View Full Version : Int Med Chat: Pulmonology + Hepatology

04-04-2005, 08:32 PM
dua_frank has joined the chat.
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[sanz] hey dua :)
[dua_frank] hey sanz!
[sanz] how is it going?
[dua_frank] how are you? nice to see you again
[sanz] yeah, got back homet his morning
[sanz] been a lovely 3.5 weeks away!
[dua_frank] like you can see, i'm the only one whos on chat at 6 pm :an
[dua_frank] great
[sanz] how's yr revision?
[sanz] i thought you start at 7?
[dua_frank] i'm getting scores on q banks between 60-65%
[dua_frank] and not improving
[sanz] good for you!!!
[sanz] well, dont worry abt it...
[sanz] that score is great
[dua_frank] really?
[sanz] yup
[nasrin06] hi dua
[sanz] i think i ended up with 65% in the end
[dua_frank] hi nasrin
[nasrin06] i want to joint your group please
[dua_frank] nasrin welcome
[lanny] hi all
[dua_frank] lanny hi, sanz got a 99%!!
[lorena] hello
[lanny] wow
lanny] congrats sanz!!!!!
[nasrin06] ok im in atlanta every doy in this hour?
[lanny] thats great
[dua_frank] yes nasrin at this time everyday
[lorena] congratulations sanz!!! thats an amazing score
[samantha] hi guys
[sanz] just know those concepts... you're doing well getting 65%
[lanny] hi sammy
[nasrin06] congrat sans
[dua_frank] hey sammy
[dua_frank] any more advise?
[samantha] sanz tell me the good news
[dua_frank] i really feel like i need to improve sanz
[dua_frank] harder :O
[dua_frank] omg :(
[sanz] i think we all do
[samantha] hi lanny dua
[dua_frank] she got a 99 sammy
[sanz] well, i felt it was harder maybe cuz i was under pressure...
[lanny] hi
[dua_frank] true
[samantha] wow!!!! wonderful
[lanny] dua youre next with a 100!!!
[dua_frank] you must have been so happy when you got the news :)
[samantha] congratulations !!! sanz great job
[sanz] there are just so many qs with 2 options left and i didnt know what to pick... whereas in UW i wont care what i picked cuz i know it's just practise
[dua_frank] you lanny
[sanz] hey if you have any qs, i'll be happy to ans them if i can, any time
[dua_frank] i don't even answer half as much as you guys here
[lanny] he he he dunno about that
[dua_frank] i just ask a lot of qs *)
[megs] hey sanz
[sanz] no no... i wouldnt be a good surgeon, i'm too fickled minded
[dua_frank] thanks a lot sanz
[megs] great to see u
[dua_frank] so keep in touch via emails please
[dua_frank] no not yet
[lanny] looks like sanz is celebrating...
[sanz] sure... any time
[sanz] hey megs
[sanz] dua!!
[megs] what up sanz??
[lanny] hey sanz congrats a milllion
[megs] congrats sanz
[lanny] i feel like guving you a hug
[dua_frank] me too :)
[sanz] megs, i'm good
[samantha] you must really good
[megs] whats the score dear??
[dua_frank] lets all group hug for sanz :) *hug*
[lanny] :)
[dua_frank] she got a 99 megs
[sanz] *hugs* to you all too
[samantha] :cl
[lanny] nice sanz im so happy for you we talked about you yesterday
[megs] thats amazing
[sanz] i couldnt have done it without your support
[megs] lol...congrats dear
[megs] lol
[lanny] oh thankyou sanz
[dua_frank] we learnt a lot from you and strug too, please do come and help us out as often as you can
[lanny] you were great and inspiring
[megs] what about strug??
[dua_frank] absolutely
[sanz] you guys are gonna do well too at this rate... i saw you've all been chatting everyday :)
[megs] you girls are amazing
[sanz] megs i dont know... she's on holidays too i think
[lanny] yes sanz
[dua_frank] sanz did group studying here help you?
[megs] really sanz did great job
[sanz] dua, yes... i makes me look up things i'm not good at
[dua_frank] great
[dua_frank] just so we know what we are doing is worth the effort
[sanz] after discussion with you, i would go back to speed read some of the weak areas...
[lanny] so sanz hope we will meet again for step 3...
[sanz] hehe lanny, i dont know if i will do step 3 yet... CS first in May
[dua_frank] oh ok
[sanz] but sure, if we have a step 3 chat i'll be there!
[megs] sanz what was your usmle cumulative score??
[lanny] oh you still have CS ok youle do fine..
[sanz] megs, UW?
[sanz] i think 65%
[megs] usmleworld i mean
[lanny] ok dua can we start
[megs] thanx sanz
[dua_frank] sure lanny
[megs] we are so happy
[megs] once again congrats
[dua_frank] oh ok
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[megs] ok guys we can start
[sanz] thnx guys and good luck :)
[lanny] whats the complication of CF
[megs] bronchiectesis
[lanny] right
[megs] what is meconium ilius and what is meconium plug syndrome..???
[lanny] pneumothx too
[megs] whats the diff betn these two??
[lorena] sorry to interrupt guys, what is the topic you are discussing today?
[dua_frank] yeah take your time to enjoy the 99
[lanny] Mplug sd has hx of constipation
[dua_frank] pulmonology lorena
[lorena] thank you dua
[samantha] sanz one doubt
[dua_frank] you'll find the schedule listed in the chat forum for every day
[sanz] sure sam... ?
[dua_frank] welcome
[dua_frank] :)
[lorena] great, and now i know the time too. See you tomorrow .bye
[samantha] while doing UW did you find it difficult
[dua_frank] bye
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[lanny] megs tell us the diff
[sanz] sam, yes i thought the UW qs are picky but they are there for a reason... just try to understand the concept rather than memorising
[samantha] it is silly but it seems like a mountain sometimes
[megs] lanny one has association with CF and other has just failure to pass meconeum
[dua_frank] so plug has no CF
[sanz] kap qbank qs are less picky... but i learnt less fr them even tho i got a higher overall score in kap qbank...
[dua_frank] but meconeum ilius always has CF association?
[samantha] it is better to time it and do or just understand it?
[megs] yes..dua
[dua_frank] thanks
[samantha] thanks sanz
[megs] but meconeum plug is not always associated WITH CF
[dua_frank] ok
[sanz] time it and do definitely, sam!!! Then go back and take yr time understanding it. I do a timed block of 46 qs, then spend 2-3 hrs understanding all the qs...
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[megs] SANZ how many q u did daily??
[sanz] 3 blocks a day megs
[megs] u mean above 100 q daily sanz?
[sanz] i didnt have much time cuz i was aiming to finish everything in 3 months so that i can go on holidays...
[dua_frank] for two months?
[sanz] 46 q x 3 each day
[dua_frank] wow thats a lot, i'm doing like only one block per day right now
[megs] oh that was really
[megs] fast
[sanz] dua but i dont do anything else.. i dont listen to kap lectures or other lectures
[dua_frank] how many are you doing every day megs?
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[megs] one block each day
[dua_frank] me too
[dua_frank] you did that for 3 months sanz?
[sanz] everyone has differnt ways of studying i guess...
[dua_frank] wb lanny
[sanz] i did UW for 25 days and kap q bank for 15 days
[lanny] im back
[dua_frank] ok
[megs] ok sanz
[dua_frank] lanny how many q blocks do you do in a day?
[samantha] thanx for sanz
[dua_frank] and sammy you
[dua_frank] ?
[lanny] dua mec ileus is assoc with CF
[lanny] M plug sd is not
[dua_frank] yes got that thanks
[samantha] doing UW wrong ans dua
[lanny] oh dua hard to tell you know i work part time so soetimes i do more other times less
[dua_frank] oh ok
[lanny] i took UW as a learning tool did q after reading second time
[dua_frank] ok
[sanz] everyone has differnt strategy of doing things i guess... as long as it works for you... one thing i find very beneficial is that after doing a block, straight away read up on the wrong qs and learn the comcept
[dua_frank] yes thats true
[lanny] i am taking kaplan now as a test and averaging 70
[dua_frank] nice 70 is really good, yuo're heading for a 99 too
[sanz] yes lanny :)
[lanny] yea right!!!!!
[lanny] kaplan q are not as easy as people think
[dua_frank] no really, ask sanz, she will tell you the same
[lanny] easier though than UW
[sanz] yeah... UW is better i think...
[lanny] so far i have spent nearly 5 mths on UW
[dua_frank] how was NBME sanz?
[dua_frank] 5 months :O
[dua_frank] how many times did you read the whole q bank lanny?
[sanz] NMBE is like UW... the real exams is as hard as NMBE... maybe even a little more mentally challenging
[lanny] i just finished the whole bank 2 wks ago
[sanz] but lanny works
[dua_frank] oh so its worth taking it then
[dua_frank] oh yes, i forgot about that
[dua_frank] lanny you sure work hard buddy
[lanny] but like i said i spent time reading the wrong and correct answers
[sanz] dua, it's worth taking it to see where you stand... but if not i have sent you the CD with the qs...
[dua_frank] when does FEV1/FVC ratio remain normal?
[samantha] yes 2nd time it makes more sense and can make notes
[dua_frank] yes thanks a lot for the cd sanz :) really appreciate it
[lanny] yes dua could have been faster if i didnt work
[lanny] but hey the pace was right for me had to pay more money t hough
[dua_frank] you're doing good lanny, don't worry about your exam, i'm sure you will do great and score a 99 too
[dua_frank] restrictive lund disease
[dua_frank] when is RV low?
[lanny] hope so dua believe me its a pain to study for this kind of test and have to work
[sanz] fibrotic lungs dua
[dua_frank] meaning restrictive yes sanz
[megs] in restrictive lung disese dua
[sanz] oh megs, you know you mentioned abt partogram when we were chatting gynae?
[dua_frank] high RV and low FVC?
[sanz] my exams have abt 3qs with partogram...
[megs] remember sanz
[dua_frank] don't tell me they showed partogram
[dua_frank] my GOD!
[lanny] whats a partogram
[megs] thas nicw
[dua_frank] did they ask you to read it???
[samantha] yea what is it?
[sanz] they give curves and you gotta fingured out if it's latent or active phase arrest etc
[dua_frank] oh man
[lanny] oh ok
[dua_frank] i better read it up again
[sanz] not too diffiult cuz its just a curve
[sanz] but i think cuz megs had mentioned it before, the qs didnt come to me as a shock
[lanny] it has to be at least 4 cm for it to be active phase arrest
[megs] yes
[sanz] so megs, thnx! Things like this i learnt fr all of you :)
[samantha] sanz how mich did you get in step 1?
[megs] lol sanz
[sanz] 89 sam
[sanz] i also prepared for 3 months
[samantha] that's gr8 sanz
[lanny] ok guys ask sanz all the q.s now for another 5 mins and lets get bk to business!!!!!!!!!!!!!!
[sanz] lanny sorry... i'll go away...
[sanz] you guys can email me anyway :)
[lanny] no sanz stay
[samantha] lanny is bussiness
[megs] lol
[sanz] hehe
[samantha] lol
[sanz] no you guys should chat
[sanz] c ya later!
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[lanny] sam youre always observing here
[lanny] lol lol lol
[dua_frank] i am scared :(
[megs] ok back guys
[lanny] about what dua
[dua_frank] this exam
[lanny] dont be
[samantha] lol evenings are bad for me lanny
[samantha] lot of distractions
[lanny] lol lol sammy ok me too im tired have been reading all day
[megs] how pack yrs are calculated???
[dua_frank] when is FFEF 25 to 75% low?
[samantha] good for you lanny once this is done we can relax
[lanny] oh sammy i cant wait after i give NBME ill feel good maybe
[samantha] yup
[dua_frank] dunno megs, tell us
[megs] a man smokes 2 pack cigareets each day for 10 yrs how many pack yrs he smokes???
[dua_frank] obstructive disease
[lanny] megs is there a formua??
[megs] lanny its like if one smoke 1 pack daily...for 10 yrs..in his smoking histrory ..we say 10 pack yrs
[dua_frank] what is the normal value?
[samantha] doubt guys what is pack years?
[dua_frank] of FEF 25-75%
[dua_frank] oh so one pack/per/year is one pack year
[lanny] yes so its 20 pack years
[megs] yes lanny
[dua_frank] 90%
[lanny] i was thinking there is another way to calc it
[dua_frank] DLCO value low in?
[samantha] got it
[megs] restrictive
[megs] dua
[dua_frank] right
[dua_frank] which is the only obstructive disease with low DLCO>
[lanny] restrict
[lanny] asthma??
[megs] emphysems
[dua_frank] right
[dua_frank] emphysema
[dua_frank] memb defect
[lanny] oh yes right dua megs
[megs] is there any screening test for ca lung???
[dua_frank] will atelectasis be visible on cxr normally?
[dua_frank] no megs
[lanny] yes
[megs] no there is not
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[dua_frank] yes
[lanny] atelectassis is visible dua
[dua_frank] is not usually lanny
[dua_frank] not on the lungs i mean
[dua_frank] you will not see lobular collapse
[dua_frank] like you see in collapsed lungs
[lanny] no the lung appears unaerated
[dua_frank] its the collapse of the terminal and small bronchioles and alveoli
[dua_frank] yes smaller in size
[lanny] yes dua i aagree
[lanny] like u said its not ususally seen
[dua_frank] what does it show on x ray of surrounding structures when its an upperlobe atelectasis?
[lanny] lower?? lobe
[dua_frank] tracheal pull to the same side
[dua_frank] how about lower lobe atelectasis?
[lanny] yes
[samantha] there will be collapse of the whole lobe
[megs] mediastinal shift
[lanny] to the same side
[dua_frank] no that is massive aletectasis megs
[samantha] seen on chest xray dua?
[dua_frank] in lower lobe there is elevation of the diaphragm on that area
[lanny] but it is still ateleciasis dua
[lanny] right dua
[megs] ohh got it dua
[megs] nice one
[dua_frank] no sammy, there will not be a collapsed lung on cxr in aletecsis
[lanny] thats why lower lobe os more visible
[dua_frank] don't confuse atelectasis with collapse of lung you might see in pleural effusion of pnemothorax
[samantha] ok dua
[dua_frank] rx?
[lanny] yes dua look for small airway involvement
[megs] bronchoscopy dua
[dua_frank] to remove plug yes
[dua_frank] but initially deep breathing and coughing up
[megs] and remove the offending factor
[dua_frank] and incentive spirometry
[samantha] atelectasis is just a small area rt?
[dua_frank] which is why you encourage patients to cough out the mucus post operatively
[dua_frank] to prevent atelectasis
[lanny] pulmonary to ilet
[samantha] and collapse is like an entire lobe
[dua_frank] sammy it can be huge too, its about the small bronchioles and alveoli collapsing rather than the whole lung
[dua_frank] its like collapsing within itself
[samantha] thanx dua
[dua_frank] welcome
[lanny] yes dua youre quite right good pt.
[dua_frank] how exactly is this pulmonary toilet given lanny/
[megs] pocorn calcification on x ray whats dx???
[dua_frank] hamartoma
[megs] popcorn
[megs] yup
[megs] bulls eye calcification on x ray??
[megs] whays dx???
[dua_frank] i think its when they flush the bronchi with distill water and flush it out again
[dua_frank] tb
[dua_frank] suck it out i mean
[dua_frank] through suction
[samantha] that is brochioalveolar lavage
[dua_frank] isn't that the same as pulmonary toilet sammy?
[lanny] funny you typed to ilet without being stopped its diff mechanisms to aid in breathing exercises usu the respiratory therapist does it
[samantha] yes dua
[dua_frank] thanks both
[samantha] wc
[lanny] yes dua that is pulm toi let also involves spirometry measurements etc..
[dua_frank] which type of asthma has high igE levels?
[dua_frank] thanks lanny
[lanny] intrinsic
[lanny] exercise
[dua_frank] extrinsic
[samantha] atopic asthama
[dua_frank] right
[lanny] sorry extrinsic
[dua_frank] intrinsic is due to non allergens lanny
[lanny] right just corrected myself
[dua_frank] tell me conditiosn which have pulsus paradoxicus
[megs] PT WITH 50YRS GAE HISTROY OF smoking +...x ray shows pulmonary nodule how will u proceed no past x ray available???
[samantha] pericardial tamponade
[samantha] CHF?
[megs] pulsus paroxus//....in pericardial effusion...
[dua_frank] you will take x rays every two months for the next two years
[dua_frank] to see if its growing in sixe
[dua_frank] size
[megs] nope dua
[dua_frank] if growth is positive you do biopsy
[dua_frank] then?
[megs] pt is high risk therefore go for biopsy
[dua_frank] oh smoking
[dua_frank] i forgot what i said was for nonsmokers
[megs] also age too
[dua_frank] thanks megs, good distinction
[dua_frank] right
[dua_frank] age plus smoking
[dua_frank] young nonsmoker do what i said right?
[lanny] if after 2 yrs no growth and nonn smoker then its ok
[megs] yes dua..
[megs] lanny too
[dua_frank] rx of aspirin induced severe asthma attack?
[samantha] dua ans to your q?
[dua_frank] tamponade yes sammym, also asthma and constrictive CMP
[samantha] thanx dua
[megs] also restrictive cardiomyopathy and consrictive pericarditis
[dua_frank] yes megs
[dua_frank] can somebody go through asthma and copd here for me please?
[dua_frank] i mean explain in detail the cause, diagnostic tests and PFTs with treatment for acute and chronic phases
[dua_frank] interleukin inhibitors
[samantha] 'cromolyn so
[samantha] for exercise induced?
[lanny] yes sam
[megs] which asthma has better prognosis intrensic or extrensic???
[dua_frank] extrinsic
[megs] yup
[megs] why
[dua_frank] coz it can be controlled by removing the allergen from surrounding?
[samantha] treatable
[lanny] its atopic agent can be found
[lanny] and treated
[samantha] yes lanny
[megs] yes lanny..and atopy goes away with progressive exposure...
[megs] like desensetization
[lanny] yes
[dua_frank] oh :O
[lanny] when is leukotrinee inhib used
[lanny] zafirlukast etc
[lanny] ??
[dua_frank] aspirin asthma?
[megs] if the regular one dont work?
[lanny] yes dua
[samantha] in resistant asthama
[lanny] also for exercise
[dua_frank] ok
[dua_frank] after you do methacholine test
[samantha] after maximum steroids have been used
[dua_frank] you give albuterol
[lanny] usu used in mod asthma
[dua_frank] you find no improvement in FEV1
[dua_frank] dx?
[samantha] sorry before oral steroids
[megs] cardiac asthma dua???
[dua_frank] COPD megs
[samantha] COPD
[dua_frank] irreversible
[dua_frank] bronchodialators don't help
[dua_frank] its also a very good differentiating test
[megs] ohh
[dua_frank] between asthma and copd
[lanny] pt with asthma being trt for UTI devs seizures and arrythmia whuch drug is he on for his asthma sms??
[dua_frank] how is DLCO in asthma?
[lanny] normal to inc?
[megs] normal
[dua_frank] right normal
[dua_frank] it can't inc i think lanny, it can be eitehr normal or low
[dua_frank] like low in memb defects- restrictive
[dua_frank] and emphysema
[lanny] yes its normal
[lanny] any answers to my q??
[samantha] did not understand q lanny
[dua_frank] decreased vesicular breath sounds prolonged expiration, dec or normal fremitus, hyperresonance, dx?
[dua_frank] dunno lanny
[megs] a child brought by mother with history of nocturanal cough...all the time in say while playng he is normal no shortness of breat..whats dx???
[megs] emphysema dua???
[lanny] atopic asthma
[dua_frank] right megs
[dua_frank] yeah atopic agree
[megs] yes..better say cough varient of asthma mostly seen in children
[dua_frank] increased expiration phase, wheezes, dec fremitus and hyperresonance, dx?
[dua_frank] ok
[lanny] fibrosis?
[megs] ashtma dua??
[dua_frank] right megs
[dua_frank] bronchial breath sounds?
[megs] pneumonia
[dua_frank] consolidation
[megs] pneumonia=consolidation
[dua_frank] dec paco2, increased ph, normal pao2, what am i talking about?
[megs] acute asthma
[dua_frank] right
[dua_frank] dec pao2, inc paco2, dec ph, dx?
[lanny] whats the key here for acute??
[dua_frank] alkalosis lanny
[lanny] right PH
[megs] status dua
[dua_frank] right megs
[lanny] cause he is not tiring yet
[dua_frank] is normal pco2 in tachypnea good or bad?
[dua_frank] and if he tires lanny?
[megs] bad
[lanny] co2 will be inc
[dua_frank] right and what will you do then?
[megs] it indicate that resp muscle not working
[lanny] give steriods cromolyn
[dua_frank] intubate
[lanny] oh yes thats no 1
[dua_frank] its an emergency lanny and cromolyn and steroids take a long time to take effect
[megs] yus...so in acidotic pt if pco2 is normal u intubate
[megs] isnt it dua???
[lanny] yes megs
[dua_frank] yes megs
[lanny] dont be fooled when pt stops tachypneic
[lanny] it can mean hes crashing
[dua_frank] right
[megs] didn t get u lanny
[dua_frank] a loud asthmatic is always better than a silent one
[megs] ohh got it
[dua_frank] whats the drug with seizures lanny?
[dua_frank] in UTI
[lanny] i have seen it in my practice
[dua_frank] i have seen it in me :) i'm an asthmatic but thankfully a loud one always :)
[lanny] have forgotten the q dua will have to scroll
[lanny] ok dua well youlle get all the q right in asthma
[dua_frank] lol not really, i don't even know which type i have yet
[dua_frank] it seems like i have a mixed picture
[lanny] i had a close friend who died od SLE after6 yrs of diag she was well until day she died of rrythmia i love SLE since then!!
[megs] he he i had extrenisc one
[megs] but now got relief lol
[lanny] good megs
[dua_frank] thats sad
[lanny] yea i used to tell her that shes ok cause she was really never ill
[lanny] she did ask me once about prognosis and rubins pathology said 5 yrs after diag i never told her that though
[lanny] but it came to pass
[dua_frank] :(
[megs] ohh
[lanny] i am inquisitively watching her son for heart sms!!
[megs] thats intelectuallization lanny
[lanny] you got it megs
[megs] yes
[lanny] i always ask the grand mother whern he goes to the doc did the doc listen to his heart??
[dua_frank] do you know why you can't give cromolyn in kids with acute attack?
[lanny] but of course dony want to alarm the family
[megs] its mast cell stabilizer..so wont work once attack sets in
[megs] just it can prvent histamine relesae
[dua_frank] no megs my book says it may increase the attack
[lanny] does not work in acute attacks
[dua_frank] i didn't understand how it can inc the attack, i know it can't help acute attacks though
[megs] i havnt come across that dua
[dua_frank] this is case of children not adults that too
[lanny] its not used for acute attacks not helpful
[lanny] even in adults
[dua_frank] does aminophylline work in acute attacks?
[megs] yes it does
[dua_frank] nope
[lanny] i have seen this in an adult med q they gave all signs of exercise ind asthma
[megs] :o
[dua_frank] it improves contractility but is a weak bronchodialator
[megs] why dua
[lanny] and ask for trt to stop it
[dua_frank] stop what lanny?
[lanny] inhaled b agonist and cromolyn is what you give
[dua_frank] improves diaphragmatic contractility that is
[dua_frank] yes exercise induced you can give those two lanny
[lanny] in acute attacks of exercise give inhaled b agonist first
[dua_frank] so lets divide these drugs into acute and chronic
[dua_frank] what can you give to control acute attacks?
[lanny] dont rush and oick cromolyncause you see exercise!!!
[dua_frank] yes
[megs] acute..b agonist
[dua_frank] its only to prophylactically prevent exercise asthma
[dua_frank] right megs
[dua_frank] all others can come under chronic management
[lanny] b agonist
[dua_frank] steroids, cromolyn, mast cell inhibits, aminophylline
[dua_frank] how long after do steroids start working?
[lanny] if pt cant take b agonist what can you give???
[samantha] what is given is nocturnal asthma
[megs] salmeterol
[samantha] cough variant?
[dua_frank] depends on it having wheeze or not sammy, might be cardiac
[megs] long acting b agonist
[dua_frank] so be careful dealing with noctornal cough
[samantha] yes rt megs and dua
[megs] in cardiac pt with asthma which drug u preferr??
[samantha] nocturnal or cough variant dua
[dua_frank] pindolol?
[dua_frank] timolol
[dua_frank] something that is lung specific
[megs] ipratropium bromide
[dua_frank] oh :O
[samantha] is it possible it is cardiac?how?dua
[dua_frank] was just guessing sammy, dunno
[samantha] oh...CHF
[dua_frank] are there any b1 specific beta agonists?
[megs] its anticholinerigic
[dua_frank] yeah normally we would give propronolol but that would be contraindicated in asthma so give ipra
[dua_frank] good q megs
[dua_frank] 12 hours for steroids to take effect
[lanny] isoproterenol is both b1 and 2 equally
[lanny] dobutamine is bi> b2
[megs] yes lanny
[lanny] dont think there is one exclusively
[dua_frank] oh
[dua_frank] small heart and inc retrosternal space on cxr with hyperinflation in both lungs, dx?
[dua_frank] and diaphragmatic flattening
[megs] which is the first line drug for COPD???
[dua_frank] o2
[dua_frank] yes megs
[lanny] steriods
[dua_frank] why ipra again megs?
[megs] atrovent
[megs] will explain
[megs] what is pathology in emphysema???
[dua_frank] memb defect
[dua_frank] elasticity lost
[megs] decreased recoil
[megs] what is patho in bronchitis??
[megs] increased resistance
[dua_frank] yes
[megs] both are cholinergic..actions...
[megs] mean ach mediated
[megs] so give anticholinegic first
[dua_frank] ohhhhhhhhh
[dua_frank] thanks megs
[dua_frank] good explaination
[samantha] thanx megs
[dua_frank] but isn't that bad for emphysema then? where the lungs are already expanded enough?
[megs] b agonist are 2 nd line drugs
[megs] emphysem......already damaged septa..so can reverse it back..
[megs] sorry can not
[dua_frank] right its irreversible
[dua_frank] so nothing really helps in emphysema, not even ipra right?
[megs] yes
[dua_frank] there is human alpha1 protease inhibitors
[megs] only 2 things decr mortality
[megs] o2 and quit smoking
[dua_frank] right
[dua_frank] good discussion
[lanny] smoking cessation is very essential
[dua_frank] whats the doc for acute exacerbation of chronic bronchitis?
[lanny] indication of home oxy thpy
[lanny] iprat bromide
[megs] agree lanny
[dua_frank] says steroids
[dua_frank] ipra for COPD in general
[lanny] steroids are for people who get frequent exacerbations
[megs] how steroid will help dua???
[dua_frank] reduces hyperresponsiveness in airways
[megs] just decr acute inflammmation
[dua_frank] there is a component of that in COPD as well as asthma
[dua_frank] yeah
[dua_frank] that is the cough in copd which mimicks asthma i guess
[dua_frank] what is the level of pa02 and o2 saturation you maintain in home o2 therapy and why?
[megs] ph 7.3 pco2 78 and po2 40 what type of COPD??
[megs] PAO2 60 AND 90% O2 DUA
[dua_frank] yes megs 80% actually
[dua_frank] 85
[dua_frank] not 80
[dua_frank] emphysema megs?
[megs] WHY DUA???
[dua_frank] coz 02 is low and dec DLCO?
[dua_frank] memb defect
[dua_frank] which asthmatic drug has narrow therapeutic index?
[samantha] theophyline
[dua_frank] right
[lanny] guys i have to leave now sanz had made me not think anymore see you all tomorrow
[dua_frank] what is the common arrythmia in copd and its rx?
[dua_frank] see you lanny
[megs] DUNNO DUA
[samantha] bye lanny
[lanny] oh dua this was the q i asked before
[megs] BYE LANNY
[dua_frank] SVT and verapramil not dig
[dua_frank] you did?
[samantha] what is kartageners synd?
[dua_frank] infertility, bronchiac, sinusitis
[dua_frank] situs inverses
[samantha] rt dua
[dua_frank] mc complication in emphysema?
[dua_frank] good megs
[dua_frank] how about bronchitis?
[samantha] infections?
[megs] agree pneumonia
[dua_frank] hypoxemia
[dua_frank] although hypoxemia happens in emphysema too but mainly in bronchitis
[dua_frank] ok tellme the vaccines used
[megs] ok
[samantha] ok
[megs] influenza yrly
[megs] and pneumococcal 5 yrly
[dua_frank] right
[dua_frank] whats teh prognostic factor for copd?
[megs] IS HIB IS GIVEN???
[dua_frank] or best indicator for survival
[megs] pft dua
[dua_frank] yeah megs, if vailable
[dua_frank] FEV1
[megs] i mean FEV1
[samantha] agree
[dua_frank] whcih is worse, bronchitis or emphysema?
[dua_frank] yes megs we do
[samantha] brochitis?
[dua_frank] emphysema
[megs] nope dua we dont give HIB vaccine in adult
[dua_frank] in elderly?
[megs] no we dont give
[dua_frank] any reason why not?
[dua_frank] when its one of the commonest infections
[dua_frank] in copd patients
[samantha] they give megs
[samantha] influenza vaccine
[megs] after 5 yrs of age no ....h. influenza risk
[megs] i am talking about HIB vaccine sammmy
[megs] not influenza'
[dua_frank] i thought the risk increases in the elderly too megs
[dua_frank] i remember reading that somewhere
[megs] u can cq this dua
[dua_frank] yeah i will
[dua_frank] mc infections in bronchiatasis?
[megs] gm negative
[megs] pseudomonas
[dua_frank] yes and encapsulated bacterias
[samantha] anerobes too
[dua_frank] ok
[dua_frank] rx?
[dua_frank] oh we talked about it already
[samantha] postural drainage and antibiotics
[dua_frank] rx of psuedo infection?
[samantha] ceftriam
[samantha] ceftriaxone
[dua_frank] piperacilin plus gentamicin
[dua_frank] yes that too but two cefs generally
[megs] cefipime and ceftazideme
[dua_frank] use combination cefs 2-3
[dua_frank] whats anticardiolipin antibody syndrome and what can it cause ?
[megs] progressive exercize tolerance on examination rales+ what dx???
[samantha] megs rt ceftazidime
[samantha] not ceftriaxone
[dua_frank] dunno megs what?
[megs] dua i know it can cause first trimester abortions lol..i am talking about anticardiolipin antibody stnd
[dua_frank] lol
[megs] ans to my q is idiopathic pulmonary fibrosis'
[dua_frank] isn't it the same as antilupus antibody? causing DVTs and PE
[dua_frank] hypercoagulable state
[megs] yes its hypercoaguable state
[dua_frank] why does it cause abortions megs?
[megs] same mechanism...trombus anywhere...can inplant ambryo properly
[megs] embryo
[dua_frank] oh ok
[megs] so abortion
[dua_frank] dx for PE?
[megs] abg first
[samantha] vQ scan
[megs] then v/q scan
[dua_frank] yes
[dua_frank] what does ABG show?
[megs] hypoxemia
[samantha] low oxygen
[dua_frank] yes
[dua_frank] rx?
[megs] ph alkaline pco2 incr and po2 decr
[dua_frank] yes
[samantha] heparin?
[dua_frank] why ph alkaline if pco2 high megs?
[samantha] oxygen
[dua_frank] pco2 is low i think
[dua_frank] due to hyperventillation
[megs] yes dua resp alkolosis due to tachypnoea
[samantha] have to go bye dua and megs
[dua_frank] thrombolytisc first
[megs] ok bye sammy
[dua_frank] then heparin and warfarin-5 days and 6 months
[samantha] bye
[dua_frank] in case of these being contraindicated embolectomy
samantha has left the chat.
[dua_frank] bye sammy
[megs] agree dua
[dua_frank] when are antiphospholipid antibodies postive in pregnancy megs?
[dua_frank] any cancer?
[megs] we screen for them if history of recurrent abortion is there dua
[megs] not related to cancer
[dua_frank] yeah so that we can decide if we need to put them on SQ heparin
[dua_frank] coz warfarin is CI
[dua_frank] to prevent PEs in these women
[dua_frank] let me check
[megs] ..we give aspirin low dose for abortion prevention dua...
[dua_frank] oh
[megs] they are not of much concerned in otherwise
[dua_frank] why do you never start warfarin directly?
[dua_frank] why first heparin then warfarin?
[megs] cuse necrosis of skin and inhibit coagualtiob
[dua_frank] right due to dec in protein c
[megs] i mean they act like b;leeding substance initially
[dua_frank] ok
[dua_frank] what do factors 5 and 8 do megs?
[dua_frank] these are procoagulants right?
[megs] yes
[dua_frank] so this is why
[dua_frank] protein c inhibits these normally
[dua_frank] warfarin inhibits protein c too
[megs] agree dua
[dua_frank] so these factors increase and cause hypercoagulable state
[dua_frank] which needs consequetive heparin administration
[dua_frank] ok then good, we got that out of the way
[megs] what ekg change u see in pulm embolism...
[dua_frank] deep s waves?
[dua_frank] oh ok
[dua_frank] thanks
[dua_frank] sinus tachycardia most common
[megs] OK DUA
[dua_frank] yes
[dua_frank] lets meet tomorrow
[megs] bye..
[dua_frank] bye megs
[megs] yes
megs has left the chat.

04-23-2005, 08:05 PM

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