Chat transcript for Endocrine Physiology

[Anonymous]

20:59:57 [crusher] hi step1.welcome to forum

20:59:57 [bisma] but i am going to join <a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000058&type=3 &subid=0" >Kaplan</a> from 15th may

21:00:12 [Step_1] hi crusher and everyone!

21:00:29 [bisma] hi

21:00:39 [SMS] hi

21:00:40 [crusher] oh cool.its a great idea,,will u join centre base/live lec

21:01:02 [bisma] yes,,i'll

21:01:04 hutals enters this room

21:01:17 [SMS] what is the topic of discussion today?

21:01:34 [bisma] o.k,,everybody Roxanita was here

21:01:39 [crusher] endocrinology

21:01:46 [SMS] good

21:01:52 [Step_1] today we'll be talking about endo physiology

21:01:53 [bisma] she left message for u all that she can't join the chat today

21:01:58 [bisma] as she had to go

21:02:12 [bisma] but she'll try to come,

21:02:33 [SMS] but we can start discussion

21:02:37 [Step_1] i must confess that this is one of my weak points, but i;ll try to keep up

21:02:39 noorain enters this room

21:02:45 [bisma] i hope i gave her message to all of u

21:02:59 [crusher] we can sak step1...the modrater

21:03:11 [noorain] hi all anyone here for endo physio chat for step 1

21:03:36 [Step_1] what we will do is everyone can shoot of questions one at a time and we try to answer. once some guesses have been made, the person can give the ans and we move on or discuss it if there are any questions. ready?

21:03:50 [SMS] what is the stored form of water soluble hr.?

21:03:57 [Step_1] hi noorain. yes endo physiology

21:04:52 [noorain] hi and thanx for letting me know

21:05:19 [Step_1] stored in vesicles

21:06:15 [hutals] i agree that water soluble hrmones stored in vesicles

21:07:19 [Step_1] is that right sms?

21:08:16 [Step_1] sms?

21:08:21 [crusher] what will be level of blood pressure in 21 oh def

21:08:37 [SMS] ya......

21:08:41 [noorain] hypertension

21:08:43 [SMS] tored in vesicles

21:08:55 [noorain] they could be salt losers or retainers

21:09:05 [SMS] the stored forms are prohormones and inactive peptides

21:10:34 [Step_1] sms, ah, didn't know what you meant....prohormone stored in vesicle along with an enzyme which splits off the active hormone

21:10:34 [noorain] crusher was that correct

21:10:41 [SMS] Lipid soluble hr. are synthesized as needed ,but there is an exception..........?

21:11:07 [crusher] thyroid horm

21:11:13 [Step_1] exception is thyroid hormones

21:11:30 [SMS] Thyroid hr. which stored covalently bound with protein

21:11:40 [SMS] has reservoir

21:11:50 [noorain] and what about the gonadotropins , are they part of the exception

21:12:37 [crusher] actually in 21 oh there is block prox to 11 corticosterone which is a weak minerlocoticosterion.so every thing adhead of block dec and behind inc,so b.p dec .cortisol dec and androgen inc,,acth oinc

21:13:49 [noorain] so they are salt loosers or retainers crusher

21:13:54 [Step_1] so 21 OHase deficiency is salt loser (renal loss of sodium)....right?

21:14:08 [noorain] yes

21:14:20 [crusher] u r right step1

21:14:33 [crusher] looser

21:15:10 [noorain] sms could you expand on your question plz, was i right or not

21:15:33 [crusher] what hormone is synthesis in zona fasiculate

21:15:57 [Step_1] contisol

21:15:57 [noorain] cortisol

21:16:11 [bisma] yes,,cortisol

21:16:22 [crusher] yes both right

21:16:39 [SMS] Damage to pit. stalk will cause decrease in all ant. pit. hr. except one..............?

21:16:40 [Step_1] what about glomerulosa?

21:17:08 [noorain] aldosterone, minerlocorticoids

21:17:11 [crusher] aldosteron

21:17:33 [SMS] except prolactin bec. it is under inhibitory control

21:17:39 [noorain] what regulates aldosterone in zona glomerulosa

21:18:02 [Step_1] except prol, i agree

21:18:02 [noorain] thanx sms,,,,,,,, i totally forgot that

21:18:07 [crusher] serum osmolarity

21:18:27 [Step_1] and yes, the ans is aldosterone for glomerulosa quest

21:18:41 [noorain] actually aldosterone in the zona glomerulosa is regulated by AT2

21:20:14 [Step_1] i meant the ans to my previous question asking what horm is syn in glomerulosa

21:20:57 [SMS] low level of cortisol is fatal in one condition......?

21:21:36 [crusher] can you tell where androsterone convert into testosterone,,,which organ/tissue

21:21:58 [Step_1] fasting?

21:22:13 [SMS] in very stressful condition.....fatal hypoglycemia can occur bec. without cortisol,glucagon can't maintain the glucose level

21:22:26 [SMS] ya.....

21:22:28 [SMS] ng

21:22:35 [SMS] fasting

21:23:30 [SMS] Can you survive with loss of ant. pit. function?

21:23:39 [SMS] and why?

21:24:10 [crusher] no cannot..cos cortisol is essential for life

21:24:39 [bisma] b/c of cortisol

21:24:45 [crusher] cos dec ACTH dec cortisol

21:25:00 [noorain] well what aobut the mineralocorticoids , they r essential as well

21:25:05 [SMS] yes,bec. mineralocorticoid system remains intact

21:25:10 [Step_1] gluccocorticoid system affected but not the mineralocorticoid, so i think its ok

21:25:29 [SMS] yes

21:25:30 [noorain] i agree with step 1

21:25:44 [bisma] thanx for correction

21:25:58 [Step_1] 20 y/o female pt has incr total T4, but notmal TSH. What might explain this?

21:26:27 [crusher] pregnacy??

21:27:32 [noorain] alright guys i have to go,,,,,,,, but will join you guys next week or whenev theres discussion, plz keep me posted, this is truly a very helpful review,,,,,,, g'luck all and until next time study hard

21:27:33 [Step_1] yes, very good. in preg --> inc estrogen --> inc TBG -> inc T4 (bound), but free T4 remains the same

21:27:52 [SMS] If ovaries doesn't have aromatase activity........then?

21:27:54 [crusher] liver sunthesis more thyroid binding globulin ,,which bind T4...while free hormone remains same...which have action TSH

21:27:54 [Step_1] great chatting with you noorain

21:28:10 [crusher] see ya noorian

21:28:24 [noorain] same here,,, take care all,,,,,

21:28:58 [crusher] estradiol synthesis occur in adipose ovaries and placenta

21:29:04 [SMS] then,it will produce testosteron instead of oestrogen

21:29:16 [Step_1] then testoserone cannot be converted to estrogen

21:29:31 [Step_1] without aromatase

21:29:46 [SMS] yes

21:30:10 [crusher] where dehydroepindosteron convert into andostenidone

21:32:01 [crusher] any one

21:32:18 [Step_1] i'm looking for it, but cant find the answer?

21:32:18 [crusher] its adrenal gland

21:32:24 Surgery4life enters this room

21:32:56 [bisma] testosterone exists in the plasma in the form of?

21:33:08 [Step_1] i thought you meant something more specific....i saw the diagram of the entire adrenal gland, but didnt think that was the ans

21:33:11 [Surgery4life] anyone studying for step 2

21:33:20 [SMS] most common clinical deficiency ( Hint : only found in Adrenals )......?

21:33:21 [crusher] what is the #1 precuror of all of foll three cortisol,aldo and androgen

21:34:04 [Step_1] hi surgery. we're all studying for step 1 tonight....endocrine physiology

21:34:05 [crusher] 21,oh def

21:34:11 [SMS] beta-hydroxylase deficiency

21:34:14 [SMS] es

21:34:31 [Surgery4life] ok........good luck with step 1.......killer exam

21:34:37 [SMS] 21-beta..........

21:34:47 [bisma] anyone answer for my q???

21:34:49 [Step_1] thanks surgery...good luck to you too

21:34:54 [crusher] what is the #1 precuror of all of foll three cortisol,aldo and androgen

21:35:12 [crusher] DHT

21:35:25 [Step_1] dht

21:35:27 [crusher] which is a active form

21:35:30 [SMS] what are the consequences of mineralocorticoid defi.?

21:35:43 [Step_1] choesterol

21:36:02 [crusher] dec na /inc K ..metab acidosis

21:36:24 [SMS] loss of Na,dec. in extracellular vol,dec. in BP and pt. will be hypotensive

21:36:44 [Surgery4life] craniopharyngioma is derived from?

21:36:46 [Step_1] loss of Na, dec vol of ECF, low bp, shock and death

21:36:48 [crusher] correct step1....cholesterol is #1 precuror

21:37:06 [SMS] Step_1......u r really good

21:37:06 nne enters this room

21:37:16 [crusher] rathkes pouch

21:37:37 [Surgery4life] correct crusher

21:38:03 [bisma] in salt restriction which area of adrenal gland increases???

21:38:53 [Surgery4life] glom

21:38:57 [Step_1] i agree, rathkes pouch

21:39:04 [crusher] cortex...glomerulosa

21:39:12 [bisma] right

21:39:30 [Step_1] hi nne

21:39:46 [bisma] aldosterone promotes sodium reabsorption

21:39:57 [nne] hi

21:40:17 [Surgery4life] clinical use of antimicrosomal antibodies to dx?

21:40:18 [Step_1] difference between central vs nephrogenic def?

21:40:55 [crusher] central dec synthesis..nephrogenic nephrone resistant to ADH

21:41:54 [crusher] i think pernecious anemia????

21:42:03 [Step_1] correct, cental will not be affected by admin of ADH, but nephrogenic will because it is a receptor deficiency

21:42:19 [Surgery4life] dx of autoimmune throiditis....highest titers with Hashimoto...mod elevated titers with graves ds

21:42:56 roshy04 enters this room

21:43:02 [nne] in first trimester which hormone maintains corpus luteum?

21:43:06 [SMS] ok,so if the pt. is dehydrated and hyperosmotic,what will happen to urine ( ADH is working).....?

21:43:10 [Step_1] hi roshy

21:43:34 [roshy04] hello guys

21:43:40 [Step_1] hcG

21:43:52 [nne] no

21:43:53 [crusher] hi roshy

21:44:05 [nne] no.

21:44:19 [nne] progesterone

21:44:43 [crusher] no i guess,if working serum osmolarity will be low

21:44:58 [SMS] Pt will produce small amount of conc. urine ( in neurogenic DI ) and pt. will continue to produce large vol. of diluted urine ( in nephrogenic DI )

21:45:31 [roshy04] hi crusher,what's the q you're discuscussing now??

21:45:47 [nne] you are right. was waiting to see if you were sure. its hcg

21:46:32 [Step_1] i was going nuts here by reading it over and over to see where i went wrong...lol

21:46:41 [Surgery4life] bye and good luck

21:47:00 [Step_1] thanx for the questions surgery and good luck

21:47:23 [crusher] rosy we r discussing about what is the #1 precuror of all of foll three cortisol,aldo and androgen

21:47:24 [bisma] good luck surgery

21:48:13 [roshy04] i think it's cholesterol?!

21:48:14 [crusher] roshy about the pt. is dehydrated and hyperosmotic,what will happen to urine ( ADH is working).....

21:48:34 [nne] no one answered clinical use of anti microsomal antibodies to dx?

21:48:40 [crusher] thanks surgery .n goodluck for step2

21:50:02 [roshy04] diabetes insipidus

21:50:52 [Step_1] failure of 3rd and 4th pharyngeal pouch to develop and absent thymic shadow seen. What dyn?

21:51:02 [roshy04] no ADH it's either not working or not there @ all

21:51:15 [crusher] can you tell what will be ECF vol in primp polydipsia....CDI and SIADH

21:51:28 [crusher] digeorge

21:52:09 [roshy04] inc,dec,inc

21:52:11 [Step_1] yes, digeorges. will have hopoparathyroidism.

21:53:02 [roshy04] what's the pathology in Digeorge?

21:54:01 [Step_1] failure of 3rd and 4th pharyngeal pouch to develop

21:54:05 [crusher] good roshy ..but can you tell in polydipsia ecf inc althogh pat losses lot of fluid

21:54:49 [roshy04] to nne:can u answer yr q about antimicrosomal abs

21:55:51 [nne] ACTH promotes production of cortisol by stimulating which hormone?

21:56:15 [roshy04] bec the pt is hyposmolar??

21:57:00 [nne] i didn't ask the question. Surgery4life asked it. Who knows the answer.

21:57:05 [roshy04] ok bec adh 'll not be affected

21:57:20 [crusher] cos pat is hyperosmoler and his/her thrist centre stimulate n drink lots of fluid will cause inc ecf vol

21:57:59 [roshy04] oh thx so much i didn't know that

21:59:04 [roshy04] but in those pts there's hyposmolarity

21:59:37 [crusher] what test will diff b/w primary polydipsia and complete dibetes insipidius...as both cause large vol of dilute urine

22:00:00 [Step_1] ADH

22:00:08 [bisma] adh

22:00:11 [crusher] no,,osmolarity will dec cos of excessive intake of water

22:00:51 [Step_1] water deprivation

22:01:07 [roshy04] hyposmolarity means dec.

22:01:42 [crusher] actually its water deprivation test in which P.polydipsia soon reduce urine flow while DI continue to flow

22:02:04 Rahat3256 enters this room

22:02:14 [crusher] yes roshy i,m sorry i misunderstood u r right

22:02:19 [Step_1] hi rahat

22:02:26 [roshy04] ok that's good

22:02:33 [Rahat3256] hi step

22:02:40 [Rahat3256] orena back???

22:03:17 [Step_1] lorena not back yet

22:03:31 [Rahat3256] hey step i cannot attain the session today.

22:03:38 [Rahat3256] i am on duty

22:03:48 [Rahat3256] jusy to say hi to you guys

22:04:03 [crusher] where does in kid adh works

22:04:05 [Step_1] no problem. thx for stopping by. i will post the transcript for you

22:04:21 [roshy04] thx rahat,consider yr self with us

22:04:30 [Rahat3256] thank you

22:04:43 [Rahat3256] hi roshy

22:05:01 [roshy04] ADH works on collecting ducts

22:05:16 [Rahat3256] ok step i gotta go now

22:05:22 [Rahat3256] bye

22:05:29 [Rahat3256] roshy

22:05:36 [Step_1] by rahat

22:05:41 [Step_1] we should discuss next chat time and topic. someone suggested following schedule of kap lan 7 wk course. anyone up for that schedule?

22:05:45 [Rahat3256] ohh me??

22:06:00 [roshy04] yes,you

22:06:00 [Rahat3256] yah i saw that mail

22:06:17 [Rahat3256] i am from bangladesh

22:06:29 [crusher] i think we were discussing on genetics for next session

22:06:44 [Rahat3256] that is a cool schedule

22:06:44 [roshy04] wow yr're chating from there

22:06:50 [Rahat3256] i crusher

22:06:54 [roshy04] i'm in canada

22:07:01 [Rahat3256] do you know the country

22:07:06 [Rahat3256] u from???

22:07:08 [crusher] hi rahat

22:07:37 [Rahat3256] hey step we better will decide about the 7day staff with lorena

22:07:43 [nne] genetics? where can i read it up from?

22:07:49 [Rahat3256] when we all will be here then we will decide

22:07:51 [roshy04] sure,i'm living in Vancouver,BC

22:08:23 [Rahat3256] ok bye then

22:08:28 [Rahat3256] talk

22:08:37 [crusher] what will be level of ANG2 and renin in prim hyperaldosternism?

22:08:48 [roshy04] i think it'll better if we delay the next time a littlepit so we'll have more time to study

22:09:10 [bisma] yes,, i agree with u

22:09:17 [roshy04] bye rahat

22:09:18 [bisma] as i am also new here

22:09:31 [bisma] i read the post in usmle forum today

22:09:45 [bisma] just wanted to check how u guys do

22:09:58 [Step_1] let me see if i can post the schedule from kap lan to see if you want to follow it. something like this. Behavioral science: 4 days, Anatomy: 4 days , Biochemistry (including genetics): 6 days , Physiology: 6 days , Immunology: 2 days , Microbiology: 4 days , Pathology: 5 days, Pharmacology: 6 d

22:10:02 [bisma] so,, i'll try to be prepared next time

22:10:16 [crusher] where is sm?

22:11:27 [bisma] who is the head here, by the way?

22:11:48 [Step_1] lorena is, but she is outta town this week

22:12:05 [bisma] o.k,,

22:12:07 [crusher] step1 lets discuss with lorena and others too about it

22:12:09 [bisma] thanx

22:12:44 [Step_1] i agree, lets do genetics next time like we discussed and then decide on a permanent schedule then. does that sound ok?

22:13:00 [bisma] so,,what is the topic for next time?

22:13:12 [crusher] i agree

22:13:20 [roshy04] ACTH + release of cortisol by cAMP which +desmolase enzyme

22:13:28 [roshy04] there any better answer

22:13:40 [Step_1] ok, then topic for next chat will be genetics....now we need to discuss a meeting date

22:14:16 [roshy04] when usually you start?

22:14:42 [Step_1] we usually start at 9pm eastern time...on time usually

22:15:02 [Step_1] right now it is 10:14 eastern in case anyone is wondering

22:15:28 [Step_1] so we will start at 9pm eastern next time and just need to decide a date.

22:15:34 svaious enters this room

22:15:53 [Step_1] any suggestions?

22:16:00 [crusher] we have not discuss enogh yet on endo its huge topic

22:16:06 [svaious] Hi ALl

22:16:11 [crusher] hi svaious

22:16:17 [svaious] Hi All!

22:16:18 [bisma] u r right crush

22:16:28 [crusher] plz shoot somew q,s

22:16:29 [roshy04] ok give it a time like 1 wek @ least

22:16:39 [Step_1] we will continue to discuss tonight, i just wanted to sshedule something while everyone is here

22:17:01 [Step_1] hi svaious

22:17:14 [svaious] hows the discussion going?

22:17:19 [svaious] hey step_1

22:17:36 [crusher] ok.step1..i ,thoght its end of sessions

22:18:10 [Step_1] nope...class is not over yet

22:18:37 [Step_1] ok, how about next wed we discuss genetics. or do you want to meet earlier?

22:18:44 [roshy04] how can i see the posting?

22:19:02 [Step_1] which posting?

22:19:23 vladi enters this room

22:19:35 [svaious] genetics is a great idea

22:19:36 [roshy04] for each forum session

22:20:00 [Step_1] they are posted in the announcement in the step 1 forum

22:20:08 [crusher] i agree on next wed with genetics

22:20:31 [vladi] sorry for being late- hi everybody

22:20:48 [Step_1] ok, if everyone else agree, reply with an "ok" for genetics as topic next wed at 9 pm eastern.

22:20:53 [crusher] hi vladi

22:20:56 [roshy04] hi Vladi,where've you been?

22:21:11 [svaious] ok

22:21:13 [hutals] ok

22:21:15 [roshy04] ok

22:21:20 [crusher] ok

22:21:32 [vladi] i've been working with patients

22:22:06 [Step_1] ok, i'll post the announcement and transcript. you guys can help spread the word so it doesnt look like i'm spamming by myself

22:22:15 [Step_1] lets continue....

22:22:20 [roshy04] ok,it's good to see yr name in the chat

22:22:54 [Step_1] got some time for a few questions vladi?

22:23:01 [vladi] let me ask you- what's main difference early (congenital) vs late-onset 21-hydroxylase defic

22:23:15 IDreamOfMedicine enters this room

22:23:44 [roshy04] ok there's a q that i want its answer,sombody asked what's the hormone that by which ACTH + cortisol secretion

22:24:02 [IDreamOfMedicine] hey where u guys from

22:24:47 [Step_1] in adult (late onset), the main problem is with an increase in 17 - ks and not salt loss

22:25:02 nne enters this room

22:25:13 [IDreamOfMedicine] where r u guys from

22:25:23 [vladi] it's incresed plasma 17-OH-progesterone after ACTH stimulation test

22:25:26 [IDreamOfMedicine] ?

22:25:42 [Step_1] hi idom, try brightening your fonts so we can see better

22:26:16 [Step_1] i'm in east coast of u.s.

22:26:52 [roshy04] i'm west coast of Canada

22:27:13 [svaious] i'm in texas

22:27:26 [crusher] water deprivation testeast coast usa

22:27:44 [crusher] east coast usa

22:28:04 [Step_1] what hormones are from post pit and which from ant?

22:28:05 [vladi] step 1 - you are right- it's really non-salt - these ladies (frequently around puberty and after) do not manifest clearly and might be indistinguishable form PCOS. Main sy- low progressed hirsutism

22:29:39 [vladi] svalious- wher are you in TX- before vancouver i've been working in Houston- i love TX

22:29:51 [crusher] ADH and oxytoxin from post pit

22:30:27 [Step_1] yes crusher...very good

22:31:00 [crusher] ant pitutary====lh/fsh..fsh..tsh..prolactin

22:31:13 [crusher] acth

22:31:17 [Step_1] correct again crusher

22:31:58 [crusher] allr releaing hormone from hypothalamus

22:32:09 [vladi] mneumonic- flagtop from <a target=new href=http://www.valuemd.com/amazon/books2_content.php?ASIN=0071429484>FA</a>

22:32:29 [Step_1] pt has incr serum insulin, hypoglycemia, decreased c-peptide. what is the cause?

22:32:52 [crusher] factious insuline inj

22:33:11 [Step_1] flagtop...please expain

22:33:25 [crusher] cos c.peptide low usually endogenous insuline sec gluteal with inc c.peptide

22:33:28 [vladi] insulinoma

22:34:39 [Step_1] the decreased c-peptide tells you that the insulin is not endogenous, so it must be from outside of body. crusher is correct that it is factitious hypoglycemia....very high yield

22:34:43 [crusher] endogenous insuline gluteal with inc c,peptide

22:35:32 [roshy04] no if it's endogenous insulin,there'll be inc in c-peptide if it's exogenous,there'll be no inc in c-peptide

22:35:51 [roshy04] crusher,what's gluteal??

22:36:03 [Step_1] asss will get converted to gluteal because the system thinks you're trying to curse. try using assoc instead....lol

22:36:21 [vladi] F- fsh, L-lh, A-acth, G-gn, T-tsh, malanOtropin, P-prolactin- all from anterior pituitary

22:36:46 [crusher] i didnot rite gluteal but trying to write associated i dono where it comes from

22:36:53 [roshy04] i didn't understand the diff.bet congenital & late onset 21 hydroxylase diff. Vladi??

22:37:24 [roshy04] ok,i felt that i don't know medicine

22:38:22 [roshy04] that's goon mnemonic Vladi

22:38:32 [roshy04] good i mean

22:38:55 [Step_1] roshy, i think thats what i said....right? the cause is from factitious insulin injection because the c-peptide in the question was low, so it could not be endogenous.

22:39:05 [crusher] whatr two hormone inhibit growth hormone sec..

22:39:14 [Step_1] thx vladi, great mneumonic

22:41:01 [nne] somatostatin

22:41:56 [Step_1] somatostatin

22:42:15 [nne] and somatomedidins

22:42:47 [crusher] correct somatostatin and somatemedians

22:43:02 [crusher] from where these hormone releases

22:43:58 SMS enters this room

22:44:25 [Step_1] ant pit?

22:44:44 [nne] hypothamalmus for somatostain and liver for somatomedins otherwise called Insulin-like growth factors

22:44:53 [vladi] pancreas

22:45:09 [Step_1] hypothalamus

22:45:13 [crusher] somatomedian is produce by growth hormone in liver

22:46:00 [crusher] and hypothalums for somatostatin....remember statin..static stop...its inhibit majority of hormones

22:46:46 [Step_1] beta cells, delta and alpha cells. which ones associated with which.....glucagon, somatostatin, insulin?

22:47:09 [vladi] what are 4 "stress" hormones?

22:47:24 [crusher] beta =insuline..alpha glucagon...delata==somatostatin???

22:48:02 [SMS] GH,Glucagon,Cortisol,Epinephrine

22:48:05 [crusher] stress hormones are epineph....cortisol..glucagon....growtrh hormone...and thyroid too i guess

22:48:23 [Step_1] yes crusher....great

22:48:28 [vladi] beta cell- insulin, glucagon- alpha ce and somatomedin- delta

22:48:37 [SMS] what happens to insulin in stress?

22:48:44 [Step_1] yes vladi

22:49:06 [roshy04] insulin's not a stress hormone

22:49:17 [roshy04] it decrease in strees

22:49:23 [crusher] glucagon act via which 2nd mess

22:49:40 [crusher] and insuline too

22:49:54 [vladi] SMS is right- it's from USMLE step 1 recall. buzzwords for the Boards?

22:50:02 [SMS] C-AMP

22:50:21 [roshy04] cAMP

22:50:25 [crusher] all stress hormones are catbolic in nature..inc glucose anf FFa conc in blood

22:50:36 [nne] a patient who appears to be female, is found to be 46XY. The patients vagina is shallow ending in a blind pouch, with palpable masses in the labia. a diagnosis of testicular feminization syndrome is made. .What hormone was present in the early fetal life of this patient?

22:51:18 [crusher] testosterone???

22:52:05 [crusher] yes cAmp for glucagon and tyrosine kinase with inusline

22:52:10 [Step_1] DHT and testosterone are present, but androgen receptors are lacking

22:52:23 [nne] Hint _ what inhibits hormone production in this supposed female?

22:52:25 [SMS] how will you differentiate between insulin secreting tumor and too much insulin injections.......?

22:52:26 [Step_1] MIF is present

22:52:38 [SMS] in a comatose pt.?

22:52:42 [nne] good

22:52:43 [vladi] right- crusher- testosterone

22:52:48 [crusher] C..peptide for diffrentiation

22:52:53 [nne] you are right

22:52:57 [SMS] measure C-Peptide

22:52:58 [SMS] yes

22:53:47 [nne] if you measure the C-peptide which one is higher

22:54:16 [crusher] endogenous insuline or insulinoma

22:54:16 [Step_1] tumor secreting has high c peptide and injections would have low

22:54:24 [roshy04] eybut in this female 5 alfa reductase was deficient that's why no ext male genitalia

22:54:39 [SMS] in case of insulin inj. .....will be higher

22:55:14 [vladi] crusher thank you for your tenacity in C-peptid. i've got one Q in real exam- probably it was about exagenous injection of insulin- could you summarize your point about this peptid

22:55:40 [SMS] i am confused.....

22:55:44 [SMS] think.....

22:56:05 [SMS] insulin secreting tumors will have low C-peptide

22:56:41 [SMS] and insulin inj. will have high C-peptide

22:56:44 [SMS] ??

22:57:03 [crusher] sure,,,C.peptide is gluteal with insuline release within the body..so if suppose insulinoma,both C.peptide and insuline inc...while if someone taking insuline from outside only insuline inc while C.peptide remains low but it only synthesis in body

22:57:05 [Step_1] my books say that exogenous have low c-peptide and endogenous has high...i think?

22:57:40 [crusher] replace gluteal with associated

22:58:04 [crusher] step1 is right

22:58:16 [vladi] roshy- 5-a-reductase convert testosterone into active form of dehydrotestosterone- that's why anyway it comes thru testosterone

22:59:07 [SMS] thanks

22:59:42 [Step_1] yes, but if the androgen receptors aren't working, it doesn't matter if 5 alpha reductase is present or not because the product will not be able to work

23:00:21 [crusher] simple is that link C..peptide with endogenous insuline release......no C.petide with exogenous

23:00:30 [roshy04] ok thx guys

23:01:02 [vladi] thank crusher- excellent- it's more than enough. i reminded my Q in real exam- they wanted to hear what it's difference between this rates for insulinoma and exogenous insulin- it's main tricky pointior oinded

23:01:27 [SMS] why protein breaks down in diabetics?

23:02:43 [Step_1] lack of insulin b/c insulin breaks down protein

23:02:44 [crusher] in Dm there is dec insuline and more glucagon...which is a catabolic hormone?????

23:03:03 [Step_1] sorry insulin inhibits breakdown of protein

23:03:18 [SMS] ya......

23:03:30 [vladi] another tricky Q- what only hormone to increase with adecrease in pituitary function

23:03:31 [SMS] o insulin is deficient in diabetics.....

23:03:36 [roshy04] insulin inc protein syuthesis & dec breakdown

23:03:40 [crusher] step1 insulins is anabolic hormone...it makes everything

23:03:45 [SMS] thats why

23:03:55 [roshy04] prolactin

23:04:35 [SMS] ?

23:05:03 [vladi] excellent- roshy

23:05:20 [roshy04] bec prolactin's the only hormone which's under inhibitory reg

23:05:31 [Step_1] crusher, i meant that insulin normally inhibits the breakdown of prot, but its deficient in diabetics so you will see an increase in protein breakdown since less inhib

23:05:46 [roshy04] thx so much

23:06:16 [vladi] sorry- i found- insulin decrease with stress- i don't know why

23:06:44 [Step_1] diabetic mother gives birth to baby who has hypoglycemia....why?

23:07:32 [nne] in insulin deficiency, what aci-base disorder is promient?

23:07:48 [vladi] let's move to sex-hormones- it's a whole bunch of them in real exam

23:07:54 [SMS] one person had a big potato in meal and other had a Steak......in which the insulin level will be higher?

23:08:21 [nne] potato

23:08:48 [roshy04] bec his insulin was inc due to his mother hyperglycemia,right step 1??

23:09:00 [vladi] what hormone in high levels blocks milk production

23:09:00 [SMS] in first ( potato).....bec. glucose is better stimuli to release Insulin

23:09:34 [SMS] than amino acids ( Steak)

23:09:36 [Step_1] diabetic mother has hyperglycemia which crosses to normal baby who produces lots of insulin in response. so when baby is born and no more excessive glucose from mom, it still has lots of insulin present causing hypoglycemia.....called neonatal hypoglycemia....impt concept!

23:09:42 [nne] baby is used to high gucose levels and needs to ,maintain that so there is excess inslin wth no gluose to act on

23:10:12 [Step_1] correct to both of you...good job

23:10:15 [crusher] mother inc glucose inc baby insuline ..so baby has hypoglycemia..but it comes to normal soon after birth..with glucose supple

23:11:37 [Step_1] yes, but immediately after birth, you will have hypoglycemia because of the excessive insulin present

23:11:59 [SMS] treatment?

23:12:22 [Step_1] will the baby be large, small, or regular size at birth? why?

23:12:44 [SMS] large

23:12:52 [roshy04] i dopamine?? block lactation

23:13:03 [nne] large baby

23:13:08 [crusher] miulk prod block by inc estrogen/progesteron

23:13:38 [Step_1] macrosomia (large) because insulin increases adipose tissue stores of fat and muscle mass...good job

23:13:54 [crusher] or dopamine agonist===bromocriptine

23:13:59 [SMS] thanks

23:14:07 [vladi] brocriptine actually block lactation

23:15:09 [crusher] in pregnancy high level of estrogen/progestron prevent prolactin

23:15:09 [roshy04] why block lactation?? dopamine 's inhibitory to prolactin

23:15:50 [crusher] oh i,m sorry its lactation.....

23:15:54 [vladi] how about sex-hormones, guys- e.g. what happens to sex hormone-binding globulin in hirsutism

23:16:01 [roshy04] yes so it's bromocriptine,estrogen,progestron all'll block lactation

23:16:01 [nne] gotta go. will read the rest from the transcript. lets keep this up.goodnight.

23:16:25 [Step_1] good night nne. thanks for chatting

23:16:34 [roshy04] goodnight nne

23:16:46 [crusher] bye bye nne

23:16:58 [nne] thanks. bye

23:17:01 [SMS] circulating level of Insulin is not necessary a good Index of Insulin activity in Type 2 (NIDDM ) ......WHY?

23:17:24 [vladi] by-by- roshy

23:17:57 [roshy04] Vladi sex hormone bin glob 'll dec in hirsutism,am i right??!!

23:18:17 [Step_1] because problem is the receptors, so they might have high insulin, but it doesnt work

23:18:23 [vladi] crusher - right- high doses estrogen blocks milk production

23:18:32 [roshy04] because the problem 's with the receptors in type 2

23:18:35 [SMS] what is the next topic of discussion and when?

23:18:48 [vladi] what prevent lactation during pregnancy

23:19:13 [roshy04] high levels of progesterone

23:19:40 [Step_1] sms, the next topic is genetics and will be discussed next wed at 9 pm eastern

23:19:41 [crusher] right..in type 2 still insuline present but recepytors are insensitive while type1 ..no insuline

23:19:54 [vladi] you're right roshy- decrease. sorry - i did not get you point that you are still here

23:19:57 [SMS] yes....u r right

23:20:16 [SMS] good night everybody

23:20:24 [SMS] a nice discussion

23:20:31 [Step_1] sms, was that a test question about the next topic....lol

23:20:35 [SMS] we need to decide next topic

23:20:41 [SMS] nd time ?

23:20:43 [Step_1] goodnight sms

23:20:46 [roshy04] night night

23:21:07 [SMS] night night step_1

23:21:33 [SMS] ok

23:21:40 [SMS] Genetics

23:22:19 [crusher] name one hormone with positive feedback.

23:22:30 [vladi] it seems that estrogen again- roshy

23:22:39 [Step_1] estrogen

23:23:17 [crusher] correct step1..estrogen has postive feedback on LH,just prior to ovulution

23:23:48 [roshy04] but the estrogen 's as high as progestrone in pregnancy,so what's the point here,can somebody explain??

23:24:28 [Step_1] what inhibits estrogen?

23:24:49 [roshy04] What ovulation,i think the q was why lactation 's suppresed in PREGNANCYYYY

23:24:53 [vladi] progesterone is necessary for the maintance of the uterine endometrium from forth month of pregnancy on

23:26:15 [crusher] FSH?

23:27:19 [vladi] roshy- don't mix up the preganacy with normal cycle

23:27:28 [Step_1] estrogen increases itself by stim fsh, but also stim LH which causes ovulation. this will result in progesterone release which will then inhibit estrogen

23:28:18 [crusher] hmm good step1..

23:28:50 [vladi] but for 3 months to maintain the corpus luteum hCG is necessary. Estrogen will be high for a whole period of pregnancy

23:29:25 [roshy04] ok so now they're talking about N cycles

23:30:42 [Step_1] yes, but it wont be as high as in the peak necessary for ovulation

23:31:30 [roshy04] What hormone causes gestational diabetes??

23:31:52 [crusher] what will be the effect of high progesteron on Mensturation and ovulution

23:31:54 [vladi] what hormone is needed for induction of ovulation and formation of the corpus luteum

23:32:00 [crusher] HPL

23:32:20 [roshy04] right

23:32:28 [Step_1] LH

23:32:58 [roshy04] because it has anti-insulin actions

23:33:10 [crusher] for induction is LH and progestreon for corpus leuteum

23:33:52 [Step_1] i guess estrogen is needed for both

23:34:13 [vladi] hPL is right , but do not forget that placenta is forming only to 20 weeks of preganacy, bu before hCS can play this role like GH

23:35:08 [crusher] whats the ans vladi

23:35:42 [vladi] step1- you are right- LH

23:36:22 [crusher] what will be the effect of high progesteron on Mensturation and ovulution

23:37:01 [roshy04] no menstruation

23:37:05 [vladi] ans-LH- see the Q again for formation, for maintance- progesterone- i agree

23:37:16 [roshy04] no ovulation also

23:38:13 [roshy04] Vladi i don't have yr phone # please send it to me through my e-mail

23:38:58 [crusher] correct roshy.....cos progesteron has neg feedback on LH..no Lh no ovulution..no menstruation bcos progesteron not dec

23:39:26 [vladi] what's hormone thins cervical mucus, stimulates LH receptors on granulosa cells, elicits the LH surge, and increse proliferation of the uterine mucosal layers

23:39:57 [crusher] name the phase of mens cycle...low prog low/slowly inc estrogen estrogen

23:40:12 [Step_1] estrogen?

23:40:57 [roshy04] vladi-estrogen,follicular-crusher

23:40:58 [crusher] estrogen

23:41:28 [crusher] corrrect early follicular phase

23:41:48 [crusher] elevated progestron in urine

23:42:44 [vladi] ans-estradiol

23:42:50 [roshy04] i think this's luteal

23:43:42 [crusher] correct luteal or pregnancy

23:44:28 [vladi] what happens to LH and FSH if gonads are removed

23:44:44 [crusher] ist 3 months estrogen//progesteron secreted by ??

23:44:59 [crusher] inc lh/fsh

23:46:03 [Step_1] hcg

23:46:43 [Step_1] causes corpus luteum to secrete

23:47:02 [vladi] right crusher, but sex steroids decrease. How about postmenopausal women

23:47:02 [Step_1] estrogen and progesterone

23:47:12 [crusher] and in last 6 months estrogen and progesteron secreted by what ?

23:47:46 [Step_1] placenta?

23:47:56 [crusher] same inc fsh/lh ..cos no estrogen prog..loss of neg feedback

23:48:48 [crusher] ist 3 months estrogen/proge by OVARY later ovaries job been taken by placenta

23:49:04 hutals exits from this room

23:49:40 [vladi] right- the same thing, how about after administration of testosterone

23:49:58 [crusher] what is the index of fetal well being

23:50:25 [crusher] dec the LH?

23:50:53 [roshy04] test 'll dec lh

23:51:02 [Step_1] hcg

23:51:22 [vladi] fetal movement

23:51:37 [crusher] what is the index of placental well being

23:52:16 [crusher] tell us in terms of hormones

23:52:31 [Step_1] i guessed hcg??

23:52:35 [vladi] right- and sex steroid increase, nothing happen to FSH. How about after administration of inhibin

23:53:23 [roshy04] fhs'll dec

23:54:00 [roshy04] placental wellbeing by HCG sec

23:54:25 [crusher] estriol is the index of FETAL Well being...and HCL (Hpl) index for placental well being.............v,HY topic

23:54:43 [vladi] after inhibin- nothing happens to sex steroids and LH, FSH decreses; after infusion of GH- all decrease decrease

23:54:49 [roshy04] or estrogen&progestrone from the 4th month on

23:55:29 [Step_1] i didnt know that one crusher...thx

23:55:38 [crusher] hcl inc with the size of placenta

23:56:06 [crusher] for confirmation see page 476 for <a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000058&type=3 &subid=0" >Kaplan</a> 2002 page ..last line

23:56:37 [vladi] where did you get from - crusher- it's kind of weird

23:56:58 [Step_1] 476 in which kap lan book?

23:57:12 [crusher] physio

23:57:51 [crusher] i think its imp from clinical view point

23:58:02 [vladi] i would rather go for antenatal monitoring: fetal movements- US- NST- BPP

23:58:05 [Step_1] my book only has 250 pages

23:58:21 [crusher] i guees resever for step2

23:59:19 [crusher] tell me which weeks we perform amniocentesis and chorionic villous sampling and for what purpose

00:01:21 [roshy04] CVS @10-12 weeks,Amnio 15 up to term

00:02:03 [crusher] wonderful...now for what purpose

00:02:06 [Step_1] i agree

00:03:03 [vladi] hCS or hPL is secreted by placenta late in pregnancy, stimulates mammary growth during pregnancy, mobilizes energy stores from the mother so that the fetus can utilize them, and has the amino acid sequence like GH (sourse USMLE step 1 recall. buzzwords for the boards)

00:03:25 [roshy04] ch abn esp trisomies,gluteal of fetal lung maturity

00:03:32 [vladi] great roshy

00:03:36 [Step_1] CVS doesn't detect neural tube defects

00:03:45 [roshy04] asesment og fetal lung mat

00:05:45 [Step_1] tell if your fetus has a problem such as Down syndrome.

00:06:54 [Step_1] what is the ans crusher

00:08:08 [vladi] guys i found a tricky Q from my real exam; what's more dangerous method to get for prenatal screening- i don't remember a whole choices but main tricky point what's more dangeorus to take - amniotic fluid, fetal blood etc

00:08:31 [crusher] i myself donot know..these r real q

00:09:41 [roshy04] i think amniotic fleid,there's 2% risk of spotaneous abortion

00:10:56 [Step_1] i think the difference is the time frame you're in. chorionic villus sampling (CVS) at 10-11 weeks and Genetic amniocentesis is a special procedure that can be performed at 15-16 weeks. It is used to determine defects like Down synd. But CVS doesn't cover neural tube defects
00:12:45 [Step_1] I think I will say goodnight now. My eyes are closing on me

00:12:58 [roshy04] i'm sorry only .5% abortion for amnio & 2% for CVS

00:13:12 [crusher] thanks step1 for imp inform

00:13:53 [Step_1] well, right after i read the answer from vladi's question.....you're welcome crusher

00:14:25 [roshy04] me too i'm waiting

00:14:54 [Step_1] just realized it is a recall so there is no answer

00:15:03 [roshy04] by the way as long as yr're the coordinator step 1 if u go to sleep,have we too??

00:16:02 [Step_1] just filling in for Lorena....but no, you should keep going if you can. try to post this last part somewhere since I will post everything until I go.

00:16:10 [crusher] the classic q...control of ejection and errection by what symp/parasymp

00:16:43 [Step_1] points and shoots. parasymp for erection and symp for ejection

00:16:54 [vladi] i think it was a question about the real risk of different precedures; amniocentesis, chorionic villus sampling and fetal blood sampling. In my opinion the percutaneous umbilical blood sampling is more dangerous due to the risk odf bleeding

00:16:57 [roshy04] erection by parasym,ejection by sym

00:17:19 [crusher] all correct

00:17:50 [Step_1] points and shoots is a great mneumonic....i'll never forget it now
00:18:35 [roshy04] i think it's u who said it

00:19:04 [Step_1] yes, but its not my mneumonic is what i meant

00:19:20 [Step_1] i got it from first aid

00:20:08 [crusher] which of em has aramotase activity...ledig or sertoli

00:20:17 [roshy04] guys by the way all of you didn't take step1 yet ar some're done with it

00:20:38 [roshy04] sertolii

00:20:53 [Step_1] ok....goodnight to all and thanks for the great chat. see you all next wed at 9pm eastern to talk about genetics....bye

00:21:26 [crusher] bye step1...always great to see u and ur post

00:21:49 [roshy04] night night

00:22:07 [crusher] correct sertoli cell..also called nurse cell cos spermatogenesis occur

i have a question

if there is protein in my urine will that effect a pregnancy test

Hi, could someone please tell me what hyperosmolar syndrome exactly is?