I am the Object of My Pimp's Affection

[Espion]

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What one thing must you ALWAYS think about when a non-smoking patient <40 years-old presents with lung cancer?

Here's my shot in the dark...alpha1 antitrypsin deficiency?

Edit: heh, nevermind.

 

[LovelyRita]

Here's my shot in the dark...alpha1 antitrypsin deficiency?

Edit: heh, nevermind.

I was thinking this too. But he said cancer. I don't know.

what's the heh, nevermind for?

 

[aphistis]

Human papilloma virus is the cause of genital warts.

Green sclerae in peds... Someone's been munching on crayons again?

Anyone willing to take a crack at my Wenkebach question? Hmmm? As a hint, the guy had mad physical exam skillz. 😛

Right, but which ones? Thus "specifically." 😉

 

[Espion]

I was thinking this too. But he said cancer. I don't know.

what's the heh, nevermind for?

I think he answered the question in the post above mine. These NMS-Surgery addled eyes o' mine don't see too well at the ripe hour of 9pm. 😀

 

[DireWolf]

Here's my shot in the dark...alpha1 antitrypsin deficiency?

Edit: heh, nevermind.

Correct. 👍 He said many pulmonologists don't even know this. AAT deficiency is one of his pet diseases.

 

[Espion]

Correct. 👍 He said many pulmonologists don't even know this. AAT deficiency is one of his pet diseases.

Oooooo, this means I can stop studying for the shelf right now, right?


[ 😡 Oh, damnit. As a member of the League of Apartment Dwellers Who Live Downstairs, I think the elephants upstairs need a little intervention. Someone is about to need a doktah in the house.]

 

[DireWolf]

Oooooo, this means I can stop studying for the shelf right now, right?


[ 😡 Oh, damnit. As a member of the League of Apartment Dwellers Who Live Downstairs, I think the elephants upstairs need a little intervention. Someone is about to need a doktah in the house.]

yes. you are allowed to stop studying.

free advice: NEVER NEVER NEVER rent an apartment unless it's on the top floor. It makes life so much more enjoyable. *stomps on floor to piss off the guy downstairs*

 

[TicDouloureux]

Right, but which ones? Thus "specifically." 😉

HPV 6 and 11 I think. Then there are a whole slew of them that cause more neoplastic lesions, 16 and 18 and 30something being the only ones I can remember.

Imipramine... a TCA which means it's a NE and 5HT reuptake inhibitor.

The green sclera continue to elude me...

Nobody wants to take a stab at the animal from which the parathyroids were first isolated? 😀

 

[Mumpu]

Parathyroids from cows maybe? They used to grind up cow thyroid (and before that, they used to eat it -- there are recipies out there!) and feed it to hypothyroid people. I suppose if some of them became hyper-PTH it would cause people to look at what's hanging out with the Big T.

How do TG's cause acute lung injury? I know you can get inhalational alveolar-filling disease from something like Pam but that won't raise your serum TGs enough to cause pancreatitis.

- Green sclera: my guess is chloroma. Anyone else?
- Waiting to hear on AVMs.
- Anyone at all on Wenkebach?

 

[BrooklynDO]

A document I found said glaucoma. My pimp thought it was river blindness 😕 .

Here's another.....How many grades of spondylolisthesis are there?

post your pimping.

i believe there to be 5... but im going back three years in my cobweb of a brain

Mine "what is the composition of fluid drained from the iliostomy of pt X" ((meaning exact electrolyte composition...from the chart in maxwell...)

 

[LovelyRita]

i believe there to be 5... but im going back three years in my cobweb of a brain

Mine "what is the composition of fluid drained from the iliostomy of pt X" ((meaning exact electrolyte composition...from the chart in maxwell...)

Whoa. So were you able to get it? How are things going? Haven't seen you around much since Step 1 prep. 😀

Guys I'm throwing in the towel on the Green Sclera and the Wenkebach story. Your pimps get the prize so far....

Have a good weekend.

 

[Mumpu]

Wenkebach simply noticed group beating with a pause which wasn't a PVC (he used a device to record radial pulse pressure waves), and he saw that the pulses got closer together as they got closer to the skipped beat. When he and a colleague recorded atrial and ventricular contractions in a dying frog heart, he saw a similar pulse phenomenon accompanied by increasing delay between atrial and ventricular contraction.

Another way to do this is by auscultation. With a short PR, the atria do not have time to completely relax, requiring relatively high ventricular pressure to shut the valves. Thus, S1 happens as the ventricles are accelerating and you get a loud S1. With a long PR, the atrial pressures are much lower and the valves shut early in systole. The ventricles have not had a chance to accelerate yet and the S1 is softer. 1st degree AV block is, in fact, one of the causes of a diminished S1, and it is possible to diagnose Wenkebach by auscultation alone because you will usually hear a progressively diminishing S1 followed by a skipped beat.

As a super-zebra note, you can get a paradoxical increase in S1 with extremely long PR intervals (above 0.36, if I recall) because the valves will actually re-open due to continuous pulmonary venous return.

I can't claim to have picked all of this up on physical exam, but the trick to good exam is "cheating" by expecting certain findings. Next time you get a patient with Wenkebach, listen to them and see if you can hear the variation in S1. If you can pick up the difference in JVPs, more power to you. I'm just happy if I see an A wave every now and then. 🙂

 

[NateatUC]

Anyone else for green sclera, or do you want the answer? Its actually going to be pretty obvious once you think about it. 😀 😀

 

[DrMom]

I think we've given up on that one (at least for what your attending had as the answer). Go ahead & tell us.

 

[EUROdocMOM]

I just have to guess on the green sclera...having kids myself...I'm gonna go with "kool-aid". Yes, the drink.
I have seen it turn stool blue, so why not sclera green?
Besides, I'm stumped! Give us the answer!

 

[Mumpu]

We wants the precious answer! Give it to us!

🙂

 

[NYC19]

Anyone else for green sclera, or do you want the answer? Its actually going to be pretty obvious once you think about it. 😀 😀

Really obvious? I certainly hope you're not going to say contact lenses...I believe they actually make some bizarre ones that could give you green sclerae (perhaps for halloween or a Hulk impersonating contest).

My guess is that you might see green sclerae in a patient with a CT disease (like OI or Ehler-Danlos; which could lead to blue sclerae) that happens to be jaundiced. Blue + Yellow = Green.

By the way, I've heard that scleral icterus is actually deposition of bile pigment in the overlying conjunctivae...

 

[Trichobezoar]

excessive mastication

What is the #1 cause of blindness in the world?

 

[BrooklynDO]

Whoa. So were you able to get it? How are things going? Haven't seen you around much since Step 1 prep. 😀

Guys I'm throwing in the towel on the Green Sclera and the Wenkebach story. Your pimps get the prize so far....

Have a good weekend.

yea i got it, but i sorta knew he was gonna ask one of us ...so i was looking at maxwell at the time

😛 dont be smart, be prepared

 

[NateatUC]

My guess is that you might see green sclerae in a patient with a CT disease (like OI or Ehler-Danlos; which could lead to blue sclerae) that happens to be jaundiced. Blue + Yellow = Green.

We have a winner! Blue (OI) + Yellow (jaundice) does indeed equal green!

Gotta love pimp questions! Keep 'em coming.

 

[Mumpu]

Oh, EVIL! Good job NYC19.

 

[NYC19]

Thanks! 🙂 Now if I could only memorize all of what I need to know for my exams... 😉

 

[pikachu]

Oooooo, this means I can stop studying for the shelf right now, right?


[ 😡 Oh, damnit. As a member of the League of Apartment Dwellers Who Live Downstairs, I think the elephants upstairs need a little intervention. Someone is about to need a doktah in the house.]

hee, hee... I call my upstairs neighbor "Clompy"

One of my favorite pimp questions of all time: What is the derivation (as in origin of the word) of "warfarin"?

 

[Mumpu]

Wisconsin Alumni Research Fund. (takes a bow)

My turn: What about lasix?

 

[Whisker Barrel Cortex]

Wisconsin Alumni Research Fund. (takes a bow)

My turn: What about lasix?

Their building is right across the street from my hospital. They take a chunk of the money earned from any medical patent created by UW doctors.

Lasix = Lasts six hours?

 

[Boomer]

Lasix = Lasts six hours?

Dead on.

 

[TeleoDeum]

undefined
From a peds perspective, another thing that will give you green sclera. When a kid has really bad DIRECT hyperbilirubinemia, not normal indirect hyperbili, and you put him under the bili lights, he will turn from a classic yellow to this orangy color and his sclera will turn a greenish color. Something about the direct hyperbili and certain wavelengths conjugating the bili.

Peace,
Greg

 

[v-tach]

Green sclerae... I would guess biliverdin reductase deficiency in someone with increased heme breakdown 😕

My turn:
How did Wenkebach discover the phenomenon named after him? (no, he didn't do an ECG 😛)

Why is diabetes mellitus named so?

Diabetes mellitus is so named because it was noticed that the urine tasted sweet (aren't you glad that's no longer a method of testing it...)

 

[v-tach]

A plastic sugreon asked me what singlutus is.

Singultus = hiccups.

 

[LovelyRita]

Four major symptoms of benign prostatic hypertrophy are--?

 

[fuegorama]

Four major symptoms of benign prostatic hypertrophy are--?

I don't know about that BENIGN hypertrophy, but hyperplasia 😉 will buy you frequency, urgency, hesitancy, incomplete emptying, straining, decreased calber of stream, dribbling and possible acute pain on micturation.
Oops-couldn't do it in four.

 

[Homunculus]

undefined
From a peds perspective, another thing that will give you green sclera. When a kid has really bad DIRECT hyperbilirubinemia, not normal indirect hyperbili, and you put him under the bili lights, he will turn from a classic yellow to this orangy color and his sclera will turn a greenish color. Something about the direct hyperbili and certain wavelengths conjugating the bili.

Peace,
Greg

kids with severe short gut syndrome and liver failure look like miniature Incredible Hulks.

--your friendly neighborhood peds intern caveman

 

[LovelyRita]

I don't know about that BENIGN hypertrophy, but hyperplasia 😉 will buy you frequency, urgency, hesitancy, incomplete emptying, straining, decreased calber of stream, dribbling and possible acute pain on micturation.
Oops-couldn't do it in four.

My bad--hyperplasia 😳
He was looking for hesitancy, urgency, decreased stream caliber and dribbling. We talked about pain, but he kind of shook that one off.
👍

 

[Doc Ivy]

HPV 6 and 11 I think. Then there are a whole slew of them that cause more neoplastic lesions, 16 and 18 and 30something being the only ones I can remember.

😀

Actually its HPV 16 and HPV 18, they bind p53 and Rb tumor suppressors with a way higher affinity than 6 and 11...

 

[CaptainJack02]

Actually its HPV 16 and HPV 18, they bind p53 and Rb tumor suppressors with a way higher affinity than 6 and 11...

i have NO idea wtf some of these posts are saying, but this thread is soo cool!

bump!

 

[LovelyRita]

i have NO idea wtf some of these posts are saying, but this thread is soo cool!

bump!

🙄

 

[DrMom]

How about this one?

What are the 3 MC causes of croup?

 

[MustafaMond]

I don't know about that BENIGN hypertrophy, but hyperplasia 😉 will buy you frequency, urgency, hesitancy, incomplete emptying, straining, decreased calber of stream, dribbling and possible acute pain on micturation.
Oops-couldn't do it in four.

Benign Prostatic Hypertrophy and Hyperplasia are 100% synonymous terms and can be used interchangeably.

 

[MustafaMond]

How about this one?

What are the 3 MC causes of croup?

viral, bacterial and allergic?

 

[LovelyRita]

Benign Prostatic Hypertrophy and Hyperplasia are 100% synonymous terms and can be used interchangeably.

😍

What's the term used to describe elevated bun/creatinine?

 

[DrMom]

viral, bacterial and allergic?

I meant by pathogen. Sorry that wasn't clear.

 

[DOtobe]

😍

What's the term used to describe elevated bun/creatinine?

Uremia?

 

[LovelyRita]

Uremia?

Pimp was looking for azotemia. 🙄

 

[DOtobe]

I always get uremia/azotemia confused 🙄

 

[Doc Ivy]

I meant by pathogen. Sorry that wasn't clear.

RSV???


Ok I'll pimp: what are the key differences between the nephritic and the nephrotic syndromes?

 

[medpa]

How about this one?

What are the 3 MC causes of croup?

My guess is (in no particular order)...

Haemophilus influenzae type b

Group A Beta hemolytic strep

Staph aureus


Can anyone explain what the difference is between azotemia and uremia? In the med dictionary they are listed as synonyms...

 

[DrMom]

My guess is (in no particular order)...

Haemophilus influenzae type b

Group A Beta hemolytic strep

Staph aureus

One of these is right according to my preceptor 🙂

 

[mycin1600]

parainfluenza!

 

[DrMom]

parainfluenza!

That's the #1

one of medpa's is the #3

🙂

 

[mycin1600]

peds sucks.