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USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


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  #1  
Old 07-31-2011
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Wink I bet anyone ask me a question I can't answer

I wanna open a topic for any questions of members regarding any part of step 1 they can't understand and I am ready to answer all questions as much as I can
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  #2  
Old 08-01-2011
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Default Nystagmus

what is the difference between in terms of anatomy for a vertical and a horizontal nystagmus, what can it help us detect clinically?

Thank you
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Old 08-01-2011
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Is astrovirus important for USMLE?

What is the significant of astrovirus?
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  #4  
Old 08-01-2011
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vertical nystagmus means a brain stem lesion or posterior fossa lesion
horizontal nystagmus is three types:
1- ocular type which is pendular {equal in both directions} no fast or slow phases spontaneous (no point of fixation)

2-cerebellar lesion with 2 phases fast phase and slow phase and fast phase towards point of fixation

3-vestibular with 2 phases fast phase and slow phase and fast phase away from point of fixation

notes:
*fast phase is due to correction by cerebral cortex

*slow phase in cerebellar lesion is due to fragmentation of movements and loss of smoothness of movements which is the responsibility of cerebellum

*slow phase in vestibular type is due to imbalance between two vestibular systems with the normal side taking upper hand

http://www.videosurf.com/video/vertical-nystagmus-64351426


http://www.videosurf.com/video/pendu...agmus-64351629


http://video.google.com/videoplay?docid=83290528059760181(cerebellar type)

(vestibular type )
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  #5  
Old 08-01-2011
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Astrovirus is a type of virus that was first discovered in 1975 using EM following an outbreak of diarrhea in humans
Astroviruses are 2835 nm diameter,icosahedralviruses that have a characteristic five- or sixpointed star-like surface structure when viewed by electron microscopy

the Astroviridae comprise a third family of nonenveloped viruses whose genome is composed of plus-sense, single-stranded RNA.

I don't think it is of high yield but we know it right now
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  #6  
Old 08-01-2011
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Default pharn

How does Ticlopidine causes thrombocytopenia?,i came across in goljan that ticlopidine and clopidogrel causes endothelial injury,if so isnt that a predisposition to clot formation?


REf: pg 257,3rd edition Goljan..under Thrombotic thrombocytopenic purpura..


thanks in advance for the reply
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  #7  
Old 08-01-2011
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Quote:
Originally Posted by usmleman2020 View Post
I wanna open a topic for any questions of members regarding any part of step 1 they can't understand and I am ready to answer all questions as much as I can
wat structure is injured if a man gets a knife stabbed in 4th intercostal space along left sternal border n if he is stabbed in fifth intercostal space along left sternal border???
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Old 08-01-2011
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Quote:
Originally Posted by drgsarunprasath View Post
How does Ticlopidine causes thrombocytopenia?,i came across in goljan that ticlopidine and clopidogrel causes endothelial injury,if so isnt that a predisposition to clot formation?


REf: pg 257,3rd edition Goljan..under Thrombotic thrombocytopenic purpura..


thanks in advance for the reply
Ticlopidine and clopidogrel act by inhibiting ADP (a factor important for increased expression GP IIa/IIIb receptor which is important for platelet activation and subsequent aggregation)
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Quote:
Originally Posted by qurat21 View Post
wat structure is injured if a man gets a knife stabbed in 4th intercostal space along left sternal border n if he is stabbed in fifth intercostal space along left sternal border???
to answer this question depend on x ray of the heart in your imagination
I think they are the following structures in 4th and 5th and 6th intercostal spaces:
-left side:bare area of the heart (right ventricles lateral to it the left one )
right side : right atrium

2nd intercostal:
L - Aortic arch
R- Right lung

3rd intercostal:
L - Pulm. trunk, Ascending aorta, SVC
R - Right lung
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  #10  
Old 08-01-2011
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any new questions
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Old 08-01-2011
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Could u explain in brief the valsalva maneuver and defecation and hand grip AV shunt on CVS physio"? please
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  #12  
Old 08-01-2011
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Default this isnt the answer to my question!!!

Ticlopidine and clopidogrel act by inhibiting ADP (a factor important for increased expression GP IIa/IIIb receptor which is important for platelet activation and subsequent aggregation)



It wud have been answer to the question what is the mechanism of action for ticlopidine...
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  #13  
Old 08-02-2011
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Quote:
Originally Posted by drgsarunprasath View Post
Ticlopidine and clopidogrel act by inhibiting ADP (a factor important for increased expression GP IIa/IIIb receptor which is important for platelet activation and subsequent aggregation)



It wud have been answer to the question what is the mechanism of action for ticlopidine...
the mechanism of action explains your question even there is endothelial injury there will be defective platelet aggregation as there is problem in the sequence of events
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Old 08-02-2011
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Could you just go over medial rectus palsy for me please. And by saccadic movements we mean like reading a line?

thanks in advance
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Old 08-02-2011
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Originally Posted by USMLE2011m View Post
Could you just go over medial rectus palsy for me please. And by saccadic movements we mean like reading a line?

thanks in advance
what do you mean by your question make it more specific?
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Old 08-02-2011
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Quote:
Originally Posted by usmleman2020 View Post
what do you mean by your question make it more specific?

What is Medial Rectus Palsy? The mechanism behind it.
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Old 08-02-2011
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Quote:
Originally Posted by Amenah View Post
Could u explain in brief the valsalva maneuver and defecation and hand grip AV shunt on CVS physio"? please

Effect of Valsalva
The Valsalva maneuver works by decreasing preload to the heart



it causes decrease of intensity of murmurs of


Aortic Stenosis


Pulmonic Stenosis


Tricuspid Regurgitation


Increased intensity of murmurs of


Hypertrophic cardiomyopathy, mitral valve prolapse
for example in HOCM it causes decrease in VR so less dilation of left ventricle less relief of obstruction increased intensity of murmur on the same concept all other conditions are explained

Hand GRIP:The handgrip maneuever is performed by clenching one's fist forcefully for a sustained time until fatiguedThe handgrip maneuver increases afterload by squeezing the arterioles and increasing Total Peripheral Resistance.no effect on venous return unlike squatting
Increased intensity of murmurs of
Aortic Regurgitation
, Mitral Regurgitation ,Ventricular Septal Defect
decrease intensity of murmurs of
Aortic Stenosis , Mitral Stenosis , Hypertrophic Cardiomyopathy
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  #18  
Old 08-02-2011
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Quote:
Originally Posted by USMLE2011m View Post
What is Medial Rectus Palsy? The mechanism behind it.
ok I will tell you what I know about medial rectus palsy if there something not clear please tell me

in medial rectus palsy it occurs due to injury to its innervation which is by third cranial nerve resulting in failure of adduction of affected eye with the following findings :
- the face looks where the eye can't go the patient will look to opposite side of affected eye to compensate for failure of adduction
-according to herring law
(the brain sends the same amount of impulses to synergistic muscles and that law can't be broken under any conditions ) so on performing cover test the 2ry angle of deviation(the angle performed by non affected eye while pt fixates by paralysed eye) is greater than 1ry angle of deviation (the angle performed by affected eye while pt fixates by normal one)
so the brain will send more impulses to paralysed medical rectus to move it and the same amount to lateral rectus of opposite side resulting in outward deviation of eye of opposite side in exaggeration of normal
-lateral rectus of rhe same eye will work unopposed resulting in outward deviation of same eye
- there may be associated ptosis

Last edited by usmleman2020; 08-02-2011 at 11:47 AM.
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Old 08-02-2011
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Very excellent explanations.............keep going
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  #20  
Old 08-02-2011
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Default Propanolol 2nd beneficit in hyperthyroidism treatment

How does propanolol decrease peripheral conversion of T4 to T3???
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  #21  
Old 08-02-2011
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Star The process

Did you do Uworld? What was your score there? How about Kaplan Qbank?
What resources did you use to study? How long did you take?
Did you do any other Q banks than the traditional once? If yes, which ones?
Any other sources and tips you would suggest or guide for people who have just started preping for the beast????

Please answer these questions as it will be a great help to me and us all to pursue the right resources and motivate us along the way.

Cheers
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  #22  
Old 08-02-2011
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Quote:
Originally Posted by NGaleas View Post
How does propanolol decrease peripheral conversion of T4 to T3???
propranolol inhibits 5'-monodeiodinase which is responsible for peripheral conversion of T4 to T3
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  #23  
Old 08-02-2011
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Quote:
Originally Posted by docji View Post
Did you do Uworld? What was your score there? How about Kaplan Qbank?
What resources did you use to study? How long did you take?
Did you do any other Q banks than the traditional once? If yes, which ones?
Any other sources and tips you would suggest or guide for people who have just started preping for the beast????

Please answer these questions as it will be a great help to me and us all to pursue the right resources and motivate us along the way.

Cheers
I haven't taken any steps yet man I started that topic to useful to all of us during our preparation I am not the best one to answer your questions ask some one who has taken the exams
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  #24  
Old 08-02-2011
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any other questions
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  #25  
Old 08-02-2011
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I meant you must be going over Uworld Kaplan and other Q banks. Whats your progress been there so far?

Quote:
Originally Posted by docji View Post
Did you do Uworld? What was your score there? How about Kaplan Qbank?
What resources did you use to study? How long did you take?
Did you do any other Q banks than the traditional once? If yes, which ones?
Any other sources and tips you would suggest or guide for people who have just started preping for the beast????

Please answer these questions as it will be a great help to me and us all to pursue the right resources and motivate us along the way.

Cheers
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  #26  
Old 08-02-2011
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Thumbs Up great job

hey dude u r doing great ........ thumbs up 4u ............... hw long v can disturb u???
i ve a qs tooo what is the rationale behind the use of alpha blocker in BPH??
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  #27  
Old 08-02-2011
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the use of alpha blocker in BPH is for symptomatic relieve and decrease urine retention by relaxation of sphincter and contraction of detrusor muscles
so they use alpha-1 blockers mainly tamsulosin but actually they have no effect on prostatic enlargement
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Old 08-02-2011
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Quote:
Originally Posted by docji View Post
I meant you must be going over Uworld Kaplan and other Q banks. Whats your progress been there so far?
I have started for 4 months studying kaplan and videos but I haven't started any q bank yet but many of my friends recommend usmle world for sure and usmle RX to help you master first aid and may be kaplan q bank
also don't forget goljan audio and review
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  #29  
Old 08-02-2011
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Any new questions
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  #30  
Old 08-03-2011
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Hi, i would like to ask u that what is the function of sup colliculus
Regarding parinaud syn.....some say paralysis of conjugate vertical gaze
some say paralysis upward gaze, so which one is correct....a little bit confused
thank u a lot
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  #31  
Old 08-03-2011
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And next qs
1 how we can differentiate between cerebellar degeration from wernike, clinicals are quite similar in alcoholic pt
2 FA says korsakoff results from damage to mamillary body, but uw says temporal lobe...which one is correct, i am confused??

thank u v much usmleman2020:sorry:
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  #32  
Old 08-03-2011
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Quote:
Originally Posted by cushingface View Post
And next qs
1 how we can differentiate between cerebellar degeration from wernike, clinicals are quite similar in alcoholic pt
2 FA says korsakoff results from damage to mamillary body, but uw says temporal lobe...which one is correct, i am confused??

thank u v much usmleman2020:sorry:

Hi, I will ofcourse let USMLEman2020 take the lead, however I would like to say this to yr questions:

there are 2 wernickes
1) Wernickes Aphasia : which is in the temporal lobe and if severed results in receptive aphasia

2) wernicks encephalopathy: of which late stage is called Korsakoff syndrome, this is damage to the mamillary body and the mediodorsal nucleus of the thalamus secondary to alcohol and B1 deficiency.

Now as for yr differentiating wernicks encephalopathy from cerebellar lesions: I believe in korsakoff they confabulate, where as they wouldn't do that in the cerebellar lesions, furthermore, the korsakoff is to do with memory, where as cerebellar lesion is more towards, posture,balance,etc.

Hope this cleared out things if not, let me know and we shall also wait for usmleman2020 to shed some light
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  #33  
Old 08-03-2011
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Help

What is the effect on the Left ventricular end diastolic volume in cases of arterial dilatation and venous dilatation?

Also why should there be a increase in Cardiac output and decrease in end diastolic volume in septic shock?
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Old 08-03-2011
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Quote:
Originally Posted by cushingface View Post
Hi, i would like to ask u that what is the function of sup colliculus
Regarding parinaud syn.....some say paralysis of conjugate vertical gaze
some say paralysis upward gaze, so which one is correct....a little bit confused
thank u a lot
what I know is that it cause paralysis of conjugate vertical gaze especially in upward gaze I mean that it becomes more evident in upward gaze
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Old 08-03-2011
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Quote:
Originally Posted by indigo View Post
What is the effect on the Left ventricular end diastolic volume in cases of arterial dilatation and venous dilatation?

Also why should there be a increase in Cardiac output and decrease in end diastolic volume in septic shock?
ok man
BP=TPR * CO
CO=SV * HR
IN CASE OF SEPTIC SHOCK there is generalized vasodilation so there is decrease in BP so there must be an increase in CO to return BP to normal and that's occurs by reflex tachycardia and increasing heart rate and tachycardia will decrease diastolic filling time and EDV
(the same effect of arterial dilation)


venodilation will decrease preload and venous return to the heart resulting in decrease CO and EDV
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  #36  
Old 08-03-2011
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Star Thanks buddy,

What happens to preload in arterial dilatation? i think it should increase,but correct if im wrong.

Also what happens if there is a shunt in the lung? Would it cause respiratory alkalosis or acidosis? Goljan says alkalosis but i thought it should be acidosis.
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  #37  
Old 08-03-2011
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Quote:
Originally Posted by indigo View Post
What happens to preload in arterial dilatation? i think it should increase,but correct if im wrong.

Also what happens if there is a shunt in the lung? Would it cause respiratory alkalosis or acidosis? Goljan says alkalosis but i thought it should be acidosis.
in arterial dilatation causes little or no change in preload(minimal effect) I think it should increase
shunt in the lung alkalosis I think due to hyperventilation
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Old 08-03-2011
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Default acute pancreatis

Pancreas secrets trypnisogen , which converted to tripsin by endokinase only found in intestine. But in acute pancreatis, when pancreas is damaged, trypsin is the major pathology factor.How trypnisogen converted to trypsin in this situation?
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  #39  
Old 08-03-2011
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Quote:
Originally Posted by fshyang View Post
Pancreas secrets trypnisogen , which converted to tripsin by endokinase only found in intestine. But in acute pancreatis, when pancreas is damaged, trypsin is the major pathology factor.How trypnisogen converted to trypsin in this situation?
acute pancreatitis is an inflammatory process not necrotic one so it will lead to passive leakage of enzymes from pancreas
exactly like thyroiditis which leads to increase in thyroid hormones at the start due to passive leakage
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  #40  
Old 08-04-2011
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Hi, usmleman2020
i am quite confused about functions of these enzyme in viral replication when it enter into the cell
1 DNA dependent DNA polymerase
2 DNA dependent RNA polymerase
3 RNA dependent DNA polymerase
4 RNA dependent RNA polymerase

Can u plz explain and give me more some examples, i really don't understand
Thank u v much:sorry:
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Old 08-04-2011
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Quote:
Originally Posted by cushingface View Post
Hi, usmleman2020
i am quite confused about functions of these enzyme in viral replication when it enter into the cell
1 DNA dependent DNA polymerase
2 DNA dependent RNA polymerase
3 RNA dependent DNA polymerase
4 RNA dependent RNA polymerase

Can u plz explain and give me more some examples, i really don't understand
Thank u v much:sorry:
viruses are four types:
DNA viruses which depend on DNA dependent DNA polymerase for direct DNA replication

exception of DNA viruses is HBV which copy its DNA after forming RNA
so it uses DNA dependent RNA polymerase to form RNA which is transcribed to DNA using RNA dependent DNA polymerase


RNA viruses are of 2 types but both types use RNA dependent RNA polymerase:

1-positive sense RNA viruses which uses its RNA to form that enzyme after cell entry
2-negative sense which contain that enzyme preformed
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  #42  
Old 08-04-2011
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any new questions
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  #43  
Old 08-05-2011
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Default what to do for histology

hi i hate histology n i hv trouble understanding the slides. plz give me tips on what to do n how to do histology. plus im reading the 2008-09 anatmy notes bcz the later 1 isnt available here n im watching the 2010 dvds n i realize its totally different. the old book is actually missing chapters like connective tissue n bone. r these things imp or wud it b okay to study the older version. are we supposed to b knowing histology in detail like all those proteoglycans n gags n wat nots..... sorry my question is a bit awkward but i'd really appreciate any kind of help/advice
thanks
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  #44  
Old 08-05-2011
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why there is hyperchloremic metabolic acidosis due to use of carbonic anhydase inhibitors.. i know the cause of metabolic acidosis in these drugs but dont know aabout chlorine ... why there is hyperchloremia?
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Quote:
Originally Posted by yasirsattar75 View Post
why there is hyperchloremic metabolic acidosis due to use of carbonic anhydase inhibitors.. i know the cause of metabolic acidosis in these drugs but dont know aabout chlorine ... why there is hyperchloremia?
carbonic anhydrase inhibitors inhibit enzyme carbonic anhydrase which is responsible for preserving HCO3 from renal filtrate
I have to explanations:
first , according to anion gap Na = Cl + HCO3 (roughly)
so a decrease HCO3 will increase Cl

second , in RBCs there is carbonic anhydrase to transform plasma CO2 into bicarbonate and every bicarbonate formed , a chloride ion is taken from plasma inside RBCs (chloride shift)
so there will be inhibition of carbonic anhydrase less formed bicarbonate more cl in plasma
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  #46  
Old 08-05-2011
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Quote:
Originally Posted by drmeena View Post
hi i hate histology n i hv trouble understanding the slides. plz give me tips on what to do n how to do histology. plus im reading the 2008-09 anatmy notes bcz the later 1 isnt available here n im watching the 2010 dvds n i realize its totally different. the old book is actually missing chapters like connective tissue n bone. r these things imp or wud it b okay to study the older version. are we supposed to b knowing histology in detail like all those proteoglycans n gags n wat nots..... sorry my question is a bit awkward but i'd really appreciate any kind of help/advice
thanks
I think you can compensate any missing points of histology in pathology goljan
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  #47  
Old 08-05-2011
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Quote:
Originally Posted by usmleman2020 View Post
carbonic anhydrase inhibitors inhibit enzyme carbonic anhydrase which is responsible for preserving HCO3 from renal filtrate
I have to explanations:
first , according to anion gap Na = Cl + HCO3 (roughly)
so a decrease HCO3 will increase Cl

second , in RBCs there is carbonic anhydrase to transform plasma CO2 into bicarbonate and every bicarbonate formed , a chloride ion is taken from plasma inside RBCs (chloride shift)
so there will be inhibition of carbonic anhydrase less formed bicarbonate more cl in plasma
okzzzzz thanxxx yeah u are right i was thinking same but i was also thinking about may b there is greater reabsorbtion of chlorideee ..... yup u are right anion gap increases more than 12 ....thanxxx dude
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  #48  
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any new questions
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  #49  
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Default Did you get any answer?

Quote:
Originally Posted by docji View Post
Did you do Uworld? What was your score there? How about Kaplan Qbank?
What resources did you use to study? How long did you take?
Did you do any other Q banks than the traditional once? If yes, which ones?
Any other sources and tips you would suggest or guide for people who have just started preping for the beast????

Please answer these questions as it will be a great help to me and us all to pursue the right resources and motivate us along the way.

Cheers
Hi docji,
I have decided to start study for the certification. I have found all this web sites. I liked your post about what resources to use to study. I am a little bit lose and I do not know where to start or what will be the best way to prepare myself. I do not have the enough money to pay Kaplan. Could you please recommend me sites or books?
Thanks in advance.
Lif.
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  #50  
Old 08-05-2011
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Default Did you get any answer

Quote:
Originally Posted by docji View Post
Did you do Uworld? What was your score there? How about Kaplan Qbank?
What resources did you use to study? How long did you take?
Did you do any other Q banks than the traditional once? If yes, which ones?
Any other sources and tips you would suggest or guide for people who have just started preping for the beast????

Please answer these questions as it will be a great help to me and us all to pursue the right resources and motivate us along the way.

Cheers
Hi docji,
I have decided to start study for the certification. I have found all this web sites. I liked your post about what resources to use to study. I am a little bit lose and I do not know where to start or what will be the best way to prepare myself. I do not have the enough money to pay Kaplan. Could you please recommend me sites or books?
Thanks in advance.
Lif.
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  #51  
Old 08-06-2011
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Originally Posted by usmleman2020 View Post
Any new questions

which phase of cell cycle has 2dsDNA??

A.G0
B.G1
C.S
D.G2
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  #52  
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Quote:
Originally Posted by USMLE2011m View Post
which phase of cell cycle has 2dsDNA??

A.G0
B.G1
C.S
D.G2
S
G2
I think that
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  #53  
Old 08-07-2011
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Originally Posted by usmleman2020 View Post
S
G2
I think that

so which one will it be? S or G2??
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  #54  
Old 08-12-2011
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hmm lets see can you answer (heh)

what are the drugs other than procainamide that cause SLE like symptoms and how do we differntiate them from the SLE caused by procainamide


also

what makes quinidine pro arrythmatic?

btw nice thread i saved it for later reference.!
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