as psoriasis
[fero] didnt know that,thx dua
[uniteus] y psoriasis dua?dunno
[dua_frank] it just is, dunno why
[uniteus] ok..
[dua_frank] other skin diseases too
[dua_frank] how will you diff b12 from folate def lab wise? what test?
[fero] MMACID IN URINE IN b 12 def
[fero] methyl malonic acid
[dua_frank] yeah
[dua_frank] test is histidine loading test
[dua_frank] normal in b12
[dua_frank] anyone knows how to read that test?
[samantha] no dua
[dua_frank] me neither
[dua_frank] ok tell me where the defect is
[megs] guys i am kicked out so badly..it was not allowing me to re enter
[dua_frank] i give a shot of vit 12 to saturate the receptors with b 12
[dua_frank] wb megs
[dua_frank] oh no
[samantha] wb megs
[uniteus] wb megs
erum has left the chat.
[megs] alright
[samantha] ok
[dua_frank] and then i give radiolabelled vit b12 and i see it in urine, what's the defect?
[uniteus] at the receptor?
[dua_frank] it's normal test silly, means you are just not taking enough b 12 :p
[megs] its just rule out pernicious anemia
[dua_frank] ok if i don't see it in urine, i give IF too and then i see urine and i find it, whats the disease?
[uniteus] vit b12def
[megs] perniceous anemia
[dua_frank] right megs
[dua_frank] ok i still don't see it so i give pancreatic enzymes and then i see it in urine, dx?
[samantha] intrinsic factor def
[dua_frank] pancreatic enzyme deficiency
[dua_frank] ok i give all and i still don't see it in urine
[dua_frank] what now?
[dua_frank] this is malabsorption, something wrong with the lining
[samantha] yes dua
[uniteus] cool...nice q dua thx
[dua_frank] welcome
[dua_frank] thats shilling test all of it
[dua_frank] helps us differentiate conditions
[megs] thanx dua
[dua_frank] atrophic gastritis, folate or b12?
[dua_frank] b12
[megs] b12
[dua_frank] also neuro
[dua_frank] good megs
[dua_frank] what drugs can cause folate def?
[megs] mtx
[uniteus] tmp-smx
[megs] sulfa
[dua_frank] yes also methotrexate and phenytoin
[dua_frank] bite cells in?
[megs] how does th carbon monaxide poisoning causes inhibition of ETC??
[dua_frank] blocks enzyme
[samantha] thalasemia
[megs] bite cells..g6pd def
[dua_frank] yes megs
[megs] they are splenic sequestreted cells
[samantha] ITP
[samantha] yes megs
[megs] which enzyme dua
[dua_frank] some enzyme :P number 2 :P
[dua_frank] cqp blah blah :P
[uniteus] :)
[samantha] forgot step 1
[megs] remember just cytochrome oxidase
wakejefe has left the chat.
[dua_frank] ok thanks
[megs] now a days these board guys are asking some step 2material on step1 and spe1 material in step2
[dua_frank] how will you differentiate iv hemolysis from extravascular?
[dua_frank] i know megs, thats just too much, i don't want step 1 biochem again :(
[megs] se heptaglobin levels
[samantha] so CO blocks cytochrome oxidase rt
[dua_frank] explain please megs
[samantha] haptoglobin will be low in intravascular hemolysis
[dua_frank] oh
[dua_frank] thanks
[megs] intravascular h rrage breakdown of hb= heptaglobin realesd
[dua_frank] coz haptoglobin is intravascular ?
[dua_frank] then they should be high
[dua_frank] right
[megs] but is reutilised
[samantha] because it is used up in hemolysis
[dua_frank] oh
[megs] sl low
[dua_frank] got it thanks
[megs] reutilized hense low levels
[dua_frank] but they are high in EV?
[dua_frank] or normal?
[megs] high
[dua_frank] why?
[megs] as the rbcs lysis in speen
[megs] it is not reabsorbed...
[dua_frank] oh
[dua_frank] thanks
[dua_frank] which coombs test do you use to detect ABO and Rh incompatibiltiy?
[dua_frank] direct or indirect?
[megs] direct in baby
[megs] indirect in mother
[dua_frank] right megs
[dua_frank] and ABO?
[samantha] because there is hemolysis in the mother
[megs] abo i think direct..not sure as antibodies r complete
[dua_frank] abo indirect
[dua_frank] the rbcs are destroyed
[megs] why dua
[dua_frank] you can work only with the serum
[dua_frank] they get attacked and lysed
[dua_frank] you have already finished giving transfusion
[dua_frank] so you have only receipients serum to work with now
[dua_frank] so indirect coombs test
[megs] didnt get u dua
[dua_frank] this is blood transfusion i was talking about megs
[megs] oh ok
[dua_frank] tell me type of AML
[dua_frank] DIC?
[dua_frank] M3
[dua_frank] megakaryocytic?
[uniteus] cml
[dua_frank] M7
[megs] m7
[dua_frank] AML types uni
[dua_frank] yes megs
[uniteus] oh :(
[dua_frank] invades skin, gingiva and CNS
[uniteus] m5
[megs] m5
[uniteus] m4 has more CNS
[dua_frank] M4 yes uni
[dua_frank] auer rods
[uniteus] m3
[dua_frank] M2
[dua_frank] erythroleukemic
[dua_frank] M6
[megs] m6
[dua_frank] so why are there any CNS symptoms when they invade and how do you treat it?
[uniteus] dunno dua
[dua_frank] coz of sludging of wbcs
[dua_frank] so you have to do lecophoresis
[dua_frank] take them out of the blood
[dua_frank] too many wbcs
[dua_frank] which is calla postive?
[uniteus] oh thx dua
[megs] all
[dua_frank] welcome
[megs] ALL
[dua_frank] yes megs
[uniteus] all
[dua_frank] which one is myeloperoxidase positive?
[uniteus] aml
[dua_frank] yes
[megs] aml
[dua_frank] give me the surface markers of aml and all
[megs] all calla antigen
[megs] aml dunno
[dua_frank] yes also cd 19(B) and cd 5(T)
[dua_frank] CD 13 and 33 for aml but not very imp
[dua_frank] just remember myeloperoxidase for aml and calla for all
[megs] ok thanx dua
[dua_frank] cns prophylaxis by?
[uniteus] thx
[dua_frank] welcome
[uniteus] arabinosde????
[uniteus] methotrexate?
[dua_frank] RT or intrathecal methotrexate
[samantha] intrathecal metho
[megs] it mtx
[dua_frank] yes good
[dua_frank] cns prophylaxis does not help for aml though
[dua_frank] only for all
[uniteus] what u find in CSF for SAH?
[samantha] blood
[dua_frank] blood
[megs] rbcs
[megs] prt
[uniteus] rt
[uniteus] what is xanthochromia?
[samantha] what cells are characteristic of CML?
[dua_frank] yellow csf
[megs] smudge cell
[samantha] yes megs
[uniteus] rt dua due to breakdown of rbc
[megs] its for cll
[megs] not for CML
[uniteus] agree megs
[uniteus] increase platelets, basophilia n increase wbd
[samantha] rt megs it is for CLL
[uniteus] wbc
[dua_frank] when does CML change to AML?
[dua_frank] good
[dua_frank] rx?
[megs] LIHE AML
[dua_frank] yes
[uniteus] lihe? what is it?
[dua_frank] ok
[megs] LIKE UNI
[dua_frank] lol
[uniteus] oh :oops:
[dua_frank] what is stress erythrocytosis?
[uniteus] ct
[fero] ct without contrast
[dua_frank] ct
[uniteus] without contrast
[samantha] CT
[dua_frank] it is megs?
[megs] DUNNO?
[dua_frank] oh
[dua_frank] its due to diuretics
[dua_frank] dec plasma valume
[dua_frank] looks like erythrocytosis
[dua_frank] yeah
[dua_frank] yes it is
[dua_frank] i mean yes they are
[dua_frank] infections in MM?
[dua_frank] and why
[uniteus] pt with urticaria, low bp, tachycardi,resp distress wid hx of eating chocolate, dx n tx?
[dua_frank] yes megs
[dua_frank] anaphylaxis?
[uniteus] encapusulae lke heamo, strep
[samantha] ppneumo and hemo
[dua_frank] yes good megs
[dua_frank] no complement either
[uniteus] rt dua..tx?
[dua_frank] epi
[uniteus] rt
[dua_frank] what do mm patients die of?
[uniteus] if pt is hemody stable what u give?
[dua_frank] dunno
[dua_frank] right megs
[dua_frank] how will you differentiate MM from MGUS?
[uniteus] renal failure
[uniteus] rt megs
[samantha] no symptoms in MGUS
[uniteus] but has increase protein
[dua_frank] yeah
[samantha] only immunogloblin spike
[uniteus] everything else N for mgus
[dua_frank] no bence jones
[dua_frank] less than 3 gm M spike
[dua_frank] when does lympedenopathy in hodgins become painful?
[dua_frank] nimodipine
[uniteus] infected
[dua_frank] alcohol ingestion
[dua_frank] rare though
[uniteus] clip d aneurysm
[megs] YUP
[samantha] treat the cause
[dua_frank] when do you start chemo in HL?
[uniteus] stage 3, 4 or wit b sym
[dua_frank] yes
[samantha] stage 3 and 4 and B symp
[dua_frank] whats the etio of NHL?
[megs] EB VIRUS
[dua_frank] and?
[uniteus] hiv
[dua_frank] yes
[dua_frank] and genetic
[dua_frank] what are downy typ2 cells?
[dua_frank] aren't they atypical cells in EBV?
[dua_frank] the atypical t cells against b cells
[uniteus] pt having surgery developed muscle rigidity, dx? tx?
[dua_frank] dunno uni
samantha has left the chat.
[uniteus] having anaesthesia halothane...dx , tx?
[fero] malignant hyper, dantrollent
[megs] AGREE
[uniteus] rt fero
[dua_frank] ah
[dua_frank] anesthetic megs
[dua_frank] meds
[fero] dantrolene
[uniteus] plus stop the halothane or any offending drugs
[dua_frank] nice q uni
[uniteus] thx
[dua_frank] how will you differentiate HL from NHL clinically?
[samantha] Tests specific to PNH?
[fero] erethism?
[dua_frank] yes
[uniteus] HL less extralymp, n more common ln on cervical
[samantha] no reid sternberg cells in NHL
[dua_frank] no systemic complaints either
[uniteus] ham test sammy
[samantha] rt megs and uni
[dua_frank] involvement of waldeyers ring too
[dua_frank] whats ham test and sugar water test, please elaborate
[uniteus] pt just having surgery develops very high temp, dx n tx?
[samantha] for Paroxysmal nocternal hemo dua
[dua_frank] brom dantroline
[dua_frank] neurolept malignant syng
[dua_frank] oh thants megs and sammy
[uniteus] rt dua for tx n megs for dx
[dua_frank] malignant hyperthermia sorry
[dua_frank] not neurolept
[dua_frank] thats by antipsychotics
[dua_frank] but almost same presentation with high fever
[dua_frank] this one is by halothane
[uniteus] remember ...neurolep malig syn is muscle rigidity while malig hyperthermia is temp
[megs] YEAH UNI
[dua_frank] thanks uni
[dua_frank] needed to get that cleared in my head
[uniteus] both caused by anaesthetics..but succin is cause of MT too
[dua_frank] no fever in neurolept
[dua_frank] yep yep
[uniteus] urw
[dua_frank] antipschotics too for neuroplet right?
[uniteus] rt dua
[dua_frank] thanks
[megs] HOW WILL u calculate % in patchy burns???
[uniteus] parkland formula
[megs] i said patchy uni...
[dua_frank] elaborate :P
[uniteus] oops
[megs] PATCH
[uniteus] add dem up..by using ur hand?????
[megs] YEAH UNI RT
[uniteus] lol..n i was just guessing
[uniteus] :)
[dua_frank] i wish i had that guessing power :(
[uniteus] aww dua..u do have it..its the reflex u told me earlier
[dua_frank] yeah :D
[dua_frank] :)
[samantha] nice q megs
[megs] IN BURNS
[dua_frank] my reflexes are weak though :P
[dua_frank] the burnt tissue megs
[dua_frank] which tumor doubles in time?
[dua_frank] 24 hrs
[fero] denervated burnt
[dua_frank] edema damages nerves
[dua_frank] so cut through to relieve pressure
[megs] ok
[uniteus] compartment syndrome
[samantha] to prevent limb compromise
[dua_frank] its burkitts lymphoma
[samantha] to inc blood supply
[megs] really dua
[megs] doesnt know that
[megs] thanx
[dua_frank] welcome
[dua_frank] yeah also to relieve pressuer on bld vessles
[uniteus] so escherectomy is for relieve for both nerve n vascular compromise right???
[dua_frank] yes
[fero] continue ,,guys, gtg, thx everyone
[uniteus] thnx
[uniteus] bye fero
[dua_frank] welcome fero
[dua_frank] take care, bye
[fero] bye
fero has left the chat.
[uniteus] i got to go too....
[uniteus] bye
[dua_frank] bye uni
[uniteus] thx
[dua_frank] shall we call it a day to megs or continue?
uniteus has left the chat.
[megs] as u say dua
[samantha] i have to go too
[dua_frank] ok sammy bye
[samantha] bye dua and megs
[dua_frank] lets stop for today megs, everybody's gone
[megs] ok then dua we wil also
[megs] go
[megs] ok
samantha has left the chat.
[dua_frank] see you tomorrow and i'll write to you about cs exam date in a couple of days
[megs] bye
[dua_frank] bye

04-02-2005, 05:48 PM
hi guys

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