01/27/05 19:08:07 sanz Joins Subroom USMLE_Step_2
01/27/05 19:08:13 [USMLE_Step_2] sanz: hey guys!
01/27/05 19:08:20 [USMLE_Step_2] strug: hi lanny atleast someone has come oh here comes sanz
01/27/05 19:08:21 [USMLE_Step_2] sanz: Strug, congrads on yr CS
01/27/05 19:08:25 rx Logs in
01/27/05 19:08:31 rx Joins Subroom USMLE_Step_2
01/27/05 19:08:33 [USMLE_Step_2] strug: thnx a lot i am very happy about it
01/27/05 19:08:48 [USMLE_Step_2] sanz: just wondering... do they give out scores in CS? or is it just pass or fail?
01/27/05 19:08:56 [USMLE_Step_2] lanny: you passed cs sanz congrats
01/27/05 19:09:00 [USMLE_Step_2] strug: its just pass or fail
01/27/05 19:09:11 [USMLE_Step_2] lanny: know how it feels thk God i passed that too
01/27/05 19:09:13 [USMLE_Step_2] sanz: lanny.. no... it's strug... i havent taken CS yet
01/27/05 19:09:28 [USMLE_Step_2] lanny: oh you will do it
01/27/05 19:09:37 [USMLE_Step_2] lanny: congrats strug
01/27/05 19:09:38 [USMLE_Step_2] strug: its one of the easiest exams of all the usmle isnt it?
01/27/05 19:09:42 [USMLE_Step_2] sanz: are you both in the match this yr?
01/27/05 19:09:47 [USMLE_Step_2] strug: not me
01/27/05 19:10:04 [USMLE_Step_2] lanny: relatively but i know peoplr who have failed
01/27/05 19:10:14 [USMLE_Step_2] strug: i have to take my step 3 since im lookin for a H1 visa
01/27/05 19:10:35 [USMLE_Step_2] sanz: but we dont need step 3 to enter match right?
01/27/05 19:10:45 [USMLE_Step_2] strug: right
01/27/05 19:10:47 [USMLE_Step_2] sanz: i dont know when to take step 3 and what it is for... hehe
01/27/05 19:10:58 [USMLE_Step_2] lanny: i am not gonna bother cause will be doing ck end march will be too late for match
01/27/05 19:11:03 [USMLE_Step_2] sanz: oh step 3 is needed for H1 visa?
01/27/05 19:11:10 [USMLE_Step_2] lanny: yes
01/27/05 19:11:13 [USMLE_Step_2] strug: u r lucky girl.....its a very tough exam
01/27/05 19:11:19 [USMLE_Step_2] sanz: otherwise we dont have to do them?
01/27/05 19:11:41 [USMLE_Step_2] strug: residents do it in their second year
01/27/05 19:11:41 [USMLE_Step_2] sanz: untill we have done residency and want to practise, i mean...
01/27/05 19:11:44 [USMLE_Step_2] lanny: if you dont need visa you dont need st 3 for resid
01/27/05 19:11:51 [USMLE_Step_2] strug: correct
01/27/05 19:11:54 [USMLE_Step_2] sanz: oh oke... thnx guys
01/27/05 19:11:58 [USMLE_Step_2] strug: ok guys endo today
01/27/05 19:12:11 [USMLE_Step_2] lanny: i will do it before resid if i dont get in this year
01/27/05 19:12:20 [USMLE_Step_2] sanz: yup.. sorry.. got side tracked
01/27/05 19:12:24 [USMLE_Step_2] lanny: ok lets shoot
01/27/05 19:12:34 [USMLE_Step_2] lanny: its ok all info helps
01/27/05 19:12:53 [USMLE_Step_2] sanz: tell me Radio iodine upt results in Hashimoto and Graves
01/27/05 19:12:55 [USMLE_Step_2] strug: whats the most common thyroid cancer?
01/27/05 19:13:06 [USMLE_Step_2] lanny: papilla
01/27/05 19:13:07 [USMLE_Step_2] strug: in graves inc in hashimoties dec
01/27/05 19:13:08 [USMLE_Step_2] sanz: pappil
01/27/05 19:13:12 [USMLE_Step_2] strug: correct
01/27/05 19:13:28 [USMLE_Step_2] sanz: correct strug, what abt thyroiditis?
01/27/05 19:13:35 [USMLE_Step_2] strug: dec
01/27/05 19:13:57 [USMLE_Step_2] sanz: yes... and for these 3 condt, the Resin Ts reupt?
01/27/05 19:14:00 [USMLE_Step_2] lanny: what strug
01/27/05 19:14:03 [USMLE_Step_2] sanz: i always get them so confused
01/27/05 19:14:10 [USMLE_Step_2] strug: thyroidits nodule painful hashimots painless
01/27/05 19:14:19 [USMLE_Step_2] lanny: yep
01/27/05 19:14:36 [USMLE_Step_2] sanz: resin T3 reuptake?
01/27/05 19:14:50 [USMLE_Step_2] lanny: in what
01/27/05 19:14:51 dua_frank Logs in
01/27/05 19:14:52 [USMLE_Step_2] strug: i dunno
01/27/05 19:14:57 dua_frank Joins Subroom USMLE_Step_2
01/27/05 19:15:03 [USMLE_Step_2] sanz: in Hashimoto, graves and thyroiditis
01/27/05 19:15:05 [USMLE_Step_2] dua_frank: hi
01/27/05 19:15:07 [USMLE_Step_2] strug: hi
01/27/05 19:15:08 [USMLE_Step_2] sanz: hey dua
01/27/05 19:15:11 [USMLE_Step_2] dua_frank: hey sanz
01/27/05 19:15:21 [USMLE_Step_2] lanny: hey dua
01/27/05 19:15:26 [USMLE_Step_2] dua_frank: what about those diseases?
01/27/05 19:15:30 [USMLE_Step_2] strug: we are talking about resin t3 uptake
01/27/05 19:15:37 [USMLE_Step_2] dua_frank: hey lanny
01/27/05 19:15:40 [USMLE_Step_2] dua_frank: thanks strug
01/27/05 19:15:41 [USMLE_Step_2] sanz: the way i remember it, in Hashimoto, RAIU and RT3 are both low and in Graves, they're both high
01/27/05 19:15:59 [USMLE_Step_2] sanz: in throiditis, RAIU is down and RT3 is up
01/27/05 19:16:02 [USMLE_Step_2] lanny: rtu inc in graves
01/27/05 19:16:12 rx Logs Out
01/27/05 19:16:33 [USMLE_Step_2] strug: the only diff betwn graves and hashimotes what i know is that raiu uptake is dec in hashimo and in c in graves
01/27/05 19:16:44 [USMLE_Step_2] sanz: i always get these tests mixed up
01/27/05 19:16:46 [USMLE_Step_2] lanny: right
01/27/05 19:16:58 [USMLE_Step_2] lanny: just memorise them sanz
01/27/05 19:17:08 [USMLE_Step_2] sanz: not good at that, lanny
01/27/05 19:17:09 [USMLE_Step_2] strug: in graves there is more production of thyroid hormone
01/27/05 19:17:09 [USMLE_Step_2] sanz: hehe
01/27/05 19:17:20 [USMLE_Step_2] lanny: me too but last m inute try
01/27/05 19:17:25 [USMLE_Step_2] sanz: ok
01/27/05 19:17:26 [USMLE_Step_2] strug: in hashimotes the inflammed gland puts out more hormone
01/27/05 19:17:37 [USMLE_Step_2] dua_frank: i don't even try
01/27/05 19:17:41 [USMLE_Step_2] sanz: lol dua
01/27/05 19:17:47 [USMLE_Step_2] strug: so in graves uptake is more because gland is hyperfuncional
01/27/05 19:18:11 [USMLE_Step_2] strug: in hashimotes uptake is less because gland is damaged or inflammed
01/27/05 19:18:20 [USMLE_Step_2] sanz: good explanation strug
7:11 PM [strug] thnx
7:11 PM [lanny] agree short and simple
7:12 PM [sanz] and since RT3 is inversely proportional to TGB binding site, it'll be low in hashi and high in Graves
7:12 PM [sanz] hey nasi!
7:12 PM [cyrus1345] Hi eveybody
7:12 PM [strug] hi nasi
7:12 PM [dua_frank] hi nasi
7:13 PM [lanny] resin will bind to more sites
7:13 PM [lanny] hi cyrus
7:13 PM [lanny] remember methimazole contra in preg
7:13 PM [dua_frank] so RT3 is the same as T3 levels in those diseases
7:14 PM [sanz] ok
7:14 PM [lanny] PTU is ok
7:14 PM [lanny] for hyperthyr common in preg
7:14 PM [dua_frank] why is methi CI in preg?
7:14 PM rsandhu has joined subroom: USMLE_Step_1
7:14 PM [lanny] teratogen
7:14 PM [strug] crossed placenta
7:15 PM [dua_frank] ok
7:15 PM [strug] what is euthyroid sick syn....scenario and t3 t4 levels?
7:15 PM [lanny] causes aplasia cutis
7:15 PM [cyrus1345] t3 is low,especiallyi ICU
7:15 PM [lanny] prolonged inflammatory condition
7:15 PM [sanz] T3 and T4 are high but TSH normal?
7:15 PM lanny has left the chat.
7:15 PM [cyrus1345] t4,tsh is mnormal
7:16 PM [dua_frank] all low
7:16 PM [strug] occurs in ICCU patients. Tsh normal.
7:16 PM [strug] most cmn t3 low
7:16 PM [strug] could be low t4 also
7:16 PM [strug] Rx
7:17 PM [lanny] atshis N in euthyr sick right?
7:17 PM [cyrus1345] nothing!!
7:17 PM [strug] nothing
7:17 PM [dua_frank] atshis?
7:17 PM [strug] tsh normal lanny
7:17 PM [dua_frank] oh tsh
7:17 PM [lanny] TSH normal in Eyes thanks
7:18 PM [lanny] thyr nodule first step in diag
7:18 PM [strug] tsh
7:18 PM [cyrus1345] measure TSH
7:18 PM [strug] if tsh normal next step
7:19 PM [dua_frank] drugs causing hypothyroidism?
7:19 PM [sanz] how do you go abt dx DM?
7:19 PM [cyrus1345] lithium
7:19 PM [dua_frank] GTT first
7:19 PM [lanny] oral glucose toler
7:19 PM [iamzuhair] hi
7:19 PM [lanny] hi zuhair
7:19 PM [sanz] hi zuhair
7:19 PM [iamzuhair] congrats strug
7:19 PM [dua_frank] antithyroid drugs, amiodarone, lithium and iodine
7:19 PM [cyrus1345] HIzahuir
7:20 PM [iamzuhair] u must be feelin grt today
7:20 PM [dua_frank] hi zuhair
7:20 PM [strug] thnks zuhair and hi
7:20 PM [sanz] the first test is random blood gluc
7:20 PM [dua_frank] why will strug be feeling great?
7:20 PM [iamzuhair] ask him
7:20 PM [sanz]
7:20 PM [dua_frank] why are you feeling great strug?
7:20 PM [dua_frank] not that i mind...
7:20 PM [strug] I passed my step 2 ck.....hurray
7:20 PM yoda1 has joined subroom: USMLE_Step_3
7:21 PM [strug] sory CS
7:21 PM [dua_frank] oh wow, congratulations
7:21 PM [sanz] yay!
7:21 PM yoda1 has joined subroom: USMLE_Step_1
7:21 PM [iamzuhair] so we doin endo
7:21 PM [dua_frank] yep
7:21 PM [iamzuhair] ok who shootin
7:21 PM [strug] Rx of subacute thyroiditits?
7:22 PM [cyrus1345] Nsaid
7:22 PM [sanz] self limited...
7:22 PM [strug] right nasi Rx of hashimotis thryoiditis?
7:22 PM [lanny] anti inflam
7:22 PM [sanz] thyroxine
7:22 PM [strug] L thyroxine sanz rith
7:23 PM [lanny] remember watch for angina
7:23 PM [strug] Lymphocytic thy?
7:23 PM yoda1 has left the chat.
7:23 PM [sanz] what Antibodies in Hashimoto?
7:23 PM [strug] anti mitochondrial
7:23 PM [sanz] dont know, strug
7:23 PM [lanny] HLAdr5
7:23 PM [strug] sorry antimicrosomal, antithyroid peroxidase
7:24 PM [sanz] yup
7:24 PM [strug] Rx of lymphocytic thryroid is symptomatic with Ppnl
7:24 PM [lanny] yep its assoc with HLA dr5
7:24 PM [sanz] ppnl = propanolol?
7:25 PM [strug] yes ppnl
7:25 PM [sanz] ok.. didnt know that...
7:25 PM [lanny] strug i dont think its antimicrosomal i think its antithyroglob
7:25 PM [lanny] can chk later and confirm
7:25 PM [sanz] just to clarify... antimitochondrila Ab is found in pri sclerosing cholangitis right?
7:25 PM [dua_frank] yes sanz
7:25 PM [lanny] yes
7:25 PM [cyrus1345] no
7:25 PM [strug] antithyroi is in glaves
7:26 PM [strug] graves i mean
7:26 PM [cyrus1345] PBS
7:26 PM [lanny] in hashimoto antithroglobulin is seenin serum
7:26 PM [iamzuhair] biliary dz
7:26 PM [cyrus1345] not PSC
7:26 PM [dua_frank] PBS?
7:27 PM [cyrus1345] PBC
7:27 PM [lanny] antimicrowomal is seen in PSC
7:27 PM [dua_frank] ?
7:27 PM [sanz] oh ok
7:27 PM [strug] lanny i m pretty sure its antimicrosomal in hashimotos
7:27 PM [sanz] thnx nasi
7:27 PM [iamzuhair] primary biliary cirrhosis
7:27 PM [cyrus1345] agree strug
7:27 PM [dua_frank] oh
7:27 PM [lanny] ok will chk
7:27 PM [iamzuhair] yes its anti microsomal
7:27 PM [sanz] yes, it's microsomal and peroxidase in Hashi
7:27 PM [lanny] right sanz
7:28 PM [sanz] mitochondrial in PBC
7:28 PM [iamzuhair] yes
7:28 PM [iamzuhair] anit sm antibody
7:28 PM [lanny] yes
7:28 PM [iamzuhair] smooth muscle
7:28 PM [strug] autoimmune hepaitits
7:28 PM [strug] am i right zuhair?
7:28 PM [iamzuhair] yes
7:29 PM [iamzuhair] antismith
7:29 PM [sanz] SLE
7:29 PM [iamzuhair] yes
7:29 PM [strug] anti endomysial?
7:29 PM [sanz] celiac
7:29 PM [iamzuhair] yes
7:29 PM [strug] celliac sprue
7:30 PM [lanny] what type of SLE has anti smith
7:30 PM [sanz] what are the elctrolytes in hyperaldosteronism?
7:30 PM [strug] acute with kidney involvemtn
7:30 PM [sanz] nephritis type lanny?
7:31 PM [strug] primary or secondary?
7:31 PM [sanz] primary
7:31 PM [strug] inc Na, dec K
7:31 PM [sanz] ABG?
7:31 PM [strug] dec renin and angiotensin
7:31 PM [strug] hypokealemic metab alkalosis
7:32 PM [sanz] good strug! you're clever
7:32 PM [strug] thanks
7:32 PM [strug] did anyone find out gitlemans syndeome?
7:33 PM [sanz] no... did u?
7:33 PM [strug] no
7:33 PM [dua_frank] nope
7:33 PM [lanny] anti smith is seen in drug induced SLE
7:33 PM [sanz] when did we discussed abt it? hehe
7:33 PM [sanz] i have lost tracked
7:34 PM [iamzuhair] anti histone
7:34 PM [iamzuhair] in drug
7:34 PM [dua_frank] anti smith in all SLEs
7:34 PM [iamzuhair] yes all sles
7:34 PM [sanz] yeah, zuhair
7:34 PM [dua_frank] it's the diagnostic one
7:34 PM [iamzuhair] its specific
7:34 PM [lanny] anti histone in drug ind..
7:34 PM [dua_frank] and yes anti histone in drug induced
7:35 PM [iamzuhair] 1 st step to evaluate a palpable thyroid nodule
7:35 PM [lanny] sorry it is anti histone not anti smith
7:35 PM [strug] TSh
7:35 PM [sanz] FNA
7:35 PM [iamzuhair] u
7:35 PM [lanny] FNAif palp
7:35 PM [iamzuhair] us
7:35 PM [iamzuhair] usg
7:36 PM [iamzuhair] ultrasound
7:36 PM [sanz] i think it's TSH
7:36 PM [dua_frank] *) usg?
7:36 PM [sanz] then Ultrasound
7:36 PM [dua_frank] why not FNAC?
7:36 PM [cyrus1345]
7:36 PM [sanz] cuz it's invasive
7:36 PM [iamzuhair] palpable thyroid nodule 1st usg
7:36 PM [dua_frank] oh
7:36 PM [iamzuhair] if cystic then fnac
7:37 PM [strug] first step is always TSH.... i dont agree wit usg
7:37 PM [cyrus1345] UW said first TSH
7:37 PM [iamzuhair] if cyst disappears after fnac nothing to be done
7:37 PM [lanny] FNA is done on an non active nodule like hyperthyr
7:37 PM [cyrus1345] I am not agree too
7:37 PM [strug] oh gosh u r talking about breast not thyroid
7:37 PM [dua_frank] strug lol
7:38 PM [sanz] zuhair, are you talking abt thyroid or breast?
7:38 PM [cyrus1345] i don't think so strug!
7:38 PM [iamzuhair] if cyst still there after fnac
7:38 PM [strug] zuhair pl check out.....yes what he is saying is abut breast not thyroid
7:38 PM [iamzuhair] thyroid
7:38 PM [iamzuhair] dude breast its no usg
7:38 PM [cyrus1345] zuhiar are you talking about breast or thyroid?
7:38 PM [iamzuhair] breast its fnac directly if mass felt
7:39 PM [iamzuhair] if mass not felt then mamogram
7:39 PM [cyrus1345] ok what is your source zuhiar?
7:39 PM [iamzuhair] did it in the questions in exam
7:39 PM [lanny] ok many discrep lets check throid diag again
7:39 PM [cyrus1345] kaplan,UW,CMDT ,Ichecked all for sure it's TSH!
7:39 PM [dua_frank] i'm confused :<
7:39 PM [iamzuhair] dont know from which book though but its in my notes
7:40 PM [iamzuhair] ok sorry for confusion
7:40 PM [sanz] i agree... it's TSH and then USS...
7:40 PM [cyrus1345] please checkit again!
7:40 PM [iamzuhair] let be double check and tell you guys tomorrow
7:40 PM [iamzuhair] but im sure
7:40 PM [cyrus1345] ok!I give up
7:40 PM [lanny] yes but if the nodule is functioning thenyou do TSH to know if it is function you gotta do FNA
7:40 PM [strug] ok taht would be great
7:41 PM [lanny] all check thyroid!!!!!!!!!!!!!!!!!!!!!!!!!
7:41 PM [strug] i think first start with Tsh ... if normal then do Fnac
7:41 PM [strug] we all need to check right
7:41 PM [sanz] but what abt breast mass, since we're on the lumps subject?
7:41 PM [lanny] mamogram first
7:41 PM [lanny] fna
7:41 PM [dua_frank] i agree with lanny
7:41 PM [lanny] cystic or solid
7:41 PM [iamzuhair] palpable and only one lump then fnac
7:41 PM [lanny] solid biopsy
7:42 PM [iamzuhair] if multiple lumps or not alpable then mamogram
7:42 PM [lanny] cystic..observe
7:42 PM [sanz] moveable lump
7:42 PM [strug] agree with lanny so far
7:42 PM [lanny] this is how i remember it.. start with simple
7:43 PM [sanz] so if it's fibrocystic, observe... if it's fibroadenoma, FNA?
7:43 PM [lanny] cystic can occur in perienses young
7:43 PM [sanz] nasi, what are yr thoughts?
7:44 PM [lanny] fibro adenoma you do fna and biopsy too
7:45 PM [strug] fibroadenoma if suspected clinically....do Fna to confirm ur diagnosis....
7:45 PM [lanny] fine needle biopsy in fibrocystis
7:45 PM [sanz] that's what i thught too... but i remember in UW, there was a q abt a lady with fibroadenoma and the ans as to do mammo first...
7:45 PM [strug] if it comes out fibradenoma u can either operate or leave it as such depending on the choice of the female
7:45 PM [lanny] right strug but do excision biopsy to confim
7:46 PM suani11 has left the chat.
7:46 PM [strug] for fibroadenoma?
7:46 PM [lanny] yes
7:46 PM [lanny] since you need to r.o.cancer
7:46 PM [lanny] prstn is same
7:47 PM [lanny] surgical rxcision is needed for trt
7:47 PM [lanny] this is for f. adenoma
7:47 PM [strug] if its a cystic disease which occures in older females than fibroadneoma... first do mamogram to look for other cysts or malignancy.....then aspirate the cyst
7:47 PM [sanz] ok
7:47 PM [lanny] yes older than 25
7:48 PM [strug] if malignant cell in the cyst or if it dosent go away with aspiarion or blood do excision bipsy
7:48 PM [lanny] yes
7:48 PM rsandhu has left the chat.
7:48 PM [strug] if it goes away watch
7:48 PM [lanny] yes
7:48 PM [sanz] ok thnx
7:48 PM [iamzuhair] thanks
7:49 PM [lanny] what is MCcune albright sd
7:49 PM [sanz] precocious puberty with hyperpigmentation
7:49 PM [sanz] and bone abn...
7:49 PM [strug] precocius puberty, aromatase enz def, cystis in bone
7:49 PM [strug] also cafe auliat spots
7:49 PM [lanny] any adrenal involv
7:49 PM [strug] nooooooooo
7:50 PM [strug] Rx
7:50 PM [lanny] is it the one with short metacarpals?
7:50 PM [sanz] no... that's pseudohypothyroidism i think
7:50 PM [strug] aromatase enz
7:50 PM [lanny] thx all
7:51 PM [strug] me to its pseudo hyperparathyroidism....hhmmmmmh hyper i guess
7:51 PM [strug] or hypo sanz?
7:51 PM [strug] end organ resistant to parathyeoid?
7:51 PM [lanny] is it pseudo pseudo hypoparathyr
7:52 PM wila has left the chat.
7:52 PM drrs has left the chat.
7:53 PM [dua_frank] both
7:53 PM [strug] Rx or prollactinoma?
7:53 PM [dua_frank] short metatarsals in both pseudo and pseudo
7:53 PM [dua_frank] pseudopseudo
7:53 PM [dua_frank] except biochem is normal in pseudopseudo
7:53 PM [lanny] thx
7:53 PM [dua_frank] presentation is the same
7:54 PM [dua_frank] in hyperparathyroidism you have osteitis fibrosa cystica
7:54 PM [dua_frank] and periosteal resorption
7:54 PM cyrus1345 has left the chat.
7:54 PM [dua_frank] bone appears thin on margins
7:55 PM [strug] bromocriptine or pergolide?
7:55 PM [dua_frank] bromocriptine
7:55 PM [lanny] for what?
7:55 PM [dua_frank] prolactinoma
7:55 PM [lanny] thx
7:56 PM [lanny] correct
7:56 PM [strug] most common cause of deathin acromealy?
7:56 PM [lanny] heart failure
7:56 PM [dua_frank] MI?
7:56 PM [strug] CHf
7:56 PM [strug] first test in acrometaly?
7:56 PM sanz has left the chat.
7:57 PM [lanny] GH stim
7:57 PM roxanita has joined subroom: USMLE_Step_1
7:57 PM [sanz] dunno what happened... got kicked out
7:57 PM [strug] we missed u
7:57 PM [dua_frank] wb sanz
7:57 PM [lanny] happened to me y.day toosanz
7:57 PM [sanz] thnx... what were we talking abt?
7:57 PM [strug] best test for acrometaly
7:57 PM [lanny] acromegaly
7:58 PM [sanz] GH?
7:58 PM [strug] MRI
7:58 PM [strug] Mx?
7:58 PM [lanny] inc glucose in blood
7:59 PM [sanz] surgery
7:59 PM [lanny] tx is surgery or raad
7:59 PM [sanz] is MRI the first test to do?
7:59 PM [strug] best test
8:00 PM [strug] first is screeing by giving 100 gm glucose
8:00 PM [lanny] always do simple test first think its GH levels
8:00 PM [sanz] ok
8:00 PM [sanz] thnx
8:00 PM [strug] the GH levels should dec, if remains>5ng/ml its excess
8:00 PM roxanita has left the chat.
8:00 PM [lanny] by glucose intoler test
8:00 PM [dua_frank] screening test for acromeg is?
8:00 PM [sanz] glucose test, dua
8:01 PM [lanny] right dua
8:01 PM [dua_frank] IGF-1
8:01 PM [dua_frank] levels
8:01 PM [dua_frank] OGTT is diagnostic test
8:01 PM [strug] what is first sign of sheeehans syn?
8:01 PM [lanny] i believe its glucose test
8:01 PM [dua_frank] hypotension?
8:01 PM [dua_frank] lanny is it diagnostic yes
8:02 PM [lanny] yes measure glucose levels high tells you high GH
8:02 PM [sanz] hypopit, strug
8:02 PM [dua_frank] but since that test takes time to do, they measure IGF-1 levels of the last 24 hrs sample
8:02 PM [strug] inability to lactate
8:02 PM [dua_frank] gives GH levels indirectly
8:02 PM [sanz] ok
8:02 PM [lanny] ok dua,
8:02 PM [strug] how to diagnose GH deficiency?
8:03 PM [sanz] glucose test again?
8:03 PM [strug] give insulin....if GH levels > 10 mg/dl no deficiency
8:04 PM [lanny] dua last 24 hr sample of?
8:04 PM [lanny] blood
8:04 PM [lanny] you mean blood collected within 24 hrs
8:04 PM [iamzuhair] sorry guys
8:04 PM [dua_frank] lanny *) , good question
8:05 PM [roxanita] Hi mick
8:05 PM [iamzuhair] had gone to check the thyroid thing
8:05 PM [roxanita] I though you were going to take step 1
8:05 PM [iamzuhair] sorry for the mix up
8:05 PM [strug] what did u find
8:05 PM [dua_frank] no its just a one time sample but gives an approx level within the 24 hours
8:05 PM [roxanita] see you
8:05 PM [lanny] ok thx wondered where you went missed you
8:05 PM [iamzuhair] i dunno where i got this in my notes from
8:05 PM [strug] welcome back zuhair
8:05 PM [iamzuhair] checked harison
8:05 PM [strug] go on
8:05 PM [iamzuhair] can i tell the scene now
8:05 PM [strug] yes
8:06 PM [sanz] yup zuhair plz
8:06 PM [lanny] roll!!!
8:06 PM [dua_frank] yes p;ease
8:06 PM [iamzuhair] ok
8:06 PM [iamzuhair] thyroid nodule 1 st do a tsh
8:07 PM [iamzuhair] if normal then do a usg guided biopsy
8:07 PM [iamzuhair] if decreased tsh then do a thyroid scan
8:07 PM [iamzuhair] if thyroid scen hot nodule seen then do a surgery
8:08 PM [iamzuhair] if cold nodule on thyroid scan then do fnac guided by usg
8:08 PM [dua_frank] i disagree
8:08 PM [dua_frank] *)
8:08 PM [strug] did u check dua?
8:08 PM [dua_frank] yeah
8:09 PM [strug] what did u find dear
8:09 PM [dua_frank] first tsh t3 and t4
8:09 PM [dua_frank] then usg
8:09 PM [iamzuhair] man i am saying this from harrison
8:09 PM [dua_frank] shows how many nodules there are
8:09 PM [dua_frank] if one, go for FNAC
8:09 PM [dua_frank] then cyto on that
8:10 PM [strug] whats ur source dua?
8:10 PM [dua_frank] oxford
8:10 PM [iamzuhair] harrison figure 320 -13 management of solitary thyroid nodule
8:11 PM [strug] thanks both of you...
8:11 PM [lanny] thanks, can we move on
8:11 PM [dua_frank] if multiple, do UGS guided biopsy then excise if malignant
8:11 PM [dua_frank] yep
8:11 PM [iamzuhair] sorry for the earlier statement
8:11 PM [iamzuhair] aneways we can check later on too
8:11 PM [sanz] no prob zuhair... it creates good discussion
8:12 PM [strug] thats fine pals dont worry
8:12 PM [dua_frank] thanks for checking though zuhair, it's pretty confusing
8:12 PM [lanny] what are yousorry abut we are bound to have disagree med is wide!!!
8:12 PM [strug] correct
8:12 PM [lanny] thanks for your research
8:12 PM [iamzuhair] its so good of you guys
8:12 PM [iamzuhair] thanks a lot
8:13 PM [iamzuhair] back to endo
8:13 PM [lanny] we all have to go back and chk again and know it since we have so many disagree
8:13 PM [lanny] CAH diag
8:14 PM [lanny] what do you measure so many hydro lase
8:15 PM [sanz] 21 something def
8:15 PM [sanz] hehe
8:15 PM [iamzuhair] 21 oh def
8:15 PM [strug] 21 alpha hydroxylase def
8:15 PM [dua_frank] whats CAH?
8:15 PM [sanz] congenital adrenal hyperplasia
8:15 PM [iamzuhair] cong adrenal hy
8:15 PM [strug] congenital adrenal hyper
8:15 PM [dua_frank] ah, thanks
8:15 PM [lanny] C21 is Most comm but what enzyme do youmeasure
8:15 PM [sanz] causes virilization in new born girls
8:16 PM [sanz] 17 prog oh
8:16 PM [strug] and salt loosing nephropathy
8:16 PM [iamzuhair] yes
8:16 PM [iamzuhair] with hypertention
8:16 PM [strug] no hypotentiso
8:16 PM [iamzuhair] yes it depends on the specific enzyme level
8:17 PM [strug] salt loosing Na therefore hypotension... i was talking about 21 hydr
8:17 PM [lanny] so what is measured
8:17 PM [strug] 17 OH progesteron
8:17 PM [lanny] progesterone pregnelonone ACTH/
8:17 PM [lanny] ok strug thx
8:18 PM [sanz] hypertension is with 11 hydrox def
8:18 PM [lanny] cause they wil all inc before the bloc
8:18 PM [dua_frank] if it's low then its 21 def and if high then 17 def?
8:18 PM [dua_frank] let me get this right guys
8:18 PM [strug] what low?
8:19 PM [dua_frank] 17 oh progesterone levels
8:19 PM [sanz] Rx is to replace mineralcorticoids
8:19 PM [dua_frank] what does it show?
8:19 PM [lanny] yes give fludricortisone
8:19 PM [strug] high in both 17 and 21 def
8:19 PM [lanny] its TOC
8:19 PM [dua_frank] and low in?
8:19 PM [sanz] agree strug
8:19 PM [iamzuhair] 21 oh def --- 17 oh progesterone lhigh
8:19 PM [dua_frank] 11 def?
8:19 PM [sanz] high in 11 def too dua
8:19 PM [dua_frank] man
8:20 PM [strug] its the first step so its high in all deficiency
8:20 PM [dua_frank] ok
8:20 PM [sanz] yes
8:20 PM [strug] because all def occur below it
8:20 PM [dua_frank] so how do you tell one apart from the other?
8:20 PM [lanny] 11 has highK and HTN
8:20 PM [sanz] 11 has HTN
8:20 PM [strug] yes
8:20 PM [sanz] 21 is salt losing... so hypotension
8:20 PM [dua_frank] so does 17 one
8:20 PM [lanny] 17 has low K and hyper
8:20 PM [dua_frank] mild hypertension
8:20 PM [iamzuhair] 11 oh def ----- htn and 11 deoxycorticosterone high in blood
8:20 PM [sanz] think of 21 as if it's Addison... only this is in kids
8:21 PM [dua_frank] ok so HTN is the differentiating point
8:21 PM [dua_frank] BP i mean
8:21 PM [lanny] yes
8:21 PM [dua_frank] ok
8:21 PM [dua_frank] thanks
8:21 PM [lanny] good diff point
8:21 PM [lanny] also 21 is MCC
8:22 PM [lanny] also mc aut recess ds
8:22 PM [strug] whats kallman syn
8:22 PM [huli72] low FSH
8:22 PM [lanny] hypogonad
8:22 PM [huli72] problems with hypothalamus
8:22 PM [strug] hypogonadotrophic hypogonadism and dec smell sensation
8:22 PM abcxyz221 has left the chat.
8:22 PM [huli72] low GnRH
8:23 PM [lanny] low fSH LH
8:23 PM [strug] hi huli good to have u here
8:23 PM [sanz] hey huli
8:23 PM [lanny] a pituitary prob due to tumor
8:23 PM [huli72] how to treat heavy undremitting hemorrhage in adolescent
8:23 PM abcxyz221 has left the chat.
8:23 PM [huli72] hi, friends
8:23 PM [lanny] hey huli
8:24 PM [sanz] estrogen
8:24 PM [huli72] yeah, sanz
8:24 PM [lanny] have a question are you ready,
8:24 PM [strug] shoot
8:24 PM [huli72] go ahead
8:24 PM [dua_frank] hi lihu
8:25 PM [huli72] hi, dua
8:25 PM [lanny] incidentaloma.. i know this cool.. what is it
8:25 PM [strug] pheochromocytoma
8:25 PM [sanz] a mass found incidentally
8:25 PM [sanz] hehe
8:25 PM [iamzuhair] lol
8:25 PM [dua_frank] sanz lol
8:25 PM [huli72] yeah,
8:25 PM [huli72] what is pseudohypoparathyroidism
8:25 PM [lanny] not pheo prst same though
8:26 PM [sanz] lanny, wuz the ans?
8:26 PM [lanny] non fctn adrenal adenoma
8:26 PM [huli72] adrel mass?
8:26 PM [lanny] prst like pheo
8:26 PM [lanny] yes a mass
8:26 PM [strug] tell the ans now
8:26 PM [lanny] tx?
8:27 PM [strug] none
8:27 PM [huli72] <3, not treatment
8:27 PM [huli72] >3 surgery
8:27 PM [lanny] no surgery
8:27 PM [lanny] whats 3 huli
8:27 PM [huli72] 3cm
8:27 PM [lanny] ok
8:27 PM [strug] i think its a pheochromocytoma found accidently on CT of abdomen...but if pt asymp u dont need to treat
8:28 PM [huli72] I am not sure about 3 cm
8:28 PM [lanny] what to do before surg
8:28 PM [iamzuhair] all causes of hirsutism
8:28 PM [strug] lanny please clarify and lemme knowthe source
8:28 PM [strug] alpha blockere
8:28 PM [lanny] ok, not sure about 3 though will chk
8:29 PM [lanny] good strug otherwise what happens if you dont give bblovk
8:29 PM [lanny] sorry alpha block/
8:29 PM [sanz] hypertension
8:29 PM [strug] cathecholamine releaesed in large no
8:29 PM [lanny] a surge in catechol and death
8:30 PM [iamzuhair] all causes of hirsutism ?
8:30 PM [lanny] DEATH>>>>!!!!!! remember
8:30 PM [sanz] PCOS. zuhair
8:30 PM [strug] this is all about pheochromocytoma...someone please tell me is it same a s incidentolame?
8:30 PM [iamzuhair] pcod
8:30 PM [iamzuhair] cushings
8:30 PM [iamzuhair] minoxidil
8:30 PM [iamzuhair] phenytoin
8:30 PM [iamzuhair] cyclosporine
8:31 PM [dua_frank] obesity
8:31 PM [iamzuhair] yes
8:31 PM [dua_frank] infertility
8:31 PM [iamzuhair] do u guys know any more
8:31 PM [strug] hey man minoxidil causes baldness....does it cause hirsutism>?
8:31 PM [lanny] yes usu non functional ie no sms but can be and prst like oheo
8:31 PM [lanny] strug your answer
8:31 PM abcxyz221 has left the chat.
8:31 PM [strug] thnx alot lanny
8:32 PM [sanz] where did you heard abt this incidentoloma lanny?
8:33 PM [strug] i heard it in kaplan video lectures
8:33 PM [sanz] i've not heard of it before... that's all
8:33 PM [lanny] in a question picked pheo, but was wrong,cause they prst the same but you have to do CT and urin to diff dg
8:33 PM [dua_frank] whats clonidine suppression test in pheo, anybody knows?
8:34 PM [dua_frank] i guess BP falls with clonidine normally but not with pheo?
8:34 PM [dua_frank] not in pheo i mean...
8:34 PM [strug] so what do u find in CT and urine for pheo and incident?
8:34 PM [sanz] i guess dua
8:34 PM [dua_frank] free cats in urine
8:35 PM [iamzuhair] check for catecholamines and potassium
8:35 PM [dua_frank] VMA and metanephrites
8:35 PM shreya has left the chat.
8:35 PM [strug] how to differn both of them lanny?
8:35 PM [dua_frank] not cats as in the feline variety, i mean catecholamines :P
8:36 PM [sanz] hehe
8:36 PM [iamzuhair] incedentalomas are 90 % non functioning
8:36 PM [lanny] ok strug..incident is not function ie no sms..but if sms it pheo(ct and urine free catechol) if this is neg its not oheo its incident
8:36 PM [iamzuhair] do dexamethsone suppression test
8:37 PM [iamzuhair] to see for adrenal cortical functioning
8:37 PM [lanny] for diag of pheo you need ct and inc catechol
8:37 PM [strug] u mean in incidentolam urind free cathe not present?
8:37 PM [iamzuhair] htn with increased cats and mass in adrenal --- pheo
8:37 PM [lanny] yes
8:37 PM [iamzuhair] yes
8:37 PM [strug] and no symptoms also?
8:38 PM [lanny] yes,
8:38 PM [strug] then in what way are they similar?
8:38 PM [lanny] but in a little percent can be
8:38 PM [dua_frank] good question strug
8:38 PM [sanz] they both present the same
8:38 PM [iamzuhair] may be may not be ---- they are same as pheochrmo
8:38 PM [sanz] lanny has been saying that...
8:38 PM [strug] but there are no symp lanny says
8:38 PM [lanny] thats why you do CT and urine cat to diff got it now
8:39 PM [sanz] usu no Sx but if there're they prst like pheo...
8:39 PM [lanny] come on strug ok read a good book youlle gei ti not diff
8:39 PM [strug] ok dear..no problem
8:39 PM [lanny] thanks dear
8:39 PM [lanny] strug are you a guy or gal
8:39 PM [strug] why?
8:39 PM [huli72] what is pseudoparathyroidism?
8:40 PM [lanny] just curious
8:40 PM [strug] are u a girl or boy?
8:40 PM [lanny] a question does not answer a question boyee or girlee
8:40 PM [strug] i m a girl...
8:40 PM [huli72] pseudohypoparathyroidism?
8:40 PM [sanz] huli, i think it's where the PTH is normal or high normal and Ca is low
8:41 PM [sanz] they have mental retardation and their fingers are short
8:41 PM [huli72] pth high
8:41 PM [huli72] ca low
8:41 PM [strug] sorry huli we just got off track
8:41 PM [huli72] high phosphorus
8:41 PM [lanny] i thought youre a boy ok enough of that..thanks im a boylol
8:41 PM [huli72] defect?
8:41 PM [lanny] lol strug
8:42 PM [huli72] strug
8:42 PM [strug] interested?
8:42 PM clover has left the chat.
8:42 PM [huli72] what is the defect?
8:42 PM [iamzuhair] unresponsiveness to parathormone peripherally
8:42 PM [strug] sorry huli i think its end organ resistenac
8:42 PM [iamzuhair] inherited
8:42 PM [huli72] in pseudohypoparathyroidism?
8:42 PM [iamzuhair] inherited
8:42 PM [huli72] yeah
8:42 PM [lanny] dont get you strug.. ive lost conc.. ok lets study
8:42 PM [huli72] other presentations?
8:42 PM zoya has left the chat.
8:43 PM [huli72] short stature
8:43 PM [huli72] round face
8:43 PM [sanz] mental retardation
8:43 PM [huli72] yeah, sanz
8:43 PM [strug] yeah stduy otherwise huli will get angry
8:43 PM [huli72] oh, I won't
8:43 PM [sanz] and they have some sorta CNS prob
8:43 PM [lanny] ah ah let huli go to heli
8:43 PM [sanz] and of cuz as usu i dont remember
8:43 PM [strug] lol
8:43 PM [huli72] metacarpals and metatarsals short
8:44 PM [dua_frank] i think you all are getting hysterical before the exam
8:44 PM [huli72] yeah,sanz
8:44 PM [lanny] i asked this question before short metacarpals
8:44 PM [iamzuhair] bony problems with normal ca and phosphrous
8:44 PM [sanz] yeah, and right after that i got kicked out of the chat room lanny
8:44 PM [strug] pagets
8:44 PM [huli72] yeah, zuhair
8:44 PM [lanny] oh yea !!come back
8:45 PM [huli72] most imp:
8:45 PM [sanz] low Ca
8:45 PM [huli72] calcification of basal ganglia
8:45 PM [iamzuhair] dude there are types in it
8:45 PM [huli72] cataracts
8:45 PM [iamzuhair] do go into it its scary
8:45 PM [huli72] how to treat?
8:45 PM [iamzuhair] dont go int types of pseudo hypo
8:46 PM [strug] ca supplemtns
8:46 PM [lanny] yes never heard of it on the test
8:46 PM [iamzuhair] there are 4 types of pseudohypoparathyroidism
8:46 PM [dua_frank] 4??????????
8:46 PM [iamzuhair] dont think they are going to ask
8:46 PM [iamzuhair] yes harrison gives 4
8:46 PM [strug] what 4 pl tell
8:46 PM [dua_frank] i don't want to know !
8:46 PM [strug] close ur eyes
8:46 PM [dua_frank] ok
8:47 PM [sanz] we have 10 mins, shall we do a more high yeild topic like diabetes?
8:47 PM [iamzuhair] 1a ,1b ,2 , phpp
8:47 PM [lanny] agree sanz
8:47 PM [lanny] 1st trt for DKA
8:47 PM [sanz] diet
8:47 PM [strug] fluisd and insulin
8:47 PM [iamzuhair] yes
8:47 PM [huli72] insulin
8:47 PM [huli72] then fluids
8:47 PM [sanz] oh you mena DKA... i thought normal DM
8:48 PM [lanny] saline
8:48 PM [dua_frank] insulin
8:48 PM [strug] most sensitive indicator of diabtic nephropathsy?
8:48 PM [lanny] 0.9%saline
8:48 PM [sanz] fluids first then insulin
8:48 PM [huli72] treatment for pseudohypoparathyroidism: vitD+ low phosphorus
8:48 PM [dua_frank] insulin plus fluids together
8:48 PM [strug] thnx huli
8:48 PM [iamzuhair] geys do know how to change doses of insulin seeing the morning and evening glucose levels
8:48 PM [huli72] albumium urine
8:49 PM [lanny] in 1st hour fliuds saline INSULIN
8:49 PM [iamzuhair] they do ask
8:49 PM [dua_frank] tell us zuhair
8:49 PM [lanny] yes a biggy !!!!!
8:49 PM [strug] random urine sample for albumin creatinine ratio if >30 abnormal
8:49 PM [huli72] we need to change to subcutanous insulin
8:49 PM [lanny] somogyi dawn etc
8:49 PM [huli72] or muscular
8:49 PM [iamzuhair] yes
8:49 PM [lanny] yes huli in 2nd hour
8:50 PM [strug] Rx of diabetic erectile dysfuction?
8:50 PM [huli72] somogyi: too much insulin given, low glu at 3
8:50 PM [sanz] Rx is to low the insulin dose at night
8:50 PM [huli72] down, too little insulin, high glu at 3 am
8:50 PM [huli72] viagra
8:51 PM [iamzuhair] lo
8:51 PM [iamzuhair] lol
8:51 PM [strug] in somogyi hypogly at night at 3 and due to couter regularoty hormines morninig hypo ...give insulin as rtretment
8:51 PM [huli72] am I right, lanny?
8:51 PM [sanz] strug, in dawn we incr pm insulin, in somagyi we lower the pm insulin
8:51 PM [strug] yes sildenafil in diab erectile dys
8:52 PM [lanny] you mean viagra
8:52 PM [lanny] yes
8:52 PM [iamzuhair] i didnt know that
8:52 PM [strug] yes u right sanz sorry
8:52 PM [sanz] they're so easily confused
8:52 PM [sanz] no need to apologise
8:53 PM [strug] u cleared my concept thanks now i will remember for ever
8:53 PM [sanz] in DKA what 3 investigations are most reliable indicator of recovery?
8:53 PM [strug] Ph
8:54 PM [sanz] yes
8:54 PM [sanz] and anion gap
8:54 PM [dua_frank] ketones?
8:54 PM [sanz] yup
8:54 PM [dua_frank] ph and glucose levels maybe
8:54 PM [sanz] mech of microalbuminuria
8:55 PM [strug] how to u diagnose DM... the cutoff points?
8:55 PM [sanz] >200 random gluc
8:55 PM [iamzuhair] 126
8:55 PM [sanz] >126 fast gluc
8:55 PM [dua_frank] 120
8:55 PM [iamzuhair] yes
8:55 PM [sanz] must be on 2 occ
8:55 PM [lanny] yes
8:55 PM [sanz] i dont know the fig for oral gluc test tho
8:56 PM [iamzuhair] ok guys need to go
8:56 PM [strug] bye zuhari
8:56 PM [iamzuhair] thanks a lot for today
8:56 PM [huli72] high Ca, low phosphorus, normal PTH, please name 2 disease?
8:56 PM [iamzuhair] see ya tomor
8:56 PM [lanny] random is 200
8:56 PM [huli72] bye zuhair
8:56 PM [lanny] bye suhair
8:56 PM [dua_frank] bye zuhair
8:56 PM [sanz] c ya tmrw
8:56 PM [strug] Pagets?
8:56 PM [huli72] no
8:57 PM [sanz] no.. pagets has everything normal except alk phos
8:57 PM iamzuhair has left the chat.
8:57 PM [strug] ectoopic Pth production?
8:57 PM [lanny] oral is 200 2 hrs after given gluc load
8:57 PM [strug] multiple myeloma?
8:57 PM [sanz] thnx lanny
8:57 PM [lanny] old man
8:57 PM [lanny] pneumonia mcc presnet
8:57 PM [sanz] wuz the ans huli?
8:58 PM [huli72] primary hyperparathyroidism and
8:58 PM [lanny] whats your ques strug
8:58 PM [huli72] familial benign hypocalciuric hypercalcemia
8:58 PM [huli72] (FBHH)
8:58 PM [strug] its the wrong ans to hulis q
8:58 PM [sanz] pri hyperparathryoidism would have high PTH isnt it?
8:58 PM [lanny] i thought youre asking about m myeloma
8:59 PM [lanny] ok got it
8:59 PM [strug] no dear lanny
8:59 PM [lanny] ok strug,, are we closing shop what tomorr
8:59 PM [huli72] I have to check, not sure about primary hyperparathyroidsim
8:59 PM cadusma has left the chat.
9:00 PM [huli72] sorry, it is high pth
9:00 PM [huli72] no
9:00 PM [sanz] yup... now that makes more sense
9:00 PM [strug] in FBhH?
9:00 PM [huli72] normal pth
9:00 PM [huli72] in both
9:01 PM [dua_frank] one third of primary hyperthyroidism patients may have normal PTH levels
9:01 PM [lanny] we hasd difficulties with parathroid and thyroid, need to chk again
9:01 PM [strug] i didnt know that
9:01 PM [lanny] lets dixcuss tomorrow
9:01 PM [sanz] oh really, dua? ok
9:01 PM [huli72] yeah, dua , I think you are right
9:01 PM [dua_frank] no sorry
9:01 PM [dua_frank] nooooooo
9:01 PM [dua_frank] correction
9:01 PM [dua_frank] one third may have normal calcium in urine
9:01 PM [sanz] the name says PIRMARY parahyperthyroid... PTH has to be high i would think...
9:01 PM [strug] hey guys please i am feeling dizzy....
9:01 PM [dua_frank] PTH is high always
9:02 PM [dua_frank] it is sanz
9:02 PM [strug] huli can u plllllll clarify i m spinning
9:02 PM [lanny] lets go chk it out guys thr diag and parathy
9:02 PM [dua_frank] urinary calcium is high too except in some cases but thats the only difference
9:02 PM [huli72] my source say that it is normal
9:02 PM [sanz] what is your source huli?
9:02 PM [dua_frank] how about hypercalcemia of malignancy?
9:03 PM [dua_frank] that can have normal PTH levels
9:03 PM [huli72] MKSAP
9:03 PM [lanny] whats MKSAP
9:03 PM [strug] ok how to diff insulinoma, factitous and sulfonylurea ingestion?
9:03 PM [huli72] C-peptide
9:03 PM [lanny] lovels of c peptide
9:03 PM [huli72] and urine toxi
9:03 PM [dua_frank] right c peptide levels
9:03 PM [huli72] ology
9:03 PM [huli72] for sulfonylurea
9:04 PM [strug] in insulinoma inc c peptide,factioous normal, inc alos in sulpony
9:04 PM [lanny] insulinoma high factit normal
9:04 PM [strug] but sulponyl present in urine
9:04 PM [dua_frank] ok
9:04 PM [strug] also insulin antiboides in exogenous ingestion
9:04 PM [sanz] thnx strug
9:05 PM [lanny] never knew that strug
9:05 PM [strug] welcome
9:05 PM [lanny] ok fellows im leaving i will chk whats on tomorrow
9:05 PM [lanny] is the sched still on this site
9:05 PM [huli72] low calcium, high phosphorus, high PTH, name 2 disease
9:06 PM [strug] hypoglycemia in pt DM with new onset renal failure..why?
9:06 PM [sanz] honeymoon period
9:06 PM [sanz] hehe
9:06 PM [dua_frank] hypoparathyroidism
9:06 PM [sanz] i dont remember the mech
9:06 PM [strug] insulin has longer half life in renal failure
9:06 PM [dua_frank] nice strug
9:06 PM [huli72] pseudohyoparathyroidism
9:06 PM [huli72] and
9:06 PM [strug] renal failure and vit d def
9:06 PM [huli72] yeah, strug
9:07 PM [huli72] diagnose of pagets's?
9:08 PM [strug] all normal except inc alk phos as sanz said
9:08 PM [huli72] yeah, incr alk phos
9:08 PM [huli72] and
9:08 PM [huli72] other presentations?
9:09 PM [strug] breast , vulvar
9:09 PM [huli72] deaf
9:09 PM [dua_frank] skull
9:09 PM [huli72] skull enlargement
9:09 PM [huli72] who get it?
9:09 PM [sanz] elderly
9:09 PM [huli72] man
9:09 PM [huli72] elderly man
9:09 PM [huli72] how to treat?
9:10 PM [strug] vit d? just a guess
9:10 PM [huli72] alendronate
9:11 PM [huli72] how to Dx exogenous thyrotoxicosis?
9:11 PM [strug] pt is on metformin .... can we do Barium or IVP on him?
9:11 PM [huli72] I think it is OK
9:11 PM [sanz] no... cause reaction?
9:12 PM [strug] inc t3 t4 low tsh Raiu normal
9:12 PM [sanz] huli, radio iodine reupt
9:12 PM [huli72] yeah, sanz
9:12 PM [huli72] what is Raiu?
9:12 PM [strug] no u cant because he can develp lactic acidosis
9:12 PM [strug] radio iodine uptake
9:12 PM [huli72] should be low
9:13 PM [strug] normal dear
9:13 PM [strug] why low?
9:13 PM [huli72] and serum throglobulin is very low
9:13 PM [sanz] so resin t3 would be high
9:13 PM [huli72] radio iodine should be low due to T4 feedback inhibit
9:13 PM [strug] i dunno about this resin thing....they dont do it now a days
9:14 PM [huli72] yeah, sanz
9:14 PM [sanz] strug, really?
9:14 PM [strug] yeap its expensive and tedious i think
9:14 PM [huli72] thanks, strug for the metformin
9:14 PM [sanz] ok
9:14 PM [strug] u r welcome
9:15 PM [strug] u too brough t up good point huli...keep it up
9:15 PM [strug] ok so see u guys tomorw
9:15 PM [huli72] gonadotropins in Klinefelter's?
9:15 PM [sanz] wuz tmrw?
9:15 PM [sanz] 46XY
9:15 PM [sanz] 47XXY sorry
9:15 PM [huli72] low or high?
9:15 PM [strug] inc LH, FSH, Estrogens.... normal or dec testrosteone
9:16 PM [huli72] yeah, strug
9:16 PM [huli72] do we go on or
9:16 PM [strug] Rx of kleinfileters?
9:16 PM [huli72] testosterone
9:17 PM [strug] huli if u have q i can stay back
9:17 PM [sanz] do you guys still want to go on? i dont mind
9:17 PM [strug] y r rigt testosterons
9:17 PM [huli72] in acromegaly, how is IGF-I?
9:17 PM [dua_frank] me neither
9:17 PM [strug] ince
9:18 PM [dua_frank] high
9:18 PM [huli72] yeah
9:18 PM [huli72] prolactin in acromegaly?
9:18 PM [strug] normal
9:18 PM [huli72] no
9:18 PM [strug] i dunno
9:18 PM [sanz] low?
9:18 PM [huli72] anything press on pituitory, prolactin will.....?
9:19 PM [huli72] go upPPPPP
9:19 PM [strug] inc
9:19 PM [sanz] nice huli
9:19 PM [huli72] yeah, strug
9:19 PM [strug] good pt huli
9:19 PM [huli72] how to treat?
9:19 PM [dua_frank] brom
9:19 PM [dua_frank] resection
9:19 PM [huli72] I am talking about acromegaly
9:19 PM [huli72] yeah, dua
9:19 PM [strug] octeodtie
9:19 PM [huli72] and ...?
9:20 PM [huli72] yeah, strug
9:20 PM [huli72] and radiation too
9:20 PM [strug] surgry too
9:20 PM [huli72] yeah...
9:20 PM [strug] extraadrenal sites of pheochrom
9:20 PM [huli72] how to treat macroprolactinoma with visual field defect?
9:21 PM [sanz] resection
9:21 PM [huli72] mediastriul
9:21 PM [strug] resection
9:21 PM [huli72] no
9:21 PM [huli72] not 1st choice
9:21 PM [sanz] radiation?
9:21 PM [strug] bromo
9:21 PM [huli72] medication 1st
9:21 PM [huli72] yeah, strug
9:21 PM [sanz] oh ok
9:22 PM [strug] celiac , superior mesentric and inferior mesentri ganglion
9:22 PM [huli72] even it is big, if give bromo or cabergoline
9:22 PM [sanz] thnx strug
9:22 PM [huli72] it will thrink
9:22 PM [huli72] thanks, strug
9:22 PM [sanz] good one huli
9:22 PM [strug] if elderly female with prolacinoma?
9:23 PM [huli72] bromo
9:23 PM [sanz] dont know strug
9:23 PM [strug] no treatment just watch
9:23 PM [huli72] why?
9:23 PM [dua_frank] coz they dont have to get pregnant
9:23 PM [sanz] hehe dua
9:23 PM [huli72] ohh dua
9:24 PM [huli72] nice point
9:24 PM [strug] yes shes right
9:24 PM [sanz] no kidding!
9:24 PM [dua_frank] :P
9:24 PM [sanz] dua, is that a fact or are you pulling my legs?
9:24 PM [dua_frank] no it's a fact sanz
9:24 PM [strug] not kidding dear sanz she is right
9:24 PM [sanz] oh ok
9:25 PM [sanz] hehe... i wont forget that anymore
9:25 PM [dua_frank] lol
9:25 PM [huli72] severe headack, stiff neck, fever, visual distrubance, in pituitary macroadenoma.
9:25 PM [huli72] what is it?
9:25 PM clover has left the chat.
9:25 PM [strug] SAH?
9:25 PM [huli72] no
9:25 PM [huli72] try again
9:26 PM [huli72] pituitory macroadenoma
9:26 PM [dua_frank] erniation?
9:26 PM [dua_frank] no idea
9:26 PM [huli72] pituitory apoplexy
9:26 PM [dua_frank] meaning?
9:26 PM [huli72] hemorrhage in the macroadenoma
9:26 PM [strug] great huli i m impressed
9:27 PM [dua_frank] nice
9:27 PM [huli72] how to Dx this?
9:27 PM [dua_frank] ct?
9:27 PM [huli72] think of blood
9:27 PM [strug] give insulin and check glu levels
9:27 PM [sanz] pituitary functions
9:27 PM [huli72] serum 1st
9:27 PM [sanz] TSH ?
9:27 PM [huli72] CT and MRI last for image
9:28 PM [strug] he y what do we see in serum?
9:28 PM [huli72] actually, it is cortisol
9:28 PM [huli72] low cortisol
9:28 PM [dua_frank] why cortisol?
9:28 PM [strug] u mean hypopiturasime?
9:28 PM [dua_frank] ok
9:28 PM [huli72] yeah, hypopituitory
9:28 PM [dua_frank] i want to say something about somogyi effect
9:29 PM [huli72] most imp: hypoadrenalism
9:29 PM [strug] yes dua go ahead
9:29 PM [strug] what do u treat first?
9:29 PM [dua_frank] we understood it as hypoglycemia right?
9:29 PM [dua_frank] and dawn as hyper
9:29 PM [dua_frank] right?
9:29 PM [strug] both have hypergly in mmorning 8
9:29 PM [huli72] yeah, dua
9:29 PM [sanz] they're both hyper in the morning
9:29 PM [dua_frank] right right
9:29 PM [sanz] somagyi has hypo at 3am
9:30 PM [strug] in somogyi due to counter regularory hormone release
9:30 PM [sanz] dawn doesnt
9:30 PM [dua_frank] no more doubts regarding that, carry on please
9:30 PM [dua_frank] thank you
9:30 PM [strug] ok huli where were u
9:30 PM [huli72] here
9:30 PM [sanz] lol
9:30 PM [strug] what do we treat first?
9:30 PM [huli72] how is csf ?
9:30 PM [strug] hemorrahgic?
9:30 PM [huli72] in pituitory apoplexy?
9:30 PM [huli72] yeah
9:31 PM [huli72] RBC and WBC
9:31 PM [strug] always treat cortisol def first...give mineralocorticaoids
9:31 PM [huli72] what you do ?
9:31 PM [strug] fluids?
9:31 PM [huli72] give dexemathesone
9:31 PM [dua_frank] steroids
9:31 PM [huli72] and ....
9:31 PM [huli72] it is an emergency
9:32 PM [dua_frank] mineralocorticoids
9:32 PM [sanz] surgery
9:32 PM [huli72] we need urgent neurosurgical decompression
9:32 PM [huli72] yeah, sanz
9:32 PM [huli72] no so hurry in minera
9:33 PM [huli72] hyper calcemia in a pt with breast ca, what do you do?
9:33 PM [strug] wow huli good keep it up u r clearing my concepts
9:33 PM [huli72] welcome, strug
9:33 PM [strug] chemo
9:34 PM [dua_frank] does anyone know why antibodies against insulin are seen in factitious hyperinsulinism?
9:34 PM [sanz] bisphos huli
9:34 PM [strug] anti insulin antinodies
9:34 PM [huli72] insulin is a protein
9:34 PM [sanz] cuz the insulin is a foreign protein
9:34 PM [strug] lol
9:34 PM [dua_frank] ah
9:34 PM [dua_frank] thanks sanz
9:34 PM [huli72] the body will produce antibody to any protein that enter blood
9:34 PM [dua_frank] obvious answe
9:35 PM [dua_frank] i love these discussions
9:35 PM [strug] me too
9:35 PM [huli72] we have to chech.... 1st
9:35 PM [sanz] us 3
9:35 PM [strug] bone spine
9:35 PM [huli72] PTH
9:35 PM [strug] ok
9:35 PM [huli72] to differentiate metastasis from primary PTH
9:36 PM [sanz] bisphos is given for extremem hyperCa right?
9:36 PM [huli72] if pth low, then do what?
9:36 PM [strug] from metasisi we cannot measure it
9:36 PM [strug] see the type of pth?
9:36 PM [huli72] if metasis, pth will be normal
9:36 PM [huli72] only 1 type of pth
9:36 PM [strug] cytokines in malognancy?
9:37 PM [huli72] pth is normal is metasis
9:37 PM [strug] huli i dont get ur q
9:37 PM [huli72] and pth is high in primary hyperparathyroidism
9:37 PM [strug] ok
9:37 PM [huli72] if pth low or normal, then go bone scan
9:38 PM [huli72] got it?
9:38 PM [sanz] i've lost you guys... huli, would you mind repeating yr q?
9:38 PM [huli72] in a pt with high ca++ and breast ca, what you do 1st?
9:39 PM [strug] huli aske d what are the investigations in a pt with breast cance an dhypercalcemia?
9:39 PM [strug] ans is do PTh next
9:39 PM [sanz] oh oke... thnx
9:39 PM [sanz] to differentiate if it's due to mets or due to hyperPTH
9:39 PM [strug] Pth normal in malignancy and high in primar hyperparath
9:39 PM [sanz] great, thnx
9:39 PM [huli72] if pth low or normal, then exclude hyperparathyroidism
9:39 PM [strug] if pth normal do bone scan
9:40 PM [huli72] nice to talk with you guys
9:40 PM [sanz] thnx all of you
9:41 PM [lanny] hey see you guys are still on had to go make dinner
9:41 PM [sanz] it helps
9:41 PM [strug] it helps u remembr things
9:41 PM [sanz] hey lanny
9:41 PM [huli72] I have to stop here, really sleepy now
9:41 PM [strug] ok then see u guys tomorrow
9:41 PM [sanz] strug, it also scares me to bits
9:41 PM [huli72] you are fine, sanz
9:41 PM [strug] its a learning proces dear why do u worry
9:41 PM [lanny] what scares you..
9:42 PM [sanz] that my exam date is in 5 weeks and i have so much to cover still...
9:42 PM [lanny] this is helpful, easier to remember questions and discussions
9:42 PM [sanz] totally agree lanny
9:42 PM [strug] what u can do is review the topic before discussion and u can clear ur doubts
9:42 PM [lanny] mine in 2 mths hope to continue after you guys stop
9:43 PM [huli72] I still have several good topic
9:43 PM [strug] if u explain someone u urself make ur concepts clear and remember it for a life time
9:43 PM [lanny] and after too agreed
9:43 PM [sanz] strug, ok... i was doing UW... but i only have 31 more qs to go
9:43 PM [strug] huli do u wanna continue
9:43 PM [lanny] absolutely strug
9:43 PM [sanz] she wants to sleep
9:43 PM [huli72] no, not today
9:43 PM [huli72] really sleepy now
9:43 PM [lanny] so whats tomorr
9:44 PM [huli72] maybe tomorrow
9:44 PM [strug] ok then see u tommow
9:44 PM [huli72] see you tomorrow
9:44 PM [lanny] wanna continue with endo
9:44 PM [huli72] have a nice dream
9:44 PM [strug] huli but u really brought up some wonderful point todays
9:44 PM [huli72] thanks, strug
9:44 PM [huli72] see you tomorrow
9:44 PM [strug] ok bye we can do endo sometime afterwards
9:44 PM [lanny] whats tomorrow
9:45 PM [sanz] dont know lanny
9:45 PM [lanny] ok will chk maybe continue endo after tomows topic
9:45 PM huli72 has left the chat.
9:46 PM [strug] bye lanny and sanz......
9:46 PM [sanz] bye strug
9:46 PM [lanny] bye strug
9:46 PM [sanz] bye dua and lanny
9:46 PM [strug] lanny hope u didnt mind my comments hehe
9:46 PM [dua_frank] bye sanz
9:46 PM [lanny] about what strug?
9:46 PM [strug] dua bye
9:46 PM [dua_frank] good night sweet dreams
9:46 PM [sanz] lol you guys
9:46 PM strug has left the chat.
9:46 PM [dua_frank] bye strug
9:47 PM [dua_frank] bye lanny, enjoy your dinner
9:47 PM sanz has left the chat.
9:47 PM [lanny] thanks just started leaving now too thanks
9:47 PM [dua_frank] welcome, bye
9:47 PM dua_frank has left the chat.
9:47 PM lanny has left the chat.