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Asclepius1
02-07-2005, 10:50 PM
02/7/05 19:05:34 [USMLE_Step_2] megs: hi lanny
02/7/05 19:05:52 [USMLE_Step_2] lanny: hi megs
02/7/05 19:06:01 [USMLE_Step_2] lanny: how're you?
02/7/05 19:06:13 [USMLE_Step_2] megs: fine thank u
02/7/05 19:06:39 [USMLE_Step_2] lanny: so we cont gynae right
02/7/05 19:06:51 [USMLE_Step_2] megs: yeah
02/7/05 19:07:02 [USMLE_Step_2] megs: when r u taking exam??
02/7/05 19:07:05 [USMLE_Step_2] lanny: good how is studies going
02/7/05 19:07:12 [USMLE_Step_2] lanny: oh end march
02/7/05 19:07:21 [USMLE_Step_2] lanny: and you
02/7/05 19:07:23 [USMLE_Step_2] megs: i am taking in may
02/7/05 19:07:40 [USMLE_Step_2] megs: i am doing my first reading
02/7/05 19:07:50 [USMLE_Step_2] lanny: ok,
02/7/05 19:07:51 sanz Logs in
02/7/05 19:07:52 sanz Joins Subroom USMLE_Step_2
02/7/05 19:08:01 [USMLE_Step_2] sanz: hey guys :)
02/7/05 19:08:07 [USMLE_Step_2] lanny: hey sanz
02/7/05 19:08:08 [USMLE_Step_2] megs: but i dont want to miss discussion over here
02/7/05 19:08:18 [USMLE_Step_2] megs: hi sanz how r u today
02/7/05 19:08:28 [USMLE_Step_2] lanny: sure it all helps many of us are going in march
02/7/05 19:09:01 [USMLE_Step_2] megs: u all guys r very good at knowlege
02/7/05 19:09:19 [USMLE_Step_2] lanny: you too
02/7/05 19:09:24 cyrus1345 Logs in
02/7/05 19:09:38 cyrus1345 Joins Subroom USMLE_Step_2
02/7/05 19:09:39 [USMLE_Step_2] sanz: megs, i'm fine thnx
02/7/05 19:09:55 [USMLE_Step_2] cyrus1345: Hi evrybody
02/7/05 19:10:01 [USMLE_Step_2] lanny: hi nasi
02/7/05 19:10:01 [USMLE_Step_2] sanz: dont know why today went by so fast! i didnt even realise it's 7pm already
02/7/05 19:10:02 [USMLE_Step_2] megs: hi cyrus
02/7/05 19:10:15 [USMLE_Step_2] sanz: hey Nasi :) ready for the big day?
02/7/05 19:10:23 [USMLE_Step_2] lanny: oh yea by the time you know it another christmas
02/7/05 19:10:36 [USMLE_Step_2] cyrus1345: no actually!
02/7/05 19:10:42 [USMLE_Step_2] sanz: today is reprodutive health right?
02/7/05 19:10:47 [USMLE_Step_2] cyrus1345: it seems I forgot everything
02/7/05 19:10:55 [USMLE_Step_2] megs: so shall we start guys???or wait for others
02/7/05 19:10:55 [USMLE_Step_2] sanz: nasi, you'll be brilliant, i KNOW
02/7/05 19:11:33 [USMLE_Step_2] sanz: it'll all come back to you when you see the questions :)
02/7/05 19:11:34 [USMLE_Step_2] lanny: keep on reading till the day comes..its al worthwhile
02/7/05 19:11:37 [USMLE_Step_2] sanz: good lucl!
02/7/05 19:11:41 [USMLE_Step_2] sanz: luck!
02/7/05 19:11:42 [USMLE_Step_2] lanny: agree sanz
02/7/05 19:11:46 [USMLE_Step_2] cyrus1345: you are so nice snaz,by the way thanks alot for your great development childhood,yesterday!it was great,big help! dear!
02/7/05 19:12:08 [USMLE_Step_2] lanny: can you share it with me nasi
02/7/05 19:12:12 [USMLE_Step_2] sanz: all of you has helped me so much, i'd love to contribute
02/7/05 19:12:22 [USMLE_Step_2] sanz: lanny... read the transcript
02/7/05 19:12:27 [USMLE_Step_2] lanny: i missed the child dev is it posted
02/7/05 19:12:33 [USMLE_Step_2] cyrus1345: it's yesterday transcript chat snaz!
02/7/05 19:12:59 [USMLE_Step_2] sanz: yesterday we forgot to discuss endom hyperplasia... i thought i should briefly mention it in a case...
02/7/05 19:13:23 [USMLE_Step_2] lanny: ok we shall start go ahead sanz
02/7/05 19:13:36 [USMLE_Step_2] sanz: 37 yr old woman with intramentral bleeding... found on biopsy that she has complex hyperplasia without atypia
02/7/05 19:13:54 [USMLE_Step_2] sanz: she doesnt want any more kids
02/7/05 19:13:58 [USMLE_Step_2] sanz: what do you do next?
02/7/05 19:14:17 [USMLE_Step_2] cyrus1345: progestron
02/7/05 19:14:17 [USMLE_Step_2] sanz: 1. hysterectomy
02/7/05 19:14:21 [USMLE_Step_2] sanz: 2. progestin
02/7/05 19:14:26 [USMLE_Step_2] sanz: 3 blah blah
02/7/05 19:14:34 [USMLE_Step_2] lanny: hysterec
02/7/05 19:14:38 [USMLE_Step_2] sanz: nasi, you're right
02/7/05 19:14:59 [USMLE_Step_2] lanny: but she dont want kids
02/7/05 19:15:04 [USMLE_Step_2] cyrus1345: oof thanks GOD!
02/7/05 19:15:11 [USMLE_Step_2] lanny: why not go straight for hyst
02/7/05 19:15:33 [USMLE_Step_2] sanz: apparently, if the woman is PREmenopausal and has Bx results WITHOUT atypia, hysterectomy is not indicated even if she doesnt want anymore kids
02/7/05 19:15:46 [USMLE_Step_2] lanny: oh withoout atypia didnt see that
02/7/05 19:15:57 [USMLE_Step_2] lanny: agree with nasi then
02/7/05 19:16:04 [USMLE_Step_2] sanz: but if she has bx results with atypia, she can opt to do hysterectomy
02/7/05 19:16:13 [USMLE_Step_2] lanny: yes sanz
02/7/05 19:16:33 [USMLE_Step_2] cyrus1345: what's risk factor for endometrail adenocarsinoma?
02/7/05 19:16:47 [USMLE_Step_2] sanz: obesity
02/7/05 19:16:56 [USMLE_Step_2] lanny: late men
02/7/05 19:17:07 [USMLE_Step_2] cyrus1345: more,more!
02/7/05 19:17:13 [USMLE_Step_2] sanz: unopposed esg
02/7/05 19:17:14 [USMLE_Step_2] megs: unopposed esstrogen exposure
02/7/05 19:17:23 [USMLE_Step_2] sanz: nulliparity
02/7/05 19:17:30 [USMLE_Step_2] sanz: early menarche
02/7/05 19:17:38 [USMLE_Step_2] lanny: tamox use
02/7/05 19:17:52 dua_frank Logs in
02/7/05 19:17:52 [USMLE_Step_2] lanny: early men
02/7/05 19:17:56 dua_frank Joins Subroom USMLE_Step_2
02/7/05 19:17:59 [USMLE_Step_2] dua_frank: hi
02/7/05 19:18:00 [USMLE_Step_2] lanny: early menses
02/7/05 19:18:01 [USMLE_Step_2] cyrus1345: good!and HTN and DIABET!!
02/7/05 19:18:09 [USMLE_Step_2] dua_frank: you guys started already !!!!
02/7/05 19:18:09 [USMLE_Step_2] sanz: oh yeah
02/7/05 19:18:12 [USMLE_Step_2] cyrus1345: Hi dua
02/7/05 19:18:16 [USMLE_Step_2] sanz: hey dua :)
02/7/05 19:18:22 [USMLE_Step_2] dua_frank: hi nasi
02/7/05 19:18:23 [USMLE_Step_2] lanny: we waited for 10 mins dua
02/7/05 19:18:24 [USMLE_Step_2] dua_frank: hey sanz
02/7/05 19:18:40 [USMLE_Step_2] dua_frank: thanks for waiting :)
02/7/05 19:18:50 [USMLE_Step_2] megs: welcome dua
02/7/05 19:19:00 [USMLE_Step_2] cyrus1345: what's risk factor for cervical carsinoma?
02/7/05 19:19:00 [USMLE_Step_2] sanz: what's the most common cause of DUB?
02/7/05 19:19:12 [USMLE_Step_2] cyrus1345: onovulation
02/7/05 19:19:15 [USMLE_Step_2] megs: anovulation
02/7/05 19:19:20 [USMLE_Step_2] dua_frank: thanks megs
02/7/05 19:19:25 [USMLE_Step_2] sanz: multiple sex partners
02/7/05 19:19:37 [USMLE_Step_2] cyrus1345: more
02/7/05 19:19:49 [USMLE_Step_2] megs: whats primary amenorrhoea??
02/7/05 19:19:53 [USMLE_Step_2] sanz: i should remember, we did it yesterday
02/7/05 19:20:27 [USMLE_Step_2] sanz: early age of intercourse and smoking
02/7/05 19:20:41 [USMLE_Step_2] lanny: no menses at 14
02/7/05 19:20:49 [USMLE_Step_2] megs: absebce of menses till16 and absence of menses 4 yrs after thelarchae
02/7/05 19:20:51 [USMLE_Step_2] cyrus1345: SMOCKING and HPV 16 ,18
02/7/05 19:21:00 strug Logs in
02/7/05 19:21:01 [USMLE_Step_2] cyrus1345: very good snaz
02/7/05 19:21:04 strug Joins Subroom USMLE_Step_2
02/7/05 19:21:11 [USMLE_Step_2] sanz: hey strug
02/7/05 19:21:18 [USMLE_Step_2] lanny: if sex develop at 16
02/7/05 19:21:19 [USMLE_Step_2] megs: hi strug
02/7/05 19:21:20 [USMLE_Step_2] strug: Thank God finally i logged in!!!!!!
02/7/05 19:21:26 [USMLE_Step_2] strug: hi sanz and megs
02/7/05 19:21:29 [USMLE_Step_2] cyrus1345: Hi strug
02/7/05 19:21:36 [USMLE_Step_2] strug: how are u all doing
02/7/05 19:21:37 [USMLE_Step_2] sanz: nasi, today is reproductive med i think... we did Cancer stuff yesterday...
02/7/05 19:21:39 [USMLE_Step_2] strug: hi nasi
02/7/05 19:21:41 [USMLE_Step_2] dua_frank: hi struggggggg :)
02/7/05 19:21:46 [USMLE_Step_2] strug: hi dua
02/7/05 19:21:53 [USMLE_Step_2] sanz: strug, were you having probs loggin in?
02/7/05 19:21:58 [USMLE_Step_2] strug: yes
02/7/05 19:22:08 [USMLE_Step_2] strug: i had to struggle to log in....
02/7/05 19:22:09 [USMLE_Step_2] sanz: good you made it!!!
02/7/05 19:22:29 [USMLE_Step_2] megs: lanny what is ur source i read from blueprint
02/7/05 19:22:31 [USMLE_Step_2] strug: ok what were u guys discussing
02/7/05 19:23:06 [USMLE_Step_2] megs: what is secondary amenorhoea??
02/7/05 19:23:26 [USMLE_Step_2] lanny: blue print, kaplan ,OB secrets
02/7/05 19:23:28 [USMLE_Step_2] strug: >3 m of amenorrhoe with normal pervious cycles
02/7/05 19:23:37 [USMLE_Step_2] lanny: agree
02/7/05 19:23:43 [USMLE_Step_2] strug: > 6 m of amenorr with irregular previous cycles
02/7/05 19:23:54 [USMLE_Step_2] megs: good strug
02/7/05 19:23:55 [USMLE_Step_2] sanz: like Asherman syndr
02/7/05 19:24:04 [USMLE_Step_2] strug: thanks megs
02/7/05 19:24:07 [USMLE_Step_2] lanny: >3mths if prev cycle was reg
02/7/05 19:24:18 [USMLE_Step_2] megs: what is asherman syndrome??
02/7/05 19:24:33 [USMLE_Step_2] strug: outflow tract obstrucion due to adhesions
02/7/05 19:24:56 [USMLE_Step_2] sanz: uterine adhesion after D&C
02/7/05 19:25:02 [USMLE_Step_2] strug: adhesions can be due to suregery or infection
02/7/05 19:25:02 [USMLE_Step_2] megs: can u be specific strug
02/7/05 19:25:14 [USMLE_Step_2] megs: yup
02/7/05 19:25:21 [USMLE_Step_2] megs: whats treatment??
02/7/05 19:25:27 [USMLE_Step_2] sanz: nil?
02/7/05 19:25:30 [USMLE_Step_2] strug: surgical
02/7/05 19:25:41 [USMLE_Step_2] megs: whay surgery??
02/7/05 19:25:54 [USMLE_Step_2] sanz: Rx for Asherman is surgical? but the endom cells are already destroyed init?
02/7/05 19:26:15 [USMLE_Step_2] megs: laser ablasions of adhesions...or u can just keep IUD
02/7/05 19:26:27 [USMLE_Step_2] megs: TO PREVENT ADHESONS IN UTERUS
02/7/05 19:26:49 [USMLE_Step_2] sanz: ok thnx
02/7/05 19:26:49 [USMLE_Step_2] strug: sanz Rx is for stenosis
02/7/05 19:27:01 [USMLE_Step_2] strug: and obstruction that is caused due to it
02/7/05 19:27:07 [USMLE_Step_2] megs: YES..
02/7/05 19:27:15 [USMLE_Step_2] megs: ENDOMETRIAM IS LOST
02/7/05 19:27:17 [USMLE_Step_2] sanz: so i guess you can salvage and get the uterine fn back...
02/7/05 19:27:35 [USMLE_Step_2] megs: CANT REGENERATE BUT CAN TRY HIGH DOSE ESTROGEN
02/7/05 19:27:56 [USMLE_Step_2] lanny: some cases are refract to thpy
02/7/05 19:28:04 [USMLE_Step_2] lanny: severe cases of asherman
02/7/05 19:28:05 [USMLE_Step_2] megs: FOR RECIDUAL ENDO TO REGENERATE
02/7/05 19:28:26 [USMLE_Step_2] lanny: one ds can be caused by doc while doing a d/c
02/7/05 19:28:39 [USMLE_Step_2] megs: YUP LANNY
02/7/05 19:29:16 [USMLE_Step_2] megs: what r the causes for primary amenorrhoea??
02/7/05 19:29:33 [USMLE_Step_2] sanz: can be due to ovarian failure...
02/7/05 19:29:36 [USMLE_Step_2] sanz: like PCOS
02/7/05 19:29:44 [USMLE_Step_2] sanz: or Turners
02/7/05 19:29:50 [USMLE_Step_2] lanny: preg
02/7/05 19:30:00 [USMLE_Step_2] lanny: pituitary dys
02/7/05 19:30:01 [USMLE_Step_2] megs: NOT PREGNANCY LANNY
02/7/05 19:30:08 [USMLE_Step_2] sanz: i take it back... PCOS is secondary amenorrhea i think
02/7/05 19:30:12 [USMLE_Step_2] lanny: always r/o preg in ammeno
02/7/05 19:30:15 [USMLE_Step_2] megs: ITS CAUSE OF SECONDORY AMENORRHOEA
02/7/05 19:30:17 [USMLE_Step_2] strug: uterus and brest present is inperforate hymen, vaginal septum,
02/7/05 19:30:37 [USMLE_Step_2] lanny: the most comm cause of ammenor is preg
02/7/05 19:30:39 [USMLE_Step_2] cyrus1345: 15 years old without breast develop or pubic hair pelvic exam normal what's your next step?
02/7/05 19:30:47 [USMLE_Step_2] megs: AGREE LANNY
02/7/05 19:30:51 [USMLE_Step_2] strug: anorexia nervosia, excessive exercise, or preg without having the first perod
02/7/05 19:30:57 [USMLE_Step_2] sanz: nasi, karyotype
02/7/05 19:31:09 [USMLE_Step_2] strug: USG to look for uterus
02/7/05 19:31:10 [USMLE_Step_2] megs: YES STRUG
02/7/05 19:31:28 [USMLE_Step_2] cyrus1345: good snaz,Karyotip and FSH
02/7/05 19:32:11 [USMLE_Step_2] lanny: strug is right too anatomical
02/7/05 19:32:19 [USMLE_Step_2] strug: hey nasi can we know if utersu present or not on pelvic exam?
02/7/05 19:32:40 [USMLE_Step_2] dua_frank: no
02/7/05 19:33:02 [USMLE_Step_2] cyrus1345: yes strug pelvioc exam will show norm vagina and uteus
02/7/05 19:33:17 [USMLE_Step_2] dua_frank: normal uterus is in the pelvis
02/7/05 19:33:26 [USMLE_Step_2] strug: ok gotcha
02/7/05 19:33:30 [USMLE_Step_2] lanny: in any case of prim amenn first things breast prst.? estrogen primed? uterus prst?
02/7/05 19:33:32 [USMLE_Step_2] strug: thanks dua and nasi
02/7/05 19:34:03 [USMLE_Step_2] strug: i gotcha ur funda nasi thanks for the q
02/7/05 19:34:06 [USMLE_Step_2] lanny: of course if breast prst then estro is ok
02/7/05 19:35:13 [USMLE_Step_2] cyrus1345: 15 yeatrs old with breat develop and pubic hair ,pelvic exam normmal what's your next step?
02/7/05 19:35:32 [USMLE_Step_2] sanz: progestin challenge
02/7/05 19:35:49 [USMLE_Step_2] sanz: and FSH measure
02/7/05 19:35:50 [USMLE_Step_2] cyrus1345: no snaz
02/7/05 19:36:09 [USMLE_Step_2] strug: testosteron level and karyo
02/7/05 19:36:28 [USMLE_Step_2] sanz: prolactin and TSH?
02/7/05 19:36:31 [USMLE_Step_2] sanz: heheh
02/7/05 19:36:42 [USMLE_Step_2] cyrus1345: conservative managment !!! :)
02/7/05 19:36:56 [USMLE_Step_2] lanny: really dont u stand the q
02/7/05 19:36:59 [USMLE_Step_2] strug: oh yes gosh
02/7/05 19:37:05 [USMLE_Step_2] strug: a very good q nasi
02/7/05 19:37:07 [USMLE_Step_2] cyrus1345: after 16 years it will be ameno
02/7/05 19:37:18 [USMLE_Step_2] strug: if secondary sexual charac present lanny
02/7/05 19:37:42 [USMLE_Step_2] sanz: oh yeah... so she doesnt need Ix until after 16 yr
02/7/05 19:37:58 [USMLE_Step_2] strug: primary amenorrhiea defined as 14 years without sec sex charac and 16 with sec sex character and no mensturation
02/7/05 19:37:59 [USMLE_Step_2] sanz: tricky nasi :)
02/7/05 19:38:09 huli72 Logs in
02/7/05 19:38:13 huli72 Joins Subroom USMLE_Step_2
02/7/05 19:38:13 [USMLE_Step_2] lanny: yea tricky indeed
02/7/05 19:38:15 [USMLE_Step_2] strug: good one
02/7/05 19:38:22 [USMLE_Step_2] strug: hi huli
02/7/05 19:38:27 [USMLE_Step_2] sanz: we have to think... hehe
02/7/05 19:38:30 [USMLE_Step_2] huli72: hi, strug
02/7/05 19:38:33 [USMLE_Step_2] cyrus1345: Hi huli
02/7/05 19:38:34 [USMLE_Step_2] dua_frank: hi huli
02/7/05 19:38:37 [USMLE_Step_2] sanz: hey huli
02/7/05 19:38:41 [USMLE_Step_2] huli72: Hi, friends
02/7/05 19:39:19 [USMLE_Step_2] sanz: 1st step in the work up of sec amenorrhoea?
02/7/05 19:39:35 [USMLE_Step_2] megs: PREGNANCY TEST
02/7/05 19:39:36 [USMLE_Step_2] strug: B hcg
02/7/05 19:39:43 [USMLE_Step_2] sanz: yup
02/7/05 19:39:44 [USMLE_Step_2] sanz: next
02/7/05 19:39:47 [USMLE_Step_2] strug: tsh
02/7/05 19:39:50 [USMLE_Step_2] sanz: yup
02/7/05 19:39:52 [USMLE_Step_2] sanz: next
02/7/05 19:39:53 [USMLE_Step_2] cyrus1345: 17 years breast develop and pubic hair pelvic exam short vagina and absent uterus next step?
02/7/05 19:39:55 [USMLE_Step_2] strug: prolactin
02/7/05 19:39:59 [USMLE_Step_2] lanny: FSH LH
02/7/05 19:40:06 [USMLE_Step_2] megs: yup
02/7/05 19:40:13 [USMLE_Step_2] huli72: no
02/7/05 19:40:14 [USMLE_Step_2] strug: testo and karyotyo
02/7/05 19:40:23 [USMLE_Step_2] huli72: agree with strug
02/7/05 19:40:32 [USMLE_Step_2] huli72: usg ingual canal
02/7/05 19:40:35 [USMLE_Step_2] cyrus1345: good strug
02/7/05 19:40:40 [USMLE_Step_2] strug: at last
02/7/05 19:40:41 [USMLE_Step_2] huli72: PE ingual canal
02/7/05 19:40:49 [USMLE_Step_2] strug: wahts that huli?
02/7/05 19:41:04 [USMLE_Step_2] huli72: to look for the undescent testis
02/7/05 19:41:08 [USMLE_Step_2] sanz: yup
02/7/05 19:41:28 [USMLE_Step_2] strug: ok sanz continue with ur next q
02/7/05 19:41:43 [USMLE_Step_2] strug: after prolactin what?
02/7/05 19:41:50 [USMLE_Step_2] sanz: ok.. so now you've done beta hCG and Prolactin and TSH
02/7/05 19:41:51 [USMLE_Step_2] sanz: next what?
02/7/05 19:41:58 [USMLE_Step_2] cyrus1345: p challange test
02/7/05 19:42:01 [USMLE_Step_2] huli72: pregesterone stim
02/7/05 19:42:01 [USMLE_Step_2] sanz: good
02/7/05 19:42:02 [USMLE_Step_2] strug: progeston challn
02/7/05 19:42:06 [USMLE_Step_2] sanz: how is it done?
02/7/05 19:42:18 [USMLE_Step_2] sanz: and what does the various results indicate?
02/7/05 19:42:19 [USMLE_Step_2] huli72: give p for 3 days?
02/7/05 19:42:19 [USMLE_Step_2] strug: give Iv one shot or 7 days of prog
02/7/05 19:42:32 [USMLE_Step_2] huli72: 7 days
02/7/05 19:42:35 [USMLE_Step_2] strug: if bleeding it was due to anovulation
02/7/05 19:42:37 [USMLE_Step_2] cyrus1345: medroxy prgesteron 5 mg for 5-7
02/7/05 19:42:47 [USMLE_Step_2] huli72: or thanks Nasi
02/7/05 19:42:49 [USMLE_Step_2] lanny: huli why usg inguinal
02/7/05 19:42:50 [USMLE_Step_2] strug: if no bleeding proceed
02/7/05 19:42:53 [USMLE_Step_2] sanz: yup.. at the end of 5-7 days... see if there's withdrawl belld
02/7/05 19:43:00 [USMLE_Step_2] sanz: bleed even
02/7/05 19:43:08 [USMLE_Step_2] huli72: that is for megs'q
02/7/05 19:43:12 [USMLE_Step_2] sanz: if bleeding, means what?
02/7/05 19:43:12 [USMLE_Step_2] megs: anovulation
02/7/05 19:43:17 [USMLE_Step_2] lanny: ok huli got it
02/7/05 19:43:27 [USMLE_Step_2] huli72: about androgen insensitive disease
02/7/05 19:43:52 [USMLE_Step_2] cyrus1345: anovulation
02/7/05 19:43:54 [USMLE_Step_2] huli72: the ovary produced estrogen
02/7/05 19:43:59 [USMLE_Step_2] sanz: yes megs adn nasi
02/7/05 19:44:06 [USMLE_Step_2] cyrus1345: then next step?
02/7/05 19:44:13 [USMLE_Step_2] strug: esto prog chann test
02/7/05 19:44:24 [USMLE_Step_2] huli72: FSH?
02/7/05 19:44:28 [USMLE_Step_2] huli72: or LH?
02/7/05 19:44:34 [USMLE_Step_2] strug: if bleedong due to lack of estrogen which could be
02/7/05 19:44:34 [USMLE_Step_2] sanz: bleeding after prog challenge means anovulation... then see if hirstut or not
02/7/05 19:44:59 [USMLE_Step_2] strug: if no bleeding see for outflow tract obstructuon
02/7/05 19:45:12 [USMLE_Step_2] sanz: if hirsute, measure test and DHEA -- PCOS
02/7/05 19:45:25 malak1993 Logs in
02/7/05 19:45:29 [USMLE_Step_2] sanz: non hirsute --> hypothalamic dysfn
02/7/05 19:45:40 [USMLE_Step_2] megs: IF NO BLEEDING AFTER COMBO...OUTFLOW OBSTR
02/7/05 19:45:45 malak1993 Logs Out
02/7/05 19:45:49 [USMLE_Step_2] sanz: yup megs
02/7/05 19:45:57 [USMLE_Step_2] dua_frank: and sanz said she was not good at obgyn, liar :P
02/7/05 19:46:10 [USMLE_Step_2] strug: dua caught u sanz
02/7/05 19:46:11 [USMLE_Step_2] sanz: dua, i just rad this before i came... hehe
02/7/05 19:46:13 [USMLE_Step_2] huli72: too humble
02/7/05 19:46:15 [USMLE_Step_2] sanz: read
02/7/05 19:46:21 [USMLE_Step_2] dua_frank: ah ha :P
02/7/05 19:46:24 [USMLE_Step_2] sanz: ask me tmrw and it would be gone
02/7/05 19:46:26 [USMLE_Step_2] sanz: hehe
02/7/05 19:46:33 [USMLE_Step_2] dua_frank: lol
02/7/05 19:46:43 [USMLE_Step_2] lanny: why do we do combo etr pro test?
02/7/05 19:46:44 [USMLE_Step_2] strug: ok continue
02/7/05 19:46:50 [USMLE_Step_2] sanz: so after proge challenge and no bleeding, you need to do what?
02/7/05 19:46:51 [USMLE_Step_2] dua_frank: yes please
02/7/05 19:47:07 [USMLE_Step_2] strug: esto prog test
02/7/05 19:47:27 [USMLE_Step_2] lanny: why estr pro strug?
02/7/05 19:47:31 [USMLE_Step_2] sanz: you've concluded that it's outflow obstruction... so rule out Asherman
02/7/05 19:47:35 [USMLE_Step_2] sanz: then measure FSH
02/7/05 19:47:45 [USMLE_Step_2] huli72: and LH
02/7/05 19:47:48 [USMLE_Step_2] megs: also cervical stenosis
02/7/05 19:47:48 [USMLE_Step_2] sanz: yes huli
02/7/05 19:47:49 [USMLE_Step_2] strug: if low hypothalamic
02/7/05 19:48:04 [USMLE_Step_2] strug: if high ovarian failure
02/7/05 19:48:06 [USMLE_Step_2] huli72: if high, ovarian failure
02/7/05 19:48:08 [USMLE_Step_2] sanz: if FSH is low, then it's severe hypothalmic dysfn
02/7/05 19:48:12 [USMLE_Step_2] sanz: like sheehan
02/7/05 19:48:23 [USMLE_Step_2] megs: what is premature ovarian failure??
02/7/05 19:48:24 [USMLE_Step_2] sanz: if FSH is high, then it's gonadal failure
02/7/05 19:48:35 [USMLE_Step_2] huli72: FSH high before 35?
02/7/05 19:48:42 [USMLE_Step_2] huli72: and menopause too
02/7/05 19:48:52 [USMLE_Step_2] megs: agree
02/7/05 19:49:04 [USMLE_Step_2] huli72: I am not sure it is 35 or....
02/7/05 19:49:15 [USMLE_Step_2] cyrus1345: 17 years with breast develo and pubic hair pelvic exam norm vagina and uterus never menstraul period next step?
02/7/05 19:49:35 [USMLE_Step_2] huli72: PE ingual canal
02/7/05 19:49:40 [USMLE_Step_2] huli72: look for testis
02/7/05 19:49:48 [USMLE_Step_2] cyrus1345: no huli
02/7/05 19:49:50 [USMLE_Step_2] strug: preg test nsi
02/7/05 19:49:51 [USMLE_Step_2] huli72: no
02/7/05 19:50:02 [USMLE_Step_2] lanny: preg
02/7/05 19:50:18 [USMLE_Step_2] cyrus1345: good strug,manage exactly like secemdary ameno
02/7/05 19:50:21 barsobia99 Logs in
02/7/05 19:50:22 [USMLE_Step_2] megs: it should be pregnancy test
02/7/05 19:50:22 barsobia99 Joins Subroom USMLE_Step_1
02/7/05 19:50:23 [USMLE_Step_2] sanz: ask abt diet and calculate BMI
02/7/05 19:50:28 [USMLE_Step_2] strug: thanks nasi
02/7/05 19:50:54 [USMLE_Step_2] sanz: what's the ans?
02/7/05 19:51:05 [USMLE_Step_2] strug: Pregnancy test sanz
02/7/05 19:51:21 [USMLE_Step_2] sanz: but she has never menstrated before...
02/7/05 19:51:25 barsobia99 Logs Out
02/7/05 19:51:31 [USMLE_Step_2] strug: she can be preg sanz
02/7/05 19:51:35 [USMLE_Step_2] megs: can happen sanz
02/7/05 19:51:38 [USMLE_Step_2] sanz: ok
02/7/05 19:51:49 [USMLE_Step_2] lanny: in amenorrhoea first r/o preg
02/7/05 19:51:50 [USMLE_Step_2] huli72: the same work up as 2nd amenorrhea
02/7/05 19:51:54 [USMLE_Step_2] megs: always rule out ppregnacy first
02/7/05 19:51:58 [USMLE_Step_2] strug: yup
02/7/05 19:52:17 [USMLE_Step_2] lanny: dont assume sex active or not
02/7/05 19:53:13 [USMLE_Step_2] megs: how will you dx PCOD
02/7/05 19:53:30 [USMLE_Step_2] huli72: 17 yo girl, no breast development, has uterus, what's next?
02/7/05 19:53:31 [USMLE_Step_2] sanz: LH/FSh and DHEA
02/7/05 19:53:36 [USMLE_Step_2] lanny: prog challenge
02/7/05 19:53:44 [USMLE_Step_2] lanny: look for vag bleed
02/7/05 19:53:44 [USMLE_Step_2] cyrus1345: serum LH/FSH raitio >3
02/7/05 19:53:53 [USMLE_Step_2] megs: all correct
02/7/05 19:54:00 [USMLE_Step_2] megs: what on USG??
02/7/05 19:54:15 [USMLE_Step_2] huli72: poly cystic ovary
02/7/05 19:54:23 [USMLE_Step_2] lanny: multiple follic cysts?
02/7/05 19:54:29 [USMLE_Step_2] megs: neckless pattern of follicles..correct huli
02/7/05 19:54:31 [USMLE_Step_2] strug: inc echogeniscity
02/7/05 19:54:40 [USMLE_Step_2] strug: necklace pattern
02/7/05 19:54:43 [USMLE_Step_2] sanz: nasi, dont know... prog challenge?
02/7/05 19:54:45 [USMLE_Step_2] cyrus1345: FSh and karyo huli
02/7/05 19:55:05 [USMLE_Step_2] huli72: yes, Nasi
02/7/05 19:55:10 [USMLE_Step_2] huli72: dx?
02/7/05 19:55:20 [USMLE_Step_2] huli72: and usg
02/7/05 19:55:21 [USMLE_Step_2] cyrus1345: turner syn
02/7/05 19:55:31 [USMLE_Step_2] huli72: yes
02/7/05 19:55:34 [USMLE_Step_2] sanz: oh, it's huli who asked the q... i am colour blind
02/7/05 19:55:35 [USMLE_Step_2] strug: or hypotahlmic failure
02/7/05 19:55:35 [USMLE_Step_2] cyrus1345: snaz I don't know
02/7/05 19:55:56 [USMLE_Step_2] strug: huli and nasi have same color
02/7/05 19:55:58 [USMLE_Step_2] huli72: and yes, strug
02/7/05 19:56:25 [USMLE_Step_2] huli72: I will change to another color
02/7/05 19:56:28 [USMLE_Step_2] cyrus1345: I changed it!
02/7/05 19:56:38 [USMLE_Step_2] sanz: hehe
02/7/05 19:56:41 [USMLE_Step_2] strug: ok thanks u guys are great
02/7/05 19:56:45 [USMLE_Step_2] sanz: golden nasi
02/7/05 19:56:49 [USMLE_Step_2] cyrus1345: :D
02/7/05 19:56:54 [USMLE_Step_2] huli72: thanks, Nasi,
02/7/05 19:56:56 beecrazee Logs in
02/7/05 19:57:00 [USMLE_Step_2] cyrus1345: hahahah ,!
02/7/05 19:57:38 beecrazee: anybody there
02/7/05 19:57:49 [USMLE_Step_2] sanz: in pt with PCOS, what other dz would you check for?
02/7/05 19:57:58 beecrazee Joins Subroom Clinical_Skills
02/7/05 19:58:05 lenhoxung Logs in
02/7/05 19:58:11 [USMLE_Step_2] sanz: maybe i should ask what other dz ar they at risk of
02/7/05 19:58:11 [USMLE_Step_2] huli72: diabetis
02/7/05 19:58:15 [USMLE_Step_2] sanz: yes... and?
02/7/05 19:58:16 lenhoxung Joins Subroom USMLE_Step_1
02/7/05 19:58:21 [USMLE_Step_2] strug: HT
02/7/05 19:58:22 sux Logs in
02/7/05 19:58:23 [USMLE_Step_2] huli72: endometria ca
02/7/05 19:58:24 [USMLE_Step_2] sanz: great
02/7/05 19:58:27 [USMLE_Step_2] sanz: you guys rock!
02/7/05 19:58:44 beecrazee Logs Out
02/7/05 19:59:05 [USMLE_Step_2] lanny: trt of PCO
02/7/05 19:59:12 [USMLE_Step_2] cyrus1345: 18 years old with dysmenor your first step?
02/7/05 19:59:15 [USMLE_Step_2] strug: oCP
02/7/05 19:59:18 [USMLE_Step_2] sanz: OCP
02/7/05 19:59:25 [USMLE_Step_2] lanny: agree
02/7/05 19:59:25 [USMLE_Step_2] dua_frank: ocp
02/7/05 19:59:28 [USMLE_Step_2] strug: NSAids nasi
02/7/05 19:59:43 [USMLE_Step_2] cyrus1345: no strug first step?


[huli72] that drug stimulate ovulation
[huli72] I forget the name
[huli72] Ci....
[sanz] clomiphene?
[megs] YUP SANZ
[huli72] yes, sanz
[sanz] but i dont think that's the first step
[huli72] and metafomin
[strug] ask her tro keep diary nasi
[cyrus1345] do pelvic eam,it's important to rule out inflamatory and infection etiolgy for pelvic pain
[cyrus1345] :D
[cyrus1345] then if rule out then go for NSAID
[cyrus1345] or ocp
[strug] can we do pelvic exam in 18 year old?
[megs] WHICH NSAID???
[strug] brufen megs
[huli72] I don't think so, strug
[megs] MEFENEMIC ACID
[cyrus1345] what do you mean strug ,it's USA my dear!
[megs] BRUFEN
[cyrus1345] she is 18 not 8 years old
[huli72] so, we can do?
[strug] ok gotcha u nasi......being an Indian cant think otherway
[dua_frank] not on usmle
[dua_frank] you cannot
[huli72] so, we can do pelvic exam in an 18 yo?
[megs] WHEN TO USE ocpills for dysmen???
[huli72] when the pt don't want to get pregnent
8:02 PM [megs] AND THEY R NOT BENEFITAED FROM NSAID
8:03 PM [megs] we can do pelvic exam in non vergin pt
8:03 PM [cyrus1345] high yield OB/Gy page 118 written by Sakala MD ,yes you should do it huli
8:03 PM [lanny] dua why cant you do pelvic exam on 18 yo
8:03 PM [huli72] thanks, Nasi
8:03 PM [dua_frank] i thought not before she is pregnant
8:03 PM [megs] u avoid pelvic exam in vergins
8:03 PM [sanz] so when can we start doing pelviv exam? what's the age cut off?
8:03 PM [strug] just a doubt...do we do it under anesthesia or ......
8:04 PM [dua_frank] i thought that was the age limit
8:04 PM [lanny] can be done under anesth
8:04 PM [cyrus1345] strug it's for child!18 years old is not child!
8:04 PM [lanny] dont think there is an age limit
8:04 PM [megs] we do but for exceptional cases
8:04 PM [cyrus1345] ye slanny never do it pelvic exam in child
8:04 PM [dua_frank] yeah megs thats what i thought too
8:04 PM [lanny] 18 yo in USA 90 % of time is not a virgin!!!
8:04 PM [strug] ok thanks nasi.....i was just confused....
8:04 PM [sanz] ok... so if no longer a virgin, we can
8:04 PM [cyrus1345] alwyes in anesthesia
8:04 PM [dua_frank] yes sanz
8:05 PM [lanny] virgin or not is not imp use anesthesia
8:05 PM [megs] if virgin and pv is neccessary do it under anaesthe
8:05 PM [sanz] ok
8:05 PM [dua_frank] ok
8:05 PM [strug] thanks nasi good point to be clearaed
8:06 PM [cyrus1345] for exaple 6 years old come with vaginal bleeding what is your next step?
8:06 PM [strug] exam under anestheis
8:06 PM [huli72] usg?
8:06 PM [cyrus1345] history is negative for any drug
8:06 PM [lanny] agree with strug
8:06 PM [cyrus1345] yes strug very good
8:06 PM [lanny] look for foreign body
8:06 PM [sanz] what is the most common location for Ect preg?
8:06 PM [strug] lanny my friend
8:06 PM [dua_frank] fal tube
8:06 PM [strug] ampulla
8:06 PM [megs] ampulla
8:06 PM [lanny] ampulla
8:06 PM [sanz] yup ampulla
8:06 PM [dua_frank] ok ampulla
8:07 PM [sanz] lol dua
8:07 PM [dua_frank] *)
8:07 PM [sanz] ampulla is part of the fall tube...
8:07 PM [dua_frank] i know
8:07 PM [lanny] yep
8:07 PM [huli72] :o
8:07 PM [dua_frank] i was too quick to put in my answer which was wrong anyway
8:07 PM [megs] what is DUB???
8:07 PM [sanz] well, it's half right!
8:07 PM [dua_frank] thanks
8:07 PM [lanny] dysfunctional uterine bleed
8:07 PM [dua_frank] dysfunctional uterine bleeding
8:07 PM calender has left the chat.
8:07 PM [strug] dysfunctional uterina bleeding megs
8:07 PM [huli72] disfunction of uteri bleeding
8:08 PM [megs] DEFINE IT
8:08 PM [sanz] usus due to anovulation
8:08 PM [strug] irregula vag bleeding without normal menstru symt....?
8:08 PM [huli72] bleeding from vaginal not due to pregnancy or mense
8:08 PM [lanny] pregnancy has to be ruoed oout
8:09 PM [megs] ABNORMAL MENS BLEEDING IN ABSENCE OF PALPABLE PELVIC PATHOLOGY
8:09 PM [sanz] ok
8:09 PM [strug] wow only a gynecologist can be so perfect......thanks megs
8:09 PM [huli72] exclude tumor too
8:09 PM [lanny] yes
8:09 PM calender has left the chat.
8:09 PM [sanz] yup strug, gotta learn fr the expert!
8:10 PM [megs] i can see u gus doing far beter than me
8:10 PM [megs] guys
8:10 PM [sanz] ok.. what is sheehan syndr?
8:10 PM [strug] postpartum pitutuiary necrosis
8:10 PM [strug] due to excessive blood loss intraprtum
8:10 PM [lanny] pituitary apoplexy post part
8:11 PM [lanny] caused by xcess blood loss
8:11 PM [cyrus1345] most comoon location for endomeetriosis?
8:11 PM [strug] culdesac
8:11 PM [cyrus1345] no
8:11 PM [megs] good strug
8:11 PM [lanny] popuch of douglkas
8:11 PM [sanz] postpartum pitui ischemia due to xs blood loss
8:11 PM [strug] ovary?
8:11 PM [sanz] what is the first sign of Sheehan synd?
8:11 PM [cyrus1345] first OVARY then cul; de sac
8:11 PM [strug] loss of lactattion sanz
8:11 PM [huli72] and fatigue
8:11 PM [strug] relly nasi first overy?
8:12 PM [megs] isnt the pouch of doglous and cul de sac same pl clarify confused???
8:12 PM [lanny] i think is pouch of douglas first
8:12 PM [cyrus1345] yes strug in my bok is written ovary
8:12 PM [strug] they are the same megs
8:12 PM [lanny] yes im used to pouch
8:12 PM [strug] ok then it must be overy :(
8:12 PM [cyrus1345] what is pathogenes of endometriosis?
8:13 PM [megs] retrograde menses
8:13 PM [strug] endometium at abnormal location
8:13 PM [cyrus1345] good megs
8:13 PM [lanny] endom tissue outside uterus
8:13 PM [cyrus1345] retrograde mense,extremely high yeild!;-)!
8:13 PM [megs] ather theories r coelomic metaplasia
8:14 PM [strug] thanks nasi :)
8:14 PM [huli72] yes, megs
8:14 PM [strug] what megs?
8:14 PM [sanz] oh yeah megs.. i have heard of it
8:14 PM [cyrus1345] how do you manage endometriosis in 34 years old?
8:14 PM [huli72] OCP
8:14 PM [strug] OCP
8:14 PM [megs] oc pills
8:14 PM [lanny] Gnrh agonist
8:15 PM [sanz] progestin
8:15 PM [sanz] hehe
8:15 PM [huli72] danazol
8:15 PM [lanny] yep huli
8:15 PM [cyrus1345] make pseduepregnacy by progestin or pseudo menopuause by danazol
8:15 PM [lanny] ocp can be used too
8:16 PM [cyrus1345] leupride
8:16 PM [megs] exactluy nasi
8:16 PM [sanz] so when do you use OCP?
8:16 PM [lanny] dont understand nasi
8:16 PM [cyrus1345] megs are you GY?
8:16 PM [huli72] when fertility is disired
8:16 PM [huli72] later
8:17 PM [sanz] see in that case you can still use progestin and danazol until the time when she wants to get pregnant right?
8:18 PM [strug] 31 year female with menometrorrhagia....next step?
8:18 PM [sanz] i thought when fertility is desired, it's lap ablation...?
8:18 PM [sanz] does any one know?
8:18 PM [cyrus1345] pregnancy test
8:18 PM [cyrus1345] strug?
8:18 PM [huli72] hCG
8:18 PM [huli72] test
8:18 PM [strug] yes nasi and huli right
8:18 PM [strug] preg test was normal....next step?
8:19 PM [huli72] lap ablation when can't be controled by medicine
8:19 PM [huli72] usg to exclude leimyoma
8:19 PM [cyrus1345] then it because of anovulation
8:19 PM [huli72] and watch for endometrial too
8:19 PM [strug] next step is to look for anatomicaal lesions like of vagina, cervix or endotmerum
8:19 PM [cyrus1345] put the paitent on OCP!I think !
8:20 PM [cyrus1345] oh ok!
8:20 PM [cyrus1345] I though we rule them out!
8:20 PM [lanny] yea continue as of sec amen
8:20 PM [cyrus1345] thanks strug
8:20 PM [strug] if no anatomical lesions.....next step?
8:20 PM [lanny] prog challenge
8:20 PM [megs] endometrial curret
8:21 PM [megs] to stop the bllediing
8:21 PM [megs] and take biopsy too
8:21 PM [strug] then it could be most likely due to DUb,,,,do an endometiral biopsy
8:21 PM [megs] treatment of puberty meno rrhagia
8:21 PM [sanz] what will the endom bx show strug?
8:22 PM [strug] proloferative endometrium sanz
8:22 PM [sanz] in DUB?
8:22 PM [strug] because of anovluation unopposed estrogen
8:22 PM [sanz] oh oke! thnx
8:22 PM cyrus1345 has left the chat.
8:23 PM [strug] megs can u specify the age
8:23 PM [megs] how to treat puberty menorrhagia 14 yrs
8:23 PM [huli72] estrogen
8:23 PM [megs] immediate rx??/
8:23 PM [strug] exam under anestheis?
8:23 PM [megs] good huli
8:23 PM [lanny] someone define menorrhagia and metro
8:23 PM [strug] u mean iv estro megs
8:24 PM [sanz] menorrhagia - lots
8:24 PM [sanz] metro - in between
8:24 PM [lanny] thx zanz
8:24 PM [megs] yeah can give iv or oral high dose
8:24 PM [sanz] megs.. i'm afraid i dont get it
8:24 PM [strug] i think if patient is unstable not otherwise
8:25 PM [megs] due to chances of thromboplebitis we avoid
8:25 PM [strug] any age pt bleeding excessively vaginally and unstable give iv estrogen
8:25 PM [sanz] ok strug thnx
8:25 PM [megs] but can give
8:25 PM [megs] how estrogen helps to stop bleeding
8:25 PM [megs] whats the mechanism
8:25 PM [huli72] repair endometrial
8:26 PM [megs] got it huli
8:26 PM [megs] sanz i think u were saying about testesterone
8:26 PM [sanz] so esg keep the endometrial in proliferative phase?
8:26 PM [megs] iv testerone is not recommended
8:26 PM [lanny] estrogen makes endomet become proliferate
8:27 PM [sanz] so helps in active profuse bleeding?
8:27 PM [lanny] yes
8:27 PM [megs] it regenerate endometrium
8:28 PM [sanz] cool.. good q
8:28 PM [megs] what other things u can give for meno rrhagia i mean medical treatment
8:28 PM [sanz] OCP
8:28 PM [lanny] megs whats thrombophlebitis in this
8:28 PM [huli72] vit K
8:29 PM [megs] side effect og estrogen is it causes throbosis
8:29 PM [lanny] so we still give pt estrofen?
8:29 PM [huli72] D&C
8:29 PM [strug] female with hirsutism, no virilisation...rapid onset.lab shows very high testosteone....pelvic exam shows adnexal mass....diagnosis?
8:30 PM [huli72] lydig cell tumor
8:30 PM [sanz] PCOS?
8:30 PM [huli72] androgen secreting tumor
8:31 PM [lanny] PCOS
8:31 PM [megs] pcos
8:31 PM [huli72] pcos is slow onset
8:31 PM [strug] huli right its an ovarian tumor most probably sertolileydig cell tunore
8:31 PM [strug] very high test is the key
8:32 PM [strug] in Pco little inc in testosteone
8:32 PM [megs] ok strug
8:32 PM [lanny] adrenal gland hyperplasia
8:33 PM [lanny] what hallmark
8:33 PM [strug] female with hirsutims without virilization....also precocius puberty and is of short strature....whats diagnosis?
8:33 PM [huli72] low ACTH
8:33 PM [sanz] dont know lanny
8:33 PM [huli72] low cortisol
8:33 PM [huli72] high dhea-s
8:34 PM [huli72] virulization, hirsutism
8:34 PM [lanny] all right
8:34 PM [sanz] Mccune Albright strug?
8:34 PM [megs] ambg ext genitalia
8:34 PM [strug] no sanz its congenial adrenal hyperplasia
8:34 PM [strug] late onset cong adre hyper autosoma recessive
8:35 PM [huli72] good q, strug
8:35 PM [megs] which enzyme def most commonly in CAH
8:35 PM [sanz] they dont have virilization as opposed to early onset CAH
8:35 PM [strug] 21 alpha
8:35 PM [lanny] 21
8:35 PM [sanz] cool
8:35 PM [huli72] 21 hydroxylase
8:35 PM [megs] YUP
8:35 PM [lanny] 21 then11
8:35 PM [lanny] trt?
8:35 PM [huli72] agree lanny
8:35 PM [strug] cortisol lanny
8:35 PM [huli72] cortisol
8:36 PM [megs] GLUCO
8:36 PM [huli72] dexamethasone
8:36 PM [lanny] cortisol
8:36 PM [lanny] trt of hirsutism?
8:36 PM [huli72] spiralactone
8:37 PM [strug] female with hirsutim, family history positive, mensus and fertility normal....diagnosis?
8:37 PM [huli72] flutamide
8:37 PM [strug] OCp and spiron lanny
8:37 PM [huli72] heritary hirsutism
8:37 PM [lanny] right strug
8:37 PM [megs] COSTITUTIONAL
8:37 PM [strug] yup Idiopathic Hirsutims
8:38 PM [strug] most common cause of androgen excessis idiopathic
8:38 PM [megs] what is pre mens syndrome??
8:39 PM [strug] occurs in the premenstarual perod
8:39 PM [huli72] migrane, headache
8:39 PM [sanz] irritative
8:39 PM [strug] for cons 3 cycles
8:39 PM [huli72] fatigue
8:39 PM [huli72] edema
8:39 PM [huli72] nausea
8:39 PM [strug] does not occur in preovularotyr peroid
8:39 PM [megs] multifactorial aetiology
8:39 PM [strug] resoves with mestruation
8:39 PM [huli72] how to trt?
8:39 PM [lanny] etiology is unknown
8:39 PM [megs] yup all correct
8:40 PM [strug] has autonomic., musculoskelatel, fatige, emotional sym
8:40 PM [lanny] bromocriptin
8:40 PM [megs] oc pills nsaids
8:40 PM [strug] antidepsenn huli
8:40 PM [sanz] OCP
8:40 PM [megs] frusemide
8:40 PM [lanny] for breast tenderness
8:40 PM [huli72] strug correct?
8:40 PM [strug] serotinin reuptake inhibitior
8:40 PM [lanny] progesterone
8:40 PM [huli72] menstrual diary too
8:40 PM [megs] yeah strug in severe cases
8:40 PM [huli72] yes, strug
8:41 PM [strug] it is most likely confused with what?
8:41 PM [huli72] I am surprised at menstual diary is the trtment.
8:41 PM [strug] its not the Rx its the first step
8:41 PM [huli72] flu?
8:42 PM [strug] because until the symp at the same time and for 3 cycles u cannot call it PMS
8:42 PM [huli72] or chronic fatigue syn?
8:42 PM [strug] Major depression huli
8:42 PM [lanny] anxiety too
8:42 PM [huli72] thnks, strug
8:43 PM [strug] mechanism of ocp in hirsutims?
8:43 PM [lanny] which vitamin are thought to be def
8:43 PM [strug] b6
8:43 PM [megs] what is diff betn hypertricosis and hirsudism??
8:43 PM [lanny] ocp has pos and neg feed back on pit cause a dec in gonadotrop
8:43 PM [strug] hirtusim is male pattern of growth megs
8:44 PM [strug] like upperlip and chest megs
8:44 PM [megs] yup strug
8:44 PM [strug] lanny i m talking about in hirsutims
8:44 PM [lanny] oh thought you meant mech of treatment in hirsuit
8:45 PM [strug] it dec testto formation by dec LH stimulation in theca cell and also dec SBG
8:45 PM zoya has left the chat.
8:45 PM [sanz] ok strug... didint know that
8:46 PM [lanny] yes strug as a conseq of neg f back on pituit
8:46 PM [strug] its imp i guess
8:46 PM [strug] yup lanny
8:46 PM [megs] if idiopathic hirsutism then???
8:47 PM [strug] spironalcatone
8:47 PM [megs] thendont traet hormonally
8:47 PM [sanz] so do they need Rx?
8:47 PM [megs] i am so bad at typig
8:47 PM [lanny] strug estrogen inc SBHG that binds thw inactive testost
8:47 PM [strug] i think we give spirnolactone
8:47 PM [strug] yup lanny u right sorry
8:48 PM [megs] give cosmetic treatment
8:48 PM [lanny] if idiopathic hirsuit we give OCP
8:49 PM [strug] but in idiopathic hirusutim there is androgen excess....we have to treat
8:49 PM [lanny] yes by giving spirono
8:49 PM [strug] lanny my friend
8:49 PM [megs] idiopathic means no cause
8:49 PM [lanny] that binds 5 alpha reduct
8:49 PM [strug] yup no cause for the inc androgen
8:50 PM [megs] spirono is not hormonal prep
8:50 PM [lanny] oh ok guys missed that idiopathic
8:50 PM [megs] so can give, i said no hormonal treatment
8:50 PM [strug] great megs thanks
8:50 PM [sanz] thnx
8:51 PM [lanny] so what do we give megs
8:51 PM [megs] cosmetic tx
8:51 PM [lanny] ok thx
8:51 PM [strug] what is the first step in infertility
8:51 PM [megs] waxin epilation
8:51 PM [sanz] semen analysis
8:51 PM [huli72] history
8:51 PM [lanny] no
8:51 PM [megs] history
8:51 PM [strug] :o megs
8:51 PM [sanz] and mentral diary
8:51 PM [lanny] sanz semen is after rule out maternal causes
8:52 PM [sanz] oh
8:52 PM [lanny] measure LH FSH
8:52 PM [strug] no lanny first is semen
8:52 PM [megs] freq of intercorce and timing
8:52 PM [strug] thats right
8:52 PM [lanny] disagree
8:52 PM [strug] after history first is semen analysis
8:52 PM [megs] in usa they investgate male and female at same time
8:52 PM [lanny] most common cause is male sperm probs but first rule out female causes
8:52 PM [strug] right
8:53 PM [sanz] MCC is female prob
8:53 PM [strug] really?
8:53 PM [huli72] but male factors are easy to assess
8:53 PM [sanz] 60% is female prob
8:53 PM [lanny] disagree sanz
8:53 PM [sanz] male probs is 40%
8:53 PM [strug] i thought both 50
8:53 PM [strug] lemme check
8:53 PM [megs] lot of time is wasted otherwise so first they find cause first
8:54 PM [lanny] its not what they do in hospitals all hosp do things differently its what USm wants
8:54 PM [megs] agree lanny
8:55 PM [megs] so what usmle want???
8:55 PM [megs] whats ans
8:55 PM [sanz] i know it's 40% male prob and 60% female probs
8:55 PM [sanz] cause is unknown in 5%
8:55 PM [strug] in US both male and female contribute for 40% of infrertility....f20% cause unknown
8:56 PM [strug] acc to swanson family practice
8:56 PM [megs] 40% male 40% female and 20% idiopathic
8:56 PM [megs] strug right
8:56 PM [megs] blue print says same
8:57 PM [strug] so we begin their workup togerhter
8:57 PM [lanny] dont remeber the percentages but semen analysis comes after evaluating the female
8:57 PM [strug] semen analysis for male and anovulation for female
8:57 PM [lanny] can chk it later guys
8:57 PM [lanny] yes strug
8:57 PM [strug] ok lanny....u men......
8:57 PM [sanz] heheh strug
8:58 PM [strug] no offences for anyone.....
8:58 PM [megs] how to test ovulation??/
8:58 PM [megs] various methods??
8:59 PM [strug] BBT
8:59 PM [strug] cercvial mucous
8:59 PM [huli72] agree with strug
8:59 PM [megs] bbt charting cx mucus
8:59 PM [sanz] cervical discharge...
8:59 PM [strug] premens cramping
8:59 PM [huli72] fern under microscopy
8:59 PM [megs] what is mittelsmerge
8:59 PM [strug] midcycle pain
8:59 PM [megs] painful ovulation
8:59 PM [lanny] well my dinner time is fast approachingright
8:59 PM [sanz] abdo pain in girls during time of ovulation
8:59 PM [huli72] bleed in the mid of peroid
9:00 PM [sanz] no bleeding right?
9:00 PM [huli72] bye, lanny, enjoy your dinner
9:00 PM [strug] hey guys i found the approch
9:00 PM [sanz] bon apetite lanny
9:00 PM [strug] first take complete historyies of both partners
9:00 PM [sanz] approach to what strug?
9:00 PM [lanny] me too let me hear yours
9:01 PM [megs] i will be back guys
9:01 PM [strug] then compleete phy exam of bothe
9:01 PM [strug] then do semen analysis twice
9:01 PM [lanny] ok let me give you mine
9:01 PM [strug] assessmetn of ovluation
9:01 PM [lanny] are you ready
9:01 PM [strug] ok lanny yes
9:02 PM [lanny] initial apprach to infert coule
9:02 PM [huli72] should be history
9:02 PM [huli72] of marriage
9:02 PM [lanny] assess pelvic factor BBT of fem
9:02 PM [lanny] hysterosalp of fem
9:02 PM [huli72] and PE
9:03 PM [lanny] to look for scarred fallop tube
9:03 PM [lanny] this is the ovulatory fctor
9:03 PM [strug] scarred fallop tube? ovularoty factor lanny?
9:03 PM [lanny] hx of damage STD
9:04 PM [sanz] prev tubal preg i think Strug
9:04 PM [lanny] scarred fallop tube pelvic sorry
9:04 PM [lanny] then semen analysis of male
9:04 PM [lanny] sorry guys dont type too well
9:05 PM [strug] lanny maybe ur right ..... but i would evaluate them togher... :)
9:05 PM [huli72] I think semen analysis should be after hx and PE
9:05 PM [huli72] then do what lanny said above
9:06 PM [lanny] yes huli that is no 1
9:06 PM [strug] i too think the same huli
9:06 PM [lanny] the investigative stages initially should proceed
9:07 PM [lanny] it all deps on a ques poss that they can both be assessed together ie the man and woman
9:07 PM [strug] what is the most common anatomical site for osteoporois?
9:07 PM [sanz] spine
9:07 PM [strug] right sanz good
9:07 PM [lanny] lumbar verteb
9:07 PM [huli72] agree sanz
9:07 PM [strug] how do u assess bone density?
9:07 PM [sanz] DEXA scan
9:08 PM [strug] DEXA scan right
9:08 PM [lanny] DEXA
9:08 PM [strug] how do u find out Ca excretion?
9:08 PM [strug] ca lossin urine i mean
9:08 PM [huli72] urine 24 hours ca
9:08 PM [lanny] yes
9:09 PM [strug] nope guys its 24 hour hydroxyproline or N-telopeptide
9:09 PM jnkhampton has left the chat.
9:09 PM [strug] Rx for osteoporisis?
9:09 PM [huli72] no, that is for collegen turn over or bone turn over
9:09 PM [sanz] exercise wt loss
9:10 PM [huli72] HRT
9:10 PM [sanz] i mean wt bearing
9:10 PM [huli72] best therapy
9:10 PM [sanz] ca supp
9:10 PM [huli72] then biphosphate
9:10 PM [sanz] vit d
9:10 PM [lanny] not sure strug about hydroxy
9:10 PM [huli72] then vit D and ca
9:10 PM [strug] huli i read it as 24 hour urine hydrocyproline for assesing ca loss
9:10 PM [huli72] strug, that should be bone loss
9:10 PM [strug] n telopeptde is a bone brekdown product u right
9:11 PM [huli72] osteroid loss
9:11 PM [huli72] not ca,
9:11 PM [strug] gold standard Rx for osteoporisi is HRT
9:11 PM [strug] biphophonates , SSri can also be given
9:11 PM [strug] benefits of HRT?
9:12 PM [huli72] heart disease
9:12 PM [huli72] HT
9:12 PM [huli72] hyperlipidia
9:12 PM [huli72] diabetes
9:12 PM [huli72] migrane
9:12 PM [sanz] it's not heart dz anymore ...
9:12 PM [huli72] depression
9:12 PM [huli72] CAD
9:12 PM [strug] dec colon ca, alzheimers. dec CAD, protects against osteoporise, relief from vaginal dryness and mental changes
9:12 PM shreya has left the chat.
9:13 PM [lanny] sanz heart dz is controv
9:13 PM [sanz] yeah, so we cannot say it decr CAD
9:13 PM [strug] rally is it controverisal?
9:13 PM [sanz] yes, HUGE controversy
9:13 PM [strug] thanks guys
9:13 PM [strug] what ar ethe C/I of HRT?
9:14 PM [huli72] throbosis
9:14 PM [strug] C/I= contraindication
9:14 PM [lanny] thrombosis
9:14 PM [huli72] breast tumor
9:14 PM [sanz] yup.. and hx of endom ca
9:14 PM [sanz] fam hx
9:14 PM [huli72] smoking
9:14 PM [strug] liver disease, H/0 breast or endo metrial cancer, thrombosis, unecplained vagina bleeding
9:14 PM [huli72] hypercoagulate state
9:15 PM [strug] no family history sanz and no smoking huli
9:15 PM [huli72] thnks, strug
9:15 PM [megs] CADisnow a days not c/i
9:15 PM [sanz] ok
9:16 PM [lanny] yes megs this topic makes pts argue with their docs >>>
9:16 PM [lanny] could be asked as an ethics question
9:16 PM [megs] how to minimise comli of hrt
9:16 PM [strug] give proges with estor
9:16 PM [sanz] like how lanny?
9:16 PM [lanny] agree strug
9:16 PM [shreya] add progesterone
9:17 PM [megs] give and strug????
9:17 PM [strug] i didnt get u megs
9:17 PM [lanny] pt asks doc about whats best to prvt heart dz.her mum died of heart dz, she heard its goodto help with her weak bones
9:17 PM [megs] use diff route of admis of hrt
9:18 PM [megs] pathch pessary
9:18 PM [strug] that dec the complications?
9:18 PM [strug] megs
9:18 PM [strug] why not give just oral megs
9:19 PM [lanny] the HRT itself is a combo of estr and pro
9:19 PM [strug] not always lanny
9:19 PM [sanz] no lanny... they have diff ways of preparations
9:19 PM [strug] if female has hystectomy i will give estrogen oonly
9:19 PM [huli72] yes, strug
9:20 PM [lanny] i was actually asking as i have heard that sometimes no prog in it.. thanks
9:20 PM [strug] no prob lanny
9:20 PM [huli72] if no uterus, no progesterone is needed.
9:21 PM [lanny] megs what is pessary
9:21 PM [strug] megs does diff routes of administaion dec the complications?
9:21 PM [megs] PATCH AVOID FIRST PASS MECH HENSE LESS ESTR REQ
9:21 PM [megs] LESS ESTROGEN LESS SIDE EFFECTS
9:21 PM [huli72] good points, megs
9:21 PM [lanny] agre thx megs
9:22 PM [strug] ah ha :)
9:22 PM [megs] THANX
9:22 PM [megs] PESSARY IS VAGINAL TABLET
9:22 PM [strug] whats the benefit of raloxifen over tamoxifen?
9:22 PM [lanny] no poss of endo cancer
9:22 PM [strug] correct lanny
9:23 PM [lanny] whats tomm guys
9:23 PM [lanny] tommorow strug the administrator in chief!
9:23 PM [strug] benign gyneco
9:23 PM [megs] ok strug
9:23 PM TTW has left the chat.
9:23 PM [lanny] ok well are we closing shop
9:23 PM [strug] prolapse, incontinene., std etc.....
9:23 PM [lanny] good
9:24 PM [huli72] see you guys, tomorrow
9:24 PM [lanny] see you huli
9:24 PM [strug] i have a doubt
9:24 PM [huli72] what is it, strug
9:24 PM [lanny] on what
9:24 PM [strug] there was a q in usmle world i didnt understand
9:25 PM [huli72] can you type it here?
9:25 PM [megs] what strug??
9:25 PM shreya has left the chat.
9:25 PM [strug] 25 yrs obese female, evaluation of faacial hari and irr mensus
9:25 PM [huli72] pcos
9:25 PM [strug] acth stimualtion...inc the dheas leverls to 12
9:26 PM [strug] the dheas level befor that was 5
9:26 PM huli72 has left the chat.
9:26 PM [sanz] yeah, i remember this q
9:27 PM [strug] what is this acth stimulation? and how does it help us in diagnosing PCOS?
9:27 PM zoya has left the chat.
9:27 PM [sanz] from what i understood from their explanation
9:27 PM [huli72] I was kicked out
9:28 PM [strug] wb huli
9:28 PM [sanz] in PCOS, their adrenal glands are more sensitive to ACTH
9:28 PM [sanz] so by giving ACTH stimulation, DHEA will incr lots
9:28 PM calender has left the chat.
9:28 PM [huli72] is pcos the answer? strug
9:28 PM [megs] yes sanz u r riht
9:28 PM [strug] i thought dheas levels high only in adrenal tumor
9:28 PM [strug] yes huli its pcos
9:29 PM [huli72] dheas were reported in pcos too
9:30 PM [strug] i choose adr tumor and got the q wrong :(
9:30 PM [sanz] yes, DHEA levels are high in adrenal tumor... but in PCOS, for some reason their adrenal is very sensitive to ACTH
9:30 PM [huli72] and you learn pcos now
9:30 PM [strug] but now i will chose PCo :)
9:30 PM [sanz] you see in adrenal tumour, ACTH wont make the DHEA go up
9:30 PM [sanz] cuz the DHEA pdt in adrenal tumour is autonomic... tumour does what it likes
9:31 PM [strug] thank you very much sanz....its so nice of u.....i will never forget now :)
9:31 PM [sanz] it's like when you have chushing and you do stim to see... if it's ect pdt, then there wont be any effect
9:32 PM [huli72] very nice theary, sanz, I won't mess up any more
9:32 PM [sanz] i think the point of the q was good tho... to show us how to diff adrenal tumour from PCOS
9:32 PM [strug] yes sanz
9:33 PM [strug] hey are we done for today......
9:33 PM [sanz] i sure hope so!
9:33 PM [strug] its 8:33
9:33 PM [sanz] i have a brain drain
9:33 PM [sanz] hehe
9:33 PM [megs] yup
9:33 PM [megs] tired
9:33 PM [strug] u did well today sanz
9:33 PM [huli72] me too
9:33 PM [strug] megs thanks fa lot for ur expert opinion
9:33 PM [sanz] yeah megs
9:33 PM [sanz] i wish i dont have an aversion to ObGyb
9:33 PM [megs] its my pleasure guys but u all r perfect guys
9:33 PM [strug] bye then all of u see u tomrrow
9:34 PM [megs] bye all
9:34 PM [huli72] bye
9:34 PM [sanz] can i ask sth?
9:34 PM megs has left the chat.
9:34 PM [strug] what sanz?
9:34 PM [sanz] you know the Cd that the USMLE sent us?
9:34 PM [sanz] there're promertirc and NMBE/FREDA
9:34 PM [strug] i have not solved it yet
9:34 PM [sanz] which is the one that is used in the exam?
9:34 PM huli72 has left the chat.
9:35 PM [strug] oh till april i think prometric
9:35 PM [sanz] i havent either but i know they have changed the format
9:35 PM [strug] no not in march dont worry
9:35 PM [sanz] oh oke
9:35 PM [sanz] thnx
9:35 PM [strug] bye
9:35 PM [sanz] bye
9:35 PM strug has left the chat.
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Asclepius1
02-14-2005, 10:23 AM
Can someone help me figure out when my last period was. I think I'm pregnant

Asclepius1
03-29-2005, 01:27 PM
02/7/05 19:05:34 [USMLE_Step_2] megs: hi lanny
02/7/05 19:05:52 [USMLE_Step_2] lanny: hi megs
02/7/05 19:06:01 [USMLE_Step_2] lanny: how're you?
02/7/05 19:06:13 [USMLE_Step_2] megs: fine thank u
02/7/05 19:06:39 [USMLE_Step_2] lanny: so we cont gynae right
02/7/05 19:06:51 [USMLE_Step_2] megs: yeah
02/7/05 19:07:02 [USMLE_Step_2] megs: when r u taking exam??
02/7/05 19:07:05 [USMLE_Step_2] lanny: good how is studies going
02/7/05 19:07:12 [USMLE_Step_2] lanny: oh end march
02/7/05 19:07:21 [USMLE_Step_2] lanny: and you
02/7/05 19:07:23 [USMLE_Step_2] megs: i am taking in may
02/7/05 19:07:40 [USMLE_Step_2] megs: i am doing my first reading
02/7/05 19:07:50 [USMLE_Step_2] lanny: ok,
02/7/05 19:07:51 sanz Logs in
02/7/05 19:07:52 sanz Joins Subroom USMLE_Step_2
02/7/05 19:08:01 [USMLE_Step_2] sanz: hey guys :)
02/7/05 19:08:07 [USMLE_Step_2] lanny: hey sanz
02/7/05 19:08:08 [USMLE_Step_2] megs: but i dont want to miss discussion over here
02/7/05 19:08:18 [USMLE_Step_2] megs: hi sanz how r u today
02/7/05 19:08:28 [USMLE_Step_2] lanny: sure it all helps many of us are going in march
02/7/05 19:09:01 [USMLE_Step_2] megs: u all guys r very good at knowlege
02/7/05 19:09:19 [USMLE_Step_2] lanny: you too
02/7/05 19:09:24 cyrus1345 Logs in
02/7/05 19:09:38 cyrus1345 Joins Subroom USMLE_Step_2
02/7/05 19:09:39 [USMLE_Step_2] sanz: megs, i'm fine thnx
02/7/05 19:09:55 [USMLE_Step_2] cyrus1345: Hi evrybody
02/7/05 19:10:01 [USMLE_Step_2] lanny: hi nasi
02/7/05 19:10:01 [USMLE_Step_2] sanz: dont know why today went by so fast! i didnt even realise it's 7pm already
02/7/05 19:10:02 [USMLE_Step_2] megs: hi cyrus
02/7/05 19:10:15 [USMLE_Step_2] sanz: hey Nasi :) ready for the big day?
02/7/05 19:10:23 [USMLE_Step_2] lanny: oh yea by the time you know it another christmas
02/7/05 19:10:36 [USMLE_Step_2] cyrus1345: no actually!
02/7/05 19:10:42 [USMLE_Step_2] sanz: today is reprodutive health right?
02/7/05 19:10:47 [USMLE_Step_2] cyrus1345: it seems I forgot everything
02/7/05 19:10:55 [USMLE_Step_2] megs: so shall we start guys???or wait for others
02/7/05 19:10:55 [USMLE_Step_2] sanz: nasi, you'll be brilliant, i KNOW
02/7/05 19:11:33 [USMLE_Step_2] sanz: it'll all come back to you when you see the questions :)
02/7/05 19:11:34 [USMLE_Step_2] lanny: keep on reading till the day comes..its al worthwhile
02/7/05 19:11:37 [USMLE_Step_2] sanz: good lucl!
02/7/05 19:11:41 [USMLE_Step_2] sanz: luck!
02/7/05 19:11:42 [USMLE_Step_2] lanny: agree sanz
02/7/05 19:11:46 [USMLE_Step_2] cyrus1345: you are so nice snaz,by the way thanks alot for your great development childhood,yesterday!it was great,big help! dear!
02/7/05 19:12:08 [USMLE_Step_2] lanny: can you share it with me nasi
02/7/05 19:12:12 [USMLE_Step_2] sanz: all of you has helped me so much, i'd love to contribute
02/7/05 19:12:22 [USMLE_Step_2] sanz: lanny... read the transcript
02/7/05 19:12:27 [USMLE_Step_2] lanny: i missed the child dev is it posted
02/7/05 19:12:33 [USMLE_Step_2] cyrus1345: it's yesterday transcript chat snaz!
02/7/05 19:12:59 [USMLE_Step_2] sanz: yesterday we forgot to discuss endom hyperplasia... i thought i should briefly mention it in a case...
02/7/05 19:13:23 [USMLE_Step_2] lanny: ok we shall start go ahead sanz
02/7/05 19:13:36 [USMLE_Step_2] sanz: 37 yr old woman with intramentral bleeding... found on biopsy that she has complex hyperplasia without atypia
02/7/05 19:13:54 [USMLE_Step_2] sanz: she doesnt want any more kids
02/7/05 19:13:58 [USMLE_Step_2] sanz: what do you do next?
02/7/05 19:14:17 [USMLE_Step_2] cyrus1345: progestron
02/7/05 19:14:17 [USMLE_Step_2] sanz: 1. hysterectomy
02/7/05 19:14:21 [USMLE_Step_2] sanz: 2. progestin
02/7/05 19:14:26 [USMLE_Step_2] sanz: 3 blah blah
02/7/05 19:14:34 [USMLE_Step_2] lanny: hysterec
02/7/05 19:14:38 [USMLE_Step_2] sanz: nasi, you're right
02/7/05 19:14:59 [USMLE_Step_2] lanny: but she dont want kids
02/7/05 19:15:04 [USMLE_Step_2] cyrus1345: oof thanks GOD!
02/7/05 19:15:11 [USMLE_Step_2] lanny: why not go straight for hyst
02/7/05 19:15:33 [USMLE_Step_2] sanz: apparently, if the woman is PREmenopausal and has Bx results WITHOUT atypia, hysterectomy is not indicated even if she doesnt want anymore kids
02/7/05 19:15:46 [USMLE_Step_2] lanny: oh withoout atypia didnt see that
02/7/05 19:15:57 [USMLE_Step_2] lanny: agree with nasi then
02/7/05 19:16:04 [USMLE_Step_2] sanz: but if she has bx results with atypia, she can opt to do hysterectomy
02/7/05 19:16:13 [USMLE_Step_2] lanny: yes sanz
02/7/05 19:16:33 [USMLE_Step_2] cyrus1345: what's risk factor for endometrail adenocarsinoma?
02/7/05 19:16:47 [USMLE_Step_2] sanz: obesity
02/7/05 19:16:56 [USMLE_Step_2] lanny: late men
02/7/05 19:17:07 [USMLE_Step_2] cyrus1345: more,more!
02/7/05 19:17:13 [USMLE_Step_2] sanz: unopposed esg
02/7/05 19:17:14 [USMLE_Step_2] megs: unopposed esstrogen exposure
02/7/05 19:17:23 [USMLE_Step_2] sanz: nulliparity
02/7/05 19:17:30 [USMLE_Step_2] sanz: early menarche
02/7/05 19:17:38 [USMLE_Step_2] lanny: tamox use
02/7/05 19:17:52 dua_frank Logs in
02/7/05 19:17:52 [USMLE_Step_2] lanny: early men
02/7/05 19:17:56 dua_frank Joins Subroom USMLE_Step_2
02/7/05 19:17:59 [USMLE_Step_2] dua_frank: hi
02/7/05 19:18:00 [USMLE_Step_2] lanny: early menses
02/7/05 19:18:01 [USMLE_Step_2] cyrus1345: good!and HTN and DIABET!!
02/7/05 19:18:09 [USMLE_Step_2] dua_frank: you guys started already !!!!
02/7/05 19:18:09 [USMLE_Step_2] sanz: oh yeah
02/7/05 19:18:12 [USMLE_Step_2] cyrus1345: Hi dua
02/7/05 19:18:16 [USMLE_Step_2] sanz: hey dua :)
02/7/05 19:18:22 [USMLE_Step_2] dua_frank: hi nasi
02/7/05 19:18:23 [USMLE_Step_2] lanny: we waited for 10 mins dua
02/7/05 19:18:24 [USMLE_Step_2] dua_frank: hey sanz
02/7/05 19:18:40 [USMLE_Step_2] dua_frank: thanks for waiting :)
02/7/05 19:18:50 [USMLE_Step_2] megs: welcome dua
02/7/05 19:19:00 [USMLE_Step_2] cyrus1345: what's risk factor for cervical carsinoma?
02/7/05 19:19:00 [USMLE_Step_2] sanz: what's the most common cause of DUB?
02/7/05 19:19:12 [USMLE_Step_2] cyrus1345: onovulation
02/7/05 19:19:15 [USMLE_Step_2] megs: anovulation
02/7/05 19:19:20 [USMLE_Step_2] dua_frank: thanks megs
02/7/05 19:19:25 [USMLE_Step_2] sanz: multiple sex partners
02/7/05 19:19:37 [USMLE_Step_2] cyrus1345: more
02/7/05 19:19:49 [USMLE_Step_2] megs: whats primary amenorrhoea??
02/7/05 19:19:53 [USMLE_Step_2] sanz: i should remember, we did it yesterday
02/7/05 19:20:27 [USMLE_Step_2] sanz: early age of intercourse and smoking
02/7/05 19:20:41 [USMLE_Step_2] lanny: no menses at 14
02/7/05 19:20:49 [USMLE_Step_2] megs: absebce of menses till16 and absence of menses 4 yrs after thelarchae
02/7/05 19:20:51 [USMLE_Step_2] cyrus1345: SMOCKING and HPV 16 ,18
02/7/05 19:21:00 strug Logs in
02/7/05 19:21:01 [USMLE_Step_2] cyrus1345: very good snaz
02/7/05 19:21:04 strug Joins Subroom USMLE_Step_2
02/7/05 19:21:11 [USMLE_Step_2] sanz: hey strug
02/7/05 19:21:18 [USMLE_Step_2] lanny: if sex develop at 16
02/7/05 19:21:19 [USMLE_Step_2] megs: hi strug
02/7/05 19:21:20 [USMLE_Step_2] strug: Thank God finally i logged in!!!!!!
02/7/05 19:21:26 [USMLE_Step_2] strug: hi sanz and megs
02/7/05 19:21:29 [USMLE_Step_2] cyrus1345: Hi strug
02/7/05 19:21:36 [USMLE_Step_2] strug: how are u all doing
02/7/05 19:21:37 [USMLE_Step_2] sanz: nasi, today is reproductive med i think... we did Cancer stuff yesterday...
02/7/05 19:21:39 [USMLE_Step_2] strug: hi nasi
02/7/05 19:21:41 [USMLE_Step_2] dua_frank: hi struggggggg :)
02/7/05 19:21:46 [USMLE_Step_2] strug: hi dua
02/7/05 19:21:53 [USMLE_Step_2] sanz: strug, were you having probs loggin in?
02/7/05 19:21:58 [USMLE_Step_2] strug: yes
02/7/05 19:22:08 [USMLE_Step_2] strug: i had to struggle to log in....
02/7/05 19:22:09 [USMLE_Step_2] sanz: good you made it!!!
02/7/05 19:22:29 [USMLE_Step_2] megs: lanny what is ur source i read from blueprint
02/7/05 19:22:31 [USMLE_Step_2] strug: ok what were u guys discussing
02/7/05 19:23:06 [USMLE_Step_2] megs: what is secondary amenorhoea??
02/7/05 19:23:26 [USMLE_Step_2] lanny: blue print, kaplan ,OB secrets
02/7/05 19:23:28 [USMLE_Step_2] strug: >3 m of amenorrhoe with normal pervious cycles
02/7/05 19:23:37 [USMLE_Step_2] lanny: agree
02/7/05 19:23:43 [USMLE_Step_2] strug: > 6 m of amenorr with irregular previous cycles
02/7/05 19:23:54 [USMLE_Step_2] megs: good strug
02/7/05 19:23:55 [USMLE_Step_2] sanz: like Asherman syndr
02/7/05 19:24:04 [USMLE_Step_2] strug: thanks megs
02/7/05 19:24:07 [USMLE_Step_2] lanny: >3mths if prev cycle was reg
02/7/05 19:24:18 [USMLE_Step_2] megs: what is asherman syndrome??
02/7/05 19:24:33 [USMLE_Step_2] strug: outflow tract obstrucion due to adhesions
02/7/05 19:24:56 [USMLE_Step_2] sanz: uterine adhesion after D&C
02/7/05 19:25:02 [USMLE_Step_2] strug: adhesions can be due to suregery or infection
02/7/05 19:25:02 [USMLE_Step_2] megs: can u be specific strug
02/7/05 19:25:14 [USMLE_Step_2] megs: yup
02/7/05 19:25:21 [USMLE_Step_2] megs: whats treatment??
02/7/05 19:25:27 [USMLE_Step_2] sanz: nil?
02/7/05 19:25:30 [USMLE_Step_2] strug: surgical
02/7/05 19:25:41 [USMLE_Step_2] megs: whay surgery??
02/7/05 19:25:54 [USMLE_Step_2] sanz: Rx for Asherman is surgical? but the endom cells are already destroyed init?
02/7/05 19:26:15 [USMLE_Step_2] megs: laser ablasions of adhesions...or u can just keep IUD
02/7/05 19:26:27 [USMLE_Step_2] megs: TO PREVENT ADHESONS IN UTERUS
02/7/05 19:26:49 [USMLE_Step_2] sanz: ok thnx
02/7/05 19:26:49 [USMLE_Step_2] strug: sanz Rx is for stenosis
02/7/05 19:27:01 [USMLE_Step_2] strug: and obstruction that is caused due to it
02/7/05 19:27:07 [USMLE_Step_2] megs: YES..
02/7/05 19:27:15 [USMLE_Step_2] megs: ENDOMETRIAM IS LOST
02/7/05 19:27:17 [USMLE_Step_2] sanz: so i guess you can salvage and get the uterine fn back...
02/7/05 19:27:35 [USMLE_Step_2] megs: CANT REGENERATE BUT CAN TRY HIGH DOSE ESTROGEN
02/7/05 19:27:56 [USMLE_Step_2] lanny: some cases are refract to thpy
02/7/05 19:28:04 [USMLE_Step_2] lanny: severe cases of asherman
02/7/05 19:28:05 [USMLE_Step_2] megs: FOR RECIDUAL ENDO TO REGENERATE
02/7/05 19:28:26 [USMLE_Step_2] lanny: one ds can be caused by doc while doing a d/c
02/7/05 19:28:39 [USMLE_Step_2] megs: YUP LANNY
02/7/05 19:29:16 [USMLE_Step_2] megs: what r the causes for primary amenorrhoea??
02/7/05 19:29:33 [USMLE_Step_2] sanz: can be due to ovarian failure...
02/7/05 19:29:36 [USMLE_Step_2] sanz: like PCOS
02/7/05 19:29:44 [USMLE_Step_2] sanz: or Turners
02/7/05 19:29:50 [USMLE_Step_2] lanny: preg
02/7/05 19:30:00 [USMLE_Step_2] lanny: pituitary dys
02/7/05 19:30:01 [USMLE_Step_2] megs: NOT PREGNANCY LANNY
02/7/05 19:30:08 [USMLE_Step_2] sanz: i take it back... PCOS is secondary amenorrhea i think
02/7/05 19:30:12 [USMLE_Step_2] lanny: always r/o preg in ammeno
02/7/05 19:30:15 [USMLE_Step_2] megs: ITS CAUSE OF SECONDORY AMENORRHOEA
02/7/05 19:30:17 [USMLE_Step_2] strug: uterus and brest present is inperforate hymen, vaginal septum,
02/7/05 19:30:37 [USMLE_Step_2] lanny: the most comm cause of ammenor is preg
02/7/05 19:30:39 [USMLE_Step_2] cyrus1345: 15 years old without breast develop or pubic hair pelvic exam normal what's your next step?
02/7/05 19:30:47 [USMLE_Step_2] megs: AGREE LANNY
02/7/05 19:30:51 [USMLE_Step_2] strug: anorexia nervosia, excessive exercise, or preg without having the first perod
02/7/05 19:30:57 [USMLE_Step_2] sanz: nasi, karyotype
02/7/05 19:31:09 [USMLE_Step_2] strug: USG to look for uterus
02/7/05 19:31:10 [USMLE_Step_2] megs: YES STRUG
02/7/05 19:31:28 [USMLE_Step_2] cyrus1345: good snaz,Karyotip and FSH
02/7/05 19:32:11 [USMLE_Step_2] lanny: strug is right too anatomical
02/7/05 19:32:19 [USMLE_Step_2] strug: hey nasi can we know if utersu present or not on pelvic exam?
02/7/05 19:32:40 [USMLE_Step_2] dua_frank: no
02/7/05 19:33:02 [USMLE_Step_2] cyrus1345: yes strug pelvioc exam will show norm vagina and uteus
02/7/05 19:33:17 [USMLE_Step_2] dua_frank: normal uterus is in the pelvis
02/7/05 19:33:26 [USMLE_Step_2] strug: ok gotcha
02/7/05 19:33:30 [USMLE_Step_2] lanny: in any case of prim amenn first things breast prst.? estrogen primed? uterus prst?
02/7/05 19:33:32 [USMLE_Step_2] strug: thanks dua and nasi
02/7/05 19:34:03 [USMLE_Step_2] strug: i gotcha ur funda nasi thanks for the q
02/7/05 19:34:06 [USMLE_Step_2] lanny: of course if breast prst then estro is ok
02/7/05 19:35:13 [USMLE_Step_2] cyrus1345: 15 yeatrs old with breat develop and pubic hair ,pelvic exam normmal what's your next step?
02/7/05 19:35:32 [USMLE_Step_2] sanz: progestin challenge
02/7/05 19:35:49 [USMLE_Step_2] sanz: and FSH measure
02/7/05 19:35:50 [USMLE_Step_2] cyrus1345: no snaz
02/7/05 19:36:09 [USMLE_Step_2] strug: testosteron level and karyo
02/7/05 19:36:28 [USMLE_Step_2] sanz: prolactin and TSH?
02/7/05 19:36:31 [USMLE_Step_2] sanz: heheh
02/7/05 19:36:42 [USMLE_Step_2] cyrus1345: conservative managment !!! :)
02/7/05 19:36:56 [USMLE_Step_2] lanny: really dont u stand the q
02/7/05 19:36:59 [USMLE_Step_2] strug: oh yes gosh
02/7/05 19:37:05 [USMLE_Step_2] strug: a very good q nasi
02/7/05 19:37:07 [USMLE_Step_2] cyrus1345: after 16 years it will be ameno
02/7/05 19:37:18 [USMLE_Step_2] strug: if secondary sexual charac present lanny
02/7/05 19:37:42 [USMLE_Step_2] sanz: oh yeah... so she doesnt need Ix until after 16 yr
02/7/05 19:37:58 [USMLE_Step_2] strug: primary amenorrhiea defined as 14 years without sec sex charac and 16 with sec sex character and no mensturation
02/7/05 19:37:59 [USMLE_Step_2] sanz: tricky nasi :)
02/7/05 19:38:09 huli72 Logs in
02/7/05 19:38:13 huli72 Joins Subroom USMLE_Step_2
02/7/05 19:38:13 [USMLE_Step_2] lanny: yea tricky indeed
02/7/05 19:38:15 [USMLE_Step_2] strug: good one
02/7/05 19:38:22 [USMLE_Step_2] strug: hi huli
02/7/05 19:38:27 [USMLE_Step_2] sanz: we have to think... hehe
02/7/05 19:38:30 [USMLE_Step_2] huli72: hi, strug
02/7/05 19:38:33 [USMLE_Step_2] cyrus1345: Hi huli
02/7/05 19:38:34 [USMLE_Step_2] dua_frank: hi huli
02/7/05 19:38:37 [USMLE_Step_2] sanz: hey huli
02/7/05 19:38:41 [USMLE_Step_2] huli72: Hi, friends
02/7/05 19:39:19 [USMLE_Step_2] sanz: 1st step in the work up of sec amenorrhoea?
02/7/05 19:39:35 [USMLE_Step_2] megs: PREGNANCY TEST
02/7/05 19:39:36 [USMLE_Step_2] strug: B hcg
02/7/05 19:39:43 [USMLE_Step_2] sanz: yup
02/7/05 19:39:44 [USMLE_Step_2] sanz: next
02/7/05 19:39:47 [USMLE_Step_2] strug: tsh
02/7/05 19:39:50 [USMLE_Step_2] sanz: yup
02/7/05 19:39:52 [USMLE_Step_2] sanz: next
02/7/05 19:39:53 [USMLE_Step_2] cyrus1345: 17 years breast develop and pubic hair pelvic exam short vagina and absent uterus next step?
02/7/05 19:39:55 [USMLE_Step_2] strug: prolactin
02/7/05 19:39:59 [USMLE_Step_2] lanny: FSH LH
02/7/05 19:40:06 [USMLE_Step_2] megs: yup
02/7/05 19:40:13 [USMLE_Step_2] huli72: no
02/7/05 19:40:14 [USMLE_Step_2] strug: testo and karyotyo
02/7/05 19:40:23 [USMLE_Step_2] huli72: agree with strug
02/7/05 19:40:32 [USMLE_Step_2] huli72: usg ingual canal
02/7/05 19:40:35 [USMLE_Step_2] cyrus1345: good strug
02/7/05 19:40:40 [USMLE_Step_2] strug: at last
02/7/05 19:40:41 [USMLE_Step_2] huli72: PE ingual canal
02/7/05 19:40:49 [USMLE_Step_2] strug: wahts that huli?
02/7/05 19:41:04 [USMLE_Step_2] huli72: to look for the undescent testis
02/7/05 19:41:08 [USMLE_Step_2] sanz: yup
02/7/05 19:41:28 [USMLE_Step_2] strug: ok sanz continue with ur next q
02/7/05 19:41:43 [USMLE_Step_2] strug: after prolactin what?
02/7/05 19:41:50 [USMLE_Step_2] sanz: ok.. so now you've done beta hCG and Prolactin and TSH
02/7/05 19:41:51 [USMLE_Step_2] sanz: next what?
02/7/05 19:41:58 [USMLE_Step_2] cyrus1345: p challange test
02/7/05 19:42:01 [USMLE_Step_2] huli72: pregesterone stim
02/7/05 19:42:01 [USMLE_Step_2] sanz: good
02/7/05 19:42:02 [USMLE_Step_2] strug: progeston challn
02/7/05 19:42:06 [USMLE_Step_2] sanz: how is it done?
02/7/05 19:42:18 [USMLE_Step_2] sanz: and what does the various results indicate?
02/7/05 19:42:19 [USMLE_Step_2] huli72: give p for 3 days?
02/7/05 19:42:19 [USMLE_Step_2] strug: give Iv one shot or 7 days of prog
02/7/05 19:42:32 [USMLE_Step_2] huli72: 7 days
02/7/05 19:42:35 [USMLE_Step_2] strug: if bleeding it was due to anovulation
02/7/05 19:42:37 [USMLE_Step_2] cyrus1345: medroxy prgesteron 5 mg for 5-7
02/7/05 19:42:47 [USMLE_Step_2] huli72: or thanks Nasi
02/7/05 19:42:49 [USMLE_Step_2] lanny: huli why usg inguinal
02/7/05 19:42:50 [USMLE_Step_2] strug: if no bleeding proceed
02/7/05 19:42:53 [USMLE_Step_2] sanz: yup.. at the end of 5-7 days... see if there's withdrawl belld
02/7/05 19:43:00 [USMLE_Step_2] sanz: bleed even
02/7/05 19:43:08 [USMLE_Step_2] huli72: that is for megs'q
02/7/05 19:43:12 [USMLE_Step_2] sanz: if bleeding, means what?
02/7/05 19:43:12 [USMLE_Step_2] megs: anovulation
02/7/05 19:43:17 [USMLE_Step_2] lanny: ok huli got it
02/7/05 19:43:27 [USMLE_Step_2] huli72: about androgen insensitive disease
02/7/05 19:43:52 [USMLE_Step_2] cyrus1345: anovulation
02/7/05 19:43:54 [USMLE_Step_2] huli72: the ovary produced estrogen
02/7/05 19:43:59 [USMLE_Step_2] sanz: yes megs adn nasi
02/7/05 19:44:06 [USMLE_Step_2] cyrus1345: then next step?
02/7/05 19:44:13 [USMLE_Step_2] strug: esto prog chann test
02/7/05 19:44:24 [USMLE_Step_2] huli72: FSH?
02/7/05 19:44:28 [USMLE_Step_2] huli72: or LH?
02/7/05 19:44:34 [USMLE_Step_2] strug: if bleedong due to lack of estrogen which could be
02/7/05 19:44:34 [USMLE_Step_2] sanz: bleeding after prog challenge means anovulation... then see if hirstut or not
02/7/05 19:44:59 [USMLE_Step_2] strug: if no bleeding see for outflow tract obstructuon
02/7/05 19:45:12 [USMLE_Step_2] sanz: if hirsute, measure test and DHEA -- PCOS
02/7/05 19:45:25 malak1993 Logs in
02/7/05 19:45:29 [USMLE_Step_2] sanz: non hirsute --> hypothalamic dysfn
02/7/05 19:45:40 [USMLE_Step_2] megs: IF NO BLEEDING AFTER COMBO...OUTFLOW OBSTR
02/7/05 19:45:45 malak1993 Logs Out
02/7/05 19:45:49 [USMLE_Step_2] sanz: yup megs
02/7/05 19:45:57 [USMLE_Step_2] dua_frank: and sanz said she was not good at obgyn, liar :P
02/7/05 19:46:10 [USMLE_Step_2] strug: dua caught u sanz
02/7/05 19:46:11 [USMLE_Step_2] sanz: dua, i just rad this before i came... hehe
02/7/05 19:46:13 [USMLE_Step_2] huli72: too humble
02/7/05 19:46:15 [USMLE_Step_2] sanz: read
02/7/05 19:46:21 [USMLE_Step_2] dua_frank: ah ha :P
02/7/05 19:46:24 [USMLE_Step_2] sanz: ask me tmrw and it would be gone
02/7/05 19:46:26 [USMLE_Step_2] sanz: hehe
02/7/05 19:46:33 [USMLE_Step_2] dua_frank: lol
02/7/05 19:46:43 [USMLE_Step_2] lanny: why do we do combo etr pro test?
02/7/05 19:46:44 [USMLE_Step_2] strug: ok continue
02/7/05 19:46:50 [USMLE_Step_2] sanz: so after proge challenge and no bleeding, you need to do what?
02/7/05 19:46:51 [USMLE_Step_2] dua_frank: yes please
02/7/05 19:47:07 [USMLE_Step_2] strug: esto prog test
02/7/05 19:47:27 [USMLE_Step_2] lanny: why estr pro strug?
02/7/05 19:47:31 [USMLE_Step_2] sanz: you've concluded that it's outflow obstruction... so rule out Asherman
02/7/05 19:47:35 [USMLE_Step_2] sanz: then measure FSH
02/7/05 19:47:45 [USMLE_Step_2] huli72: and LH
02/7/05 19:47:48 [USMLE_Step_2] megs: also cervical stenosis
02/7/05 19:47:48 [USMLE_Step_2] sanz: yes huli
02/7/05 19:47:49 [USMLE_Step_2] strug: if low hypothalamic
02/7/05 19:48:04 [USMLE_Step_2] strug: if high ovarian failure
02/7/05 19:48:06 [USMLE_Step_2] huli72: if high, ovarian failure
02/7/05 19:48:08 [USMLE_Step_2] sanz: if FSH is low, then it's severe hypothalmic dysfn
02/7/05 19:48:12 [USMLE_Step_2] sanz: like sheehan
02/7/05 19:48:23 [USMLE_Step_2] megs: what is premature ovarian failure??
02/7/05 19:48:24 [USMLE_Step_2] sanz: if FSH is high, then it's gonadal failure
02/7/05 19:48:35 [USMLE_Step_2] huli72: FSH high before 35?
02/7/05 19:48:42 [USMLE_Step_2] huli72: and menopause too
02/7/05 19:48:52 [USMLE_Step_2] megs: agree
02/7/05 19:49:04 [USMLE_Step_2] huli72: I am not sure it is 35 or....
02/7/05 19:49:15 [USMLE_Step_2] cyrus1345: 17 years with breast develo and pubic hair pelvic exam norm vagina and uterus never menstraul period next step?
02/7/05 19:49:35 [USMLE_Step_2] huli72: PE ingual canal
02/7/05 19:49:40 [USMLE_Step_2] huli72: look for testis
02/7/05 19:49:48 [USMLE_Step_2] cyrus1345: no huli
02/7/05 19:49:50 [USMLE_Step_2] strug: preg test nsi
02/7/05 19:49:51 [USMLE_Step_2] huli72: no
02/7/05 19:50:02 [USMLE_Step_2] lanny: preg
02/7/05 19:50:18 [USMLE_Step_2] cyrus1345: good strug,manage exactly like secemdary ameno
02/7/05 19:50:21 barsobia99 Logs in
02/7/05 19:50:22 [USMLE_Step_2] megs: it should be pregnancy test
02/7/05 19:50:22 barsobia99 Joins Subroom USMLE_Step_1
02/7/05 19:50:23 [USMLE_Step_2] sanz: ask abt diet and calculate BMI
02/7/05 19:50:28 [USMLE_Step_2] strug: thanks nasi
02/7/05 19:50:54 [USMLE_Step_2] sanz: what's the ans?
02/7/05 19:51:05 [USMLE_Step_2] strug: Pregnancy test sanz
02/7/05 19:51:21 [USMLE_Step_2] sanz: but she has never menstrated before...
02/7/05 19:51:25 barsobia99 Logs Out
02/7/05 19:51:31 [USMLE_Step_2] strug: she can be preg sanz
02/7/05 19:51:35 [USMLE_Step_2] megs: can happen sanz
02/7/05 19:51:38 [USMLE_Step_2] sanz: ok
02/7/05 19:51:49 [USMLE_Step_2] lanny: in amenorrhoea first r/o preg
02/7/05 19:51:50 [USMLE_Step_2] huli72: the same work up as 2nd amenorrhea
02/7/05 19:51:54 [USMLE_Step_2] megs: always rule out ppregnacy first
02/7/05 19:51:58 [USMLE_Step_2] strug: yup
02/7/05 19:52:17 [USMLE_Step_2] lanny: dont assume sex active or not
02/7/05 19:53:13 [USMLE_Step_2] megs: how will you dx PCOD
02/7/05 19:53:30 [USMLE_Step_2] huli72: 17 yo girl, no breast development, has uterus, what's next?
02/7/05 19:53:31 [USMLE_Step_2] sanz: LH/FSh and DHEA
02/7/05 19:53:36 [USMLE_Step_2] lanny: prog challenge
02/7/05 19:53:44 [USMLE_Step_2] lanny: look for vag bleed
02/7/05 19:53:44 [USMLE_Step_2] cyrus1345: serum LH/FSH raitio >3
02/7/05 19:53:53 [USMLE_Step_2] megs: all correct
02/7/05 19:54:00 [USMLE_Step_2] megs: what on USG??
02/7/05 19:54:15 [USMLE_Step_2] huli72: poly cystic ovary
02/7/05 19:54:23 [USMLE_Step_2] lanny: multiple follic cysts?
02/7/05 19:54:29 [USMLE_Step_2] megs: neckless pattern of follicles..correct huli
02/7/05 19:54:31 [USMLE_Step_2] strug: inc echogeniscity
02/7/05 19:54:40 [USMLE_Step_2] strug: necklace pattern
02/7/05 19:54:43 [USMLE_Step_2] sanz: nasi, dont know... prog challenge?
02/7/05 19:54:45 [USMLE_Step_2] cyrus1345: FSh and karyo huli
02/7/05 19:55:05 [USMLE_Step_2] huli72: yes, Nasi
02/7/05 19:55:10 [USMLE_Step_2] huli72: dx?
02/7/05 19:55:20 [USMLE_Step_2] huli72: and usg
02/7/05 19:55:21 [USMLE_Step_2] cyrus1345: turner syn
02/7/05 19:55:31 [USMLE_Step_2] huli72: yes
02/7/05 19:55:34 [USMLE_Step_2] sanz: oh, it's huli who asked the q... i am colour blind
02/7/05 19:55:35 [USMLE_Step_2] strug: or hypotahlmic failure
02/7/05 19:55:35 [USMLE_Step_2] cyrus1345: snaz I don't know
02/7/05 19:55:56 [USMLE_Step_2] strug: huli and nasi have same color
02/7/05 19:55:58 [USMLE_Step_2] huli72: and yes, strug
02/7/05 19:56:25 [USMLE_Step_2] huli72: I will change to another color
02/7/05 19:56:28 [USMLE_Step_2] cyrus1345: I changed it!
02/7/05 19:56:38 [USMLE_Step_2] sanz: hehe
02/7/05 19:56:41 [USMLE_Step_2] strug: ok thanks u guys are great
02/7/05 19:56:45 [USMLE_Step_2] sanz: golden nasi
02/7/05 19:56:49 [USMLE_Step_2] cyrus1345: :D
02/7/05 19:56:54 [USMLE_Step_2] huli72: thanks, Nasi,
02/7/05 19:56:56 beecrazee Logs in
02/7/05 19:57:00 [USMLE_Step_2] cyrus1345: hahahah ,!
02/7/05 19:57:38 beecrazee: anybody there
02/7/05 19:57:49 [USMLE_Step_2] sanz: in pt with PCOS, what other dz would you check for?
02/7/05 19:57:58 beecrazee Joins Subroom Clinical_Skills
02/7/05 19:58:05 lenhoxung Logs in
02/7/05 19:58:11 [USMLE_Step_2] sanz: maybe i should ask what other dz ar they at risk of
02/7/05 19:58:11 [USMLE_Step_2] huli72: diabetis
02/7/05 19:58:15 [USMLE_Step_2] sanz: yes... and?
02/7/05 19:58:16 lenhoxung Joins Subroom USMLE_Step_1
02/7/05 19:58:21 [USMLE_Step_2] strug: HT
02/7/05 19:58:22 sux Logs in
02/7/05 19:58:23 [USMLE_Step_2] huli72: endometria ca
02/7/05 19:58:24 [USMLE_Step_2] sanz: great
02/7/05 19:58:27 [USMLE_Step_2] sanz: you guys rock!
02/7/05 19:58:44 beecrazee Logs Out
02/7/05 19:59:05 [USMLE_Step_2] lanny: trt of PCO
02/7/05 19:59:12 [USMLE_Step_2] cyrus1345: 18 years old with dysmenor your first step?
02/7/05 19:59:15 [USMLE_Step_2] strug: oCP
02/7/05 19:59:18 [USMLE_Step_2] sanz: OCP
02/7/05 19:59:25 [USMLE_Step_2] lanny: agree
02/7/05 19:59:25 [USMLE_Step_2] dua_frank: ocp
02/7/05 19:59:28 [USMLE_Step_2] strug: NSAids nasi
02/7/05 19:59:43 [USMLE_Step_2] cyrus1345: no strug first step?


[huli72] that drug stimulate ovulation
[huli72] I forget the name
[huli72] Ci....
[sanz] clomiphene?
[megs] YUP SANZ
[huli72] yes, sanz
[sanz] but i dont think that's the first step
[huli72] and metafomin
[strug] ask her tro keep diary nasi
[cyrus1345] do pelvic eam,it's important to rule out inflamatory and infection etiolgy for pelvic pain
[cyrus1345] :D
[cyrus1345] then if rule out then go for NSAID
[cyrus1345] or ocp
[strug] can we do pelvic exam in 18 year old?
[megs] WHICH NSAID???
[strug] brufen megs
[huli72] I don't think so, strug
[megs] MEFENEMIC ACID
[cyrus1345] what do you mean strug ,it's USA my dear!
[megs] BRUFEN
[cyrus1345] she is 18 not 8 years old
[huli72] so, we can do?
[strug] ok gotcha u nasi......being an Indian cant think otherway
[dua_frank] not on usmle
[dua_frank] you cannot
[huli72] so, we can do pelvic exam in an 18 yo?
[megs] WHEN TO USE ocpills for dysmen???
[huli72] when the pt don't want to get pregnent
8:02 PM [megs] AND THEY R NOT BENEFITAED FROM NSAID
8:03 PM [megs] we can do pelvic exam in non vergin pt
8:03 PM [cyrus1345] high yield OB/Gy page 118 written by Sakala MD ,yes you should do it huli
8:03 PM [lanny] dua why cant you do pelvic exam on 18 yo
8:03 PM [huli72] thanks, Nasi
8:03 PM [dua_frank] i thought not before she is pregnant
8:03 PM [megs] u avoid pelvic exam in vergins
8:03 PM [sanz] so when can we start doing pelviv exam? what's the age cut off?
8:03 PM [strug] just a doubt...do we do it under anesthesia or ......
8:04 PM [dua_frank] i thought that was the age limit
8:04 PM [lanny] can be done under anesth
8:04 PM [cyrus1345] strug it's for child!18 years old is not child!
8:04 PM [lanny] dont think there is an age limit
8:04 PM [megs] we do but for exceptional cases
8:04 PM [cyrus1345] ye slanny never do it pelvic exam in child
8:04 PM [dua_frank] yeah megs thats what i thought too
8:04 PM [lanny] 18 yo in USA 90 % of time is not a virgin!!!
8:04 PM [strug] ok thanks nasi.....i was just confused....
8:04 PM [sanz] ok... so if no longer a virgin, we can
8:04 PM [cyrus1345] alwyes in anesthesia
8:04 PM [dua_frank] yes sanz
8:05 PM [lanny] virgin or not is not imp use anesthesia
8:05 PM [megs] if virgin and pv is neccessary do it under anaesthe
8:05 PM [sanz] ok
8:05 PM [dua_frank] ok
8:05 PM [strug] thanks nasi good point to be clearaed
8:06 PM [cyrus1345] for exaple 6 years old come with vaginal bleeding what is your next step?
8:06 PM [strug] exam under anestheis
8:06 PM [huli72] usg?
8:06 PM [cyrus1345] history is negative for any drug
8:06 PM [lanny] agree with strug
8:06 PM [cyrus1345] yes strug very good
8:06 PM [lanny] look for foreign body
8:06 PM [sanz] what is the most common location for Ect preg?
8:06 PM [strug] lanny my friend
8:06 PM [dua_frank] fal tube
8:06 PM [strug] ampulla
8:06 PM [megs] ampulla
8:06 PM [lanny] ampulla
8:06 PM [sanz] yup ampulla
8:06 PM [dua_frank] ok ampulla
8:07 PM [sanz] lol dua
8:07 PM [dua_frank] *)
8:07 PM [sanz] ampulla is part of the fall tube...
8:07 PM [dua_frank] i know
8:07 PM [lanny] yep
8:07 PM [huli72] :o
8:07 PM [dua_frank] i was too quick to put in my answer which was wrong anyway
8:07 PM [megs] what is DUB???
8:07 PM [sanz] well, it's half right!
8:07 PM [dua_frank] thanks
8:07 PM [lanny] dysfunctional uterine bleed
8:07 PM [dua_frank] dysfunctional uterine bleeding
8:07 PM calender has left the chat.
8:07 PM [strug] dysfunctional uterina bleeding megs
8:07 PM [huli72] disfunction of uteri bleeding
8:08 PM [megs] DEFINE IT
8:08 PM [sanz] usus due to anovulation
8:08 PM [strug] irregula vag bleeding without normal menstru symt....?
8:08 PM [huli72] bleeding from vaginal not due to pregnancy or mense
8:08 PM [lanny] pregnancy has to be ruoed oout
8:09 PM [megs] ABNORMAL MENS BLEEDING IN ABSENCE OF PALPABLE PELVIC PATHOLOGY
8:09 PM [sanz] ok
8:09 PM [strug] wow only a gynecologist can be so perfect......thanks megs
8:09 PM [huli72] exclude tumor too
8:09 PM [lanny] yes
8:09 PM calender has left the chat.
8:09 PM [sanz] yup strug, gotta learn fr the expert!
8:10 PM [megs] i can see u gus doing far beter than me
8:10 PM [megs] guys
8:10 PM [sanz] ok.. what is sheehan syndr?
8:10 PM [strug] postpartum pitutuiary necrosis
8:10 PM [strug] due to excessive blood loss intraprtum
8:10 PM [lanny] pituitary apoplexy post part
8:11 PM [lanny] caused by xcess blood loss
8:11 PM [cyrus1345] most comoon location for endomeetriosis?
8:11 PM [strug] culdesac
8:11 PM [cyrus1345] no
8:11 PM [megs] good strug
8:11 PM [lanny] popuch of douglkas
8:11 PM [sanz] postpartum pitui ischemia due to xs blood loss
8:11 PM [strug] ovary?
8:11 PM [sanz] what is the first sign of Sheehan synd?
8:11 PM [cyrus1345] first OVARY then cul; de sac
8:11 PM [strug] loss of lactattion sanz
8:11 PM [huli72] and fatigue
8:11 PM [strug] relly nasi first overy?
8:12 PM [megs] isnt the pouch of doglous and cul de sac same pl clarify confused???
8:12 PM [lanny] i think is pouch of douglas first
8:12 PM [cyrus1345] yes strug in my bok is written ovary
8:12 PM [strug] they are the same megs
8:12 PM [lanny] yes im used to pouch
8:12 PM [strug] ok then it must be overy :(
8:12 PM [cyrus1345] what is pathogenes of endometriosis?
8:13 PM [megs] retrograde menses
8:13 PM [strug] endometium at abnormal location
8:13 PM [cyrus1345] good megs
8:13 PM [lanny] endom tissue outside uterus
8:13 PM [cyrus1345] retrograde mense,extremely high yeild!;-)!
8:13 PM [megs] ather theories r coelomic metaplasia
8:14 PM [strug] thanks nasi :)
8:14 PM [huli72] yes, megs
8:14 PM [strug] what megs?
8:14 PM [sanz] oh yeah megs.. i have heard of it
8:14 PM [cyrus1345] how do you manage endometriosis in 34 years old?
8:14 PM [huli72] OCP
8:14 PM [strug] OCP
8:14 PM [megs] oc pills
8:14 PM [lanny] Gnrh agonist
8:15 PM [sanz] progestin
8:15 PM [sanz] hehe
8:15 PM [huli72] danazol
8:15 PM [lanny] yep huli
8:15 PM [cyrus1345] make pseduepregnacy by progestin or pseudo menopuause by danazol
8:15 PM [lanny] ocp can be used too
8:16 PM [cyrus1345] leupride
8:16 PM [megs] exactluy nasi
8:16 PM [sanz] so when do you use OCP?
8:16 PM [lanny] dont understand nasi
8:16 PM [cyrus1345] megs are you GY?
8:16 PM [huli72] when fertility is disired
8:16 PM [huli72] later
8:17 PM [sanz] see in that case you can still use progestin and danazol until the time when she wants to get pregnant right?
8:18 PM [strug] 31 year female with menometrorrhagia....next step?
8:18 PM [sanz] i thought when fertility is desired, it's lap ablation...?
8:18 PM [sanz] does any one know?
8:18 PM [cyrus1345] pregnancy test
8:18 PM [cyrus1345] strug?
8:18 PM [huli72] hCG
8:18 PM [huli72] test
8:18 PM [strug] yes nasi and huli right
8:18 PM [strug] preg test was normal....next step?
8:19 PM [huli72] lap ablation when can't be controled by medicine
8:19 PM [huli72] usg to exclude leimyoma
8:19 PM [cyrus1345] then it because of anovulation
8:19 PM [huli72] and watch for endometrial too
8:19 PM [strug] next step is to look for anatomicaal lesions like of vagina, cervix or endotmerum
8:19 PM [cyrus1345] put the paitent on OCP!I think !
8:20 PM [cyrus1345] oh ok!
8:20 PM [cyrus1345] I though we rule them out!
8:20 PM [lanny] yea continue as of sec amen
8:20 PM [cyrus1345] thanks strug
8:20 PM [strug] if no anatomical lesions.....next step?
8:20 PM [lanny] prog challenge
8:20 PM [megs] endometrial curret
8:21 PM [megs] to stop the bllediing
8:21 PM [megs] and take biopsy too
8:21 PM [strug] then it could be most likely due to DUb,,,,do an endometiral biopsy
8:21 PM [megs] treatment of puberty meno rrhagia
8:21 PM [sanz] what will the endom bx show strug?
8:22 PM [strug] proloferative endometrium sanz
8:22 PM [sanz] in DUB?
8:22 PM [strug] because of anovluation unopposed estrogen
8:22 PM [sanz] oh oke! thnx
8:22 PM cyrus1345 has left the chat.
8:23 PM [strug] megs can u specify the age
8:23 PM [megs] how to treat puberty menorrhagia 14 yrs
8:23 PM [huli72] estrogen
8:23 PM [megs] immediate rx??/
8:23 PM [strug] exam under anestheis?
8:23 PM [megs] good huli
8:23 PM [lanny] someone define menorrhagia and metro
8:23 PM [strug] u mean iv estro megs
8:24 PM [sanz] menorrhagia - lots
8:24 PM [sanz] metro - in between
8:24 PM [lanny] thx zanz
8:24 PM [megs] yeah can give iv or oral high dose
8:24 PM [sanz] megs.. i'm afraid i dont get it
8:24 PM [strug] i think if patient is unstable not otherwise
8:25 PM [megs] due to chances of thromboplebitis we avoid
8:25 PM [strug] any age pt bleeding excessively vaginally and unstable give iv estrogen
8:25 PM [sanz] ok strug thnx
8:25 PM [megs] but can give
8:25 PM [megs] how estrogen helps to stop bleeding
8:25 PM [megs] whats the mechanism
8:25 PM [huli72] repair endometrial
8:26 PM [megs] got it huli
8:26 PM [megs] sanz i think u were saying about testesterone
8:26 PM [sanz] so esg keep the endometrial in proliferative phase?
8:26 PM [megs] iv testerone is not recommended
8:26 PM [lanny] estrogen makes endomet become proliferate
8:27 PM [sanz] so helps in active profuse bleeding?
8:27 PM [lanny] yes
8:27 PM [megs] it regenerate endometrium
8:28 PM [sanz] cool.. good q
8:28 PM [megs] what other things u can give for meno rrhagia i mean medical treatment
8:28 PM [sanz] OCP
8:28 PM [lanny] megs whats thrombophlebitis in this
8:28 PM [huli72] vit K
8:29 PM [megs] side effect og estrogen is it causes throbosis
8:29 PM [lanny] so we still give pt estrofen?
8:29 PM [huli72] D&C
8:29 PM [strug] female with hirsutism, no virilisation...rapid onset.lab shows very high testosteone....pelvic exam shows adnexal mass....diagnosis?
8:30 PM [huli72] lydig cell tumor
8:30 PM [sanz] PCOS?
8:30 PM [huli72] androgen secreting tumor
8:31 PM [lanny] PCOS
8:31 PM [megs] pcos
8:31 PM [huli72] pcos is slow onset
8:31 PM [strug] huli right its an ovarian tumor most probably sertolileydig cell tunore
8:31 PM [strug] very high test is the key
8:32 PM [strug] in Pco little inc in testosteone
8:32 PM [megs] ok strug
8:32 PM [lanny] adrenal gland hyperplasia
8:33 PM [lanny] what hallmark
8:33 PM [strug] female with hirsutims without virilization....also precocius puberty and is of short strature....whats diagnosis?
8:33 PM [huli72] low ACTH
8:33 PM [sanz] dont know lanny
8:33 PM [huli72] low cortisol
8:33 PM [huli72] high dhea-s
8:34 PM [huli72] virulization, hirsutism
8:34 PM [lanny] all right
8:34 PM [sanz] Mccune Albright strug?
8:34 PM [megs] ambg ext genitalia
8:34 PM [strug] no sanz its congenial adrenal hyperplasia
8:34 PM [strug] late onset cong adre hyper autosoma recessive
8:35 PM [huli72] good q, strug
8:35 PM [megs] which enzyme def most commonly in CAH
8:35 PM [sanz] they dont have virilization as opposed to early onset CAH
8:35 PM [strug] 21 alpha
8:35 PM [lanny] 21
8:35 PM [sanz] cool
8:35 PM [huli72] 21 hydroxylase
8:35 PM [megs] YUP
8:35 PM [lanny] 21 then11
8:35 PM [lanny] trt?
8:35 PM [huli72] agree lanny
8:35 PM [strug] cortisol lanny
8:35 PM [huli72] cortisol
8:36 PM [megs] GLUCO
8:36 PM [huli72] dexamethasone
8:36 PM [lanny] cortisol
8:36 PM [lanny] trt of hirsutism?
8:36 PM [huli72] spiralactone
8:37 PM [strug] female with hirsutim, family history positive, mensus and fertility normal....diagnosis?
8:37 PM [huli72] flutamide
8:37 PM [strug] OCp and spiron lanny
8:37 PM [huli72] heritary hirsutism
8:37 PM [lanny] right strug
8:37 PM [megs] COSTITUTIONAL
8:37 PM [strug] yup Idiopathic Hirsutims
8:38 PM [strug] most common cause of androgen excessis idiopathic
8:38 PM [megs] what is pre mens syndrome??
8:39 PM [strug] occurs in the premenstarual perod
8:39 PM [huli72] migrane, headache
8:39 PM [sanz] irritative
8:39 PM [strug] for cons 3 cycles
8:39 PM [huli72] fatigue
8:39 PM [huli72] edema
8:39 PM [huli72] nausea
8:39 PM [strug] does not occur in preovularotyr peroid
8:39 PM [megs] multifactorial aetiology
8:39 PM [strug] resoves with mestruation
8:39 PM [huli72] how to trt?
8:39 PM [lanny] etiology is unknown
8:39 PM [megs] yup all correct
8:40 PM [strug] has autonomic., musculoskelatel, fatige, emotional sym
8:40 PM [lanny] bromocriptin
8:40 PM [megs] oc pills nsaids
8:40 PM [strug] antidepsenn huli
8:40 PM [sanz] OCP
8:40 PM [megs] frusemide
8:40 PM [lanny] for breast tenderness
8:40 PM [huli72] strug correct?
8:40 PM [strug] serotinin reuptake inhibitior
8:40 PM [lanny] progesterone
8:40 PM [huli72] menstrual diary too
8:40 PM [megs] yeah strug in severe cases
8:40 PM [huli72] yes, strug
8:41 PM [strug] it is most likely confused with what?
8:41 PM [huli72] I am surprised at menstual diary is the trtment.
8:41 PM [strug] its not the Rx its the first step
8:41 PM [huli72] flu?
8:42 PM [strug] because until the symp at the same time and for 3 cycles u cannot call it PMS
8:42 PM [huli72] or chronic fatigue syn?
8:42 PM [strug] Major depression huli
8:42 PM [lanny] anxiety too
8:42 PM [huli72] thnks, strug
8:43 PM [strug] mechanism of ocp in hirsutims?
8:43 PM [lanny] which vitamin are thought to be def
8:43 PM [strug] b6
8:43 PM [megs] what is diff betn hypertricosis and hirsudism??
8:43 PM [lanny] ocp has pos and neg feed back on pit cause a dec in gonadotrop
8:43 PM [strug] hirtusim is male pattern of growth megs
8:44 PM [strug] like upperlip and chest megs
8:44 PM [megs] yup strug
8:44 PM [strug] lanny i m talking about in hirsutims
8:44 PM [lanny] oh thought you meant mech of treatment in hirsuit
8:45 PM [strug] it dec testto formation by dec LH stimulation in theca cell and also dec SBG
8:45 PM zoya has left the chat.
8:45 PM [sanz] ok strug... didint know that
8:46 PM [lanny] yes strug as a conseq of neg f back on pituit
8:46 PM [strug] its imp i guess
8:46 PM [strug] yup lanny
8:46 PM [megs] if idiopathic hirsutism then???
8:47 PM [strug] spironalcatone
8:47 PM [megs] thendont traet hormonally
8:47 PM [sanz] so do they need Rx?
8:47 PM [megs] i am so bad at typig
8:47 PM [lanny] strug estrogen inc SBHG that binds thw inactive testost
8:47 PM [strug] i think we give spirnolactone
8:47 PM [strug] yup lanny u right sorry
8:48 PM [megs] give cosmetic treatment
8:48 PM [lanny] if idiopathic hirsuit we give OCP
8:49 PM [strug] but in idiopathic hirusutim there is androgen excess....we have to treat
8:49 PM [lanny] yes by giving spirono
8:49 PM [strug] lanny my friend
8:49 PM [megs] idiopathic means no cause
8:49 PM [lanny] that binds 5 alpha reduct
8:49 PM [strug] yup no cause for the inc androgen
8:50 PM [megs] spirono is not hormonal prep
8:50 PM [lanny] oh ok guys missed that idiopathic
8:50 PM [megs] so can give, i said no hormonal treatment
8:50 PM [strug] great megs thanks
8:50 PM [sanz] thnx
8:51 PM [lanny] so what do we give megs
8:51 PM [megs] cosmetic tx
8:51 PM [lanny] ok thx
8:51 PM [strug] what is the first step in infertility
8:51 PM [megs] waxin epilation
8:51 PM [sanz] semen analysis
8:51 PM [huli72] history
8:51 PM [lanny] no
8:51 PM [megs] history
8:51 PM [strug] :o megs
8:51 PM [sanz] and mentral diary
8:51 PM [lanny] sanz semen is after rule out maternal causes
8:52 PM [sanz] oh
8:52 PM [lanny] measure LH FSH
8:52 PM [strug] no lanny first is semen
8:52 PM [megs] freq of intercorce and timing
8:52 PM [strug] thats right
8:52 PM [lanny] disagree
8:52 PM [strug] after history first is semen analysis
8:52 PM [megs] in usa they investgate male and female at same time
8:52 PM [lanny] most common cause is male sperm probs but first rule out female causes
8:52 PM [strug] right
8:53 PM [sanz] MCC is female prob
8:53 PM [strug] really?
8:53 PM [huli72] but male factors are easy to assess
8:53 PM [sanz] 60% is female prob
8:53 PM [lanny] disagree sanz
8:53 PM [sanz] male probs is 40%
8:53 PM [strug] i thought both 50
8:53 PM [strug] lemme check
8:53 PM [megs] lot of time is wasted otherwise so first they find cause first
8:54 PM [lanny] its not what they do in hospitals all hosp do things differently its what USm wants
8:54 PM [megs] agree lanny
8:55 PM [megs] so what usmle want???
8:55 PM [megs] whats ans
8:55 PM [sanz] i know it's 40% male prob and 60% female probs
8:55 PM [sanz] cause is unknown in 5%
8:55 PM [strug] in US both male and female contribute for 40% of infrertility....f20% cause unknown
8:56 PM [strug] acc to swanson family practice
8:56 PM [megs] 40% male 40% female and 20% idiopathic
8:56 PM [megs] strug right
8:56 PM [megs] blue print says same
8:57 PM [strug] so we begin their workup togerhter
8:57 PM [lanny] dont remeber the percentages but semen analysis comes after evaluating the female
8:57 PM [strug] semen analysis for male and anovulation for female
8:57 PM [lanny] can chk it later guys
8:57 PM [lanny] yes strug
8:57 PM [strug] ok lanny....u men......
8:57 PM [sanz] heheh strug
8:58 PM [strug] no offences for anyone.....
8:58 PM [megs] how to test ovulation??/
8:58 PM [megs] various methods??
8:59 PM [strug] BBT
8:59 PM [strug] cercvial mucous
8:59 PM [huli72] agree with strug
8:59 PM [megs] bbt charting cx mucus
8:59 PM [sanz] cervical discharge...
8:59 PM [strug] premens cramping
8:59 PM [huli72] fern under microscopy
8:59 PM [megs] what is mittelsmerge
8:59 PM [strug] midcycle pain
8:59 PM [megs] painful ovulation
8:59 PM [lanny] well my dinner time is fast approachingright
8:59 PM [sanz] abdo pain in girls during time of ovulation
8:59 PM [huli72] bleed in the mid of peroid
9:00 PM [sanz] no bleeding right?
9:00 PM [huli72] bye, lanny, enjoy your dinner
9:00 PM [strug] hey guys i found the approch
9:00 PM [sanz] bon apetite lanny
9:00 PM [strug] first take complete historyies of both partners
9:00 PM [sanz] approach to what strug?
9:00 PM [lanny] me too let me hear yours
9:01 PM [megs] i will be back guys
9:01 PM [strug] then compleete phy exam of bothe
9:01 PM [strug] then do semen analysis twice
9:01 PM [lanny] ok let me give you mine
9:01 PM [strug] assessmetn of ovluation
9:01 PM [lanny] are you ready
9:01 PM [strug] ok lanny yes
9:02 PM [lanny] initial apprach to infert coule
9:02 PM [huli72] should be history
9:02 PM [huli72] of marriage
9:02 PM [lanny] assess pelvic factor BBT of fem
9:02 PM [lanny] hysterosalp of fem
9:02 PM [huli72] and PE
9:03 PM [lanny] to look for scarred fallop tube
9:03 PM [lanny] this is the ovulatory fctor
9:03 PM [strug] scarred fallop tube? ovularoty factor lanny?
9:03 PM [lanny] hx of damage STD
9:04 PM [sanz] prev tubal preg i think Strug
9:04 PM [lanny] scarred fallop tube pelvic sorry
9:04 PM [lanny] then semen analysis of male
9:04 PM [lanny] sorry guys dont type too well
9:05 PM [strug] lanny maybe ur right ..... but i would evaluate them togher... :)
9:05 PM [huli72] I think semen analysis should be after hx and PE
9:05 PM [huli72] then do what lanny said above
9:06 PM [lanny] yes huli that is no 1
9:06 PM [strug] i too think the same huli
9:06 PM [lanny] the investigative stages initially should proceed
9:07 PM [lanny] it all deps on a ques poss that they can both be assessed together ie the man and woman
9:07 PM [strug] what is the most common anatomical site for osteoporois?
9:07 PM [sanz] spine
9:07 PM [strug] right sanz good
9:07 PM [lanny] lumbar verteb
9:07 PM [huli72] agree sanz
9:07 PM [strug] how do u assess bone density?
9:07 PM [sanz] DEXA scan
9:08 PM [strug] DEXA scan right
9:08 PM [lanny] DEXA
9:08 PM [strug] how do u find out Ca excretion?
9:08 PM [strug] ca lossin urine i mean
9:08 PM [huli72] urine 24 hours ca
9:08 PM [lanny] yes
9:09 PM [strug] nope guys its 24 hour hydroxyproline or N-telopeptide
9:09 PM jnkhampton has left the chat.
9:09 PM [strug] Rx for osteoporisis?
9:09 PM [huli72] no, that is for collegen turn over or bone turn over
9:09 PM [sanz] exercise wt loss
9:10 PM [huli72] HRT
9:10 PM [sanz] i mean wt bearing
9:10 PM [huli72] best therapy
9:10 PM [sanz] ca supp
9:10 PM [huli72] then biphosphate
9:10 PM [sanz] vit d
9:10 PM [lanny] not sure strug about hydroxy
9:10 PM [huli72] then vit D and ca
9:10 PM [strug] huli i read it as 24 hour urine hydrocyproline for assesing ca loss
9:10 PM [huli72] strug, that should be bone loss
9:10 PM [strug] n telopeptde is a bone brekdown product u right
9:11 PM [huli72] osteroid loss
9:11 PM [huli72] not ca,
9:11 PM [strug] gold standard Rx for osteoporisi is HRT
9:11 PM [strug] biphophonates , SSri can also be given
9:11 PM [strug] benefits of HRT?
9:12 PM [huli72] heart disease
9:12 PM [huli72] HT
9:12 PM [huli72] hyperlipidia
9:12 PM [huli72] diabetes
9:12 PM [huli72] migrane
9:12 PM [sanz] it's not heart dz anymore ...
9:12 PM [huli72] depression
9:12 PM [huli72] CAD
9:12 PM [strug] dec colon ca, alzheimers. dec CAD, protects against osteoporise, relief from vaginal dryness and mental changes
9:12 PM shreya has left the chat.
9:13 PM [lanny] sanz heart dz is controv
9:13 PM [sanz] yeah, so we cannot say it decr CAD
9:13 PM [strug] rally is it controverisal?
9:13 PM [sanz] yes, HUGE controversy
9:13 PM [strug] thanks guys
9:13 PM [strug] what ar ethe C/I of HRT?
9:14 PM [huli72] throbosis
9:14 PM [strug] C/I= contraindication
9:14 PM [lanny] thrombosis
9:14 PM [huli72] breast tumor
9:14 PM [sanz] yup.. and hx of endom ca
9:14 PM [sanz] fam hx
9:14 PM [huli72] smoking
9:14 PM [strug] liver disease, H/0 breast or endo metrial cancer, thrombosis, unecplained vagina bleeding
9:14 PM [huli72] hypercoagulate state
9:15 PM [strug] no family history sanz and no smoking huli
9:15 PM [huli72] thnks, strug
9:15 PM [megs] CADisnow a days not c/i
9:15 PM [sanz] ok
9:16 PM [lanny] yes megs this topic makes pts argue with their docs >>>
9:16 PM [lanny] could be asked as an ethics question
9:16 PM [megs] how to minimise comli of hrt
9:16 PM [strug] give proges with estor
9:16 PM [sanz] like how lanny?
9:16 PM [lanny] agree strug
9:16 PM [shreya] add progesterone
9:17 PM [megs] give and strug????
9:17 PM [strug] i didnt get u megs
9:17 PM [lanny] pt asks doc about whats best to prvt heart dz.her mum died of heart dz, she heard its goodto help with her weak bones
9:17 PM [megs] use diff route of admis of hrt
9:18 PM [megs] pathch pessary
9:18 PM [strug] that dec the complications?
9:18 PM [strug] megs
9:18 PM [strug] why not give just oral megs
9:19 PM [lanny] the HRT itself is a combo of estr and pro
9:19 PM [strug] not always lanny
9:19 PM [sanz] no lanny... they have diff ways of preparations
9:19 PM [strug] if female has hystectomy i will give estrogen oonly
9:19 PM [huli72] yes, strug
9:20 PM [lanny] i was actually asking as i have heard that sometimes no prog in it.. thanks
9:20 PM [strug] no prob lanny
9:20 PM [huli72] if no uterus, no progesterone is needed.
9:21 PM [lanny] megs what is pessary
9:21 PM [strug] megs does diff routes of administaion dec the complications?
9:21 PM [megs] PATCH AVOID FIRST PASS MECH HENSE LESS ESTR REQ
9:21 PM [megs] LESS ESTROGEN LESS SIDE EFFECTS
9:21 PM [huli72] good points, megs
9:21 PM [lanny] agre thx megs
9:22 PM [strug] ah ha :)
9:22 PM [megs] THANX
9:22 PM [megs] PESSARY IS VAGINAL TABLET
9:22 PM [strug] whats the benefit of raloxifen over tamoxifen?
9:22 PM [lanny] no poss of endo cancer
9:22 PM [strug] correct lanny
9:23 PM [lanny] whats tomm guys
9:23 PM [lanny] tommorow strug the administrator in chief!
9:23 PM [strug] benign gyneco
9:23 PM [megs] ok strug
9:23 PM TTW has left the chat.
9:23 PM [lanny] ok well are we closing shop
9:23 PM [strug] prolapse, incontinene., std etc.....
9:23 PM [lanny] good
9:24 PM [huli72] see you guys, tomorrow
9:24 PM [lanny] see you huli
9:24 PM [strug] i have a doubt
9:24 PM [huli72] what is it, strug
9:24 PM [lanny] on what
9:24 PM [strug] there was a q in usmle world i didnt understand
9:25 PM [huli72] can you type it here?
9:25 PM [megs] what strug??
9:25 PM shreya has left the chat.
9:25 PM [strug] 25 yrs obese female, evaluation of faacial hari and irr mensus
9:25 PM [huli72] pcos
9:25 PM [strug] acth stimualtion...inc the dheas leverls to 12
9:26 PM [strug] the dheas level befor that was 5
9:26 PM huli72 has left the chat.
9:26 PM [sanz] yeah, i remember this q
9:27 PM [strug] what is this acth stimulation? and how does it help us in diagnosing PCOS?
9:27 PM zoya has left the chat.
9:27 PM [sanz] from what i understood from their explanation
9:27 PM [huli72] I was kicked out
9:28 PM [strug] wb huli
9:28 PM [sanz] in PCOS, their adrenal glands are more sensitive to ACTH
9:28 PM [sanz] so by giving ACTH stimulation, DHEA will incr lots
9:28 PM calender has left the chat.
9:28 PM [huli72] is pcos the answer? strug
9:28 PM [megs] yes sanz u r riht
9:28 PM [strug] i thought dheas levels high only in adrenal tumor
9:28 PM [strug] yes huli its pcos
9:29 PM [huli72] dheas were reported in pcos too
9:30 PM [strug] i choose adr tumor and got the q wrong :(
9:30 PM [sanz] yes, DHEA levels are high in adrenal tumor... but in PCOS, for some reason their adrenal is very sensitive to ACTH
9:30 PM [huli72] and you learn pcos now
9:30 PM [strug] but now i will chose PCo :)
9:30 PM [sanz] you see in adrenal tumour, ACTH wont make the DHEA go up
9:30 PM [sanz] cuz the DHEA pdt in adrenal tumour is autonomic... tumour does what it likes
9:31 PM [strug] thank you very much sanz....its so nice of u.....i will never forget now :)
9:31 PM [sanz] it's like when you have chushing and you do stim to see... if it's ect pdt, then there wont be any effect
9:32 PM [huli72] very nice theary, sanz, I won't mess up any more
9:32 PM [sanz] i think the point of the q was good tho... to show us how to diff adrenal tumour from PCOS
9:32 PM [strug] yes sanz
9:33 PM [strug] hey are we done for today......
9:33 PM [sanz] i sure hope so!
9:33 PM [strug] its 8:33
9:33 PM [sanz] i have a brain drain
9:33 PM [sanz] hehe
9:33 PM [megs] yup
9:33 PM [megs] tired
9:33 PM [strug] u did well today sanz
9:33 PM [huli72] me too
9:33 PM [strug] megs thanks fa lot for ur expert opinion
9:33 PM [sanz] yeah megs
9:33 PM [sanz] i wish i dont have an aversion to ObGyb
9:33 PM [megs] its my pleasure guys but u all r perfect guys
9:33 PM [strug] bye then all of u see u tomrrow
9:34 PM [megs] bye all
9:34 PM [huli72] bye
9:34 PM [sanz] can i ask sth?
9:34 PM megs has left the chat.
9:34 PM [strug] what sanz?
9:34 PM [sanz] you know the Cd that the USMLE sent us?
9:34 PM [sanz] there're promertirc and NMBE/FREDA
9:34 PM [strug] i have not solved it yet
9:34 PM [sanz] which is the one that is used in the exam?
9:34 PM huli72 has left the chat.
9:35 PM [strug] oh till april i think prometric
9:35 PM [sanz] i havent either but i know they have changed the format
9:35 PM [strug] no not in march dont worry
9:35 PM [sanz] oh oke
9:35 PM [sanz] thnx
9:35 PM [strug] bye
9:35 PM [sanz] bye
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Asclepius1
04-15-2005, 01:38 PM
having relashionship when ovulation is two day over is safe







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