josephmedman has joined the chat.
[schoolagain] hello out there is anyone in?
[gbono2] Is this the goljan chat?
[gbono2] anyone there?
[gbono2] bye
[fakehugs] does anyone know if goljan chat is cards tonight
[junglemits] hi
[josephmedman] goljan chat in usmle step 1 room
[madhav95] samantha
[kimmyg] hello?
[breeze] hello?
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Now entering USMLE_Step_1 subroom.
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[josephmedman] can you believe it took me 15 minutes to log on today..
[josephmedman] this site is horrible..
[josephmedman] server isnt powerful enough..
[josephmedman] where did you guys get?
[josephmedman] sorry for hte tardiness
[georgere] That's OK :cl
[josephmedman] where are you guys right now..
[erum] josephmedman hi
[josephmedman] hi erum..
[georgere] We have not started anything.
[josephmedman] oh ok..
[josephmedman] can i start up then?
[Jibbsie]
[erum] josephmedman me too just got here
[georgere] SURE!!
[josephmedman] one sec let me just organize my questions here
[josephmedman] ok here we go
[josephmedman] most common cause of death in MI?
[fakehugs] arrythmia
[josephmedman] 1st 2nd and 3rd in order of frequency
[Jibbsie] arrythmia
[georgere] arrythmia
[erum] arrythmia
[Jibbsie] then cardiac rupture
[erum] rurture
[josephmedman] good
[josephmedman] now tell me the most common cause of death due to HTN
[erum] stroke
[fakehugs] 3rd?
[josephmedman] sorry..haha..i messed the question up..i meant 1st 2nd and 3rd most common causes of death due to HTN
[josephmedman] stroke is not number one
[josephmedman] what is number one..
[georgere] cerebral bleeding?
[josephmedman] no
[Jibbsie] cardiac failure
[josephmedman] MI is number one
[josephmedman] stroke number two
[josephmedman] and renal failure number 3
[erum] ok
[josephmedman] what is the most common cause of renovascular HTN?
[erum] tx
[josephmedman] ahhh..messed that up too
[josephmedman] sorry guys..i meant what is the MCC of 2nd HTN
[josephmedman] but i just gave the answer away
[erum] atherosclerosis plaque
[josephmedman] umm..erum i think it would be more arteriosclerotic if it involved the kidney
[josephmedman] somebody correct me if i am wrong
[Jibbsie] so what woud]ld be causing the reno vacular hbp
[erum] hbp?
[josephmedman] artteriosclerosis of renal vascular orifice?
[josephmedman] for men
[josephmedman] and for womein i think it is fibromuscular hyperplasia
[Ammu] yes
[josephmedman] can someone tell me when arteriolosclerosis occurs in the kidney vs. atherosclerosis?
[josephmedman] like hyaline arteriolosclerosis of kiney vs. atherosclerosis of renal artery
[erum] d/m
[erum] 4 hyaline art
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[Jibbsie] arteriolo - DM
[josephmedman] and HTN is always atherosclerosis?
[Jibbsie] YES
[josephmedman] what about essential HTN?
[erum] hptn 4 athero
[josephmedman] hptn??
[josephmedman] whats that
[Jibbsie] hypertension
[erum] hypertension
[mistere] decreased Na secretion - essential HTN
[img1md] I thinkbenign ht hyaline arteriolosclerosis
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[Jibbsie] esp in blacks
[josephmedman] ok tight..
[josephmedman] what type of HTN do you get in severe hypOthyroisism?
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[erum] onion skinning of vessels in essential hyptn
[josephmedman] when you have onion skinning isnt that usually of arterioles?rather than arteries?
[josephmedman] answer: siastolic HTN..
[mistere] systolic HTN
[erum] vessels in general
[josephmedman] and you get systolic HTN in hyPERthyroidism
[Jibbsie] diastolis, Joe?
[josephmedman] or graves disease better yet
[Jibbsie] in hypo
[josephmedman] diastolic in hypo
[josephmedman] sever form
[josephmedman] and in graves you get systolic
[mistere] ok got it
[josephmedman] what is the MCC of 2nd htn in FM of repro age?
[josephmedman] gotcha..thanks..
[Jibbsie] hyperthyroidsm?
[erum] welcome
[josephmedman] oral contraceptives
[ppliutcm] renal failure
[josephmedman] hey guys..im reading here in goljan
[Jibbsie] ohh
[josephmedman] pathology associated with hypertension
[mistere] stroke
[josephmedman] hyaline arteriolosclerosis: iunsudation of protein into the walls of arterioles by increased luiminal pressure narrow vessel lumen preoduces cmall vessel ischemia
[josephmedman] it says here that it is the hyaline arteriolosclerosis that leads to renal failure in HTN
[josephmedman] so you get athero and arteriolo?
[josephmedman] can anyone shed some light on that?
[erum] yep
[erum] t
[erum] hats what i said
[josephmedman] haha thanks
[josephmedman] but in DM it is JUST arteriolosclerosis you are saying right?
[Jibbsie] actually arteriolo is both DM and HTN
[Jibbsie] BUT DIFF MECH
[josephmedman] but DM only has arteriolo?
[Jibbsie] Yes
[josephmedman] hmm..
[josephmedman] ok..
[josephmedman] jibbs? can you maybe go over the difference in mechanisms real quick?
[josephmedman] can anyone tell me the most common complication of HTN?
[erum] no d/m later develop athero
[Jibbsie] In HTN , it's like u said. In D.M, it's due to glcosylation. Both produce same damage
[josephmedman] ahhh..gotcha..thanks guys..
[Jibbsie] of arteriol
[erum] due to reaction to injury theory
[erum] d/m gets athero later on
[josephmedman] gotcha..
[josephmedman] ok..
[josephmedman] what is the MC complication of HTN?
[Jibbsie] ventricular hypertophy
[georgere] LVH
[josephmedman] left ventricular hypertrophy
[erum] rt
[josephmedman] oh let me explain something real quick
[josephmedman] the reason why oral contraceptives are the MCC of 3nd HTN in FM of reproductive age is because estrogen increases the liver synthesis of angiotensin
[josephmedman] ok..here is an anat. question that has been asked..
[josephmedman] where in the brain so ALL hypertensive bleeds occur and be specific?
[Jibbsie] but u said 2nd earlier on
[img1md] putamen
[josephmedman] i meant secondary
[josephmedman] sorry jibbs
[josephmedman] trying to type too fast
[Jibbsie] lateral striate
[josephmedman] jsut got back from teh track and my brain is lackign oxygen
[josephmedman] it is the golobis pallidus..remember that guys..
[Jibbsie] sorry dear
[josephmedman] very impt.
[josephmedman] globis pallidus*
[Jibbsie] supplied by?
[josephmedman] wow..you got me there..
[sillyglue] lenticular striate aas
[Jibbsie] middle cerebral via lateral striate
[sillyglue] branches off the middle cerebral or something
[josephmedman] anatomy is goign to be my downfall on this exam
[josephmedman] what drug increases the baseline plasma renin activity?
[Jibbsie] don't say that Joe. U are fine
[josephmedman] what are you guys using for anat?
[josephmedman] and neuro..
[Jibbsie] high yield neuro
[josephmedman] and what about gross..
[josephmedman] i heard the neuro in step up is really good
[josephmedman] not sure thoguh..havent done that subject..
[Jibbsie] haven't done gross
[josephmedman] ok so the drug that increases PRA is captopril
[josephmedman] it directly stimulates renin release
[josephmedman] and what drug does the exact opposite
[josephmedman] what group fo drugs actually
[josephmedman] captopril works in increasing renin by dropping the level of ATII
[josephmedman] now what works the opposite
[Jibbsie] Captopril - ACE I right
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[ppliutcm] b-bloker
[josephmedman] good beta blockers
[josephmedman] yeah captopril is ACE
[josephmedman] catecholamines also increase PRA
[josephmedman] ok why do you get paroxysmal nocturnal dyspnea in left heart failure?
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[Jibbsie] pulm edema
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[Jibbsie] so a htnsive px on Captopril has increased levels of Renin? hmm
[img1md] fluid redistribution on lying down
[josephmedman] because when you are lyign down and have left heart failure what is happening..you have increased venous return due to lack of gravity..it cant be handled by the left heart and blood backs up into the lungs..if you stand up or put a pillow under head it decreases benous return to the heart
[erum] when u lay down centre of gravity shifts
[josephmedman] captopril is an ACE inhibitor
[josephmedman] it increases the PRA
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[josephmedman] because it drops the level of AT II
[josephmedman] bnegative feedback
[josephmedman] you have the potential for renal failure if bilateral renal artery stenosis is present
[josephmedman] because AT II is the primary modulator of intrarenal blood flow in both kidneys
[josephmedman] so when ACE drops the level of AT II
[josephmedman] renal failure occurs
[josephmedman] got me jibbs?
[Jibbsie] yeah
[josephmedman] when do you see hepatomegaly?
[josephmedman] what type of HF?
[mistere] RHF
[arezooman] Right side
[Ammu] RHF
[Jibbsie] rt sided failure
[josephmedman] explain
[img1md] venous congestion
[arezooman] Rv failure most commonly due to Left
[josephmedman] good..you also get ascites and dep. pitting edema..also an impt. one jugular venous distension
[josephmedman] you have a problem of the right heart getting blood thru the pulmonay vesels to the left heart
[josephmedman] thats why anytime you ahv a problem on the right side
[josephmedman] it is going to effect the left side
[josephmedman] RHF is a diag of signs not symptoms
[josephmedman] remember
[josephmedman] what are some high output failures guys?
[img1md] but mcc of rhf is left hf rt?
[purabi] anemia
[josephmedman] yes img1md
[arezooman] one is berberi
[img1md] anemia,
[malak1993] hyperthyroidism
[josephmedman] yes..good
[img1md] pagets disease
[arezooman] thyrotoxicosis
[arezooman] paget
[josephmedman] arezooman
[josephmedman] explain that one if you can
[arezooman] which one?
[josephmedman] how does pagets cause high output
[malak1993] A-V fistula
[josephmedman] failure
[arezooman] becasue of AVM?
[josephmedman] avm?
[arezooman] artrovenous malformation
[josephmedman] ahhh..ok cool..
[arezooman] the same as AV fistula
[josephmedman] which pagets though?
[josephmedman] of bone?
[arezooman] yes
[img1md] of bone
[josephmedman] thanks..
[arezooman] the other one I mean breast or vagina is CA
[josephmedman] does everyoen here know fetal circulation?
[arezooman] what about it?
[josephmedman] if you dont please go back and memorize it..
[josephmedman] everything about it..
[josephmedman] i can go over it real quick if you guys would like..
[img1md] let me check aboutpagets
[arezooman] yes, pls
[malak1993] ok
[josephmedman] ok.its really long
[georgere] plz
[josephmedman] so im going to just go over all the main points if that is ok..
[arezooman] that would be great, thanks
[img1md] due to increased blood flow Harrison
[josephmedman] ok..first of all the chorionic villus in the placenta is the primary site of o2/co2 exchange for the fetus..
[arezooman] img>>> u r right
[josephmedman] arezooman?
[josephmedman] right about what?
[arezooman] about paget
[josephmedman] pagets isnt a high output?
[arezooman] yes, it is
[img1md] yes
[josephmedman] oh ok..
[arezooman] sorry 4 that
[josephmedman] didnt you say it was though?
[arezooman] yes, I did
[josephmedman] ok..
[josephmedman] here are some normal values to remmber
[josephmedman] in pregnancy normal HCT is around 35 percent
[josephmedman] SAO2 in around 98 p[ercent
[josephmedman] and arterial PO2 is around 105mm Hg
[josephmedman] fetal Hgb has a high afinity for O2 so it is ideal for gas exchange in the chorinonic villi of hte placenta
[josephmedman] no here we go..
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[josephmedman] we start off with teh umbliical vein which has an SAo2 of around 80 percent and a PO2 of 30-35
[josephmedman] REMEMBER!!it has the highest amount of oxygen in the fetal circulaton
[josephmedman] it carries the oxygenated blood from teh chorionic villus
[josephmedman] to the fetal liver
[josephmedman] about half of that blood mixes with hepatic sinusoid blood which has a saturation of o2 of around 26 percent
[malak1993] bypass liver
[josephmedman] the remaining 50 percent enters the DUCTUS VENOSUS which drains directly into the IVC
[josephmedman] ok when you mix that 80 percent blood
[josephmedman] with the 26 percent hep. sin. blood
[josephmedman] the NEW SAo2 becomes around 67 percent
[josephmedman] those sinusoids with this new blood are then drained by the hepatic vein which empties into the IVC
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[josephmedman] ok..now this IVC blood before it enters teh fetal RA
[josephmedman] what is the percent
[josephmedman] 67 percent right..
[josephmedman] most of this blood is shunted through a parent formaen ovale into the LA where the SAo2 is 60 percent
[josephmedman] in the fetus this is normal
[josephmedman] the right to left shunt
[josephmedman] in adults its not..
[josephmedman] it then goes to the LV and then to the aorta
[josephmedman] most SVC derived blood enters teh RV
[josephmedman] and most of the bloo going into the pulm arteris is shunted thru a PDA and from there into the DESCENDING aorta
[josephmedman] which is a right to left shunt
[josephmedman] can anyoen tell me what keeps the patent ductus open in the fetus?
[arezooman] Prostaglandins
[arezooman] PGI2
[Ammu] e
[josephmedman] PGE2
[arezooman] E2, sorry
[josephmedman] now blood in the aorta goes to the pplacenta via two arteries
[josephmedman] umbilical with a lower PO2 that the mother
[Jibbsie] Is it released from the collapsed lungs
[josephmedman] these have the LEAST amount of o2
[josephmedman] int eh fetus
[josephmedman] around 20-23
[josephmedman] umblical vein has the most
[josephmedman] opposite of us i guess..
[josephmedman] ok question
[josephmedman] do you ahve a right shift or left shift
[josephmedman] in the fetus
[arezooman] Left shift
[josephmedman] why?
[arezooman] becasue of HbF
[josephmedman] so what is a left shift goign to do?
[arezooman] it does not have beta chain and 2,3 DPG binds to beta chain
[arezooman] it binds to 02 more firmly
[josephmedman] ok..i mean with oxygen
[josephmedman] what does a left shift mean
[ppliutcm] pge1 keep paten ductus open
[arezooman] [email protected] disso curve shifts to left
[josephmedman] pge2 keeps patent ductus open
[malak1993] DEC O2 deliver to tissue
[josephmedman] good malak
[arezooman] and binds to it better
[josephmedman] ok..someoen tell me what eisenmenger's syndrome is?
[arezooman] releases harder
[malak1993] Thanx
[josephmedman] yes arezooman..thats what i was lookign for..
[Ammu] reversal
[purabi] reversal of Left to right shunts
[Jibbsie] left to right shunt after many years of rt to lt due to hypertrophy and increased pr on rt side of the heart
[arezooman] due to pul. HTN
[josephmedman] other than pulm HTN
[josephmedman] waht else is it due to..
[georgere] At first L to T shunt, but then R to shunt eventually. Because the Right side is going to be more pressure than left side.
[josephmedman] what else doe sit produce i mean..
[josephmedman] pulm HTN
[josephmedman] right vetriclar Hypertrophy
[georgere] OK
[josephmedman] and volume overload in the LV with hypertrophy and dilatioon
[josephmedman] ok..what genetic diseases is VSD associated with?
[img1md] downs
[georgere] Down synd.
[Ammu] edward
[Jibbsie] down's
[malak1993] down
[josephmedman] no downs
[josephmedman] edwards is one..
[img1md] in downs only asd?
[josephmedman] i only know of fetal alcohol synd. is ASD
[josephmedman] the other one i was looking for is cri du chat
[josephmedman] which is the imp. one to know for the boards
[arezooman] Downs, edwards and Pit (13)
[Jibbsie] Turner's is ASD
[arezooman] all of them are asssos with VSD
[josephmedman] which is a partial deletion of chromosome 5
[arezooman] Turne is coarction of Aorta
[img1md] criduchat
[arezooman] crid du chat
[Jibbsie] sorry
[arezooman] short arm of 5
[josephmedman] turners is preductal coarctation
[Ammu] pdeletion
[Jibbsie] pre ductal or post?
[Jibbsie] ok
[arezooman] yes, infantile type, post is adult type
[malak1993] pre
[josephmedman] hey arezooman are you sure abotu that?
[arezooman] IN===INfantile
[josephmedman] the vsd associations..with all of them.
[arezooman] Preductal is infantile, post is adult type
[arezooman] I will check it again
[img1md] what are heartdefects in downs endocardial cushion defect?
[arezooman] asfar I remeber all of them have VSD
[josephmedman] ok..cool..
[img1md] mc is endo rt
[Ammu] yes
[josephmedman] img1md waht is endo rt?
[arezooman] what is mc is endo rt?
[img1md] I mean endocardial ciushion defect
[arezooman] ok
[josephmedman] tetrology of falot people?
[josephmedman] what is it?
[josephmedman] fallot*
[arezooman] vsd, overriding, RVH, PS
[img1md] vsd rt vh, overriding of aorta ps
[josephmedman] this of namonic PROV
[arezooman] pentalogy of fallot is adding ASD to tetra
[malak1993] RVH,PS.overriding of aorta
[josephmedman] pulmonic stenosis, Rigth ventricular hypertrophy, Overriding aorta VSD
[josephmedman] it is the MC cyanotic congentical heart disease..
[josephmedman] and the cyanosis depends on the degree of pulmonary valve stenosis
[josephmedman] really?
[malak1993] yes
[josephmedman] i never knwo that aresooman..
[josephmedman] nice to know
[arezooman] A good case: all family members who exposed to CO died, except the pregnant mother, why?
[arezooman] thanks, Joe
[img1md] fetal hb?
[josephmedman] increased fetal Hgb?
[arezooman] Perfect
[arezooman] Baby sacrified hismelf to meother
[georgere] Good Q!
[img1md] yes
[img1md] Are microscopic polyarteritis and microscopic polyangitis are one and the same?
[img1md] sorry to interrupt
[josephmedman] do you guys know the difference between kartageners and complete transpositioon of the great vessels?
[malak1993] dextro cardia in kart
[img1md] kartageners aorta is fromlt itself ?
[img1md] I mean aorta fromlt ventricle?
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[Ammu] chambers in kartagenrs
[josephmedman] in kartageners heart is on the right but is completely normal..in transp. the thing being transposed is the ventricles whie the atria are fine..in transposition you NEED shunts to mainttain life..it is associated with maternal diabetes..aorta is transposed and empties the RV and PA is transposed and emptes the LV
[arezooman] kartanger== dynein problem we have dextrocardia but I think we do not have transposition of vessels
[img1md] yes
[josephmedman] kartageners is immotile cilia syndrome
[josephmedman] which means all men are infertile
[josephmedman] but i think only 30 percent of females are infertile
[josephmedman] correct me on the second stat if i am wrong
[josephmedman] but thats what i rembmer
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[img1md] Please see my doubt above
[img1md] Are microscopic polyarteritis and microscopic polyangitis are one and the same?
[josephmedman] no..kartagners there is nothign wrong with the vessels
[josephmedman] at all..
[josephmedman] only thing is that heart is on the right side..
[josephmedman] instead of left
[josephmedman] otherwise everythign is completely normal
[img1md] yes
[josephmedman] answer your questions img1md?
[arezooman] sometimes, liver is on left side as well
[img1md] Are microscopic polyarteritis and microscopic polyangitis are one and the same?
[josephmedman] i think so..im not sure though..
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[arezooman] poly angitis like what disases?
[img1md] I mean microscopic poly angitis is a variant of PAN rt
[Jibbsie] pls I hope I can get the transcript. I have been out
[josephmedman] i got you jibbs..
[arezooman] same here
[img1md] I have read p anca positive only inthis variantnot in classic pan
[josephmedman] ok guys..biochem question..where does the heart receive most of its ATP?
[arezooman] As far as I know P-ANCA is postive in PAN, not a specific variant, I am not sure though
[Jibbsie] beta oxidation
[arezooman] FA
[arezooman] in herat failue, some glucose, as well as fetal heart
[josephmedman] most imp is beta oxidation of FA
[img1md] thanksl l will check later
[josephmedman] ok..waht type of ischemia do you see in exertional angina?
[josephmedman] when do you see it..
[josephmedman] and what do you see on EKG?
[arezooman] St dep
[arezooman] endocardial
[josephmedman] ST depression-SUB endocardial..think SUB/DEPRESSED
[josephmedman] how long does the chest pain last?
[arezooman] Printzmetal epicardial, ST elev
[josephmedman] in this
[josephmedman] yeah..prinzemetal has st elevation
[arezooman] less than 30 min?
[josephmedman] secondary to coronary artery vasospasm
[img1md] yes
[josephmedman] it is chest pain at rest
[josephmedman] and is transmural ischemia
[img1md] unstable rt
[arezooman] oh, you mean it is unstable angina?
[arezooman] u mean after 30 min it will be labelled as unstable?
[josephmedman] with coronary artery vasospasm it penetrates the outside fo the heart and goes in
[img1md] I am not sure
[josephmedman] no..im talking about prinzmetal arezooman
[img1md] ok
[josephmedman] in exertional it is 1-15 minutes
[arezooman] sorry, go on pls
[josephmedman] in prinzmetal you have ischemia throughout the entire thickenss of the chest wall..
[josephmedman] unstable is FREQUENT bouts of chest pain at rest
[josephmedman] its due to the release of things liek TXA2
[img1md] No I man angina at rest is unstable I think so
[arezooman] Isn;t it if chest pain cntinues more than 30 min it should be labelled as unstable? I am not sure
[img1md] no
[Jibbsie] I understand why prinnz is transmural. Why is stable endocardial?
[img1md] if it continues it is MI rt
[arezooman] U can not diganose MI based on symptoms
[img1md] unstable angina is angina at rest
[img1md] without exertion
[img1md] it can lead to MI
[josephmedman] unstable is frequent bouts at rest
[arezooman] u are right, that's one criteria,
[img1md] and st dep also?
[Jibbsie] why is it endocardial?
[arezooman] like any change in quality or quantity of stable angina will be unstable
[josephmedman] prinzmetal is the entire thickness of the MYOCARDIUM
[img1md] i think so
[josephmedman] but arzooman
[josephmedman] unstable is only at rest right?
[josephmedman] stable isnt necessarily at rest
[arezooman] that's one of the criteria
[arezooman] any angina at rest is unstable, but it's not all
[josephmedman] unstable is severe fixed MULTIVESSEL atheroscleroitc disease
[arezooman] in a stbale patient if he says quality or quantity of pain is change, then it is also unstable
[josephmedman] oh ok..
[arezooman] and MI is diagnosed when you have 2 of the following 3
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[arezooman] 1-hystory, 21-EKG 3-Lab
[josephmedman] gotcha..
[josephmedman] lab is based on ckmb
[josephmedman] people say troponin is new gold standard
[josephmedman] but i dont think so
[arezooman] what about troponin?
[josephmedman] because trop lasts 7 days
[img1md] yes after 8 hrs rt
[josephmedman] so you will not be able to tell reinfarct as goos as you can tell with ckmb
[img1md] cpk mb afetr 8hrs I think
[josephmedman] which is gone in 1.5 to 3 days..
[josephmedman] ok guys..
[josephmedman] its 9:40
[josephmedman] time to eat..
[arezooman] troponin appears 5hours, Ma: 15 hours, remains 5 days,
[josephmedman] ill post this transcriopt for all who missed..
[Jibbsie] u did not explain my Q
[josephmedman] troponin remains 7 days
[josephmedman] i have in my text
[arezooman] that's great, thanks JOe
[josephmedman] whats the questions kibs?
[img1md] thanks
[josephmedman] jibs?
[Jibbsie] About why it's endocardial ischemia
[josephmedman] wwhat is endocardial ischemia?
[arezooman] Jibb>> I am not sure, but I think becuase that part is more prone to ischemia
[Jibbsie] I understand why prinz is transmural
[arezooman] becasue of pressure
[img1md] how
[josephmedman] because when you have coronary artery vasospasm
[img1md] ok
[josephmedman] you penetrate the outside
[josephmedman] of the heart and go in
[josephmedman] so you have ischemia throughout the full thickness of the myocardium
[josephmedman] you get me?
[Jibbsie] I get that one.But ot the endocardial one
[josephmedman] i dont know what you mean
[josephmedman] i never said endocardial
[Jibbsie] Stable angina - endocardial ischemia?
[arezooman] no, in regular ischemia why it is endocardial?
[josephmedman] hmm..
[img1md] i doubt mcc of 2nd ht in female is renovascular and ocps in general?
[arezooman] that's what I think because that part is more stressed to blood pressure
[josephmedman] its sub endocardial
[josephmedman] ocps?
[Jibbsie] yeah. Mech?
[img1md] sorry to iterrupt
[Jibbsie] why?
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[Jibbsie] okay. Arez
[arezooman] I am not sure, I will look it up
[arezooman] sorry
[img1md] please see my doubt above
[Jibbsie] Thanks every body. Great discussion as always. Goodnight.
[josephmedman] gnite jibs..ill try to find out that for you and i will post transcripts
[georgere] So we are going to do respiratory tomorrow?
[josephmedman] img1md
[josephmedman] please write it more clearly
[josephmedman] i dont knwo what you are trying to ask
[Jibbsie] Thanks Joe
[img1md] mcc of 2nd ht is renovascular or ocp in female?
[josephmedman] ocp?
[arezooman] oral contraceptive pills?
[josephmedman] MCC of HTN in REPRODUCTIVE years
[josephmedman] not in all women
[josephmedman] is oral contraceptives
[josephmedman] estrogen increases liver syntheiss of Angiotensin..
[arezooman] after idiopathic?
[img1md] ok .
[josephmedman] and the MC secondary cause of hypertension is renovascular hypertension
[josephmedman] in males it is atherosclerosis of the renal artery orifice
[img1md] yes
[josephmedman] and in women it is fibromuscular hyperplasia of the renal artery
[josephmedman] they are both High renin hypertnesions
[img1md] ok
[josephmedman] nbecause the involved kidney has increased PRA
[josephmedman] remember
[ppliutcm] joe, my goljan page 60 says placenta-derived pge1 keeps patent ductus open. am i right?
[josephmedman] captopril increases baseline PRA
[img1md] thanks
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[arezooman] what was PRA?
[georgere] plasma renin activity
[arezooman] thanks
[img1md] ok guys thank you and good night
[arezooman] bye
[josephmedman] it is PGE2
[josephmedman] for sure..
[josephmedman] adn indomethacin is used to close it after birth if defect is still there..
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[josephmedman] nice discussion guys..
[josephmedman] take care..
[georgere] Thank you everybody and see you tomorrow!
[josephmedman] see you tomorrow at 8pm again..
[arezooman] thanks Joe
[josephmedman] no prob..ill post this on this site and usmle.net..
[ppliutcm] thanks everyone
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