View Full Version : Int Med chat: Endocrinology

03-09-2005, 08:42 PM
dua_frank has joined the chat.
[neelam] then
[neelam] bye
[tony_hu] I am planning to have EE in September, 05. Does any IMG have good ideas how to prepare the exam and what materials should I read. Your help would be very much appreciated.
[blacktown] hi
[blacktown] where are you from?
[blacktown] erum
[david100] hi
[andy1240] hi
[andy1240] no bodyhere?
[thalamus] andy1240 hi
Now entering USMLE_Step_2 subroom.
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[docra] hi group
[dua_frank] hi docra
[docra] have u started the discussion
[dua_frank] not yet
[lanny] hi all
[dua_frank] hi lanny
[fero] hi everyone
[lanny] wanna make a point from y day...broncho carc and mesothelioma are both syn with asbestos and cig smoking
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[megs] hi all
[fero] ya ,lanny,,,,i looked for it in davidson but could not find,,,
[dua_frank] hi megs
[docra] hi all
[megs] have u started??
[fero] hi doc, hi megs
[fero] lanny ,,tell megs also
[megs] what fero???
[fero] lanny looked up something ,,,, a point about syn effect of smoking and asbes on mesothioma aand br ca
[samantha] hi everyone
[megs] hi sammy
[samantha] hi megs are we ready to start endo
[fero] i rechecked it in goljan lanny,,,it says the opp
[dua_frank] i'm going to tell a sign or symptom here, yuo're going to tell me the possible diagnoses
[fero] ok dua
[dua_frank] hypotension
[uniteus] hi everyone
[fero] HI UNI
[docra] anaphylaxis
[dua_frank] hi uni
[lanny] hypovolemia
[dua_frank] we're doing endocrine today docra
[megs] addisons disesse
[lanny] i thought endo today
[docra] oops
[dua_frank] adrenal insufficiency
[samantha] ok
[megs] addison is same as adrenal def??
[dua_frank] fatigue
[megs] hypothyroidsm
[samantha] hypo thy
[dua_frank] megs there are other conditions in that category too
[dua_frank] not just addisons
[megs] ok
[dua_frank] whoa fero *)
[fero] wat dua?
[dua_frank] in that the MC symptom would be alterned mental status fero
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[lanny] addisons is adreno coritical deficiency
[dua_frank] hypotension is not the hallmark for it
[fero] o,,most common u r talking about,,,okok carry on
[fero] lol
[dua_frank] yes yes
[fero] well its a coma *)
[dua_frank] it should strike you as the cause
[dua_frank] headaches
[fero] acromegaly
[kaash110zeh] hyperpig
[samantha] DKA?
[dua_frank] pit tumours and pheochromocytomas
[megs] pitutory adenoma
[megs] ok
[dua_frank] seizures
[megs] siadh
[lanny] what are you guys talking aboout?/
[dua_frank] yes fero
[samantha] DKA
[dua_frank] DKA goes into coma not seizures
[dua_frank] hypoglycemia and hypocalcemia
[megs] siezures due to SIADH hyponitremia
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[dua_frank] renal stones
[samantha] hyperpara
[megs] hyperparathyroidism
[dua_frank] yes
[dua_frank] and pagets disease
[dua_frank] hypogonadism
[fero] KALLMAN
[fero] klein fliether syn
[uniteus] Klinefether
[lanny] dua what are you talking about
[dua_frank] hypopituatarism
[lanny] whats the q??
[uniteus] infections such as TB n leprosy
[fero] sheehan syn
[dua_frank] causes that might result in the signs and symtoms i'm writing here lanny
[lanny] oh ok
[dua_frank] uni we're on endocrine
[uniteus] :) got carried away...but they do cause hypogonadism
[dua_frank] lol
[fero] in a case of hyperprolactinemia,,which test will u order first?
[docra] gh
[samantha] fsh and lh
[uniteus] TFT?
[lanny] TSH
[fero] good uni
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[fero] TSH, and trh even before u check the prolactin levels
[dua_frank] why fero?
[lanny] the test orderd fo is the TSH
[uniteus] hypothyroidism can cause hyperproc
[docra] and history of medication
[dua_frank] ah right
[fero] normal D inhib PROLACTIN, trh inhib this action
[fero] D> dopamine
[fero] MCC of death in acromegaly?
[dua_frank] MI
[lanny] heart dz
[uniteus] heart failure
[megs] cardiac failure
[samantha] cardiac failure
[fero] rt everyone
[fero] cardiomegaly it is
[uniteus] what is the screening test of Acromegaly?
[fero] give 100 g gluse and meas GH
[megs] glucose stimulation??
[lanny] Glucose stim
[samantha] fasting Gh level
[uniteus] rt....give them glucose 100g n measure the GH if > 5 then acrom more likely
[fero] u find an empty sella on a a ct scan done,,,on apt,,what will u do to manag?
[dua_frank] nothing
[fero] rt dua..
[lanny] agreee dua
[uniteus] nothing...unless dey have htn
[megs] reassurance
[lanny] why do you do nothing??
[uniteus] dunno..but how do u diagnose empty sella by CT or MRI? dunno the ans
[docra] endocrinr symptoms r not likely
[dua_frank] coz pit is just misplaced
[dua_frank] its still there but just not in the sella
[lanny] right not in the sellla empty sella
[dua_frank] MRI uni
[uniteus] thx dua
[lanny] uni MRI i think
[dua_frank] all tumours and lesions always MRI
[dua_frank] blood CT
[lanny] agree
[fero] ok,,here is a good one. bl gluc lev .1 am> 120 mg/dl glusoe, 3am> 70 mg,5 am>90mg, 8am> 300mg..( pt on insulin therapy) wat is the explan..??
[lanny] dua CT with no contrast!!
[dua_frank] yes lanny
[dua_frank] smyogi phenomenon
[uniteus] somo effect..cant rem
[lanny] somogyi
[samantha] somogyi effect
[fero] wat causes this hypergly?
[docra] somogi
[dua_frank] counterinsulin hormones
[fero] rt doc dua
[docra] stress hormones
[fero] which ones?
[dua_frank] all
[dua_frank] gh
[dua_frank] epi
[dua_frank] almost all
[dua_frank] ok
[samantha] glucagon GH and cortisol
[lanny] right GH is diff
[lanny] peaks aroound 5 -7 am
[fero] gh is the one associa with dawn phen
[lanny] yes fero
[dua_frank] ok
[lanny] cause it peaks in the dawn
[fero] ok how will u manage both these pt,,, both present with hypergylsemia?
[dua_frank] whats the difference in dawn and smoyogi?
[fero] dawn is due to GH INC IN EARLY morn hrs
[dua_frank] give less dose of night insulin fero?
[uniteus] dawn u have increase glucose that needs amounts of insulin
[uniteus] increase insulin to maintain
[lanny] late nighthypo in somo
[lanny] late nigth normo in dawm
[fero] in som> dec insulin dose, in dawn u inc the dose
[uniteus] somo has hypo in late nite
[dua_frank] ok thanks uni and fero
[fero] ya uni,,, usually associa with bad dreams
[uniteus] lol didnt know dat part thx fero
[fero] lol
[dua_frank] well in that case usmle causes somogyi effect to then
[dua_frank] :an
[docra] so exactly wat hormones envolve dua
[fero] sure does dua...
[dua_frank] GH cortisol, epi, like they said before docra
[fero] in dawn GH>
[fero] IN SOMOGY> E , NE
[megs] agree fero
[fero] in usmle one> HCL...ACID,,,,,
[fero] LOL
[docra] thanx dua
[dua_frank] lol fero
[dua_frank] welcome docra
[lanny] counter reg hormones is epi cortisol....
[docra] :)
[fero] rt lanny
[megs] in somogy glucagon is responsible for morning hyperglysemia
[dua_frank] yeah they're otherwise called as diabetogenic hormones as they raise the glucose level
[fero] yes megs thats one of the counterreg horm too
[lanny] somogyi is due to xcess insulin dose at noght
[fero] rt lanny
[lanny] GH is not a counter reg hormone
[fero] gh is invol in dawns lanny
[megs] epi and nor epi and glucagon..these trhee
[docra] so all stress hormones right
[lanny] yes megs
[megs] not cortisol??
[lanny] megs got it all three
[docra] not cortisol?
[lanny] cortisol too mrgs
[megs] ok lanny thanx
[fero] why dont we measure GH in acromeg,,,,,? instead we do a glu stimm test y?
[samantha] not sure
[dua_frank] exaggerated GH response due to insulin
[dua_frank] you give glucose, insulin released
[fero] GH,,is relasesd in a pulsatile way
[dua_frank] insulin> GH released
[megs] agree fero
[fero] agree dua,,but my ques was,, y not direct GH,,U R RT
[samantha] yes dua
[lanny] you give so much ins at night that by 3 am all wane off leaving the oerson hypo
[dua_frank] continue with your explaination fero
[megs] there is circadian rythm for growth hormone secr
[fero] how will u diff , insulinoma form fact injec of Insulin
[lanny] c peptide
[docra] c peptide
[lanny] value
[megs] agree c peptides
[fero] thas it dua,,GH IS ONLY RELeased in pulses,,,ILGF is BETTER way,,r glun stimm test
[docra] plz explain gh ferro
[samantha] c peptide fero
[megs] if iv insulin..no c peptide levels raised
[uniteus] c peptide increase in insu but decrease in fact inj
[dua_frank] ok thanks
[fero] in which other cond also the c pet is raised?
[lanny] agree uni
[megs] if endogenous insulin peptide increases
[docra] insulinoma
[fero] besides that doc
[uniteus] sulfonylurea
[megs] gh excess fero?
[dua_frank] acromegaly?
[fero] good uni,,how will u diff
[dua_frank] dunno
[fero] its sulf use
[uniteus] presence of drug in blood
[dua_frank] ok
[fero] in urine ,,good uni
[uniteus] or urine
[fero] blood too i guess
[megs] wow..uni fero...didnt know that
[dua_frank] nice q
[megs] thnax
[fero] its an imp point guys
[docra] oh its to inc endogenous insulin thats y
[lanny] sulfonylureas inc endo insulin prod
[uniteus] y do u get hypogly in alcoholics?
[fero] rt doc...,sulfony urea use,,looks like insulinoma....the labs i mean
[lanny] thiamine def
[docra] the cycle divert
[dua_frank] ADH enzyme used up
[dua_frank] by alcohol
[docra] gluconoegenesis i think
[lanny] coenzyme needs vit B1 to wrok
[dua_frank] so no glucose released from liver
[megs] fero u r saying about gh excess??
[megs] what is that pl explain
[fero] no megs,,i didnt ask any ques reg that
[fero] wat megs?
[megs] why we do not directly measure GH levels in acromegaly>>>
[fero] my last point was about sulf
[fero] o
[uniteus] rt dua....cause alcoholics dont eat ..starvation..used up the glycogen stores....n alcohol induces hypogly by inhibiting gluconeogen
[lanny] has to do with vitamin def and an enzyme too
[lanny] in gluconoegenesis
[fero] ok,,, GH,is released in pulses..it diff,,,in diff time frame... ILGF( insulin like growth factor) is a better index
[uniteus] not much of vit def lanny...but agree on enzy
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[dua_frank] thiamine def causes wernickes and korsakoffs lanny
[dua_frank] you're confused between the two i think
[lanny] the vit is a cofactor
[fero] ILGF..also indictaes GH acti.. BUT for usmle,,learn glus stim test
[dua_frank] fero what you just said there went over my head *)
[dua_frank] but the last part about glucose sti test registered :P
[fero] dua,,it was from step 1 kaplan....
[dua_frank] i know
[fero] endo sec
[dua_frank] which is why i don't remember now :P
[dua_frank] we learnt all kinds of junk for step 1 :P
[megs] somatomedin and IGF Both denotes gh activity
[fero] rt megs good.
[docra] i was right
[megs] but gluc stimulaton test is used for diagnosis..hmmm
[fero] yes..
[docra] its the divertion of gluconeogensis
[megs] yes docra
[docra] nadh/nad is used up in liver
[fero] Tt for gastroparesis?
[docra] no moer left
[megs] metoclor
[lanny] metoclopropramide
[megs] and cisapri
[megs] but not used now
[fero] rt megs...drug for nueropathic pain in DM?
[lanny] gaabaprntin
[megs] agree lanny
[fero] good lanny gabapentin
[lanny] megs whats used now for gastro??
[fero] metoclopramide
[megs] metoclor lanny
[megs] cisa causes torsades
[megs] hense banned
[lanny] oh i thought you meant something else
[lanny] agree
[fero] managment of a solitary thy nodule? Dx?
[lanny] measure TSH first
[fero] best initial test?
[fero] rt lanny
[uniteus] TSH then FNA
[docra] amitriptylin n carbamazapine is also for pain
[docra] ?
[lanny] TSH
[megs] tsh first
[fero] dunno doc,,,
[megs] see pt is hypo or hyper...
[fero] agree uni lanny megs
[lanny] right docra but not for diaetic pain
[dua_frank] whats the glucose test for acromegaly show?
[megs] if ab normal tsh..do t3 t4..
[fero] > 5
[uniteus] increase GH>5
[fero] gh
[dua_frank] yes
[docra] i havent seen gabapentene
[dua_frank] what will you see normally in that test?
[fero] gh< 5 dua?
[megs] supression of gh with glucose
[uniteus] decrease GH
[dua_frank] yes uni
[dua_frank] and megs
[dua_frank] i'm glad we're clear on that :P
[uniteus] :)
[uniteus] what is the tx for hyperprolac?
[dua_frank] brom
[lanny] bromocripptine
[megs] bromo
[uniteus] rt dua, lanny, megs
[docra] bromo
[fero] octrotide is better
[lanny] dunno that fero
[uniteus] if pt has big pit adenoma due to hyperprol what is the tx?
[megs] octride for acromegaly fero
[megs] not for hyperprolactinoma'
[samantha] pergolide
[fero] sure about this one guiys
[megs] carbagoline uni??
[uniteus] octreotide is for acro just checked
[dua_frank] resection
[fero] octrotide is a somatostatin analoge.. better then bromo
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[dua_frank] plus octreotide
[lanny] surgery or radiation
[dua_frank] yeah i agree fero
[megs] yup uni but for treating acro it is better
[fero] thx dua...
[uniteus] answer is bromocriptine..always first no matter what ..then surger later...
[fero] lol
[lanny] for macro adenoma
[fero] no way uni,,,,
[fero] i DONT AGREE
[lanny] agree uni
[fero] i did QUES WROUNG ,,
[megs] how somato statin analogue will help in prolactinoma fero???explain
[uniteus] hmmmm....will check on this one..anyone has better reason
[fero] for me,,octrotide is better
[dua_frank] explain metyrapone test
[fero] megs we r talking about acromegaly,,arnt we
[docra] how cum ferro
[lanny] megs i dont know too see no connection
[docra] aout prolactin
[fero] i ans octrotide for acromegaly
[megs] with acro we use octride agreee
[fero] sorry if i conveyed myself wroung
[lanny] fero right
[megs] i thout u talked about hyer prolacti
[lanny] bromo is for pit adenpma
[fero] no megs
[samantha] octreotide for acromegaly rt?
[fero] rt saman
[lanny] yes sam
[megs] ok my mistake...i think uni also thought same
[samantha] bromo for prolactinoma
[megs] ok
[uniteus] yeah..think so...megs
[docra] ;)
[fero] guys but bromo is also used in acromegaly
[lanny] guys i remeber bromo can be used in acromegaly it can shrink tumor size but in a small percent of people...
[fero] rt lanny
[docra] bromo for both
[docra] oct only for acro
[lanny] yes guys it just camer back to me fero youre right
[megs] fero sroll up then u will know...u answered actride is better for prolactinoma
[fero] nopes,,,dont agree,, for acromeg its octrotide,,,
[megs] :box ferroooo
[fero] megs i already said sorry,,if i mis conveyed myself dear
[uniteus] lol
[dua_frank] man
[fero] lol
[uniteus] dua u ok?
[dua_frank] lets just say this
[docra] ok next ques
[dua_frank] octreotide never given for hyperprolactinoma
[uniteus] :nah:
[dua_frank] confusion cleared :P
[fero] agree dua,,,
[dua_frank] uni back at ya :nah:
[lanny] agree
[docra] :gun :gun
[uniteus] agree dua
[dua_frank] see how easily i solved this heated debate :congrats:
[lanny] but bromo can be given to acromeg
[megs] ok.. :p wow dua great
[dua_frank] :P
[lanny] FINALLY!!!!!
[megs] shoot next q
[dua_frank] lol
[uniteus] :) :lolup: thanks dua
[fero] agree lanny
[fero] but octrotide is given first...
[lanny] *choochoo*
[fero] lol
[dua_frank] next is metyrapone test
[dua_frank] lanny lol
[docra] tt of siadh?
[megs] yeah fero BOSS
[megs] demeclocycline
[fero] lithium... democy
[lanny] AGREE FERO
[megs] fluid restr first
[uniteus] retrict fluids too
[docra] fluid rest
[dua_frank] lithium too
[lanny] dua awhat about metyraoine test??
[docra] tt underlying causes first
[dua_frank] dunno lanny, thats why me asking you
[dua_frank] i forgot, i knew what it was in step 1
[dua_frank] its a test to diagnose ACTH deficiency
[docra] when v use hypertonic saline
[dua_frank] thats all i know
[dua_frank] i don't know how it works
[lanny] its a test for secondary hypoadrenal dua
[docra] and very symptomatic pt cns
[megs] pt with cns symp...give hypertonic saline
[dua_frank] we don't give hypertonic saline in SIADH docra, if thats what you're asking
[dua_frank] we may give lasix with normal saline
[lanny] yea we give isotonic
[fero] non malignant pul conditions causing SIADH?
[docra] yup but only with cns s
[dua_frank] before we try lithium and demeclo
[docra] ymptoms i wanted to say
[dua_frank] COPD
[dua_frank] asthma
[megs] agree doc
[uniteus] tb
[megs] drugs.inf mononucleosis
[fero] PULM MEGS.....
[lanny] none
[uniteus] head injury
[fero] TB is correct
[megs] oh sorry
[uniteus] lung abscess
[docra] cns problems
[fero] good uni pnuemonia too
[megs] pneumonia and lung absecss too
[fero] rt megs
[docra] can sarcoidsis give siadh?
[dua_frank] it gives hypercalcemia is what i know
[fero] only heard it cause hyperca, and ACE IS RAISED doc
[dua_frank] dunnoa bout SIADH
[docra] oh ace not adh
[fero] lol
[docra] u r right fero
[fero] D/D,,,OF pshycogenis polydipsia and,,central DI?
[lanny] docra i thik it gives siadh not sure
[lanny] mean sarcoid
[docra] give adh
[megs] water restriction fero
[lanny] water depriv test
[lanny] fails to conc urine in psycho
[lanny] sorry in DI
[lanny] in psycho urine becomes conc
[megs] in psychogenic polydypsis water resriction concentrates urine and decrese in urinery flow
[fero] dont know much on this one,,but,,,giv inj of vasopress will correct the psh polydipsia.. also..serum and urine Osm r diluted.....does anyone know ,,?
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[dua_frank] thats for nephrogenic fero
[megs] agree dua
[fero] ok thx dua
[dua_frank] welcome
[lanny] arginie vasopressin is for diff bet central and nephro DI
[megs] thats for differntiating neprogenic and CENTAL DI
[fero] ok..thx
[lanny] in central give arg vaso ur osmol is greater than serim
[docra] so water dep for psychos
[docra] ?
[lanny] yes to diff DI from drinking too much water
[megs] HEY SANZ
[sanz] hey guys
[uniteus] hi sanz
[megs] HOW WAS IT ???
[dua_frank] hey sanz
[fero] , HI SANZ
[sanz] just wanted to say i posted my exams experience in the foru
[dua_frank] thanks
[uniteus] thx
[sanz] and also thank you all :)
[megs] GREAT ...
[lanny] SANZ...WELCOME!!1
[docra] hi sanz
[lanny] youo just finished yes
[sanz] it was doable but i didnt perform well i think
[lanny] hope the chat helped you
[sanz] yes lanny... came back abt 2 hrs ago...
[lanny] dont worry sanz sure you will do well
[sanz] just couldnt do anything so i thought i'll post my thoughts now when everything is still fresh in my mind
[lanny] thats good
[dua_frank] thanks a lot sanz
[fero] thx sanz,,
[sanz] if you have time, read step 1 first aid
[fero] dua....
[fero] lol
[megs] OK SANZ
[docra] what subjects ,all?
[lanny] you mean the whole book1!
[dua_frank] man step 1 again
[sanz] megs, thnx... there were so many soooooo many qs where i'm left with 2 choices and i just dont know which to pick...
[dua_frank] thats scary
[sanz] they gave me starling curve
[dua_frank] did they ask biochem too?
[megs] GOD HELP US....... :o
[sanz] and histology slides
[dua_frank] i hate that one :(
[docra] will u plz tell wat subjets from step 1
[sanz] histology! I didnt even do it properly in step 1
[erum] docra how is it going?
[sanz] heck i didnt do it properly when i was a student either
[sanz] hehe
[docra] good sis
[dua_frank] lol
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[erum] good keep on
[uniteus] good luck sanz
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[docra] its a smart group erum
[erum] n have fun
[lanny] sanz any special topics in first aid or subjects to revise?
[docra] yeah i am
[sanz] thanx uni...
[samantha] did the chat help sanz?
[erum] docra thinks u guys r smart :) :)
[sanz] sam yes
[sanz] it helps
[sanz] do UW
[dua_frank] but not if you want them for step3, i would understand that :)
[sanz] and NMBE
[sanz] lanny, pharm
[lanny] what about kaplan
[sanz] kaplan... just eat everything in kaplan
[fero] how many times did u revise kaplan sanz?
[sanz] digest everything
[kaash110zeh] erum r u preparing for both steps?
[lanny] thx sanz im gonna do pharm and patho from first aid
[erum] ok take care
[sanz] twice
[sanz] fero i read kaplan twice
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[uniteus] we will get constipated sanz...lol ...thanks for yur help esp chat ..help me a lot
[fero] ok thx sanz
[sanz] ideally i should read it 3x but ran outta time
[fero] u will b fine sanz
[sanz] uni... hehe.. got a lot of contipation qs
[sanz] hehe
[dua_frank] lol
[uniteus] :)
[lanny] sanz go rest and join us from time to time
[docra] if i do only uw not q bank is it ok
[sanz] doc yes
[sanz] kap qbank is not as good
[uniteus] yeah...dont think about it...go to beach n relax ..
[sanz] i did it tho...
[docra] thanx saz
[samantha] did you do kaplan q bank sanz
[lanny] so you dont recommend kap q bank
[docra] best of luck
[sanz] i'm going on holidays for 4 weeks...so i guess it's ok uni
[sanz] lanny, its good but i think kap qbank aint all that high yield
[fero] enjoy sanz
[docra] did u get alot of surgery?
[sanz] i would do NMBE early
[uniteus] cool..have fun then...
[sanz] not a lot... just trauma
[docra] ok
[uniteus] which one sanz i mean which form first?
[lanny] thanks one more were q preety basic mean familiar topics??
[sanz] find someone to discuss NMBE qs
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[docra] i guess obs and peeds cum alot
[sanz] i did it with strug and we managed to clear up a few stuff
[samantha] how many times did u do UW sanz?
[sanz] uni... i find form 2 better
[sanz] sam once
[sanz] i did UW just once... ran outta time
[uniteus] :congrats: thanks
[sanz] LOADS of psy
[dua_frank] so ideally its good to do kaplan q bank, uw and nbme twice right sanz?
[lanny] well sanz youre done i pray you have what you deserve and more!!!enjoy your holiday
[sanz] i wuldnt do kap qbank twice...
[docra] for psych is kaplan book enough
[dua_frank] ok
[sanz] doc yes
[samantha] what did you do last week of prep sanz?
[sanz] the psy qs are very very tricky
[sanz] first aid
[sanz] sam
[docra] like always
[sanz] oh yeah... eat everything in FA too
[lanny] yea that exam is a trio!!
[lanny] trip!!
[fero] u did FA R CRUSH sanz
[sanz] i dont have crush
[lanny] theyre waiting to twist you around
[fero] same here
[sanz] i dont have harrison or CMDT
[sanz] i dont think you need them ifyou know kaplan notes
[dua_frank] i don't think that will help anyway sanz
[docra] i m not doing first aid 2
[fero] ok thx sanz
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[dua_frank] cmdt and harrisons i mean
[docra] is it ok
[sanz] dua you're right... just read kaplan... quite enuf
[megs] thanx sanz happy holidays...
[lanny] sanz how sas cardio
[sanz] megs, loads of obgyn
[lanny] was cardio
[sanz] and i thought of you!
[megs] ya i read u r forum post sanz
[sanz] i think they gave me more obgyn cuz they knew i am not good at it!!!
[sanz] just to spite me
[sanz] hehe
[dua_frank] lol
[dua_frank] i that case i'm getting obgyn too :(
[dua_frank] megs help me please :(
[lanny] me too
[lanny] :gun
[docra] r v going to disscus obs in this forum?
[lanny] shoot them b ....rds!!
[dua_frank] lol
[samantha] sanz atleast you are done with it!
[fero] dua after IM which subject do u have in mind?
[lanny] docra we wlii make a sched after med
[megs] ok.
[dua_frank] nbme is what i need more than anything though
[sanz] ok
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[lanny] lots of cardio sanz
[sanz] lanny dont remember...
[docra] ok lanny
[sanz] must have
[lanny] i could imagine
[dua_frank] obgyn fero
[sanz] ECG of V Fib
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[fero] sanz where did u post,,this site r usmle. n et
[sanz] this site...
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[samantha] How to read medicine sanz?
[fero] ok thx
[sanz] cant post it in usmle net
[sanz] it says error
[lanny] sanz lets hope we will meet agian in st 3 in next few months
[sanz] sam, i read kap notes then do UW, Kap QBank and re read kap notes again
[sanz] lanny, yeah...
[lanny] i should be going mid april
[sanz] all the best to you
[samantha] thx sanz
[megs] :scared:
[lanny] thankyou sanz
[megs] thanx sanz
[dua_frank] forget about this exam now sanz, have a fun vacation
[dua_frank] you know you'll get the score you want :)
[sanz] now just have to leave it to God...
[megs] yeah all the best to u dear
[samantha] you will get good score good luck sanz
[sanz] anyway, if you guys have qs, just leave me a msg in my mailbox in this forum
[sanz] i'll check it fr time to time and ans them as best i could...
[dua_frank] will do, thanks
[lanny] we will
[megs] thanx sanz
[lanny] how do we do that do you know
[sanz] lanny there's a mailbox in valumd
[sanz] it's like a personal email box
[lanny] ok i see
[sanz] you just address yr post to sanz and i'll get it
[lanny] good hope youre going somewhere exotic sanz
[lanny] have fun
[sanz] ok... i wont disreupt yr chat anymore... sorry
[fero] not at all sanz
[dua_frank] its a pleasure to have you here :)
[sanz] what ar you guys doing today anyway?
[uniteus] yeah...agree dua
[dua_frank] and thanks for all the inputs about the exam sanz, appreciate it
[lanny] no no sanz it was great that you came i thought you will rest tonight and come tomorrow
[fero] u didnt mention .mine and unis name,,sanz,,,,,heheh ,,just kidding
[fero] lol
[dua_frank] lol fero
[sanz] aaawww fero
[uniteus] :)
[samantha] visit us again sanz
[sanz] i didnt know you when we were chatting
[lanny] endocrine sanz
[fero] sure sanz,,just kidding
[fero] gl
[sanz] but yup... thnx too... i learnt something fr u abt long term effects of iron ingestion
[dua_frank] lol
[fero] lol,,,dont laugh dua
[fero] :)
[samantha] are u releaved after the exam?
[dua_frank] shall we get back to our chat?
[sanz] sam, not at all!!!
[dua_frank] we still got to slog while sanz enjoys her vacation now :(
[sanz] the wait for the results is the worst part
[dua_frank] i envy her :P
[lanny] long term eff of Fe ing is FERO!!!
[uniteus] hush dua :)
[sanz] dua hehe... you guys will do so much better, i'm sure
[fero] lanny.....even i dont remember
[sanz] you're all very smart!
[sanz] fero, it's stricture
[dua_frank] not smatter than you and strug
[sanz] you asked the q and i didnt know the ans
[sanz] so now i know for life
[sanz] hehe
[fero] wow,,sanz,,thas the spirit
[lanny] yes agree sanz and strug did good with q's
[samantha] yes strug and sanz were ans all the q's
[sanz] ok... go study!! I'm moving my butt to the couch
[dua_frank] bye sanz :)
[megs] lol ok bye have a nice time
[uniteus] thanks a lot ...have fun.. bye sanz :)
[fero] good nite sanz
[samantha] bye sanz
[sanz] bye everyone... thnx for your support and all yr contributions
[sanz] *hugs*
[dua_frank] *hugs back*
[dua_frank] welcome :0
[dua_frank] :)
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[megs] *welcome*
[megs] shoot somebodt
[megs] iam lost
[samantha] back to reality
[fero] ok.. normal, T4 and TSH... AND low T3 and total thyr
[fero] ?
[dua_frank] low
[megs] is that sick euthyroid
[fero] Dx?
[dua_frank] oh :P
[fero] good megs
[dua_frank] lol
[megs] tricky one from UW
[lanny] TSH onormal
[fero] how does management of HONK diff from DKA?
[dua_frank] more fluids and half insulin in HONK
[fero] good dua
[samantha] DKA insulin HONK fluids mainly
[fero] total T4 in OCP use r preg?
[samantha] inc
[dua_frank] coz est ineffective?
[fero] rt sam,, and free T4?
[dua_frank] oh
[samantha] normal fero
[lanny] norm
[dua_frank] thyroglobulin
[fero] GOod and TSH?
[dua_frank] thanks, good q
[dua_frank] dec
[fero] normal dua
[samantha] normal?
[dua_frank] oops
[megs] normal TSH
[lanny] norm tsh
[dua_frank] t4 the inhibitory hormone
[fero] since free t 4 is normal
[dua_frank] ok
[megs] YEAH FERO
[fero] its the other way in androgen use and nephrotic syn?
[lanny] steroid dec TBG
[fero] point to remember is that pregnancy and OCP, inc albumins,,also TBG...
[dua_frank] sarcoidosis causes secondary DI not SIADH
[fero] rt lanny
[docra] thanx dua
[dua_frank] i mean nephrogenic DI
[dua_frank] welcome
[fero] normal RAIU?
[samantha] Hypertension and orthstasis where does it occur?
[fero] WHERE?.....ADRENALS?
[samantha] in which condition fero
[lanny] pheo?
[fero] ya lanny
[samantha] correct lanny
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[samantha] what are the secondary causes of hypertension?
[dua_frank] Nephrogenic DI< ADH levels are inc or dec?
[fero] RAIU> 5 TO 30%
[lanny] fibro musc hyperpllaxia
[fero] NORMAL to inc ?
[lanny] inc dua
[dua_frank] yes fero and lanny
[dua_frank] how do you rx nephr DI?
[dua_frank] good
[samantha] rt megs and lanny
[dua_frank] how will you rx lithium induced DI?
[fero] desmopressin?
[dua_frank] same rx
[dua_frank] desmo works only in central DI
[megs] THIAZIDES??
[fero] o
[dua_frank] lithium causes nephr di
[dua_frank] yes emgs
[dua_frank] megs i mean
[fero] yes ,,dua.s mall points but,,,, ....
[samantha] pheo hyperaldo and renal artery stenosis
[dua_frank] yep
[lanny] DI trt is with desmopressin
[samantha] sec causes of hypertension
[dua_frank] don't go picking desmopression blindly as soon as you see SAIDH
[dua_frank] access the type first
[lanny] no not SIACDH dua
[dua_frank] oops
[fero] good point...neh DI pts,,,,prefers ice
[dua_frank] i mean DI
[lanny] desmo is not used for SIADH
[lanny] oh ok
[lanny] for nephro its thiazide diueetics
[dua_frank] yes
[lanny] for central is desmo
[fero] karotype in klienfli syn?
[dua_frank] how is na level in urine in siadh?
[lanny] XXY
[fero] 47xxy,,,rt
[lanny] hyponatremia
[dua_frank] high lanny
[dua_frank] i asked urine
[fero] > 20 m eg/l
[lanny] urine is hyper tonic
[dua_frank] right fero
[dua_frank] yep so its water retention and natriuresis
[uniteus] high for urine Na
[lanny] yes
[fero] small amaounts of con urine is formed in SIADH
[fero] CONCENtrated
[dua_frank] rx?
[dua_frank] ok we already discussed that
[dua_frank] forget it
[lanny] by now we should all know that dua11111
[fero] fluid rest and diur based on Osm dua
[samantha] dec hco3 inc anion gap and inc K?
[dua_frank] yes fero
[dua_frank] MA sammy
[samantha] what is MA dua?
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[dua_frank] metabolic acidosis
[lanny] barters
[samantha] yes diabetic keto acidosis
[fero] honk?
[fero] o
[dua_frank] i like fero's o
[fero] lol
[dua_frank] so cute lol
[lanny] oh yea fero is a honk!!!!
[dua_frank] lol
[dua_frank] guys you ready to stay back and complete endo today right?
[lanny] 15 mins i can do
[fero] guys,,hyperosm non keto coma
[lanny] we know fero
[dua_frank] ok
[lanny] guys are you willing to stay...................
[uniteus] ok...i can stay
[fero] sure lanny 15 min it is
[uniteus] where's megs?
[dua_frank] inc tsh dec t4 and dec t3 dx?
[uniteus] hypothy
[lanny] hypothyroid
[lanny] hashimoto
[fero] hypo,,,hashi
[dua_frank] inc tsh, inc t4 and inc t3?
[fero] hyper, graves
[lanny] graves
[lanny] no
[dua_frank] nope
[dua_frank] tsh inc
[uniteus] secondary hypo
[dua_frank] pituatary cause
[fero] dua i wrote ,,o ,,then deleted
[fero] lol
[lanny] agree
[dua_frank] lol fero
[fero] ok yes pit
[dua_frank] dec tsh, dec t4 and dec t3 dx?
[lanny] pit apoplexy
[dua_frank] good
[dua_frank] i just wanted to give pit scenario with thyroid levels
[lanny] good dua
[dua_frank] hashimotos what anbodies?
[samantha] nice dua
[lanny] antiperoxidase
[samantha] antimicrosomal
[dua_frank] yes
[lanny] antimicrosomal
[dua_frank] PSC?
[fero] anti perox is 100% specific
[dua_frank] sorry i mean PBC
[lanny] anti mitochond
[dua_frank] yes
[uniteus] antimitochon for psc
[lanny] no uni
[lanny] for PBC
[uniteus] ah..pbc
[fero] isnt it ANCA
[dua_frank] yes it is fero
[dua_frank] i meant to ask primary biliary cirrhosis
[uniteus] pan = pANCA
[dua_frank] antimitochondrial
[lanny] ANCA forPSC
[fero] rt lanny
[fero] no
[fero] lanny PSC is anti mito
[fero] dua?
[uniteus] fero *) *)
[fero] dua..... repeat it plz
[dua_frank] how will you diff promary hyperthyroidism from thyroiditis and taking exogenous thyroxine or due to tumours by labs?
[dua_frank] fero, PSC has ANCA and PBC has antimito Abs
[fero] RAIU
[dua_frank] good fero
[dua_frank] graves disease, associated conditionS?
[uniteus] autoimmune
[uniteus] myxedema n ophth
[samantha] opthalmopathy diffuse goiter
[samantha] pretibial mye
[dua_frank] DM MG Pern anemia
[uniteus] autoimmune like pernicious anemia
[dua_frank] i didn't ask manifestations :P
[fero] men
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[uniteus] :( but i put autoimmune dua
[samantha] oh!
[fero] o
[dua_frank] whats throtoxicosis factitia
[dua_frank] oh sorry uni :(
[samantha] taking thyroid inj dua
[samantha] thyroxine i mean
[dua_frank] yes
[dua_frank] ft4, tsh and raiu in order
[dua_frank] you tell me diagnosis ok?
[uniteus] TSH> t4 > raiu
[dua_frank] inc, inc, inc
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[dua_frank] oi uni wait for the q :P
[uniteus] pit
[dua_frank] lol
[dua_frank] yes
[fero] graves
[uniteus] oops
[dua_frank] dec dec dec
[uniteus] pit apolexy
[dua_frank] yes
[dua_frank] normal normal normal but TT4 dec
[uniteus] euthyroid sick somethin
[fero] *) i better stay num.....
[dua_frank] nephrotic synd and cirrhosis too
[dua_frank] normal normal normal and inc tt4
[uniteus] error?
[samantha] estrogen OCP?
[dua_frank] yes sammy
[dua_frank] the opposite of your previous ans uni
[dua_frank] inc, dec inc
[dua_frank] graves guys :P
[uniteus] cant remember the order...ahhh
[dua_frank] lol sorry uni
[samantha] what is dec?
[dua_frank] how is t3 resin uptake in graves?
[dua_frank] sammy lol
[dua_frank] decrease
[dua_frank] and youve been answering my q not knowing what dec was? :P
[uniteus] Increase in graves raiu
[samantha] no no what is dec for?
[dua_frank] yes uni
[dua_frank] inc resin t3 uptake too
[dua_frank] didn't get your q sammy
[dua_frank] rx of graves?
[samantha] inc dec and inc stands for what dua ?
[samantha] in graves?
[uniteus] propranolol, then antithyroid...
[dua_frank] ft4, tsh and raiu sammy
[dua_frank] yes uni
[samantha] got it dua
[dua_frank] rx throid storm?
[fero] thx dua
[fero] proph thiouracil, methimazole, iodine, fluids
[samantha] propranolol
[fero] oxy cooling blankets wat ever that is
[dua_frank] yes
[uniteus] hydration, glucocor, oxygen , propranolol
[dua_frank] why do you give naiodide and PTU?
[uniteus] for which one dua?
[dua_frank] thyroid storm as well as graves
[dua_frank] i want their moa
[fero] to suppress the thr sec dua?
[lanny] dua sorry i had to go plz post todays see you guys
[dua_frank] bye lanny
[dua_frank] will do
[uniteus] bye lanny
[fero] BYE LANNY
[samantha] bye lanny
[dua_frank] na iodide shifts the tyroid toward synthesis more than release
[dua_frank] and PTU blocks release iteself
[uniteus] PTU - inhibit release
[fero] ok..
[dua_frank] methimezole?
[fero] wats the S/E of pro thiouracil?
[uniteus] agranulo
[fero] same mech as phro dua/
[dua_frank] agranulo
[fero] rt dua uni
[dua_frank] yeah fero and dec syn as well i think
[dua_frank] right?
[fero] not sure dua
[fero] me going dua,,too tired
[fero] wats for tomorrow
[dua_frank] which is the one that stops conversion of t3 to t4?
[fero] u guys continu
[samantha] iodine can be given to dec hormone production
[fero] thas phroph
[uniteus] iodine??
[fero] which one is safe in preg?
[fero] prophothiouracil dua..?
[dua_frank] yeah ptu
[dua_frank] also dexamethasone
[fero] does PTU cross placenta?
[dua_frank] who wants to stay here?
[dua_frank] no fero
[dua_frank] methi does
[fero] dua it can crosss
[uniteus] ID fero tom
[fero] thas y... even ptu should b used in low doses
[dua_frank] yeah
[dua_frank] methi more
[uniteus] not PTU...dat is y it is used in pregnant
[dua_frank] sorry
[fero] rt dua
[fero] both cross,,PTU LESS
[dua_frank] thanks
[uniteus] yeah..agree...sorry to u all
[fero] me going to cook guys,,
[fero] take care and nite all
[dua_frank] uni and sammy want to stay or go?
[uniteus] nite fero
[uniteus] me...
[uniteus] ok
[fero] bye
[samantha] bye fero
[uniteus] i can staye
[dua_frank] bye fero
fero has left the chat.
[samantha] little tired
[dua_frank] lets finish thyroid
[uniteus] ok
[dua_frank] and then we can go
[samantha] ok'
[dua_frank] mc cause of hypothyroidism?
[uniteus] hasm
[samantha] hashimoto
[uniteus] hashi
[dua_frank] post ablative
[dua_frank] thats after surgery or radioactive iodine
[samantha] yes
[dua_frank] drugs that can cause HYPOTY?
[uniteus] agree dua..forgot bout it
[samantha] goitrogens
[dua_frank] hashimotos is second
[uniteus] eck..LITHIUM
[dua_frank] and ASA
[dua_frank] right
[samantha] amiodarone
[dua_frank] how does an infant's belly present as in a cretin?
[samantha] pot belly
[uniteus] umbilical hernia
[uniteus] too
[dua_frank] yes with umb hernia
[samantha] oh!
[dua_frank] how are the reflexes and mental status?
[samantha] hypo reflex
[samantha] and dementia?
[dua_frank] yes
[uniteus] slow on return for reflex
[dua_frank] not dementia but MR
[samantha] delayed reflexes ok dua
[samantha] in children
[dua_frank] fibrosis in?
[dua_frank] yes
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[samantha] reidel thyroid
[dua_frank] yes
[dua_frank] hyper eu and then hypostate
[dua_frank] dx?
[uniteus] didnt get the q dua..
[samantha] hashi moto
[samantha] or is it thyroiditis?
[dua_frank] dequervains
[dua_frank] subacute thyroiditis
[dua_frank] rx?
[samantha] ok
[dua_frank] but youre right even hashimotis
[uniteus] Aspirin
[uniteus] for Subacute / de Q
[dua_frank] and predni and propranolol
[samantha] ok
[uniteus] what is hyper eu dua?
[samantha] agree dua
[dua_frank] hyperthyroid state
[dua_frank] euthyroid state
[dua_frank] and then hypothyroid state
[uniteus] oh...ok..thax
[dua_frank] goitre is painless dx
[dua_frank] welcome
[uniteus] graves,
[uniteus] adenoma
[dua_frank] hypothyroid goitre
[dua_frank] hashimotos
[dua_frank] painful is dequervains
[uniteus] yeah ..is nt dat is the one wid hx of viral illness?
[dua_frank] yes uni
[uniteus] ok..thx
[samantha] shall we call it a day dua and uni?
[dua_frank] ok sammy
[uniteus] ok
[dua_frank] bye
[uniteus] bye dua n sammy
[samantha] thax see you tom
[uniteus] thx

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