Welcome
dua_frank has joined the chat.
[erum] mine is 6
[erum] north is 7
[drsujitvasanth] oh...
[drsujitvasanth] yeah...
[drsujitvasanth] hi lanny
[erum] how is your chat going
[erum] now a days
[drsujitvasanth] i havent read much gynea..so not that much use...
[drsujitvasanth] how about u?
[drsujitvasanth] lets go o the step2 room...
erum has joined subroom: USMLE_Step_2
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[erum] hi all
[dua_frank] hi
[samantha] hi everyone
[lanny] hi sam
[erum] it looks good in yoyr room
[erum] v dont have that many ppl
[samantha] hi lanny
[erum] in step 1 chat
[erum] keep it up n good luck to all
[drsujitvasanth] ok erum...
[drsujitvasanth] thanks...
[lanny] this is step 2 chat erum
[erum] yeh iknow im leaving ....bye
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[lanny] dua can we start?
[dua_frank] yes sure i dont' see why not
[samantha] reproductive gyne today
[lanny] repro gynae right
[lanny] post menoause woman on prem and prov bleeds is this normal?
[dua_frank] yes
[lanny] partially dua
[lanny] its normal on one condition
[lanny] whats it?
[dua_frank] that she has a uterus? lol
[samantha] no other patho present
[samantha] like DUB
[lanny] well we assume she has a uterus if she bleeds
[lanny] yes sam youre on the right track
[lanny] what does premand prov do?
[megs] hi all
[dua_frank] hi megs
[dua_frank] hi megs
[lanny] hi megs
[megs] hey dua
[samantha] inhibit LH and FSH?
[lanny] ok guys it is only normal if bleed starts after day 25
[dua_frank] how's your prep going?
[megs] trying to finish first reading
[lanny] remember these drugs simulate menses
[dua_frank] same here, it feels like it's taking forver just to read once
[megs] it will take 1 week of arpril
[uniteus] hi everyone
[dua_frank] i don't know how i will complete second reading by april end like i had planned to
[drsujitvasanth] hiuni hi megs
[dua_frank] i'm getting a little scared
[lanny] prolif endometrium progesterone etc but no ovulation so they slough endo off and bleeding ensues
[samantha] yes...
[megs] dua dont worry
[megs] i am with u
[dua_frank] thanks megs, its good to know that
[megs] i know my exam will be in june
[lanny] but they have to be taken for 25 days before you can see this bleeding and its normal
[dua_frank] mine too
[megs] though i plan to take in may
[dua_frank] can't delay more than that though
[dua_frank] coz we have to take cs in july if we want to enter match
[megs] i dont think i will be able to take it as per plan
[megs] yup dua
[dua_frank] ok lets get back to discussion on main chat
[megs] on monday i registered for cs
[dua_frank] date?
[dua_frank] you didn't tell me
[megs] ok fine will talk later
[megs] i did not take date dua
[dua_frank] oh just registered
[dua_frank] online?
[megs] just apllied.
[dua_frank] ok i'll wait for the date when you fix it
[samantha] Your point lanny?
[megs] ok we will talk in the end
[dua_frank] ok
[samantha]
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[lanny] post men bleeding
[dua_frank] i still didn't get it
[lanny] make sure woman is not on ERT ie rule out pt on ERT
[dua_frank] are there any conditions where they do not bleed on day 25 postmenstral even if they are on those pills lanny?
[dua_frank] oh ok, i see now
[lanny] ah dua
[lanny] oh ok thats better
[lanny] remember any bleed in post menopa woman has to be investig..
[lanny] but if she is on ERT and tells you i bleed after 25 days its normal
[dua_frank] ok
[lanny] prem and prov are estro and prog
[megs] dont think so dua
[lanny] they mimic the mens cycle
[samantha] ok unless they are on estro and prog that's the exception
[dua_frank] how do you treat post partum hemorrahge?
[lanny] thats the point
[uniteus] massage the uterus, iv oxytocin, cathetrise
[samantha] ok lanny
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[dua_frank] right and ligate vessels on both sides
[lanny] uterine arteries?
[dua_frank] which vessels?
[dua_frank] or lanny?
[samantha] oxtocyin?
[dua_frank] where do these uterine arteries come from?
[lanny] oh iliac
[samantha] internal iliac
[megs] internal iliac
[dua_frank] no a branch of that
[dua_frank] hypogastric
[dua_frank] you do not ligate iliac
[lanny] wow anatomy again!!!
[dua_frank] that will compromise blood supply to the limbs too
[lanny] remember now
[lanny] right dua
[megs] yeah
[dua_frank] where do ovarian arteries come from?
[lanny] branch of renal????
[dua_frank] aortic
[megs] directly aorta
[dua_frank] right megs
[samantha] rt from the aorta left from renal
[megs] agree sammy
[dua_frank] yes
[megs] like testicular arteries
[dua_frank] same goes for veins
[samantha] yea!
[lanny] right
[dua_frank] right to IVC and left to renal vein
[dua_frank] some cancer is associated with this
[dua_frank] can you recollect which one?
[lanny] testicular
[dua_frank] left renal cancer?
[megs] i know about the varicocele common on left side dua
[uniteus] varicocele
[dua_frank] i remember it blocks the veins and presents as varicele
[lanny] yes megs
[dua_frank] right
[megs] dunno about cancer
[dua_frank] i remember that from surgery megs
[lanny] but the varicocele doent mean renal cancer
[dua_frank] thats how it manifests sometimes
[lanny] could mean anything
[megs] is it sigmoid ca..or rectal ca dua???
[dua_frank] blocks drainage lanny
[dua_frank] renal megs
[dua_frank] coz it drains to left renal vein
[dua_frank] somebody can verify that and let me know if i am right
[lanny] right dua
[megs] ok thanx lanny...can u summerise it
[dua_frank] thanks
[lanny] left ov art arise from left renal
[lanny] right ov art arixe from aorta direct
[lanny] r ov vein drains into IVC
[lanny] l ov vein drains into renal vein
[megs] ok
[megs] thanx
[lanny] first step in mgmt of post men bleed?
[megs] d and c
[megs] histopath first
[lanny] right megs
[megs] always rule out malignancy
[lanny] endo sampling
[lanny] right
[lanny] mcc of post men bleed?
[drsujitvasanth] atrophy
[megs] atrophy
[lanny] right sujit megs
[megs] endometrial or vaginal
[lanny] how to trt?
[megs] both
[megs] with ERT
[lanny] what drugs you use?
[megs] estrogen replacement therapy..
[megs] premarin
[lanny] and?
[megs] andprogesterone +
[lanny] right
[lanny] provera
[lanny] this comes to my early point guys
[lanny] if woman bleeds after 35 days its normal
[lanny] 25
[megs] while consideri ng HRT IN post menopausal pt...with intact uterus always use E+p
[lanny] yes
[lanny] to avoid endo cancer
[megs] yeas lanny
[dua_frank] what is leutinization of the granulosa cell exactly?
[megs] progesterone protect endometrium from cancerous efffect og estrogen
[lanny] pre mensses bleed in young girl what to consider?
[lanny] yes megs
[megs] forign body
[megs] lanny
[megs] and sarcoma botryoids...or precaustious puberty
[lanny] sarcom a boty
[lanny] sex abuse
[lanny] right megs
[lanny] next step?
[samantha] examine the pt
[megs] pelvic exma under anestesia
[lanny] right always do under anesthesia sam
[megs] or under sedation
[lanny] yes
[samantha] ok
[lanny] megs wanna discuss prec puberty
[megs] sure lanny
[lanny] how is prec puberty diag?
[samantha] if pubertal changes occur before 6 or 7 yrs
[megs] before 8 yrs...apeerance of sec sex charectors
[megs] what is normal cronology in sexual development???
[lanny] right megs
[megs] chronological order odf sexual growth
[megs] ???/
[lanny] tanner stages 1 to 4
[uniteus] breast enlarg> pubic hair> growht> menarche
[megs] YUP UNI
[lanny] whats first diag step
[megs] WHAT IS INCOMLETE PRECAUTIOUS PUBERTY???
[lanny] only one change invove
[uniteus] think only one of them is presnet...
[lanny] breast enlarge or early menses
[megs] YES UNI LANNY
[lanny] or eally growth too
[lanny] first diag step???
[megs] IT S BACUSE OF END ORGAN SENSITIVITY TO HORMONES
[lanny] right megs
[lanny] first diag step??
[megs] thorough physical exam will be forst step
[megs] first.
[lanny] right then??
[lanny] CT scan of head abdomen
[megs] then ultra sound ...
[lanny] and pelvis
[megs] then cns investigations
[lanny] its CT scan megs
[megs] u mean lanny before ultra sound u do ct
[megs] ???is it
[lanny] yes CT or MRI
[lanny] never heard about US
[megs] i thought before CT WE DO USG
[lanny] can you tell why US
[megs] to see presence of estrogen secreting ovarian tumor lanny
[samantha] hi
[lanny] thought CT scan can detect them
[megs] wb sammy
[megs] u mean do ct abdopelvis
[lanny] yes
[lanny] ok dysfunctional uterine bleedine what is it??
[megs] then its fine lanny
[samantha] abnormal bleeding either pre or post menopausal
[megs] abnoramal vaginal bleeding without any anotomic cause..mean palpable pelvi pathology
[megs] most common cause is anovulation
[lanny] change in mens freq duration aor volume
[lanny] right megs
[lanny] what can this lead to??
[samantha] anemia
[megs] agree ..anemia
[megs] due to excess bloodloss
[lanny] right guys endo cancer too
[samantha] in case of endo hyperplasia lanny
[lanny] right
[lanny] endom proliferates without progest
[lanny] caouse no ovulation
[megs] what is the treatment of anovulatory dub???
[lanny] hence its name anovulatory cycles
[samantha] OCP's
[lanny] danazol
[lanny] OCP for sex active
[megs] yes sammy
[samantha] or clomiphene citrate
[samantha] if preg is desired
[megs] thats for young pt desiring pregnancy
[megs] what about premenopausal pt??/what will u give??
[samantha] yes megs
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[lanny] progesterone
[megs] you can give only progesterone from day 14 to 25..good lanny
[lanny] yes megs
[megs] mittlesmerz what is it???
[samantha] what are the correctable causes of anovulation?
[lanny] how does clomi citrate work?
[lanny] mid cycle pain megs
[dua_frank] painful ovulation
[samantha] pain at midcycle during ovulation
[lanny] due to release of ovulaton
[megs] all correct
[megs] correctable cause of anovulation ...is that PCOD SAMMY
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[samantha] hypothyroidism and hyperprolac
[samantha] megs
[samantha] do TSH and prolactin levels
[megs] oh thanx sammy
[megs] i was thinking about DUB AND ANOVULATION
[samantha] oh..
[lanny] thats the same thing megs
[lanny] well DUB is a caiuse of anovul
[megs] true lanny
[dua_frank] whats mccune albright syndrome?
[lanny] an enzyme that produces estrogen from ovaries
[dua_frank] aromatase
[lanny] is stimulated
[uniteus] due to gonad independent....stimulatkion of aromatase enzyeme producing estrogen
[megs] precacious pubery+polystotic fibrosa cystica
[dua_frank] right megs
[uniteus] n cafe au lait spots too
[dua_frank] also cafe au lait spots
[megs] hmmm
[lanny] oh yea never heard about cafe au lait
[lanny] in mcune
[samantha] multiple cystic bone leisions pres
[lanny] yes sam
[lanny] bone lesions and prec pub
[lanny] plus caf au lait spots
[samantha] tx?
[lanny] dua youre quiet
[lanny] give anaromatase enzyme inhib??
[megs] auromatic enzyme inhibiters
[megs] sorry auromatase
[dua_frank] obgyn is not my strong subject lanny
[samantha] rt megs
[dua_frank] i let megs handle that
[lanny] ok dua
[lanny] most common cause of prec puberty??
[dua_frank] can you name those drugs megs?
[uniteus] cah
[dua_frank] idiopathic i think
[lanny] right dua
[lanny] good
[megs] vorozole is one i know
[dua_frank] thanks megs
[lanny] how do you trt idio p pub??
[dua_frank] provera, danazol
[drsujitvasanth] GnRh analohgues
[dua_frank] GnRH anologues
[lanny] right dua
[uniteus] gnrh
[lanny] leuprolide
[dua_frank] DOC is GnRH agonists
[lanny] right
[lanny] leuprolide is one of them
[megs] how they act???
[dua_frank] inhibit FSH and LH release
[dua_frank] if given continously
[lanny] like stim the rptors constantly down reg them
[megs] yup dua
[drsujitvasanth] blocks axis
[megs] till what stage u traet them???
[lanny] dunno megs
[megs] till desired bone growth is achieved..
[uniteus] stage 3? till height is reach
[megs] yup uni
[lanny] whats stage3 uni
[uniteus] tanner
[megs] tanners stage 3 lanny
[lanny] oh ok
[megs] what is primary amenorrhoea???
[dua_frank] mensturation never begun
[lanny] lack of menses by 15
[drsujitvasanth] never had periods
[dua_frank] even after 16 yrs
[uniteus] no menses at 16 wid secondary sex char or 14 without
[megs] what is cryptomenorrhoea
[dua_frank] or fully developed secondary sexual characteristics
[megs] correct uni
[dua_frank] sealed hymen
[lanny] agree
[megs] true dua
[lanny] menses is not seen
[lanny] but it occurs
[dua_frank] i saw this case, can never forget :O
[lanny] oh tell us dua
[drsujitvasanth]
[uniteus] dua was it painful for patient?
[dua_frank] cryto
[dua_frank] vague pain uni but yes there was pain
[dua_frank] she complained more of a swelling vaginally
[dua_frank] coz the blood was collected there
[lanny] so surgry was done right
[dua_frank] yeah we just gave a small cut
[dua_frank] created the hymen
[lanny] yep
[megs] a girl with 14 yrs with amenorrhoea...what will be next step???she never had menses before..what will be next step??
[uniteus] check for second sex char
[megs] yup
[lanny] look for uterus?
[megs] then look for uterus lanny
[uniteus] cool dua..
[uniteus] i probably think of tumor if i c dat
[megs] but in uw i have faced such q that they say always do pregnacy test first in each case?
[lanny] right megs
[megs] even though its 14 yrs...always rule out pregnancy first
[lanny] always a poss of preg before first menses
[uniteus] oh...ok..thx megs
[megs] then rest of the work
[drsujitvasanth] ah..thankx lanny...
[lanny] remember always do easier and cheap test first!!!!
[lanny] before USound CT scann and all thos e more expensive ones
[megs] 100% agree with u lanny
[drsujitvasanth] mosrtly lol..not always
[lanny] always
[drsujitvasanth] i was doing q bank and got some wrong cus i picked cheapest
[lanny] especialy with ethics in mind
[drsujitvasanth] breast ca with mets to bone....first test...xrat or bone scan?
[lanny] you dont wanna teoo a 14 yr old she hasnt got a uterus
[drsujitvasanth] qbank said bone scan
[lanny] or she has no breast
[megs] ok if uterus absent...then how wil you proceed in case of amenorrhoea???
[uniteus] check for breast development?
[megs] x *** sujit
[lanny] tests for karyotype
[megs] yeas lanny
[lanny] no uni you do all that before
[drsujitvasanth] qbank said bone scan..folloed by xray
[lanny] brest exam preg test ct scan
[uniteus] oh..ok..got it..i guess she has them right megs?
[lanny] all done first
[lanny] thenif all clear start more diff and expensive test
[uniteus] check Testosterone too
[lanny] right
[megs] if mets..clastic lesions can be seen then no need of bone scan sujit
[megs] just x *** will suffice
[megs] what others say???
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[samantha] i think bone scan for mets too!
[lanny] MRI??
[drsujitvasanth] i put xrat...and got the q wrong..
[drsujitvasanth] xray..oops
[megs] is that q from uw sujit??
[megs] bcause same q i got wrong for bone scan
[drsujitvasanth] noo..qbank
[megs] it said ans is x ***
[drsujitvasanth] lol...
[megs] ok then..there should be third person to clear it
[lanny] what tissues do sarcomas arise from connective?
[drsujitvasanth] yes
[drsujitvasanth] @ lanny
[megs] connective lanny
[lanny] thanks
[drsujitvasanth] i think the CORRECT anwaer is xray...
[drsujitvasanth] just saying qbank didnt agree lol
[megs] what is kalmans syndrome???
[lanny] anosmia and infertility?
[megs] primary amenorrhoea with anosmia+midline facial defect+ colorblindness...its inability of hypothalamous to produce GNRH
[megs] yeas lanny
[samantha] defect in the area that prod GNRH it is close to the olfactory
[megs] amenoorhoea with sec sexula charectors + with absent uterus dx???
[lanny] turners
[samantha] mulerian agensis
[samantha] and androgen insensiti
[samantha] syndrome
[megs] all correct
[megs] in turners breast will beunderdeveloped lanny
[lanny] yes i just realizesd thanks
[lanny] and uterus is present
[samantha] and streak gonads
[lanny] in mullerian agenesis whichs tructures are absent??
[megs] what is most common cause of sec amenorrhoea???
[samantha] uterus cervix fallo and upper vag
[megs] utrus,faloopian tubes cx and upper vagina
[lanny] right all expt ovary and lower vagina
[megs] pregnancy is the most common cause of sec amenorrhoea
[uniteus] pregnancy
[samantha] preg?
[lanny] right
[megs] what is sien leventhal syndrome???
[megs] stien
[lanny] PCOS
[uniteus] pcos
[megs] yea=
[lanny] obese female cant have ovulate infertile diabetic
[uniteus] wid hirsutism too
[samantha] what medications can cause anovulation?
[drsujitvasanth] antipsychotics
[megs] ITS AHO...AMENORRHOEA+HIRSUTISM+OBESITY
[samantha] and..?
[lanny] GNRH antag
[megs] antidepressents
[samantha] rt megs and sujit
[lanny] dopamine agonist
[lanny] am i right???
[samantha] it inhibits prolactin rt lanny
[samantha] if the cause is due to hyperprol yes u are rt
[lanny] but thats for lactation not for ovulation
[uniteus] megs ...cool ...cookiet chip AHOY = Amenorrhea, hirsutism, obesity ..
[samantha] sorry may be not
[uniteus] for pcos
[megs] can u name some dopa agonist lanny
[samantha] not sure lanny i will check and let u know
[megs] we give bromocriptine for anovulation...as it normalise the elavated levle of prolactin ...and hense brings about ovulation
[lanny] yes megs so i as right in a round about way
[lanny] thanks
[megs] lanny i dont think that dopa agonist cause anovulation
[drsujitvasanth] agree megs
[drsujitvasanth] da antags...
[lanny] yea megs your explan is right i turned it around
[megs] otherwise they have been excellent contraceptives..isnt it
[lanny] prolactin inhib horm is dopamine right?
[drsujitvasanth] yes
[lanny] so dopamine inhibits prolactine and hence lactatin
[megs] dopamine inhibit prolactin secretion
[lanny] so how does the axis get affected with GNRH and fsh lkLH
[lanny] and LH? reminfd me plz
[megs] pulsatile release of gnrh stimulate secretion of afsh and lh
[samantha] there is no connection of GNRH and dopamine?
[lanny] and this is blocked by prollactin right?
[lanny] yes there is sam
[samantha] how?
[lanny] thats what im trying to remember
[lanny] PIH i think inhib GNRH axis
[megs] prolactin has inhibitory effect on lh
[lanny] which is same as dopamune
[megs] LH
[megs] PROLACTIN INHIBIT LH SURGE
[samantha] really megs?
[lanny] but not directly megs
[megs] HENSE NO OVULATION
[lanny] it works thru GNRH i think
[megs] I WILL CQ LANNY
[lanny] me too thanks
[megs] I AM NOT REMEMBERING
[megs] HEY DUA COME AND SOLVE THIS PRB
[uniteus] wake up! wake up! wake u!
[dua_frank] here megs
[dua_frank] thinking too
[megs] sammy i remember that prolactin inhibit lh surge and hense ovulation..but not remebering how???
[lanny] need a physio book dont have any here will let you know tom guys
[megs] i may be wrong...can u clarify u r point
[dua_frank] all i know is the PRL will inhibit all pit hormones
[drsujitvasanth] k lanny thanks...
[dua_frank] FSH and LH are among them
[dua_frank] i guess thats how
[dua_frank] esp if there is a prolactinoma
[dua_frank] lol
[samantha] megs prolactin is in ant piut
[lanny] thats why a preg woman lactating cant be preg for some mths
[samantha] and lh in ant pit too rt?
[megs] yes lanny
[lanny] cause the inc prol will inhib the pit hormones
[lanny] and FSH and LH will be dec
[lanny] so dopamine is the same as PIH
[megs] i think dua u did a graet help
[dua_frank] right
[samantha] yes lanny it inhibits estr and proge
[dua_frank] i'm glad i could help
[lanny] thats how dopamine will do the same as PIH
[uniteus] thx dua
[dua_frank] not that obgyn is in any way my strong point :P
[uniteus]
[lanny] and dopa antag like bromocript will cause lactation cause it antagonises prolactin
[dua_frank] obgyn not my strong subject
[dua_frank] yeah but has nothing to do with FSH and LH lanny, totally different axis for lactation
[megs] agree dua
[lanny] yes dua
[drsujitvasanth] oh ok
[lanny] there is a hormone called prolactin releasing hormone right?
[dua_frank] there is one more hormone that keeps prolactin at bay
[dua_frank] and thats PIF
[dua_frank] prolactin release inhibiting factor
[lanny] yes dua
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[lanny] thats what i meant
[dua_frank] same effect as dopamine
[lanny] and its dopamine
[dua_frank] i mean this is dopamine
[lanny] yes finally were getting there!!!
[megs] so finally prolactin inhibit lh surge and thus inhibit ovulation..
[dua_frank] right
[megs] am i right saying that???
[lanny] no
[lanny] the opposite megs
[dua_frank] no no megs is right
[megs]
[dua_frank] increased prolactin suppresses pituatary FSH and LH remember?
[dua_frank] lactation
[dua_frank] not normal prl but increased prl
[dua_frank] remember the difference
[lanny] right
[lanny] yes inc pro inhib fsh lh
[samantha] prolactin cannot inhibit lactation megs
[megs] i never said that sammy
[samantha] yes it inhibits ovulation
[megs] i just said prolactin inhibit ovulation
[samantha] that's rt
[uniteus] *)
[megs] so lanny what dopa agoniST do???
[megs] and what dopa antagonist dO???
[lanny] dopa agonist like prol release inhib hormone will dec release of prolactin and cause ovulation
[lanny] since prolactin effect of suppressing fsh lh is removed
[dua_frank] no no
[megs] dua is rt
[megs] i agree with her
[megs] dopa antagonist will do that lanny
[lanny] ok we all have to read over this cause its important!!
[megs] lot of confusion here..yes tomorrow we will again clarify this
[lanny] but isnt dopamine = PRIH
[uniteus] ok...we wil check it for tom
[megs] now my head is hot
[dua_frank] yeah so with dopamine antagonist you are removing the inhibitory effect on prl lanny
[dua_frank] lol megs
[uniteus] am wid u megs
[dua_frank] get it?
[lanny] yes dua
[samantha] Gnrh does it cause anovulation that was the q
[dua_frank] meaning prl will rise
[lanny] so you see dua im right
[dua_frank] with dopamine antagonists
[dua_frank] :O
[lanny] yes
[dua_frank] you said the same? *)
[lanny] yes
[dua_frank] oops sorry then
[dua_frank] you're right
[lanny] didint i??
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[dua_frank] this was too much for our brains
[dua_frank] yes you did, i just check again
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[uniteus] lol
[megs] ok lanny just tell me bromocriptine is agonist or antagonist???
[dua_frank] you know what i just found?
[drsujitvasanth] ag...
[dua_frank] bromo is agonist
[megs] then lanny u are corect..for whatever u said...
[megs] i got confused
[lanny] yea that was the confusion bromocriptine is dopamine ag
[dua_frank] which are DA antagonist drugs? my mind is too heated up right now to recollect any of them lol
[dua_frank] please remind me
[dua_frank] metoclropromide?
[drsujitvasanth] chlormazone
[lanny] so dopamine will cause ovulation
[drsujitvasanth] zine
[megs] DA antagonists are metoclopropamide
[uniteus] used for gastroparesis
[drsujitvasanth] haloperidol...
[megs] yeas lany
[drsujitvasanth] d2 antags...
[dua_frank] THANKS MEGS!!!!!!!!!! thank god my brain is not dead yet
[drsujitvasanth] eto might be d1 not sure...
[lanny] antipsychotics are what agonist or antag of dopamine?
[drsujitvasanth] antag's
[uniteus] antagonist
[drsujitvasanth] i think meto may only act peripherally...
[dua_frank] yes
[drsujitvasanth] so it wont affect prolactin.?
[dua_frank] centrally are those antipsychotics
[lanny] right thats why people on these drugs have probs ovulating
[dua_frank] wow we're finally connecting things together lanny
[dua_frank] its like discovering something new lol
[uniteus] what is the differnce between hirsutism n virilization
[samantha] cemetidine?
[lanny] they have diff with menses
[drsujitvasanth] cimetidine is ant atnihistamine
[dua_frank] sammy that too
[dua_frank] thats on stomach
[lanny] agree dua .......lol lol
[dua_frank] or maybe not
[dua_frank]
[dua_frank] i know meto, i know antipsychotics
[drsujitvasanth] Hist h2 blocker,..
[samantha] but it causes galactorrea?
[dua_frank] i also know there is a third kind of DA antagonist
[dua_frank] you know sammy, you may be right
[drsujitvasanth] sammy -- i think it causes gynaecomastia...
[dua_frank] hey it causes gynacomastia
[dua_frank] not galactorrhea
[dua_frank] but there is a thrid class of DA antagonists
[samantha] i will ch dua
[uniteus] gynecomastia due to antiandrogneic effect
[megs] hirsutism is androgen dependent excess hairgrowth in female uni
[dua_frank] think of receptors
[lanny] people on antipsychotics have galactoroea
[dua_frank] DA type 1 2 3
[dua_frank] where are they all present?
[samantha] u r rt
[drsujitvasanth] ?
[megs] and virilism is effect of androgens on gonads too
[dua_frank] brain, stomach and?
[drsujitvasanth] only know d1 and 2
[dua_frank] ok tell me areas
[dua_frank] brain stomach and?
[drsujitvasanth] kideny?
[drsujitvasanth] kidney
[uniteus] rt megs
[dua_frank] i don't know any DA antagonist acting there
[drsujitvasanth] there must be...
[drsujitvasanth] dopamine acts or renal art...
[uniteus] sp virilization female has masculinization
[megs] yea uni agree
[uniteus] which one causes hirsutism but no virilization?
[uniteus] PCOS is the ans
[drsujitvasanth] nooo
[drsujitvasanth] oops
[drsujitvasanth] ok
[uniteus] huh?
[samantha] dobutamine
[lanny] hydroxylase def
[drsujitvasanth] what is virulization?
[samantha] acts on renal
[uniteus] virilization -> female masculinization
[drsujitvasanth] male 2ndry sexual chars? male genitalia?
[lanny] uni wats answer hirsuit but no virile?
[drsujitvasanth] sam--renal dise dopamine (low dose)
[uniteus] PCOS lanny
[lanny] thx
[samantha] causes vasodilation sujit?
[drsujitvasanth] yes,,
[uniteus] megs can u guide us for investigation of hirsutism please
[samantha] ok
[uniteus] or anyone please
[samantha] dobutamine given to inc BP
[drsujitvasanth] agree @ sam
[megs] first u see for signs of virilization
[megs] if yes then suspect androgen secreting tumour
[uniteus] ok...so what test next?
[megs] if virilising singns absent...see for body mass index
[samantha] thanx sujit
[megs] then do free androgen levels
[megs] DHEAS
[uniteus] oh..ok..so dis is first done before the 17OHprog n testosterone
[megs] IF THEY ARE INCR IT IS ADRENAL TUMOUR ...
[megs] IF BODY MASS INDEX IS HIGH THEN U DO INVESTIGATIONS FOR PCOS...
[megs] LIKE SR FSH TO LH RATIO
[megs] SR TESTESTERONE
[[uniteus] ok...so testosterone is mild increa in pcos while markedly for ovarian tumor
[megs] but increased teststerone will associated with virilising symptoms most of the times
[megs] yes uni
[uniteus] cool...ok...thx...gettin it all cleared now..was confuse ealrier
[uniteus] thx megs
[megs] urw
[megs] ok guys got to go
[megs] thanx
[megs] bye all
[drsujitvasanth] thankx megs
[uniteus] thx n bye megs
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[uniteus] i going to ...
[uniteus] thanks n bye all
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[drsujitvasanth] you know... i think we might be mising the big picture...
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[drsujitvasanth] it doesnt eally matter y da antags cause amenorhea...
[drsujitvasanth] thats part 1...part just need to know that they do..
[dua_frank] today was heavy
[drsujitvasanth] i didnt learn much useul today
[dua_frank] i learnt what i know i won't ever remember lol
[dua_frank] i don't know what i learnt
[samantha] ammenorrhea or anovulation sujit?
[dua_frank] megs was great though, as usual
[drsujitvasanth] true
[dua_frank] see you all tomorrow
[dua_frank] bye
[drsujitvasanth] frank
[drsujitvasanth] files...
[dua_frank] yes i'll try tonight sujit
[drsujitvasanth] send a small zip lol
[dua_frank] i will
[samantha] alright bye guys
[dua_frank] bye
[drsujitvasanth] k bye