I think there is a slight error with the Concept of -Asthma Crisis. Asthma Crisis presents first with a Resp Alkalosis due to the patient elevated RR which will then explain the low PaCO2 and the cerebral vasoconstriction due to hypocapnia and the somnolence ... Respiratory Acidosis presents later if the crisis is not managed promptly, it would mean that our patient probably is starting to hypo-ventilate which leaves us with couple of pathways of why is this happening...is it because low RR (ie. muscle fatigue) ? or is it because of the obstructive nature of the disease? or perhaps it could be a combination of both, either way it will lead to less efficient gas exchange and the accumulation of CO2 which will lead to Hypercapnia and cerebral vasodilation. I COULD BE WRONG! but it just don't add up to me.
Thank you so much for your content. As I go through my NbME exam I can see how you’ve taken the important clinical presentations from the vignette and package it concisely as you present each disease. It’s so extremely helpful and saves so much time as I go through my incorrect mcqs. I don’t have to hunt for the must know information from various resources. You package it so nicely right here in one place. It almost feels like I’m cheating. You’re a great teacher (and a life saver) You’re passionate and to the point, and that makes it sooo enjoyable to learn from you. Thank you ! I feel like I have more hours in my day now. I told my med school classmates about you too. -niya
This is a really good video for USMLE review, is the first one that I watch so I imagine the rest are as good, def going to use your programs for preparation!!!
Hi sir , sorry but please in future videos can you keep your front cam view in the left side of the slide , so just we can see questions more properly. Thanks
Hi - thanks for that, I am trying to change that on Zoom live streams as that is default option. So sorry for any inconvenience, if you would like to see the HD versions as well as the videos broken up, then please enroll in my Top Concepts (free) course - hyguru.com. Thanks for your continued support!!
Am so so Happy and grateful I finally passed my USMLE exam 🎉🎉 with the help of the channel and Mr Carlos. I wanna say a big thanks to the channel admin for accepting me into the channel. Never give up you will also passed your exam with the help of the channel and Mr Carlos
Oh god. Is this carlos guy related to usmle recalls? I came across such posts on reddit. Shame on you guys, people like you have made it the usmle journey all the more tough n unfair!
It's not about watching videos here on CZcams and wasting your time on materials and reviews that won't help, I was ignorant doing so till I got recommended to Mrs Margaret Smith, some how watching videos helped me too because without watching them i wouldn't have known about Mrs Margaret
Increased intrathoracic pressure ➡️ decreased venous return (there is less gradient of pressure between SVC and RA; i.e. RA pressure is high so SVC cannot fill RA thus low VR). Thanks!
In your question about the pt who is obese w/ dyspnea. The increase in residual volume is correct too right because the pt will have air trapping? Why is decreased FRC the better answer?
Type 2 pneumocyte increase in ILD or decrease?I think uw says increase type 2 and decrease type 1. please correct me if i am wrong. thanks for your nice lecture.
Peak expiratory flow rate is increased due to radial traction in Restrictive pathology but in myasthenia gravies peak expiratory flow rate is decreased?Can you please explain?
HY Points
-Hypoventilation & High Altitude --> Normal A-a Gradiant
-V/Q Mismatch, Diffusion Defect, Right-To-Left Shunt --> Alveolar-Capillar interface impairment --> ↑A-a Gradiant
-High Altitude --> ↓Patm --> ↓Alveolar PAO2
-High Altitude --> Hypoxemia --> ↑EPO secretion from Peritubular Capillary cells (Kidney) -> ↑RBC Mass (↑Hb/Htc)
-Hypoxemia --> ↑Synthesis of 2,3-BPG -> Hb dissociation Curve shifts to Right -> ↓Hb Affinity for O2 --> ↑Off-Load Of OXygen from Hemoblogin into the Tissues
-Hyperventilation (↑RR) in High-Altitude --> ↓PaCO2 --> Cerebral Vasoconstriction --> ↓Cerebral Perfusion --> Light Headeadness
(Respiratory Alkalosis)
-Polycythemia Vera --> LOW Erytropoetin (EPO) + Itchiness + High Hb/Ht
-Obstructive Sleep Apnea (OSP) --> V/Q Mismatch (Hypoxemia) + BMI > 30 + Daytime Sleepy + Headache
-V/Q Mismatch --> CAn be Shunt or DEAD Space type
-COPD (Mucus)/Foreign Body/Sleep Apnea (Colapse of Alveolar Wall) --> Plugggin of Alveoli --> V/Q Mismatch (Hypoxemia) due to SHUNT
-Pulmonary Embolus --> blockage of Pulmonary Artery --> No PErfusion --> Dead Space
-Hypoxia & Adenosine --> Mediate Coronary Blood flow in the Coronary Arteries
-Asthma Crisis + Resp Acidosis + Somnolence --> Hyperventilation --> ↓PaCO2 --> Cerebral Vasoconstriction -->↓Cerebral Perfusion
-Impediding Uncus Herniation --> Txt Hyperventilations (will ↓PaCO2 --> Cerebral Vasoconstriction --> ↓Cerebral Blood flow
-PGE-2 causes dilation of Afferent Arteriole of Kidney
-Longstanding OSP --> Hypoxemic Pulmonary Vasoconstriction --> Right Heart Failure (HF)
-Increased Radial Alveolar Traction in Pulmonary Fibrosis --> High Peak Expiratory Flow
-Tetralogy of Fallot --> Abnormal Neural Crest Migration --> Deviation of the Infundibular Septum (3rd and 4rd Pharyngeal Pouches Defect)
-Thin-Tall patient with SOB + ↓SpO2 --> Apical Subpleural bleb rupture --> Spontaneous Pneumothorax
-Thin-Tall males, Pre-Existing Lung disease, Marfans/Ehlors Danlos --> Spontaneous Pneumothorax
-Hyperplasia of Submucosa Glands --> Bronchitis
-Cystic Fibrosis causes Obstructive Lung disease/Bronquiectasis
-Eosinophils are induced by IL-4 and IL-5, and causes release of MBP which perpetuates Broncoconstriction
-IL-10 and TGF-β increases Fibrosis of the Lung
-Lack of Type 2 Pneumocytes --> NO Stem Cells --> More Fibrosis
-Wekness worse at End of Day + Cranial Nerve problems + Low peak Expiratory flow --> Myasthenia G (REstrictive Lung disease)
-External intercostals --> Inspiration / Internal intercostals --> Expiration / C3-C5 -> Diaphragm
-SiADH, ACTH, and Lambert Eaton (Type II HSR) --> Small Cell lung cancer / Paraneoplastic Syndromes
-Neuroendocrine Origin tumor -> NCAM, CD56, Chromogranin, Synaptophysin
-RhabdomyoSarcoma (Viginal Area) --> DEsmin (+)
-Erwing Sarcoma -> "Onion-Skin" Appearance
-Neuroblastoma --> High N-MYC Oncogene
-Intercellular bridges & Keratin Pearls + CAvitation and Necrosis + PTHrP --> Squamous CEll lung (Central tumor)
-Trigger (i.e. Pancreatitis/trauma/infection) --> Release of inflammatory cytokines --> Neutrophil Migration
--> ↑ROS & ↑Pulmonary capillary vsodilation -> Exudative effusion --> Alveolar Hyaline membrane
So useful tell us more
These are awesome, very helpful. do you also have for other systems? If you do can you please share it with us?
I think there is a slight error with the Concept of -Asthma Crisis. Asthma Crisis presents first with a Resp Alkalosis due to the patient elevated RR which will then explain the low PaCO2 and the cerebral vasoconstriction due to hypocapnia and the somnolence ... Respiratory Acidosis presents later if the crisis is not managed promptly, it would mean that our patient probably is starting to hypo-ventilate which leaves us with couple of pathways of why is this happening...is it because low RR (ie. muscle fatigue) ? or is it because of the obstructive nature of the disease? or perhaps it could be a combination of both, either way it will lead to less efficient gas exchange and the accumulation of CO2 which will lead to Hypercapnia and cerebral vasodilation. I COULD BE WRONG! but it just don't add up to me.
Your series has been so great! Thanks for putting out these great, free content for us :)
I loved it ! You made my weekend!
Love you from the Bottom of heart for the explanations and free materials
Thank you so much for your content. As I go through my NbME exam I can see how you’ve taken the important clinical presentations from the vignette and package it concisely as you present each disease. It’s so extremely helpful and saves so much time as I go through my incorrect mcqs. I don’t have to hunt for the must know information from various resources. You package it so nicely right here in one place. It almost feels like I’m cheating. You’re a great teacher (and a life saver) You’re passionate and to the point, and that makes it sooo enjoyable to learn from you. Thank you ! I feel like I have more hours in my day now. I told my med school classmates about you too.
-niya
Your content is amazing. Keep it up!!! Thank you so much!!
You are the best and completely saving my butt for this exam.
Great review! Thank you, very helpful.
THANK YOU THANK YOU - you explain things SO well!
This is so helpful! Thanks a lot
Thank you so much Dr.!!! It's really amazing explanation and easy to follow. You explained the important concepts very clearly and effectively.
This is a really good video for USMLE review, is the first one that I watch so I imagine the rest are as good, def going to use your programs for preparation!!!
Thanks so much for your support! Cant wait to see you in the course :)
This was amazing! Thank you!!!
thank you for literally saving all of us
Thank you so much and you are a Great Teacher
Outstanding presentation
This was AWESOMEEEE
Thanks for your effort
Thank you so much Dr.
Sir extremely helpful lecture thank alot sir
You are awesome!!
Thanks alot
Hi sir , sorry but please in future videos can you keep your front cam view in the left side of the slide , so just we can see questions more properly. Thanks
Hi - thanks for that, I am trying to change that on Zoom live streams as that is default option. So sorry for any inconvenience, if you would like to see the HD versions as well as the videos broken up, then please enroll in my Top Concepts (free) course - hyguru.com. Thanks for your continued support!!
This was amazing and exactly what I needed!
Thankss!!! It's one of my favorite organ systems to teach lol! Hope studying is going well.
Hello
Hello
@@hyguruprep
Hello
Yes
thankyou
sir
Am so so Happy and grateful I finally passed my USMLE exam 🎉🎉 with the help of the channel and Mr Carlos. I wanna say a big thanks to the channel admin for accepting me into the channel. Never give up you will also passed your exam with the help of the channel and Mr Carlos
Who's Mr Carlos?
@@hyguruprep A man who changed my life.
@@hyguruprep you can also contact him for help.
Oh god. Is this carlos guy related to usmle recalls? I came across such posts on reddit. Shame on you guys, people like you have made it the usmle journey all the more tough n unfair!
The USMLE test is really frustrating, I can't believe I failed again after studying so much🥺🥺😓😭😭
I've heard a lot of good stories about this same woman all over CZcams channels can she really help
It's my first time I'm scared, I don't wanna fail
It's not about watching videos here on CZcams and wasting your time on materials and reviews that won't help, I was ignorant doing so till I got recommended to Mrs Margaret Smith, some how watching videos helped me too because without watching them i wouldn't have known about Mrs Margaret
Wow Mrs Margaret Smith has really made name for herself
Please does anyone know how I can reach her Mrs Margaret
Hi! I am from Canada
In the last question why isn't left to right shunt the right option.?
Hello from Florida
Why does tension pneumothorax cause decrease in preload? What’s the mechanism behind it please ?
Thank you so much again! You are amazing
Increased intrathoracic pressure ➡️ decreased venous return (there is less gradient of pressure between SVC and RA; i.e. RA pressure is high so SVC cannot fill RA thus low VR). Thanks!
In your question about the pt who is obese w/ dyspnea. The increase in residual volume is correct too right because the pt will have air trapping? Why is decreased FRC the better answer?
Greetings from South African
Type 2 pneumocyte increase in ILD or decrease?I think uw says increase type 2 and decrease type 1.
please correct me if i am wrong.
thanks for your nice lecture.
Elevated
Hello from Nepal
Peak expiratory flow rate is increased due to radial traction in Restrictive pathology but in myasthenia gravies peak expiratory flow rate is decreased?Can you please explain?
Hello from india
Is this enough if study this and skip fa?
India
Hi
Dominica
Hi Rahul, First of all, great course. Would it be possible in the future to move your camera window so it doesn't cover the vignette text? Thanks.
Great feedback! Yes, will definitely try.
Starts at 12:34 thank me later