02/13/05 19:09:23 [USMLE_Step_2] lanny: hi samantha
02/13/05 19:09:34 [USMLE_Step_2] megs: he sanz welcome
02/13/05 19:09:41 [USMLE_Step_2] sanz: hello lovely people!
02/13/05 19:09:47 [USMLE_Step_2] samantha: hi sanz
02/13/05 19:09:50 [USMLE_Step_2] lanny: hi sanz
02/13/05 19:11:15 [USMLE_Step_2] lanny: are we starting
02/13/05 19:11:19 [USMLE_Step_2] sanz: shall we do breast surgery first?
02/13/05 19:11:30 [USMLE_Step_2] lanny: fine sanz
02/13/05 19:12:28 [USMLE_Step_2] sanz: 23 yr old with HUGE breast lump... freely mobile... next step?
02/13/05 19:12:29 [USMLE_Step_2] megs: ok sanz
02/13/05 19:12:50 [USMLE_Step_2] lanny: FNA
02/13/05 19:12:55 [USMLE_Step_2] sanz: good...
02/13/05 19:13:05 [USMLE_Step_2] sanz: if FNA is clear... what next?
02/13/05 19:13:34 [USMLE_Step_2] lanny: onserve next cycle?
02/13/05 19:13:42 [USMLE_Step_2] samantha: reassurance
02/13/05 19:13:54 [USMLE_Step_2] sanz: yes... if the FNA decr the breats lump size... you can observe
02/13/05 19:14:09 [USMLE_Step_2] sanz: but most women would want to remove it anyway, in that case you can oblige them
02/13/05 19:14:23 [USMLE_Step_2] lanny: yes sanz
02/13/05 19:14:27 [USMLE_Step_2] sanz: but if FNA is bloody or the lump comes back... then what?
02/13/05 19:14:44 [USMLE_Step_2] lanny: open biopsy
02/13/05 19:15:07 [USMLE_Step_2] sanz: yes...
02/13/05 19:15:15 [USMLE_Step_2] megs: yup biopsy
02/13/05 19:15:19 [USMLE_Step_2] samantha: mammography
02/13/05 19:16:01 [USMLE_Step_2] sanz: let's say someone has a freely moblie breast lump that is soooo huge that it distorts the shape of breast... Dx?
02/13/05 19:16:15 [USMLE_Step_2] sanz: say she's 25yr old
02/13/05 19:16:19 [USMLE_Step_2] megs: cystosarcoma phylloids
02/13/05 19:16:28 [USMLE_Step_2] sanz: good megs
02/13/05 19:16:32 [USMLE_Step_2] lanny: agree
02/13/05 19:16:35 [USMLE_Step_2] sanz: what is she at risk of?
02/13/05 19:16:54 [USMLE_Step_2] sanz: malignancy...
02/13/05 19:16:56 [USMLE_Step_2] megs: ca breast
02/13/05 19:17:01 [USMLE_Step_2] sanz: so it must be removed
02/13/05 19:17:05 [USMLE_Step_2] megs: yeah
02/13/05 19:17:10 [USMLE_Step_2] sanz: great
02/13/05 19:17:16 [USMLE_Step_2] samantha: malignancy
02/13/05 19:17:26 [USMLE_Step_2] lanny: yes
02/13/05 19:18:01 [USMLE_Step_2] sanz: someone with bloody nipple d/c... Dx?
02/13/05 19:18:16 [USMLE_Step_2] megs: duct papiloma
02/13/05 19:18:17 [USMLE_Step_2] lanny: intradict papilloma
02/13/05 19:18:21 [USMLE_Step_2] samantha: intraductal pappilloma
02/13/05 19:18:23 [USMLE_Step_2] strug: intraductal pao
02/13/05 19:18:27 [USMLE_Step_2] strug: hi everyone
02/13/05 19:18:27 [USMLE_Step_2] sanz: what next?
02/13/05 19:18:33 [USMLE_Step_2] sanz: hi strug
02/13/05 19:18:35 [USMLE_Step_2] lanny: hi strug!!
02/13/05 19:18:37 [USMLE_Step_2] megs: hi strug
02/13/05 19:18:40 [USMLE_Step_2] strug: circumareolar removal sanz
02/13/05 19:18:49 [USMLE_Step_2] strug: hi lanny megs sanz
02/13/05 19:18:52 [USMLE_Step_2] lanny: FNA
02/13/05 19:18:56 [USMLE_Step_2] megs: biopsy
02/13/05 19:18:59 [USMLE_Step_2] lanny: nd open biopsy
02/13/05 19:19:05 [USMLE_Step_2] sanz: actually, i think nexzt step is to do mammo
02/13/05 19:19:20 [USMLE_Step_2] strug: oooohhhh gosh i misunderstood
02/13/05 19:19:28 [USMLE_Step_2] strug: yup sanz i too thik mammo
02/13/05 19:19:29 [USMLE_Step_2] sanz: to rule out any other leision... then galatogram
02/13/05 19:19:34 [USMLE_Step_2] lanny: yea mammogr or open biopsy
02/13/05 19:19:45 [USMLE_Step_2] sanz: only then you can so surgery
02/13/05 19:19:54 [USMLE_Step_2] lanny: why galactogram?
02/13/05 19:19:54 [USMLE_Step_2] sanz: i think that's the order anyway... correct me if i'm worng
02/13/05 19:20:16 [USMLE_Step_2] strug: because mammo wotn be so informatiove in a young female
02/13/05 19:20:18 [USMLE_Step_2] sanz: cuz it's intraductal, galactogram will guide you
02/13/05 19:21:03 [USMLE_Step_2] lanny: oh yes thanks
02/13/05 19:21:06 [USMLE_Step_2] strug: sanz is right sorry
02/13/05 19:21:24 [USMLE_Step_2] sanz: also these tumours are small... so might not show on mammo... so galactogram would be beneficial to the surgeons...
02/13/05 19:21:32 [USMLE_Step_2] samantha: rule out malig
02/13/05 19:22:04 [USMLE_Step_2] sanz: lactating woman with a mass... Dx?
02/13/05 19:22:11 [USMLE_Step_2] strug: abscess
02/13/05 19:22:17 [USMLE_Step_2] lanny: mastitis
02/13/05 19:22:19 [USMLE_Step_2] sanz: Rx?
02/13/05 19:22:23 [USMLE_Step_2] samantha: mastitis
02/13/05 19:22:33 [USMLE_Step_2] strug: I and D also do biop of wall
02/13/05 19:22:34 [USMLE_Step_2] lanny: more info needed
02/13/05 19:22:42 [USMLE_Step_2] megs: galactocele
02/13/05 19:22:44 [USMLE_Step_2] samantha: hot compress
02/13/05 19:22:48 [USMLE_Step_2] sanz: yeah lanny... i'm sorry
02/13/05 19:23:02 [USMLE_Step_2] samantha: and continue nursing
02/13/05 19:23:17 [USMLE_Step_2] sanz: if you feel a fluctuating mass... Dx?
02/13/05 19:23:31 [USMLE_Step_2] strug: he he sanz
02/13/05 19:23:44 [USMLE_Step_2] strug: abscess right?
02/13/05 19:23:58 [USMLE_Step_2] megs: abscess then
02/13/05 19:24:01 [USMLE_Step_2] lanny: abscess
02/13/05 19:24:02 [USMLE_Step_2] sanz: see lanny, i'm definitely not one of those spy from exam board... cuz i dont know how to make qs!
02/13/05 19:24:02 [USMLE_Step_2] sanz: hehe
02/13/05 19:24:17 [USMLE_Step_2] lanny: he he he...
02/13/05 19:24:28 [USMLE_Step_2] sanz: if there is no flucatuating mass, then it's mastitis
02/13/05 19:24:41 [USMLE_Step_2] lanny: maybe youre trying to trick you clever>>>>
02/13/05 19:24:51 [USMLE_Step_2] lanny: yea sanz
02/13/05 19:25:01 [USMLE_Step_2] strug: ok guys tell me whats core biopsy, inciinal bipy?
02/13/05 19:25:02 [USMLE_Step_2] sanz: if abscess Rx?
02/13/05 19:25:13 [USMLE_Step_2] lanny: drain
02/13/05 19:25:15 [USMLE_Step_2] strug: incion and dreinage and biop of abs well
02/13/05 19:25:16 [USMLE_Step_2] megs: incision and drainaige
02/13/05 19:25:27 [USMLE_Step_2] strug: abscess wall biopsy
02/13/05 19:25:29 [USMLE_Step_2] samantha: yes drain
02/13/05 19:25:31 [USMLE_Step_2] megs: by taking a radial incision
02/13/05 19:25:39 [USMLE_Step_2] lanny: yea megs
02/13/05 19:25:42 [USMLE_Step_2] sanz: i think cone Bx is when you take quite a lot of tissue with clear margin
02/13/05 19:26:04 [USMLE_Step_2] lanny: why biopsy the wall
02/13/05 19:26:34 [USMLE_Step_2] strug: to rule out cancer
02/13/05 19:26:36 [USMLE_Step_2] sanz: strug, yes
02/13/05 19:26:52 [USMLE_Step_2] samantha: yes
02/13/05 19:27:00 [USMLE_Step_2] lanny: right strug
02/13/05 19:27:07 [USMLE_Step_2] strug: i m confused between incional , core and excisional bipsy can anyone defince them
02/13/05 19:27:08 [USMLE_Step_2] sanz: megs, i didnt know it's a radial incision to drain breast abscess...
02/13/05 19:27:31 [USMLE_Step_2] lanny: clear margins is the key in cone
02/13/05 19:27:34 [USMLE_Step_2] megs: yup to avoid cutting of the ducts
02/13/05 19:27:40 [USMLE_Step_2] lanny: just like a real cone
02/13/05 19:27:42 [USMLE_Step_2] sanz: thnx
02/13/05 19:27:50 [USMLE_Step_2] sanz: megs
02/13/05 19:27:56 [USMLE_Step_2] lanny: yes rigth radial incision
02/13/05 19:28:15 fana78 Logs in
02/13/05 19:28:33 [USMLE_Step_2] megs: otherwise all lactierous ducts will be injured..if we take cerciumcial incision
02/13/05 19:28:39 fana78 Joins Subroom USMLE_Step_1
02/13/05 19:28:41 [USMLE_Step_2] lanny: sanz the incision is made perpendic to the ducts to avoid damage to them
02/13/05 19:28:57 [USMLE_Step_2] megs: yeah lanny is right
02/13/05 19:29:24 fana78 Joins Subroom USMLE_Step_2
02/13/05 19:29:30 fana78 Leaves Subroom
02/13/05 19:29:36 fana78 Logs Out
02/13/05 19:29:44 [USMLE_Step_2] sanz: strug, my abv ans was for CONE Bx... core biopsy is like needle biopsy
02/13/05 19:29:58 [USMLE_Step_2] sanz: CONE Bx is for cervical ca and stuff
02/13/05 19:30:09 [USMLE_Step_2] sanz: sorry misread yr q
02/13/05 19:30:56 [USMLE_Step_2] strug: i was wondering.....but couldnt figure out.....
02/13/05 19:31:00 [USMLE_Step_2] lanny: needle biopsies are core biopsie the needle inserts in the core of the tissue
02/13/05 19:31:09 vladimir Logs in
02/13/05 19:31:11 [USMLE_Step_2] sanz: yes that's right
02/13/05 19:31:18 [USMLE_Step_2] megs: fibrocystic disess..which type is risk for malignancy???
02/13/05 19:31:19 vladimir Joins Subroom USMLE_Step_2
02/13/05 19:31:55 [USMLE_Step_2] vladimir: hi everybody
02/13/05 19:31:59 [USMLE_Step_2] megs: i mean which finding on histopath
02/13/05 19:32:04 [USMLE_Step_2] sanz: for incisional and excisional bx, you need to go to the theatre to do them
02/13/05 19:32:16 [USMLE_Step_2] samantha: low risk
02/13/05 19:32:16 [USMLE_Step_2] sanz: incisional Bx means they will oly remove part of the leision
02/13/05 19:32:24 [USMLE_Step_2] sanz: excisional Bx means they remove everything
02/13/05 19:32:34 [USMLE_Step_2] megs: agree sanz
02/13/05 19:32:36 [USMLE_Step_2] sanz: they'r both also known as open biopsy
02/13/05 19:32:42 [USMLE_Step_2] lanny: yes
02/13/05 19:33:18 [USMLE_Step_2] sanz: megs phyllodes?
02/13/05 19:33:54 [USMLE_Step_2] samantha: firm rubbery mass freely movable upper rt quad
02/13/05 19:34:12 [USMLE_Step_2] samantha: quadrant?
02/13/05 19:34:26 [USMLE_Step_2] megs: ITS epithelial hyperplasia in histopath ,,may cause malignancy
02/13/05 19:34:32 strug Logs in
02/13/05 19:34:33 strug Joins Subroom USMLE_Step_2
02/13/05 19:34:42 [USMLE_Step_2] sanz: oh ok
02/13/05 19:35:00 [USMLE_Step_2] strug: i was kicked out.....
02/13/05 19:35:07 [USMLE_Step_2] strug: what r u guys discussing?
02/13/05 19:35:14 [USMLE_Step_2] sanz: abt Bx
02/13/05 19:35:15 [USMLE_Step_2] megs: sammy fibroadenoma???
02/13/05 19:35:20 [USMLE_Step_2] sanz: incisional Bx means they will oly remove part of the leision
02/13/05 19:35:22 [USMLE_Step_2] samantha: yes good
02/13/05 19:35:24 [USMLE_Step_2] sanz: excisional Bx means they remove everything
02/13/05 19:35:28 [USMLE_Step_2] sanz: they'r both also known as open biopsy
02/13/05 19:36:06 [USMLE_Step_2] sanz: core bx means just using a needle and extracting some tissue
02/13/05 19:36:30 [USMLE_Step_2] strug: thanks thanks
02/13/05 19:36:45 [USMLE_Step_2] vladimir: what difference beween core and FN biopsy
02/13/05 19:36:49 [USMLE_Step_2] lanny: whats most potential of malignancy
02/13/05 19:37:01 [USMLE_Step_2] lanny: what breast cancer
02/13/05 19:37:10 [USMLE_Step_2] sanz: core Bx will take the tissue... FNA is for extarcting fluids
02/13/05 19:37:58 [USMLE_Step_2] vladimir: right sanz- FN for cytology of tumor, but core - for tissue diagnosis
02/13/05 19:38:05 [USMLE_Step_2] lanny: what br ca has great chance of malignant
02/13/05 19:38:14 [USMLE_Step_2] sanz: potential malignancy of breat ca, lanny? i think it's death!
02/13/05 19:38:19 [USMLE_Step_2] samantha: breast ca in preg what to dO?
02/13/05 19:38:29 [USMLE_Step_2] vladimir: what size of needle for FH and core Bx
02/13/05 19:38:41 [USMLE_Step_2] lanny: no sanz i mean which cancer is most malignant
02/13/05 19:38:41 [USMLE_Step_2] sanz: core Bx has smaller needle
02/13/05 19:38:49 [USMLE_Step_2] sanz: lobular ca
02/13/05 19:39:06 [USMLE_Step_2] vladimir: usually 18 G-FN
02/13/05 19:39:12 [USMLE_Step_2] megs: scirrous lanny
02/13/05 19:39:14 [USMLE_Step_2] lanny: inflammatory ca
02/13/05 19:39:19 [USMLE_Step_2] sanz: whao that's big vlad... i'm surprised
02/13/05 19:39:20 [USMLE_Step_2] megs: oh
02/13/05 19:39:45 [USMLE_Step_2] lanny: a variant of infiltraring ductal
02/13/05 19:40:02 [USMLE_Step_2] sanz: vlad, is that 18 G FN for core or FNA?
02/13/05 19:40:10 [USMLE_Step_2] samantha: treatment of breastca in preg?
02/13/05 19:40:15 [USMLE_Step_2] vladimir: i mean no more than 18G
02/13/05 19:40:25 [USMLE_Step_2] lanny: dont worry about needle size
02/13/05 19:40:26 [USMLE_Step_2] sanz: sam, you treat as normal. only no chemo in 1st tri and no radioation
02/13/05 19:40:35 [USMLE_Step_2] lanny: they wont expect us to know
02/13/05 19:40:36 [USMLE_Step_2] sanz: lanny i dont... just surprised
02/13/05 19:40:42 [USMLE_Step_2] megs: agree sanz
02/13/05 19:40:45 [USMLE_Step_2] samantha: yes
02/13/05 19:41:17 [USMLE_Step_2] sanz: i cant imagine ppl sticking an 18 Fgn into me! hehehe
02/13/05 19:41:30 [USMLE_Step_2] vladimir: i mean fo FN- for FN, we don't - Lanny, but pats are worried- thet frequently ask me to show the needle
02/13/05 19:41:51 [USMLE_Step_2] strug: vlad r u a surgeoin?
02/13/05 19:42:07 [USMLE_Step_2] samantha: what radiological apperance on mammography is ca suspected?
02/13/05 19:42:11 [USMLE_Step_2] lanny: got you vlad
02/13/05 19:42:17 [USMLE_Step_2] sanz: sam, calcification
02/13/05 19:42:23 [USMLE_Step_2] vladimir: i'm clinical research fellow in urology
02/13/05 19:42:25 [USMLE_Step_2] lanny: agree
02/13/05 19:42:48 [USMLE_Step_2] samantha: right sanz
02/13/05 19:42:53 [USMLE_Step_2] sanz: where did you train vlad?
02/13/05 19:43:14 [USMLE_Step_2] lanny: any m ore breast
02/13/05 19:43:20 [USMLE_Step_2] lanny: questions?
02/13/05 19:43:34 [USMLE_Step_2] sanz: no.. next?
02/13/05 19:43:36 [USMLE_Step_2] lanny: kidney stones
02/13/05 19:43:39 [USMLE_Step_2] strug: wait
02/13/05 19:43:45 [USMLE_Step_2] sanz: ok strug
02/13/05 19:43:46 [USMLE_Step_2] lanny: what size you xpect to pass
02/13/05 19:43:48 cyrus1345 Logs in
02/13/05 19:43:54 cyrus1345 Joins Subroom USMLE_Step_2
02/13/05 19:43:55 [USMLE_Step_2] sanz: 5 mm
02/13/05 19:44:02 [USMLE_Step_2] cyrus1345: Hi everybody
02/13/05 19:44:04 [USMLE_Step_2] megs: less than .5 cm
02/13/05 19:44:06 [USMLE_Step_2] strug: hi nasi
02/13/05 19:44:10 [USMLE_Step_2] sanz: hey nasi
02/13/05 19:44:12 [USMLE_Step_2] strug: whats up nasi
02/13/05 19:44:12 [USMLE_Step_2] megs: hi nasi
02/13/05 19:44:17 [USMLE_Step_2] lanny: hi nasi welcome to kidney stones
02/13/05 19:44:20 [USMLE_Step_2] samantha: hi nasi
02/13/05 19:44:26 [USMLE_Step_2] lanny: good
02/13/05 19:44:34 [USMLE_Step_2] lanny: what size we do litho
02/13/05 19:44:40 [USMLE_Step_2] sanz: 3cm
02/13/05 19:44:44 [USMLE_Step_2] strug: Rx of infiltarating ductal ca?
02/13/05 19:45:02 [USMLE_Step_2] vladimir: in St.Petersburg, Russia- sorry i've been kicked out for a while
02/13/05 19:45:06 [USMLE_Step_2] lanny: larger sanz
02/13/05 19:45:20 [USMLE_Step_2] sanz: no prob vlad
02/13/05 19:45:26 [USMLE_Step_2] sanz: my dad was in russia for 6 yrs
02/13/05 19:45:41 [USMLE_Step_2] vladimir: great sanz
02/13/05 19:45:46 [USMLE_Step_2] sanz: but the only russian word i know is spaciva... which i believe means thnx?
02/13/05 19:45:48 [USMLE_Step_2] sanz: hehe
02/13/05 19:45:51 [USMLE_Step_2] megs: depends on stage strug
02/13/05 19:46:05 [USMLE_Step_2] sanz: strug, i think pre op chemo and surgery
02/13/05 19:46:11 [USMLE_Step_2] vladimir: lanny also got graduation in my city
02/13/05 19:46:13 [USMLE_Step_2] strug: really megs i didnt know that
02/13/05 19:46:44 [USMLE_Step_2] strug: i think for infiltrating ductal Rx is lumpectomy with axillary sampleing with post opt radiation
02/13/05 19:46:45 [USMLE_Step_2] lanny: yea vlad
02/13/05 19:47:03 [USMLE_Step_2] cyrus1345: it depends the size and location too strug
02/13/05 19:47:04 [USMLE_Step_2] vladimir: sanz- spasibo to be exact
02/13/05 19:47:09 [USMLE_Step_2] sanz: hehe oke
02/13/05 19:47:25 [USMLE_Step_2] lanny: back to kidney stones
02/13/05 19:47:33 [USMLE_Step_2] lanny: when do we not do litho
02/13/05 19:47:33 [USMLE_Step_2] cyrus1345: it's for small and far
02/13/05 19:47:37 [USMLE_Step_2] strug: can u guys enlighted me alittle on breast ca Rx
02/13/05 19:48:12 [USMLE_Step_2] lanny: mod radical mast and irrad
02/13/05 19:48:12 [USMLE_Step_2] sanz: yeah, i need help too
02/13/05 19:48:27 [USMLE_Step_2] lanny: or lumpectomy are standard
02/13/05 19:48:36 [USMLE_Step_2] strug: nasi and megs?
02/13/05 19:48:45 [USMLE_Step_2] cyrus1345: if it's for example 4 cm and under areole
02/13/05 19:48:46 [USMLE_Step_2] sanz: ok, lets go thru scenerios.... if the breat lump is small and in upp outer quad.. what do we do?
02/13/05 19:48:58 [USMLE_Step_2] cyrus1345: you had to do MRM
02/13/05 19:49:09 [USMLE_Step_2] strug: if around areola?
02/13/05 19:49:12 [USMLE_Step_2] megs: agree nasi
02/13/05 19:49:27 [USMLE_Step_2] cyrus1345: yes strug
02/13/05 19:49:55 [USMLE_Step_2] strug: Mrm nasi?
02/13/05 19:49:56 [USMLE_Step_2] cyrus1345: but far from areola and small do radiation+lumpectomy and axillary node disection
02/13/05 19:50:13 [USMLE_Step_2] cyrus1345: modified radical mastectomy
02/13/05 19:50:26 [USMLE_Step_2] megs: yup nasi
02/13/05 19:50:28 [USMLE_Step_2] strug: ok thank s nasi
02/13/05 19:50:42 [USMLE_Step_2] samantha: fna sanz
02/13/05 19:50:57 [USMLE_Step_2] cyrus1345: paitent with mild back pain and breast canser next step?
02/13/05 19:51:06 [USMLE_Step_2] sanz: bone scan and look for mets
02/13/05 19:51:11 [USMLE_Step_2] strug: x rays of bone and chest
02/13/05 19:51:18 [USMLE_Step_2] sanz: or MRI spine
02/13/05 19:51:24 [USMLE_Step_2] lanny: mri spine
02/13/05 19:51:24 [USMLE_Step_2] cyrus1345: bone positive next step?
02/13/05 19:51:41 [USMLE_Step_2] strug: x *** nasi
02/13/05 19:51:43 [USMLE_Step_2] lanny: PET scan
02/13/05 19:51:49 [USMLE_Step_2] sanz: radiation
02/13/05 19:51:50 [USMLE_Step_2] samantha: chemo and radiation
02/13/05 19:51:54 [USMLE_Step_2] cyrus1345: yes first bone scan then X ***
02/13/05 19:52:10 [USMLE_Step_2] lanny: why x *** after MRI scan
02/13/05 19:52:12 [USMLE_Step_2] cyrus1345: but for multiplr myloma NEVER bone scane
02/13/05 19:52:22 [USMLE_Step_2] lanny: yes nasi good pt
02/13/05 19:52:29 [USMLE_Step_2] strug: x *** with punched out lytic lesion on MM
02/13/05 19:52:35 [USMLE_Step_2] vladimir: never PT lanny-it's very expensive and not efficient
02/13/05 19:53:06 [USMLE_Step_2] lanny: thx vlad where can we do it to diag what?
02/13/05 19:53:15 [USMLE_Step_2] strug: Rx of ductal carcinoma in situ?
02/13/05 19:53:21 [USMLE_Step_2] vladimir: by the way i got Q FROM STEP 1 how breast ca metastatsize to back
02/13/05 19:53:26 [USMLE_Step_2] sanz: mastectomy strug
02/13/05 19:53:37 [USMLE_Step_2] strug: simple mastectomy right
02/13/05 19:53:42 [USMLE_Step_2] cyrus1345: you do x *** lanny to rule out benighn reasons for positive scan
02/13/05 19:54:08 [USMLE_Step_2] strug: is it through blood vlad
02/13/05 19:54:11 [USMLE_Step_2] sanz: vlad, hematologic spread?
02/13/05 19:54:46 [USMLE_Step_2] vladimir: usually PT for 2 situations- brain and heart befor e bypass
02/13/05 19:54:48 [USMLE_Step_2] cyrus1345: i think so too
02/13/05 19:54:50 [USMLE_Step_2] sanz: remind me again why we cannot do bone scan in MM, nasi... read it before but forgot
02/13/05 19:55:21 [USMLE_Step_2] vladimir: yest strug- what's vesel
02/13/05 19:55:37 [USMLE_Step_2] strug: bone scan is positive for old fracture also sanz
02/13/05 19:55:42 [USMLE_Step_2] cyrus1345: what's lesion in MM lytic or blas sanz?
02/13/05 19:55:46 [USMLE_Step_2] strug: lytic
02/13/05 19:55:48 [USMLE_Step_2] sanz: lytic
02/13/05 19:55:56 [USMLE_Step_2] vladimir: intercostalis
02/13/05 19:56:03 [USMLE_Step_2] sanz: thnx vlad
02/13/05 19:56:04 [USMLE_Step_2] strug: oohhh vlad thanks
02/13/05 19:56:18 [USMLE_Step_2] sanz: gotcha nasi.. thx!
02/13/05 19:56:22 [USMLE_Step_2] sanz: i wont forget again!
02/13/05 19:56:32 [USMLE_Step_2] cyrus1345: welcome
02/13/05 19:56:43 [USMLE_Step_2] vladimir: blastiic mostly for prostate cancer, for rest-lytic
02/13/05 19:57:06 [USMLE_Step_2] strug: Rx of Inflamma carcinoma?
02/13/05 19:57:25 [USMLE_Step_2] sanz: bad Px... pre op chemo and mastectomy
02/13/05 19:57:25 [USMLE_Step_2] lanny: right vlad
02/13/05 19:57:35 [USMLE_Step_2] strug: right
02/13/05 19:57:36 [USMLE_Step_2] cyrus1345: acute back pian +breast canser next step?
02/13/05 19:57:55 [USMLE_Step_2] strug: steroids....?
02/13/05 19:58:01 [USMLE_Step_2] cyrus1345: good job
02/13/05 19:58:24 [USMLE_Step_2] vladimir: nasi-it's cord compresson
02/13/05 19:58:40 [USMLE_Step_2] cyrus1345: yes vlad
02/13/05 19:58:47 [USMLE_Step_2] lanny: steroids is rght
02/13/05 19:58:54 [USMLE_Step_2] lanny: immediate steroids
02/13/05 19:59:13 [USMLE_Step_2] vladimir: what's next
02/13/05 19:59:19 [USMLE_Step_2] strug: RT
02/13/05 19:59:23 [USMLE_Step_2] cyrus1345: MRI
02/13/05 19:59:31 [USMLE_Step_2] strug: radiothereapy
02/13/05 19:59:39 [USMLE_Step_2] megs: radiation
02/13/05 19:59:41 [USMLE_Step_2] lanny: irrad
02/13/05 20:00:10 [USMLE_Step_2] sanz: how do you treat hyperCa in bone mets?
02/13/05 20:00:39 [USMLE_Step_2] megs: iv saline..
02/13/05 20:00:43 [USMLE_Step_2] samantha: iv fluids
02/13/05 20:00:53 [USMLE_Step_2] lanny: calcitoni bisphosph
02/13/05 20:01:03 [USMLE_Step_2] sanz: IV Fluids are for acute hyperCa... but for bone mets, it's bisphos
02/13/05 20:01:20 [USMLE_Step_2] megs: pamidronate sanz
02/13/05 20:01:21 [USMLE_Step_2] sanz: good lanny
02/13/05 20:01:34 [USMLE_Step_2] vladimir: no-orthopedic stabilization- e.g.corporodesis
02/13/05 20:01:35 [USMLE_Step_2] sanz: yes... pamidronate is a bisphosnate
02/13/05 20:01:43 [USMLE_Step_2] lanny: pamidronate is a bisphosphonate
02/13/05 20:02:01 [USMLE_Step_2] cyrus1345: 31 years with 2 cm mass in left breast comes and goes with mense and painful next step?
02/13/05 20:02:28 [USMLE_Step_2] sanz: FNA
02/13/05 20:02:31 [USMLE_Step_2] strug: reaassureance nasi
02/13/05 20:02:35 [USMLE_Step_2] megs: reassure
02/13/05 20:02:38 [USMLE_Step_2] cyrus1345: NO!
02/13/05 20:02:38 [USMLE_Step_2] lanny: sanz i think it depends on the level of hyper ca for saline
02/13/05 20:02:46 [USMLE_Step_2] strug: sorry nasi
02/13/05 20:02:49 [USMLE_Step_2] strug: wait
02/13/05 20:02:55 [USMLE_Step_2] lanny: observe
02/13/05 20:02:55 [USMLE_Step_2] sanz: mammo?
02/13/05 20:02:58 [USMLE_Step_2] strug: mammogram
02/13/05 20:03:00 [USMLE_Step_2] lanny: next cycle
02/13/05 20:03:11 [USMLE_Step_2] strug: followed by aspiration
02/13/05 20:03:13 [USMLE_Step_2] lanny: mammo in a 30 yr old?
02/13/05 20:03:17 [USMLE_Step_2] strug: yes
02/13/05 20:03:24 [USMLE_Step_2] vladimir: watchful waiting- ususally after menses see again
02/13/05 20:03:28 [USMLE_Step_2] strug: after 30 yr always do mammo to rule out cancer
02/13/05 20:03:29 [USMLE_Step_2] cyrus1345: yes mamo she is over 30 you should sure that there is no other lesion ln breast by mamo
02/13/05 20:03:36 [USMLE_Step_2] lanny: agree vlad
02/13/05 20:03:43 [USMLE_Step_2] megs: ok nasi
02/13/05 20:03:51 [USMLE_Step_2] cyrus1345: good job sanz and strug
02/13/05 20:04:03 [USMLE_Step_2] sanz: so the order goes like this.. mammo, then FNA then all well, reassure
02/13/05 20:04:10 [USMLE_Step_2] sanz: cuz she's over 30
02/13/05 20:04:23 [USMLE_Step_2] lanny: what if 25 yrs?
02/13/05 20:04:29 [USMLE_Step_2] strug: i think its not FNa but its simple aspiration of fluid
02/13/05 20:04:33 [USMLE_Step_2] strug: sanz
02/13/05 20:04:35 [USMLE_Step_2] cyrus1345: it's not FNA in cystic sanz it's
02/13/05 20:04:41 [USMLE_Step_2] sanz: strug, yeah you might be right
02/13/05 20:04:41 [USMLE_Step_2] cyrus1345: yes strug
02/13/05 20:04:45 [USMLE_Step_2] cyrus1345: agree
02/13/05 20:05:13 [USMLE_Step_2] lanny: so how do you aspirate fliud strug
02/13/05 20:05:48 [USMLE_Step_2] lanny: same pt above but 25 yrs/
02/13/05 20:07:26 [USMLE_Step_2] strug: lanny yeah i wont doa mammo
02/13/05 20:07:43 [USMLE_Step_2] strug: in a pt 25 yrs
02/13/05 20:08:15 [USMLE_Step_2] cyrus1345: bloody dischrge in 46 Dx?
02/13/05 20:08:25 [USMLE_Step_2] strug: intraductal
02/13/05 20:08:31 [USMLE_Step_2] lanny: in 25 or less no need for a mammo
02/13/05 20:08:33 [USMLE_Step_2] megs: intraductal carsinoma
02/13/05 20:08:37 [USMLE_Step_2] cyrus1345: next step?
02/13/05 20:08:50 [USMLE_Step_2] strug: galactorgram
02/13/05 20:08:58 [USMLE_Step_2] cyrus1345: hey good job
02/13/05 20:09:11 [USMLE_Step_2] strug: sanz just told us this he he
02/13/05 20:09:16 [USMLE_Step_2] strug: before u came nasi
02/13/05 20:09:37 [USMLE_Step_2] cyrus1345: ok
02/13/05 20:09:41 [USMLE_Step_2] sanz:
02/13/05 20:09:43 [USMLE_Step_2] sanz: good revision
02/13/05 20:09:53 [USMLE_Step_2] strug: yfeah now i will never forget thanks nasi
02/13/05 20:10:20 [USMLE_Step_2] lanny: hey strug why not mammogram in 46 yo
02/13/05 20:10:38 [USMLE_Step_2] strug: becasue here the issue is the papilloma
02/13/05 20:10:47 [USMLE_Step_2] cyrus1345: today is general surgery or special?
02/13/05 20:10:49 [USMLE_Step_2] strug: it wont show up on the mammogram its very tiny
02/13/05 20:10:58 [USMLE_Step_2] strug: special nasi
02/13/05 20:11:06 [USMLE_Step_2] sanz: mammo wont show the Dx... but it will rule out other malignancy...
02/13/05 20:11:29 [USMLE_Step_2] sanz: so in nasi's q, the next step is to do galactogram... and later she will prolly need mammo
02/13/05 20:11:38 [USMLE_Step_2] lanny: isnt bloody discharge seen also in infiltrating ductal
02/13/05 20:11:43 [USMLE_Step_2] strug: female with positive axillary nodes 45 ys premamopausal just operated for breast cancer....what next?
02/13/05 20:12:06 [USMLE_Step_2] strug: hey lanny this is how we go
02/13/05 20:12:23 [USMLE_Step_2] strug: first see the age....intrad ucatal in 20 s to 40s
02/13/05 20:12:36 [USMLE_Step_2] strug: infilta a 50 s
02/13/05 20:13:03 [USMLE_Step_2] sanz: strug... chemo?
02/13/05 20:13:11 [USMLE_Step_2] strug: so in age 20 s to 40s the first guess for a bloody nipple dischare is intraductal and to see that we do galacgogram
02/13/05 20:13:46 [USMLE_Step_2] strug: yup sanz chemo in premeno
02/13/05 20:14:06 [USMLE_Step_2] strug: is she is receptor positive and post meno giv tamoxifene
02/13/05 20:14:27 [USMLE_Step_2] lanny: agree strug
02/13/05 20:14:34 [USMLE_Step_2] megs: seems to be only breast today
02/13/05 20:14:47 [USMLE_Step_2] sanz: breast is quite high yield...
02/13/05 20:14:52 [USMLE_Step_2] lanny: tam for estro and prog pos
02/13/05 20:14:55 [USMLE_Step_2] strug: agree with sanz
02/13/05 20:15:01 [USMLE_Step_2] sanz: so we should clear all our doubts now once and for all
02/13/05 20:15:02 [USMLE_Step_2] cyrus1345: which type of breast can be bilateral?
02/13/05 20:15:08 [USMLE_Step_2] sanz: lobular
02/13/05 20:15:14 [USMLE_Step_2] cyrus1345: good
02/13/05 20:15:30 [USMLE_Step_2] strug: lobular
02/13/05 20:15:42 [USMLE_Step_2] lanny: ok risk factors
02/13/05 20:15:47 [USMLE_Step_2] lanny: no 1 r factor?
02/13/05 20:15:54 [USMLE_Step_2] megs: age
02/13/05 20:15:54 [USMLE_Step_2] sanz: age is the biggest
02/13/05 20:15:59 [USMLE_Step_2] vladimir: did you discuss fat necrosis
02/13/05 20:16:00 [USMLE_Step_2] strug: hey guys for this adjuvant thereapy there is a controver between obgyn and surgery
02/13/05 20:16:16 [USMLE_Step_2] strug: i think family history is biggest?
02/13/05 20:16:23 [USMLE_Step_2] lanny: age over 50
02/13/05 20:16:30 [USMLE_Step_2] sanz: no... age, i'm quite sure
02/13/05 20:16:33 [USMLE_Step_2] lanny: next?
02/13/05 20:16:47 [USMLE_Step_2] megs: nope usmle world...says age is biggest risk
02/13/05 20:16:57 [USMLE_Step_2] strug: thanks guys megs and sanz
02/13/05 20:17:03 [USMLE_Step_2] cyrus1345: kaplan said age too
02/13/05 20:17:12 [USMLE_Step_2] lanny: first degrr relative fam hx is second
02/13/05 20:17:26 [USMLE_Step_2] sanz: ok lanny
02/13/05 20:17:29 [USMLE_Step_2] megs: agree lanny the family history
02/13/05 20:17:37 [USMLE_Step_2] strug: hypoglycemic
02/13/05 20:17:40 [USMLE_Step_2] vladimir: megs- why usmle world is getting like a kaplan- i don't think so
02/13/05 20:17:49 [USMLE_Step_2] lanny: 3rd personal hx of other breast
02/13/05 20:18:03 [USMLE_Step_2] lanny: or ovary ca
02/13/05 20:18:10 [USMLE_Step_2] megs: hey...vlad didnt get u???
02/13/05 20:18:25 [USMLE_Step_2] megs: agree lanny
02/13/05 20:18:35 [USMLE_Step_2] sanz: what abt prognostic factors?
02/13/05 20:18:55 [USMLE_Step_2] sanz: which is #1?
02/13/05 20:19:08 [USMLE_Step_2] lanny: vlad first is age over 50 then fam hx in first deg rel sister mother then if previous ca in other breast or ovarian
02/13/05 20:19:14 [USMLE_Step_2] strug: ln status sanz
02/13/05 20:19:18 [USMLE_Step_2] vladimir: megs- i asked why usmle world for us should be guidlines like kaplan
02/13/05 20:19:25 [USMLE_Step_2] sanz: yes strug... LN - which is stage
02/13/05 20:19:38 [USMLE_Step_2] sanz: UW is quite good i think
02/13/05 20:19:44 [USMLE_Step_2] strug: other pronostic factore?
02/13/05 20:19:55 [USMLE_Step_2] sanz: size and receptor status
02/13/05 20:19:57 [USMLE_Step_2] lanny: i listen to kaplan many yrs of research in this test
02/13/05 20:20:04 [USMLE_Step_2] megs: estrogen receprer positve..bad or good prg???
02/13/05 20:20:05 [USMLE_Step_2] strug: dna ploidy too sanz
02/13/05 20:20:06 [USMLE_Step_2] sanz: and some kind neu stuff
02/13/05 20:20:11 [USMLE_Step_2] sanz: which i dont rememebr
02/13/05 20:20:12 [USMLE_Step_2] lanny: UW ques are preety good too
02/13/05 20:20:32 [USMLE_Step_2] vladimir: i agree lanny- i just ask why in last year everybody refer to usmle world
02/13/05 20:20:34 [USMLE_Step_2] strug: good megs
02/13/05 20:20:38 [USMLE_Step_2] sanz: positive is good megs
02/13/05 20:20:48 [USMLE_Step_2] megs: good pregnosis..
02/13/05 20:20:58 [USMLE_Step_2] lanny: TNM staging is prognostic megs
02/13/05 20:21:06 [USMLE_Step_2] lanny: stage 4 is worse
02/13/05 20:21:08 [USMLE_Step_2] megs: yup lanny
02/13/05 20:21:19 [USMLE_Step_2] lanny: receptor positivity is good
02/13/05 20:21:35 [USMLE_Step_2] megs: HER RECEPTORS..GOOD OR BAD??/
02/13/05 20:21:43 [USMLE_Step_2] sanz: bad
02/13/05 20:21:43 [USMLE_Step_2] vladimir: i agree for breast stage is best prognosis
02/13/05 20:21:47 [USMLE_Step_2] megs: bad...v good sanz
02/13/05 20:21:59 cryogenetic2000 Logs in
02/13/05 20:21:59 [USMLE_Step_2] sanz: this HER is the same as neu right?
02/13/05 20:22:01 cryogenetic2000 Joins Subroom USMLE_Step_1
02/13/05 20:22:04 [USMLE_Step_2] vladimir: the receptor
02/13/05 20:22:09 [USMLE_Step_2] strug: what megs?
02/13/05 20:22:25 [USMLE_Step_2] vladimir: her2-it's extremely important
02/13/05 20:22:43 [USMLE_Step_2] lanny: its HER -2 over expression
02/13/05 20:22:51 [USMLE_Step_2] sanz: poor px
02/13/05 20:22:57 [USMLE_Step_2] vladimir: yes
02/13/05 20:23:00 [USMLE_Step_2] lanny: thats bad too
02/13/05 20:23:08 [USMLE_Step_2] lanny: mean poor prog
02/13/05 20:23:10 [USMLE_Step_2] strug: Her is neu.....?
02/13/05 20:23:20 [USMLE_Step_2] lanny: not sure
02/13/05 20:23:21 [USMLE_Step_2] strug: i thougth its same a s esto prog?
02/13/05 20:23:25 [USMLE_Step_2] vladimir: yes
02/13/05 20:23:38 [USMLE_Step_2] strug: so its good pro if+
02/13/05 20:23:49 [USMLE_Step_2] strug: u will get response to thereapy
02/13/05 20:23:58 cryogenetic2000 Logs Out
02/13/05 20:24:09 [USMLE_Step_2] lanny: mnem HER is female 2 both brest not good
02/13/05 20:24:24 [USMLE_Step_2] sanz: HER is epidermal growth factor receptor
02/13/05 20:24:34 [USMLE_Step_2] sanz: esg is hormone receptor
02/13/05 20:24:38 [USMLE_Step_2] sanz: they're different strug
02/13/05 20:24:50 [USMLE_Step_2] strug: oh yeah gotccha
02/13/05 20:24:59 [USMLE_Step_2] strug: Her-2 is not good right guys
02/13/05 20:25:05 [USMLE_Step_2] megs: sanz explained it strug
02/13/05 20:25:14 [USMLE_Step_2] lanny: yea strug look at my mnemonic
02/13/05 20:25:33 [USMLE_Step_2] strug: its the epidermal growth factor and Her is female 2 breast not good
02/13/05 20:25:46 [USMLE_Step_2] sanz: lol
02/13/05 20:25:55 [USMLE_Step_2] lanny: its both over exp not good
02/13/05 20:26:09 [USMLE_Step_2] sanz: ok, had enuf with breast?
02/13/05 20:26:12 [USMLE_Step_2] sanz: shall we move on?
02/13/05 20:26:15 [USMLE_Step_2] lanny: YYEESS
02/13/05 20:26:28 [USMLE_Step_2] lanny: lets go hey presto!!!!!!!
02/13/05 20:26:28 [USMLE_Step_2] strug: lanny wants some kidney stuff
02/13/05 20:26:31 [USMLE_Step_2] sanz: ok lanny... stone
02/13/05 20:26:34 [USMLE_Step_2] samantha: ok
02/13/05 20:26:40 [USMLE_Step_2] vladimir: her-2/neu-it's oncogene of the erbB oncohene family, which is related to to epidermal growtrh factor
02/13/05 20:26:47 [USMLE_Step_2] sanz: lithoripsy if >3cm? no?
02/13/05 20:26:50 [USMLE_Step_2] lanny: now you rem my ques..
02/13/05 20:27:02 [USMLE_Step_2] lanny: lithotripsy what size do you do
02/13/05 20:27:16 [USMLE_Step_2] strug: 7 mm
02/13/05 20:27:22 [USMLE_Step_2] lanny: >7
02/13/05 20:27:30 [USMLE_Step_2] cyrus1345: agree
02/13/05 20:27:40 [USMLE_Step_2] megs: vlad can help us
02/13/05 20:27:48 [USMLE_Step_2] lanny: you dont wanna break med size cause you gonna make more small ones
02/13/05 20:27:50 [USMLE_Step_2] vladimir: it's amplified 2-20 fold in 1/3 of breaqst carcinoma and is associated with decreased survival and shortened time to relapse
02/13/05 20:28:07 [USMLE_Step_2] lanny: thx vlad
02/13/05 20:28:12 [USMLE_Step_2] strug: C/I to ESWL?
02/13/05 20:28:25 [USMLE_Step_2] sanz: so at what size do you do lithotripsy, vlad?
02/13/05 20:28:33 [USMLE_Step_2] cyrus1345: pregnancy
02/13/05 20:28:43 [USMLE_Step_2] sanz: bleeding
02/13/05 20:28:49 [USMLE_Step_2] strug: preg, bleeding diatheiss, > 7mm stone
02/13/05 20:28:55 [USMLE_Step_2] strug: good job guys
02/13/05 20:29:11 [USMLE_Step_2] strug: How do u prevent recurrance of calcium stone?
02/13/05 20:29:16 [USMLE_Step_2] vladimir: i agree- more than 7 mm, although some handbook point out more than 5-6
02/13/05 20:29:17 [USMLE_Step_2] lanny: you dont do litho in preg strug
02/13/05 20:29:20 [USMLE_Step_2] sanz: high fluids
02/13/05 20:29:26 [USMLE_Step_2] cyrus1345: yes
02/13/05 20:29:28 [USMLE_Step_2] strug: yes lanny
02/13/05 20:29:44 [USMLE_Step_2] strug: preg= pregnancy lanny
02/13/05 20:30:02 [USMLE_Step_2] lanny: yes you said we do in preg we dont
02/13/05 20:30:04 [USMLE_Step_2] vladimir: but there is no strict policy- some kind of calyceal stones even less than 7 mm require ESWL
02/13/05 20:30:19 [USMLE_Step_2] strug: what else guys for prevention of recurrance?
02/13/05 20:30:22 [USMLE_Step_2] sanz: and thiazide if high fluids dont help
02/13/05 20:30:50 [USMLE_Step_2] strug: lanny i asked about contraindications of lithro which are pregnancy, bleeding, and stone > 7 mm
02/13/05 20:30:57 [USMLE_Step_2] vladimir: i do sometimes if the stone (even 4-5 mm) cannot pass from calyx
02/13/05 20:31:07 [USMLE_Step_2] lanny: thats right i may not have seen the q.
02/13/05 20:31:30 [USMLE_Step_2] strug: :an lanny
02/13/05 20:31:49 [USMLE_Step_2] vladimir: but practical life is not theory- i don't want you mislead- let's go through official stuff
02/13/05 20:31:51 [USMLE_Step_2] lanny: strug youre ok?
02/13/05 20:32:08 [USMLE_Step_2] sanz: new born not passing urine now day 2 of life... dx?
02/13/05 20:32:13 [USMLE_Step_2] lanny: yep guys what vlad does in practice is diff the books say 7mm
02/13/05 20:32:21 [USMLE_Step_2] strug: for prev of recurance we give more fluids, dec Na in diet, inc Ca in diet, thiazide
02/13/05 20:32:33 [USMLE_Step_2] strug: first meatal stenosis sanz
02/13/05 20:32:44 [USMLE_Step_2] vladimir: most important point for ESWL whther kidney is blocked- i.e. obturated stone or not
02/13/05 20:32:58 [USMLE_Step_2] megs: meatal stenosis..or stricture sanz
02/13/05 20:33:04 [USMLE_Step_2] sanz: post urethral valves is most common
02/13/05 20:33:09 [USMLE_Step_2] strug: lanny
02/13/05 20:33:21 [USMLE_Step_2] sanz: more common than meatal stenosis... but you should rule that out as well
02/13/05 20:33:24 [USMLE_Step_2] megs: ok remember now sanz...
02/13/05 20:33:31 [USMLE_Step_2] lanny: strug needs some spanking!!!!
02/13/05 20:33:49 [USMLE_Step_2] strug:
02/13/05 20:33:52 [USMLE_Step_2] sanz: Dx test for PUV?
02/13/05 20:33:53 [USMLE_Step_2] vladimir: nasi- do you remember when i argued with you about blocking kidney
02/13/05 20:34:20 [USMLE_Step_2] cyrus1345: yescompletely
02/13/05 20:34:31 [USMLE_Step_2] cyrus1345: VCUG sanz
02/13/05 20:34:37 [USMLE_Step_2] sanz: great job nasi
02/13/05 20:34:37 [USMLE_Step_2] strug: first catherise sanz
02/13/05 20:34:45 [USMLE_Step_2] vladimir: retrograde yrethrogram for PUV
02/13/05 20:34:51 [USMLE_Step_2] strug: diagnosi is by VCug right agree
02/13/05 20:35:00 [USMLE_Step_2] sanz: yes strug, first step is cath...
02/13/05 20:35:04 [USMLE_Step_2] sanz: but dx is VCUG
02/13/05 20:35:24 [USMLE_Step_2] strug: agree dear
02/13/05 20:35:53 [USMLE_Step_2] sanz:
02/13/05 20:36:30 [USMLE_Step_2] strug: 65 yrs pt with heamtrue....next step?
02/13/05 20:36:43 [USMLE_Step_2] sanz: UA
02/13/05 20:36:44 [USMLE_Step_2] cyrus1345: U/A and BUN cr
02/13/05 20:36:52 [USMLE_Step_2] lanny: UA
02/13/05 20:37:30 [USMLE_Step_2] vladimir: as for catheterization-it should be done gently 1-2 attempts without any violance-another words- DO NOT HARM
02/13/05 20:37:32 [USMLE_Step_2] strug: sorry guys m not sure but i thought it was IVP
02/13/05 20:38:06 [USMLE_Step_2] cyrus1345: no first you had to do U/A and BUN cr strug
02/13/05 20:38:07 [USMLE_Step_2] sanz: i think UA is usually first in most uro work up
02/13/05 20:38:26 [USMLE_Step_2] strug: thanks
02/13/05 20:38:29 [USMLE_Step_2] cyrus1345: whys should we do BUN cr?
02/13/05 20:38:33 [USMLE_Step_2] vladimir: yes
02/13/05 20:38:34 [USMLE_Step_2] megs: hematuria in old pr..work up for renal cell carcinoma
02/13/05 20:38:39 [USMLE_Step_2] strug: to see the kidney fucntion nasi
02/13/05 20:38:49 [USMLE_Step_2] cyrus1345: yes and if cr morethan 2
02/13/05 20:38:54 [USMLE_Step_2] cyrus1345: never do IVP
02/13/05 20:39:03 [USMLE_Step_2] strug: oh yeah good pt nasi
02/13/05 20:39:07 [USMLE_Step_2] lanny: strug you are right deps on the q
02/13/05 20:39:15 [USMLE_Step_2] lanny: more stuff necessary
02/13/05 20:39:45 [USMLE_Step_2] strug: if IVP contraindi what next?
02/13/05 20:39:52 [USMLE_Step_2] lanny: CT
02/13/05 20:39:56 [USMLE_Step_2] megs: abdominal CT
02/13/05 20:40:00 [USMLE_Step_2] strug: good lanny and megs
02/13/05 20:40:02 [USMLE_Step_2] sanz: DM pt complains of seeing floaters and light flashes... Dx?
02/13/05 20:40:11 [USMLE_Step_2] strug: if negative ct what next?
02/13/05 20:40:20 [USMLE_Step_2] cyrus1345: cystescopy
02/13/05 20:40:22 [USMLE_Step_2] megs: cystoscopy
02/13/05 20:40:25 [USMLE_Step_2] lanny: cysto
02/13/05 20:40:26 [USMLE_Step_2] strug: cental vein occlusion nasi
02/13/05 20:40:41 [USMLE_Step_2] strug: yup cystoscropy right nasi megs and lanny
02/13/05 20:40:42 [USMLE_Step_2] cyrus1345: retinal detchment
02/13/05 20:40:42 [USMLE_Step_2] lanny: at that age bladder cancer is likelt
02/13/05 20:40:47 [USMLE_Step_2] sanz: yes nasi... good job
02/13/05 20:41:04 [USMLE_Step_2] sanz: the key words are floaters and flashes
02/13/05 20:41:07 [USMLE_Step_2] vladimir: cysto and retrograde pyelogram if it's needed
02/13/05 20:41:12 [USMLE_Step_2] strug: very bad at opthal
02/13/05 20:41:14 [USMLE_Step_2] megs: good question sanz
02/13/05 20:41:31 [USMLE_Step_2] sanz: strug, me too... we'll go thru them and we're all be ace by tonight!
02/13/05 20:41:45 [USMLE_Step_2] sanz: the number of floaters correlates to what?
02/13/05 20:41:52 [USMLE_Step_2] strug: we have a separate day for opthal sanz
02/13/05 20:41:53 [USMLE_Step_2] lanny: we may have to make a night for eye high yield
02/13/05 20:41:56 [USMLE_Step_2] sanz: oh we do?
02/13/05 20:42:02 [USMLE_Step_2] strug: yes for dermat too
02/13/05 20:42:03 [USMLE_Step_2] sanz: ok then... sorry
02/13/05 20:42:13 [USMLE_Step_2] strug: no prob sanz
02/13/05 20:42:16 [USMLE_Step_2] lanny: oh thats good!!! i hate these glaucomas and infections!!
02/13/05 20:42:39 [USMLE_Step_2] strug: pl guys atleast glance the timetable once!!!!!!!
02/13/05 20:42:47 [USMLE_Step_2] sanz: ok... cont with urology then
02/13/05 20:42:54 [USMLE_Step_2] cyrus1345: 23 years old with 3 years history of frontal sinusitis come with diplopia and high fever next step?
02/13/05 20:43:03 [USMLE_Step_2] sanz: strug, i did... just didnt rmember... sorry
02/13/05 20:43:17 [USMLE_Step_2] sanz: CT sinus
02/13/05 20:43:30 [USMLE_Step_2] strug: CT of brain
02/13/05 20:43:32 [USMLE_Step_2] sanz: cavernous sinus thrombosis?
02/13/05 20:43:39 [USMLE_Step_2] strug: could be cavernous thromosis
02/13/05 20:44:12 [USMLE_Step_2] cyrus1345: yes hospitalized it's emegency then IV AB then CT scan
02/13/05 20:44:22 [USMLE_Step_2] sanz: oh oke Ab first
02/13/05 20:44:29 [USMLE_Step_2] cyrus1345: and drainage of affected sinus
02/13/05 20:44:51 [USMLE_Step_2] strug: thanks nasi.......new stuff comes in the head old one vansihes
02/13/05 20:45:06 [USMLE_Step_2] vladimir: i agree with nasi- treatment for this case, then diagnosis
02/13/05 20:45:26 [USMLE_Step_2] cyrus1345: 18 years old with episthaxy and 1 cm polyp in nasal DX?
02/13/05 20:45:29 [USMLE_Step_2] lanny: whats the drug OC for Cav sinus
02/13/05 20:45:37 [USMLE_Step_2] sanz: asthma
02/13/05 20:45:47 [USMLE_Step_2] lanny: asthma
02/13/05 20:46:00 [USMLE_Step_2] cyrus1345: no
02/13/05 20:46:06 [USMLE_Step_2] lanny: cocaine use
02/13/05 20:46:10 [USMLE_Step_2] cyrus1345: UW question!
02/13/05 20:46:10 [USMLE_Step_2] strug: nasophary fibnrron nasi
02/13/05 20:46:27 [USMLE_Step_2] cyrus1345: yes juvinal nasophar
02/13/05 20:46:27 [USMLE_Step_2] strug: juvenile nasopharyngeal fibroadenoma
02/13/05 20:46:33 [USMLE_Step_2] cyrus1345: good job sanz
02/13/05 20:46:40 [USMLE_Step_2] sanz: no no it's not me
02/13/05 20:46:44 [USMLE_Step_2] cyrus1345: sorry srug!
02/13/05 20:46:48 [USMLE_Step_2] sanz: the credit goes to strug
02/13/05 20:46:50 [USMLE_Step_2] cyrus1345: lol
02/13/05 20:47:06 [USMLE_Step_2] strug:
02/13/05 20:47:14 [USMLE_Step_2] lanny: whats doc for cav sinus nasi?
02/13/05 20:47:17 [USMLE_Step_2] cyrus1345:
02/13/05 20:48:00 [USMLE_Step_2] sanz: we shoot at each other so violently that the admin has removed those icons and replace them with milder less violent ones!
02/13/05 20:48:10 [USMLE_Step_2] vladimir: strug- it's your portrait
02/13/05 20:48:19 [USMLE_Step_2] cyrus1345: I don't know exactly lanny!
02/13/05 20:48:29 [USMLE_Step_2] strug: how can u say that vlad?
02/13/05 20:48:32 [USMLE_Step_2] lanny: ok
02/13/05 20:48:41 [USMLE_Step_2] lanny: no vlad ha ha ha
02/13/05 20:48:47 [USMLE_Step_2] sanz: i would think 3rd gen cef lanny
02/13/05 20:48:57 [USMLE_Step_2] cyrus1345: i think so
02/13/05 20:49:09 [USMLE_Step_2] lanny: is it cb an infection?
02/13/05 20:49:19 [USMLE_Step_2] sanz: CB?
02/13/05 20:49:24 [USMLE_Step_2] lanny: caused by
02/13/05 20:49:35 [USMLE_Step_2] strug: amox lanny
02/13/05 20:49:37 [USMLE_Step_2] strug: ?
02/13/05 20:49:41 [USMLE_Step_2] vladimir: anywayyway- you are very attractive
02/13/05 20:49:59 [USMLE_Step_2] strug: when did u see me? vlad
02/13/05 20:50:05 [USMLE_Step_2] cyrus1345: a 48 years gradually shows anappropriate behaivor ,papilla edema on right eye and optic strophy on left where is the lesion?
02/13/05 20:50:18 [USMLE_Step_2] sanz: lanny yes...
02/13/05 20:50:24 [USMLE_Step_2] lanny: thx sanz
02/13/05 20:50:38 [USMLE_Step_2] lanny: frontal
02/13/05 20:50:42 [USMLE_Step_2] vladimir: i i just guess
02/13/05 20:50:43 [USMLE_Step_2] cyrus1345: optic atrophy
02/13/05 20:50:57 [USMLE_Step_2] strug: left side nasi?
02/13/05 20:51:06 [USMLE_Step_2] cyrus1345: good job strug!
02/13/05 20:51:18 [USMLE_Step_2] strug: thanks nasi
02/13/05 20:51:23 [USMLE_Step_2] strug: u r putting good q
02/13/05 20:51:28 [USMLE_Step_2] sanz: wait
02/13/05 20:51:33 [USMLE_Step_2] lanny: left side of what?
02/13/05 20:51:42 [USMLE_Step_2] strug: of the body lanny
02/13/05 20:51:50 [USMLE_Step_2] cyrus1345: frontal
02/13/05 20:51:55 [USMLE_Step_2] sanz: how did that cause papillaedema on the right?
02/13/05 20:51:58 [USMLE_Step_2] strug: oooohhhhhh he he
02/13/05 20:52:01 [USMLE_Step_2] lanny: i thought frontal
02/13/05 20:52:10 [USMLE_Step_2] cyrus1345: LEFT FRRONTAL!
02/13/05 20:52:14 [USMLE_Step_2] strug: pr effect sanz
02/13/05 20:52:18 [USMLE_Step_2] sanz: ok
02/13/05 20:52:19 [USMLE_Step_2] lanny: yes
02/13/05 20:52:32 [USMLE_Step_2] lanny: boy you were confusing me here
02/13/05 20:52:40 [USMLE_Step_2] cyrus1345: who me?
02/13/05 20:52:55 [USMLE_Step_2] lanny: yes i said frontal before
02/13/05 20:53:05 [USMLE_Step_2] lanny: and was surprised that it was wrong
02/13/05 20:53:15 [USMLE_Step_2] vladimir: i enjoyed a line of recent discussion
02/13/05 20:53:18 [USMLE_Step_2] cyrus1345: every body knows it's frontal,the key is left or right!
02/13/05 20:54:03 [USMLE_Step_2] cyrus1345:
02/13/05 20:54:04 [USMLE_Step_2] strug: olp pt pain in legs while walking, releived by rest , pt can ride bicylcle....pain releived when he sits down or bends......pulses normal.....diagnosis?
02/13/05 20:54:11 [USMLE_Step_2] lanny: so its not left side of body its left frontal lobe
02/13/05 20:54:23 [USMLE_Step_2] cyrus1345: spinal stenosis
02/13/05 20:54:25 [USMLE_Step_2] sanz: spinal stenosis
02/13/05 20:54:34 [USMLE_Step_2] strug: thats ok guys we r here to have dounts and clear those
02/13/05 20:54:37 [USMLE_Step_2] lanny: agree
02/13/05 20:55:05 [USMLE_Step_2] strug: Neurogenci claudication guys
02/13/05 20:55:17 [USMLE_Step_2] strug: is it due to spinal stenosi i dunno ?
02/13/05 20:55:21 [USMLE_Step_2] cyrus1345: it's same strug
02/13/05 20:55:22 [USMLE_Step_2] sanz: yes
02/13/05 20:55:26 [USMLE_Step_2] lanny: sure
02/13/05 20:55:27 [USMLE_Step_2] sanz: same name!
02/13/05 20:55:31 [USMLE_Step_2] strug: ok good job guys
02/13/05 20:55:38 [USMLE_Step_2] strug: what next step?
02/13/05 20:55:43 [USMLE_Step_2] sanz: MRI
02/13/05 20:55:48 [USMLE_Step_2] lanny: its caused by neuro claud
02/13/05 20:56:02 [USMLE_Step_2] strug: yes sanz MRI
02/13/05 20:56:05 [USMLE_Step_2] megs: how bendinf relives the pain, anybody will tell???
02/13/05 20:56:06 [USMLE_Step_2] lanny: agree
02/13/05 20:56:31 [USMLE_Step_2] lanny: dont u stand megs
02/13/05 20:56:34 [USMLE_Step_2] sanz: megs, the spinal canal is narrow... and it traps nerves
02/13/05 20:56:41 [USMLE_Step_2] cyrus1345: when you bend meg youmake more space between spinal nd canal
02/13/05 20:56:41 [USMLE_Step_2] strug: less compres on the spine i guess
02/13/05 20:56:49 [USMLE_Step_2] sanz: if your body is flexed, it relieves the pressure
02/13/05 20:57:03 [USMLE_Step_2] lanny: oh now i got it sanz right
02/13/05 20:57:13 [USMLE_Step_2] megs: thank u sanz
02/13/05 20:57:13 [USMLE_Step_2] sanz: so these pts can climb hills without probs cuz climbing involves some flexion of yr body
02/13/05 20:57:23 [USMLE_Step_2] lanny: sanz...
02/13/05 20:57:30 [USMLE_Step_2] strug: ur good sanz
02/13/05 20:57:31 [USMLE_Step_2] lanny: youre going tooo far
02/13/05 20:57:32 [USMLE_Step_2] megs: good to know sanz
02/13/05 20:57:41 [USMLE_Step_2] vladimir: same thing with hanging
02/13/05 20:57:53 [USMLE_Step_2] sanz: lanny, it is true... in the exam q they will say pt can walk uphill
02/13/05 20:57:57 [USMLE_Step_2] lanny: at this age of s stenosis over 70 many dont climb
02/13/05 20:58:26 [USMLE_Step_2] strug: lanny they climb
02/13/05 20:58:37 [USMLE_Step_2] cyrus1345: good job sanz!
02/13/05 20:58:40 [USMLE_Step_2] strug: in US they do all kind of wierd stuff
02/13/05 20:58:41 [USMLE_Step_2] lanny: i know just a remark
02/13/05 20:58:58 [USMLE_Step_2] strug: i have a doubt guys
02/13/05 20:59:03 [USMLE_Step_2] vladimir: they don't climb due to concomitant artritis etc
02/13/05 20:59:10 [USMLE_Step_2] strug: controver between USmle world and kaplan
02/13/05 20:59:17 [USMLE_Step_2] sanz: ok strug, go on
02/13/05 20:59:18 [USMLE_Step_2] strug: about managemet of PVD
02/13/05 20:59:41 [USMLE_Step_2] strug: inkaplan they say u treat only when diabling and affecting thw quality of life
02/13/05 20:59:45 [USMLE_Step_2] vladimir: i mean degenerative artritis
02/13/05 20:59:57 [USMLE_Step_2] sanz: oh i know EXACTLY which q you mean...
02/13/05 21:00:07 [USMLE_Step_2] sanz: when to do angio and when to give ASA and ex
02/13/05 21:00:09 [USMLE_Step_2] sanz: right strug?
02/13/05 21:00:25 [USMLE_Step_2] strug: yus that one but i dont remember the q right now
02/13/05 21:00:43 [USMLE_Step_2] sanz: i actually went to look at my med student surg textbook
02/13/05 21:00:45 [USMLE_Step_2] sanz: UW is right
02/13/05 21:00:53 [USMLE_Step_2] cyrus1345: what's wrong with it strug?
02/13/05 21:01:49 [USMLE_Step_2] strug: USMLE world Rx of PVD is diff from kaplan
02/13/05 21:01:50 [USMLE_Step_2] cyrus1345: first start with medication CA chnael blocker no response and paitent is disable to do rutine works ,then surgery
02/13/05 21:02:03 [USMLE_Step_2] sanz: yup
02/13/05 21:02:05 [USMLE_Step_2] cyrus1345: am I wrong strug?
02/13/05 21:02:31 [USMLE_Step_2] strug: no i dont think so but i m not very sure about the Rx either
02/13/05 21:02:39 megs Logs Out
02/13/05 21:02:52 [USMLE_Step_2] sanz: i think the q in UW that strug meant was like this... pt has cold legs and claudication... they ask next step right?
02/13/05 21:03:06 [USMLE_Step_2] strug: yes
02/13/05 21:03:21 megs Logs in
02/13/05 21:03:25 [USMLE_Step_2] sanz: so i answered angio... and got wrong
02/13/05 21:03:30 megs Joins Subroom USMLE_Step_2
02/13/05 21:03:36 [USMLE_Step_2] sanz: the ans is ASA with excercise
02/13/05 21:03:54 [USMLE_Step_2] cyrus1345: is it going to interfer with his rutine life?then send for surgery
02/13/05 21:04:02 [USMLE_Step_2] sanz: we only do angio if it's rest pain and ganrenous, in view of surgery
02/13/05 21:04:20 [USMLE_Step_2] strug: yes sanz exactly this is my doubt
02/13/05 21:04:22 [USMLE_Step_2] sanz: if he can relive his claudication with rest, medical therapy is sufficient
02/13/05 21:05:16 [USMLE_Step_2] lanny: so he should not exercise then
02/13/05 21:05:33 [USMLE_Step_2] sanz: he should
02/13/05 21:06:13 [USMLE_Step_2] vladimir: agree with sanz- i also picked up angio
02/13/05 21:06:38 [USMLE_Step_2] cyrus1345: 71 years heavy smoker and drinker comes with persitent unilateral earache and lyphnode in nech what is best next step?
02/13/05 21:06:52 [USMLE_Step_2] sanz: yeah vlad i got it rong too ... angio is done only if it's rest pain or pain with gangrene and you want to do surg
02/13/05 21:07:11 [USMLE_Step_2] strug: thansk sanz
02/13/05 21:07:22 [USMLE_Step_2] lanny: when is doppler studies
02/13/05 21:07:25 [USMLE_Step_2] lanny: done
02/13/05 21:07:26 [USMLE_Step_2] strug: panendocopy nasi
02/13/05 21:07:36 [USMLE_Step_2] cyrus1345: :cl
02/13/05 21:07:47 [USMLE_Step_2] strug:
02/13/05 21:07:52 [USMLE_Step_2] vladimir: Bx
02/13/05 21:08:08 [USMLE_Step_2] cyrus1345: what is BX vlad?
02/13/05 21:08:21 [USMLE_Step_2] strug: dont do a biopsy is the message vlad for this q which nasi asked
02/13/05 21:08:38 [USMLE_Step_2] strug: coz u will interfere with further surgery vlad
02/13/05 21:08:52 [USMLE_Step_2] vladimir: biopsy
02/13/05 21:09:16 [USMLE_Step_2] vladimir: why
02/13/05 21:09:19 [USMLE_Step_2] strug: do they ask the margins for Melanoma?
02/13/05 21:09:21 [USMLE_Step_2] cyrus1345: NEVER BIOPSY
02/13/05 21:09:47 [USMLE_Step_2] cyrus1345: strug already explained
02/13/05 21:09:54 [USMLE_Step_2] lanny: strug you mean panendoscopy?
02/13/05 21:10:13 [USMLE_Step_2] lanny: of which areas
02/13/05 21:10:25 [USMLE_Step_2] strug: this pt has metastaris from primary in the chest and if u bipsy u will make an incion and make the further incion o f the surgery u do for reamoval of primary difficult vlad
02/13/05 21:10:55 [USMLE_Step_2] vladimir: why it's melanoma
02/13/05 21:12:24 [USMLE_Step_2] lanny: nasi why the earache ? can you tell
02/13/05 21:12:33 [USMLE_Step_2] vladimir: all right-let's put in another words- wide excision BXx
02/13/05 21:12:51 [USMLE_Step_2] strug: can i request u guys something lanny and vlad
02/13/05 21:13:39 cyrus1345 Logs Out
02/13/05 21:13:48 [USMLE_Step_2] vladimir: all right-go ahead
02/13/05 21:14:22 [USMLE_Step_2] strug: can u please read and come the topics which we discuss
02/13/05 21:15:13 [USMLE_Step_2] strug: somethings which u guys ask r right in kaplan notes....we should nt be wasting time on those things which are already in the notes....
02/13/05 21:15:41 [USMLE_Step_2] vladimir: but i did not catch it up
02/13/05 21:15:49 [USMLE_Step_2] strug: we can discuss much more if all of us read and come......thats the reason i put the timetable
02/13/05 21:16:13 [USMLE_Step_2] strug: i can understand vlad
02/13/05 21:16:16 [USMLE_Step_2] lanny: hey strug this is not wasting time we are here to clarify areas which we dont u. stand
02/13/05 21:16:35 [USMLE_Step_2] strug: yes thats right lanny
02/13/05 21:16:48 [USMLE_Step_2] lanny: i dont think i am asking any thing out of context
02/13/05 21:17:07 [USMLE_Step_2] strug: ok no prob lanny sorry
02/13/05 21:17:13 [USMLE_Step_2] lanny: thankyou
02/13/05 21:17:14 [USMLE_Step_2] sanz: well, i'll explain then... in a smoker with LN , there's a high possibility of sq cell ca
02/13/05 21:17:16 [USMLE_Step_2] strug: just try to read and come please
02/13/05 21:17:34 [USMLE_Step_2] megs: go on sanz
02/13/05 21:17:44 [USMLE_Step_2] lanny: my ques was why panendoscopy?
02/13/05 21:17:46 [USMLE_Step_2] vladimir: lanny- i agree- we are here to help each other-do not
02/13/05 21:18:10 [USMLE_Step_2] lanny: if we suspect lung cancer in a smoker
02/13/05 21:19:12 [USMLE_Step_2] sanz: so if you biopsy the nodes, it makes surgery more difficult...
02/13/05 21:19:41 [USMLE_Step_2] strug: its not just lung cancer lanny it could be anything
02/13/05 21:19:50 [USMLE_Step_2] strug: below the clavicle
02/13/05 21:20:07 [USMLE_Step_2] strug: it could be esophageal, stomach cancer etc.....
02/13/05 21:20:12 [USMLE_Step_2] lanny: sanz thanks
02/13/05 21:20:30 [USMLE_Step_2] vladimir: soryy, but i've never hear that any kind of Bx can do operation more sophisticated
02/13/05 21:20:49 [USMLE_Step_2] strug: there are towo places i know where never bipsy vlad
02/13/05 21:21:07 [USMLE_Step_2] strug: one is parottid masss and second in LN metast
02/13/05 21:21:27 [USMLE_Step_2] lanny: thats correct
02/13/05 21:21:32 [USMLE_Step_2] strug: in a smoker, drinker for LN mass
02/13/05 21:21:59 [USMLE_Step_2] vladimir: ther is anecdotal cases with a pillage of tumor cell during biopsy, but it' kind of wird
02/13/05 21:22:46 [USMLE_Step_2] lanny: vlad with LN dissection etc biopssy it is diff if you wanna do surg later
02/13/05 21:23:08 [USMLE_Step_2] lanny: it may interfere with surgery
02/13/05 21:23:20 cyrus1345 Logs in
02/13/05 21:23:20 [USMLE_Step_2] sanz: oke guys... i've had enuf for a day... c u tmrw?
02/13/05 21:23:24 [USMLE_Step_2] strug: pt with cold , history of BPH, complains that he cant void
02/13/05 21:23:26 cyrus1345 Joins Subroom USMLE_Step_2
02/13/05 21:23:32 [USMLE_Step_2] vladimir: in fact, we do a lot of bx from metatstic lyph nodes especially if you have 2 tumors and don't know which one can metatstsize
02/13/05 21:23:48 [USMLE_Step_2] sanz: wb nasi
02/13/05 21:23:53 [USMLE_Step_2] strug: wb nasi
02/13/05 21:24:17 [USMLE_Step_2] vladimir: it's very stupid Q
02/13/05 21:24:26 [USMLE_Step_2] strug: diagnosis ?
02/13/05 21:24:34 [USMLE_Step_2] cyrus1345: Hi ,sorry just kick out
02/13/05 21:25:13 [USMLE_Step_2] strug: pt with histroy of BPH, complains that he cannot void, has a cold...diagnosis?
02/13/05 21:25:20 [USMLE_Step_2] vladimir: llanny- we do Bx if we are going to excise their LN
02/13/05 21:25:34 [USMLE_Step_2] megs: UTI STRUG????
02/13/05 21:25:35 [USMLE_Step_2] sanz: UTI?
02/13/05 21:25:41 [USMLE_Step_2] lanny: agree vlad
02/13/05 21:25:50 [USMLE_Step_2] strug: acute urinary retention.....
02/13/05 21:25:55 [USMLE_Step_2] sanz: oh
02/13/05 21:26:01 [USMLE_Step_2] strug: Rx?
02/13/05 21:26:09 [USMLE_Step_2] sanz: cath
02/13/05 21:26:10 [USMLE_Step_2] megs: cathetor
02/13/05 21:26:15 [USMLE_Step_2] strug: yup
02/13/05 21:26:20 [USMLE_Step_2] vladimir: acute retention
02/13/05 21:26:52 [USMLE_Step_2] strug: right vlad
02/13/05 21:26:56 [USMLE_Step_2] vladimir: and give AB
02/13/05 21:27:17 [USMLE_Step_2] megs: agree vlad
02/13/05 21:27:22 [USMLE_Step_2] strug: catherisation
02/13/05 21:27:35 [USMLE_Step_2] strug: i duno about antibiotics
02/13/05 21:27:44 [USMLE_Step_2] lanny: alpha blockers?
02/13/05 21:27:45 [USMLE_Step_2] strug: can give alpha blockers
02/13/05 21:27:48 [USMLE_Step_2] strug: yes lanny
02/13/05 21:28:34 [USMLE_Step_2] lanny: if i remember phenergan alpha blocker is a cold med and they conxtrict bladder neck
02/13/05 21:28:48 [USMLE_Step_2] lanny: sorry alpha agonist
02/13/05 21:29:04 [USMLE_Step_2] strug: business executive held up in a meting, T6 paraplegic for many years....cant do his self catherei becoz of metting, has pounding headache, perspiraiton and bradycardia....BP 220/120 diagnoisis?
02/13/05 21:29:13 [USMLE_Step_2] strug: lanny correct
02/13/05 21:29:31 [USMLE_Step_2] vladimir: yes-you can give alpha-blocker and even proscar, but first of all-AB
02/13/05 21:30:20 [USMLE_Step_2] strug: ?
02/13/05 21:30:25 [USMLE_Step_2] sanz: ooohhh strug... it's at the tip of my tongue...
02/13/05 21:30:34 [USMLE_Step_2] lanny: me too
02/13/05 21:30:52 [USMLE_Step_2] lanny: some reflux?
02/13/05 21:30:55 [USMLE_Step_2] sanz: neuro
02/13/05 21:31:12 [USMLE_Step_2] megs: dunno
02/13/05 21:31:13 [USMLE_Step_2] vladimir: is it reflux
02/13/05 21:31:17 [USMLE_Step_2] sanz: sorry... dont know
02/13/05 21:31:19 [USMLE_Step_2] strug: autonomic dysreflexia
02/13/05 21:31:22 [USMLE_Step_2] lanny: give us options strug
02/13/05 21:31:31 [USMLE_Step_2] strug: sorry i gave the ans
02/13/05 21:31:40 [USMLE_Step_2] lanny: ok thx
02/13/05 21:31:52 [USMLE_Step_2] sanz: oh yeah strug
02/13/05 21:31:53 [USMLE_Step_2] cyrus1345: thanks od one
02/13/05 21:31:59 [USMLE_Step_2] cyrus1345: good
02/13/05 21:32:08 [USMLE_Step_2] strug: Rx?
02/13/05 21:32:27 [USMLE_Step_2] lanny: ok lets do prostrate hy
02/13/05 21:32:40 [USMLE_Step_2] lanny: strug you have prost q
02/13/05 21:32:43 [USMLE_Step_2] vladimir: electrostimulation
02/13/05 21:32:51 [USMLE_Step_2] strug: alpha blocker and CCB....ofcouse catheretisation first
02/13/05 21:33:42 [USMLE_Step_2] sanz: COPD pt with hilar mass, pre op FEV is 1100 with FEV of 60% of his lung fn from affected lungs... is he fit for surgery?
02/13/05 21:33:42 [USMLE_Step_2] lanny: whats CCB strug
02/13/05 21:33:57 [USMLE_Step_2] lanny: no
02/13/05 21:34:01 [USMLE_Step_2] sanz: why?
02/13/05 21:34:04 [USMLE_Step_2] strug: 72 yres man noticed bubbles coming along with urine....he also gives symp of mild cystitis ....test to confirm diagnosis?
02/13/05 21:34:06 [USMLE_Step_2] vladimir: it's been recently q in usmlenet- many infection for 2 yeras due to chronic prostatitis, what do next
02/13/05 21:34:21 [USMLE_Step_2] sanz: CT strug... pneumaturia
02/13/05 21:34:32 [USMLE_Step_2] strug: sweat test vlad
02/13/05 21:34:33 [USMLE_Step_2] lanny: right sanz
02/13/05 21:34:38 [USMLE_Step_2] strug: right sanz
02/13/05 21:34:58 [USMLE_Step_2] vladimir: strug- it fistula
02/13/05 21:35:02 [USMLE_Step_2] strug: 800 ml residual vo l should remain after the lung removed sanz
02/13/05 21:35:05 [USMLE_Step_2] cyrus1345: C can st
02/13/05 21:35:16 [USMLE_Step_2] sanz: good stuff strug
02/13/05 21:35:17 [USMLE_Step_2] strug: yes nasi i understood
02/13/05 21:35:23 [USMLE_Step_2] sanz: hehe nasi
02/13/05 21:35:43 [USMLE_Step_2] strug: CCb= calcium channel blockers lanny
02/13/05 21:35:51 [USMLE_Step_2] lanny: thx strug
02/13/05 21:36:05 [USMLE_Step_2] sanz: need to learn how to work out lung fn stuff...
02/13/05 21:36:20 [USMLE_Step_2] strug: yes sanz pl go on
02/13/05 21:36:22 megs Logs Out
02/13/05 21:36:47 [USMLE_Step_2] strug: ok shalli ask?
02/13/05 21:36:50 [USMLE_Step_2] sanz: ok, if FEV is 1500 and FEV is 40%?
02/13/05 21:37:02 [USMLE_Step_2] vladimir: it was some ptions to q- he failed with cipro for chronic proistatitis, what do next- (by the way it's NBME q
02/13/05 21:37:08 [USMLE_Step_2] sanz: FEV 40% on affected lung to be removed, i mean
02/13/05 21:37:12 [USMLE_Step_2] strug: surgery
02/13/05 21:37:15 [USMLE_Step_2] strug: can be done sanz
02/13/05 21:37:23 [USMLE_Step_2] sanz: yes strug
02/13/05 21:37:30 [USMLE_Step_2] sanz: well done!
02/13/05 21:37:50 [USMLE_Step_2] vladimir: strug- which kind of surgery
02/13/05 21:37:50 [USMLE_Step_2] sanz: cuz in this case the residual FEV is 900ml
02/13/05 21:38:01 [USMLE_Step_2] strug: pt with c/0 hemoptysis.....chest x *** u find coin lesionnext step?
02/13/05 21:38:15 [USMLE_Step_2] sanz: what age?
02/13/05 21:38:20 [USMLE_Step_2] sanz: find old X Rays
02/13/05 21:38:26 [USMLE_Step_2] strug: yes right
02/13/05 21:38:33 [USMLE_Step_2] lanny: agree
02/13/05 21:38:48 [USMLE_Step_2] strug: ok the x *** showed no lesion this x *** at present shows lesion
02/13/05 21:38:58 [USMLE_Step_2] strug: what next?
02/13/05 21:39:02 [USMLE_Step_2] sanz: if young and regular border , likely to be benign
02/13/05 21:39:10 cyrus1345 Logs Out
02/13/05 21:39:20 [USMLE_Step_2] sanz: then follow up with CXR
02/13/05 21:39:41 [USMLE_Step_2] strug: x *** shows signs of malignancy what next?
02/13/05 21:40:07 [USMLE_Step_2] sanz: malignancy work up...
02/13/05 21:40:09 [USMLE_Step_2] sanz: Ct
02/13/05 21:40:12 [USMLE_Step_2] strug: good
02/13/05 21:40:20 [USMLE_Step_2] strug: and also sputum cytology
02/13/05 21:40:23 [USMLE_Step_2] sanz: thoracotomy and sugery
02/13/05 21:40:35 [USMLE_Step_2] strug: ct scan shows liver meta what next?
02/13/05 21:40:57 [USMLE_Step_2] strug: no surger sanz at this stage
02/13/05 21:41:00 [USMLE_Step_2] sanz: oh ok
02/13/05 21:41:09 [USMLE_Step_2] sanz: CT abdo?
02/13/05 21:41:09 [USMLE_Step_2] vladimir: location- depends the next step
02/13/05 21:41:25 [USMLE_Step_2] lanny: CT
02/13/05 21:41:40 [USMLE_Step_2] sanz: or biopsy
02/13/05 21:41:44 [USMLE_Step_2] strug: ct abdo shows liver metastis what next?
02/13/05 21:41:53 [USMLE_Step_2] sanz: biopsy
02/13/05 21:42:03 [USMLE_Step_2] strug: no no sanz u need to stop the work up here
02/13/05 21:42:22 [USMLE_Step_2] strug: because the tumore is non resectable u need to give chemco
02/13/05 21:42:29 [USMLE_Step_2] lanny: medication
02/13/05 21:42:52 [USMLE_Step_2] sanz: ok... gotcha thnx strug
02/13/05 21:43:09 [USMLE_Step_2] sanz: well, i should go... getting sleepy...
02/13/05 21:43:18 [USMLE_Step_2] strug: ok think that ct was negagtive, sputum ctyotology unconclusive pt is old and smoler what next?
02/13/05 21:43:42 [USMLE_Step_2] sanz: biopsy?
02/13/05 21:43:44 [USMLE_Step_2] sanz: hehe
02/13/05 21:43:48 [USMLE_Step_2] lanny: abd CT neg?
02/13/05 21:44:00 [USMLE_Step_2] strug: yes u can do a bipys at htis stage
02/13/05 21:44:04 [USMLE_Step_2] strug: yes lanny ct neg
02/13/05 21:44:04 [USMLE_Step_2] vladimir: if it's solitary met in liver do surgery of promary tumor and minimal invasive ablation for liver met
02/13/05 21:44:17 [USMLE_Step_2] sanz: night guys!
02/13/05 21:44:21 [USMLE_Step_2] sanz: c ya tmrw!
02/13/05 21:44:25 [USMLE_Step_2] strug: bye sanz me too leaving
02/13/05 21:44:28 sanz Logs Out
02/13/05 21:44:29 [USMLE_Step_2] lanny: g night sanz
02/13/05 21:44:37 [USMLE_Step_2] lanny: see you tom
02/13/05 21:44:40 [USMLE_Step_2] strug: hey guys i hope i didnt offend anyone
02/13/05 21:45:02 [USMLE_Step_2] strug: bye lanny and vlad
02/13/05 21:45:09 [USMLE_Step_2] lanny: bye strug
02/13/05 21:45:14 [USMLE_Step_2] strug: i didnt mean to be rude
02/13/05 21:45:28 [USMLE_Step_2] vladimir: by