View Full Version : Int Med chat: Left Overs

03-15-2005, 08:32 PM
dua_frank has joined the chat.
[drsujitvasanth] any advice?
[drsujitvasanth] anyone have Glojan step 2 notes?
[erum] can v take step 2 ck b4 step
[drsujitvasanth] i think so.
[erum] 1
[drsujitvasanth] hey frank...
[drsujitvasanth] hi
[drsujitvasanth] hi?
[hinaya77] hello
[hinaya77] :-happy :nah: :nah:
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[samantha] hi dua
[drsujitvasanth] hey
[lanny] hello all
[drsujitvasanth] hey lanny...
[dua_frank] hi all
[lanny] hey sujit
[dua_frank] hi sammy
[lanny] hi dua
[dua_frank] so todays the last day for IM
[drsujitvasanth] hi again frank, dua, sam....
[drsujitvasanth] k...
[dua_frank] hi sujut
[dua_frank] sujit
[lanny] yes dua
[drsujitvasanth] ok...
[dua_frank] ok then ask aything you want :)
[samantha] hi all
[lanny] any plans for next topic
[dua_frank] not yet lanny
[drsujitvasanth] <--just got permit for CK/CS....
[dua_frank] which subject should we go for next?
[drsujitvasanth] which one is most o the exam after Int Med?
[lanny] OB or surgery
[samantha] what about medicine again?
[dua_frank] peds
[drsujitvasanth] good point...samantha
[drsujitvasanth] medicine is very important...
[dua_frank] yeah i know but we will be coming back to it in 15 days
[drsujitvasanth] ah ok...
[samantha] ok
[dua_frank] maybe more than 15 days
[dua_frank] depends on the next subject
[dua_frank] wanted to give a week each to obgyn, surg and psych
[drsujitvasanth] k
[dua_frank] shall we go for obgyn next lanny?
[lanny] lagree dua
[drsujitvasanth] surg and pych probably dont deserve a week each...
[lanny] i think so we can do a week in OB GYN
[dua_frank] ok then i'll make a schedule and post it
[drsujitvasanth] could they share a week/?
[lanny] yes
[dua_frank] sure sujit
[lanny] both OBGYN one week
[drsujitvasanth] yep
[dua_frank] yes
[dua_frank] 7+5+5
[dua_frank] so 17 days
[dua_frank] how does that sound?
[lanny] most of us are going in april and may so we have to do the most in time we got
[dua_frank] we can go for IM again after obgyn
[dua_frank] if you want it that way
[drsujitvasanth] k
[lanny] sounds good
[drsujitvasanth] OK...
[lanny] so one week for OBGYN and foll 2 wks for med
[dua_frank] ok then obgyn (7days) > IM (ten days)> pysch and surg
[drsujitvasanth] yep..
[dua_frank] how many more days to go for your exam lanny?
[lanny] well as of now sced for 12th
[lanny] april
[dua_frank] so you have a month
[dua_frank] almost
[drsujitvasanth] where r u doning it lanny?
[lanny] subject to change dep on my score on CCSSA
[lanny] yes 1 mth
[dua_frank] oh
[dua_frank] lanny then in that case can we go with the old schedule?
[dua_frank] ogyn, surg, psy and then IM
[samantha] alright
[lanny] ok dua
[drsujitvasanth] k...
[lanny] you mean prev chat sched
[dua_frank] yes
[lanny] sounds good
[dua_frank] we can come back to IM again in 15 days
[drsujitvasanth] k
[lanny] that sched was perfct
[dua_frank] yeah
[lanny] agree
[dua_frank] ok then lets start
[drsujitvasanth] k
[lanny] we should do surgery and OB in 2 wks
[lanny] psych 3 days
[drsujitvasanth] ok...
[dua_frank] which type of thyroid condition presents with fibrosis?
[dua_frank] ok lanny
[lanny] ridels
[drsujitvasanth] <- not sure
[dua_frank] yes ridels
[samantha] reidels thyroiditis
[drsujitvasanth] what happens in reidels? hyper then hypo?
[dua_frank] how will you diff dequervains from hashimotos?
[uniteus] hi everyone
[dua_frank] no sujit
[drsujitvasanth] hi uni..
[dua_frank] just hypo
[dua_frank] gradually
[drsujitvasanth] ah...
[dua_frank] hi uni
[drsujitvasanth] k
[uniteus] got bad internet connection yesterday..hope not today
[lanny] hi uni
[samantha] hi uni
[lanny] what is a hot nodule
[dua_frank] tsh is low in DQ and high in hashi, hashi is painless
[drsujitvasanth] hasimoto is usually women?
[samantha] in dequierans no uptake
[dua_frank] ESR high in DQ too
[dua_frank] yes sujit
[dua_frank] DQ post viral hashi AI
[lanny] deq hx of viral inf
[drsujitvasanth] whats the etiology of DQ?
[dua_frank] rx of both?
[uniteus] viral sujit
[drsujitvasanth] k
[samantha] viral?
[drsujitvasanth] k
[samantha] it is subacute thyroiditis
[dua_frank] antithyroid and antimicrosomal abs in hashi too
[uniteus] aspirin for DQ
[drsujitvasanth] rx. throxine+ steroids?
[dua_frank] yes uni
[dua_frank] thyroixin in hashi
[dua_frank] one aims at antiinflammation and other replacement
[drsujitvasanth] wow...didnt know this stuff!
[dua_frank] which thyroid ca is more common in the elderly?
[uniteus] anaplastic?
[samantha] anaplatic?
[drsujitvasanth] sounds right...
[dua_frank] follicular
[uniteus] oh :(
[lanny] yes dua
[dua_frank] awww uni
[dua_frank] anaplastic is a type of follicular
[dua_frank] smile uni :)
[lanny] most malignant
[uniteus] :)
[drsujitvasanth] :)
[dua_frank] theres also parafollicular
[drsujitvasanth] parafollicular c cell?
[drsujitvasanth] calcitonin secreting?
[dua_frank] yeah whats the marker for this one?
[dua_frank] yes
[lanny] calcitonin
[lanny] med ca of thyoid
[drsujitvasanth] <-- did a thyoid surery job
[dua_frank] and this is the type seen in sipple and type IIb MEN syndome
[dua_frank] nice sujit
[drsujitvasanth] still dont know this stuff lol
[dua_frank] medullary is parafollicular lanny
[lanny] yes dua
[lanny] just wanted to give another name
[dua_frank] thanks
[samantha] so medullary ca secretes calcitonin
[drsujitvasanth] i didnt realise they were the same...
[dua_frank] yes
[lanny] yes
[dua_frank] parafollicular, c cell or medullary
[dua_frank] all the same
[lanny] they are sujit
[drsujitvasanth] k
[dua_frank] whats sipple syndrome?
[drsujitvasanth] its a type of MEN
[lanny] MEN type2
[drsujitvasanth] its2a or b i think
[uniteus] men
[dua_frank] what all do you find in that?
[lanny] med ca of throid parathyroid pit
[dua_frank] tell me all the men uni :P
[drsujitvasanth] multiple endocrine neoplasia = men
[samantha] type 1 3 P's
[drsujitvasanth] 1 = 3ps parathyroid, pituitry, phaeochromocytoma
[dua_frank] this is a PPP too like men type I but different ps
[dua_frank] yeah here you have parafollicular instead of pituatary
[uniteus] 2a pheo, hyperpara, medullary thyroid ca
[dua_frank] thats sipple
[uniteus] 2b pheo, medullary thyroid ca, neuroma
[drsujitvasanth] which one is sipple?
[lanny] 2 is sipple
[dua_frank] good uni
[lanny] in USA its type2
[lanny] a
[drsujitvasanth] <--sorry i got ppp wrong lol
[drsujitvasanth] 2b is the one with the neuromas..
[drsujitvasanth] i rmember that
[lanny] yes
[dua_frank] psammoma bodies in?
[lanny] 1 is pituitary
[drsujitvasanth] first aid says a few dx's
[drsujitvasanth] thyroid ca (?medullary)
[lanny] right
[samantha] yes it is pituitary parathyroid and pancretic
[drsujitvasanth] there are a few others...but i cant remember
[uniteus] medullary thyroid ca dua
[dua_frank] yes
[dua_frank] where else uni?
[drsujitvasanth] yay thanks sam!
[uniteus] meningioma
[dua_frank] right
[drsujitvasanth] oh yeah :)
[dua_frank] one in ovary too
[uniteus] ok cool
[dua_frank] granulosa tumour right?
[drsujitvasanth] oh yeah too :)
[lanny] where is mallory bodies found?
[drsujitvasanth] liver?
[uniteus] brain?
[drsujitvasanth] alcoholic cirrosis
[drsujitvasanth] mallories hyaline...
[lanny] right
[lanny] also in what thyroid ca?
[drsujitvasanth] dont know..
[lanny] papppilary
[uniteus] papikllary ca?
[dua_frank] really?
[dua_frank] i didn't know that
[lanny] yes dua
[dua_frank] are you sure lanny?
[lanny] if im not ill say so dua
[drsujitvasanth] OK. method for evaluation of a thyoidnodule...
[drsujitvasanth] only 1 right answer..
[samantha] FNA
[lanny] calcifications in thyroid roundish appearance dua
[dua_frank] thanks lanny
[drsujitvasanth] yep!
[uniteus] dua...psommona body is in papillary thyroid ca not medullary ca ..just checked..sorry
[drsujitvasanth] FNA --> highest yield in maligancy
[dua_frank] didn't i say the same uni?
[dua_frank] i thought i said psomomma in papillary
[uniteus] oh..ok...hehehe
[dua_frank] how does hypoproteinuria affect calcium levels?
[drsujitvasanth] dua..you know I really dont think they'll ask you the histology in part 2..
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[drsujitvasanth] it affects total calcium..but not ionised calcium
[dua_frank] no but that might be your hint or key word in the q sujit
[dua_frank] yes right
[drsujitvasanth] calcium is about 50% protein bound
[dua_frank] why?
[dua_frank] right
[lanny] ionized Ca is active form
[drsujitvasanth] yep.
[dua_frank] why does sarcoidosis cause hypercalcemia?
[drsujitvasanth] hmm...
[lanny] ionized ca is not prtn bound sujit
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[lanny] T cell reaction dua???
[dua_frank] activates vit d
[drsujitvasanth] ah yes...vit d elevated...
[dua_frank] in the granulomas
[drsujitvasanth] agree with lanny
[lanny] actuallt is due to inc vit D
[samantha] for every 1.0 gm/dl drop in albumin total ca will dec by .8 mgms
[drsujitvasanth] about protein bound,,,
[lanny] inc vit D3 inc intest absorp of CA
[dua_frank] how will you differentiate primary hyperthyroidism from cancers causing hypercalcemia?
[dua_frank] yes thanks sammy
[drsujitvasanth] hyperparathyroidism...
[lanny] PTH
[drsujitvasanth] PTHrP
[dua_frank] right
[dua_frank] how is the phosphate level in hyperparathyroidism?
[lanny] low
[dua_frank] yes
[drsujitvasanth] i always get this wrong..darn!
[dua_frank] and in vit d deficiency?
[drsujitvasanth] Po4 down?
[lanny] normal to low
[dua_frank] right lanny
[drsujitvasanth] Po4 in vit D toxicity?
[dua_frank] yes sujut
[dua_frank] sujit
[dua_frank] nooooooooo
[dua_frank] high
[drsujitvasanth] high...
[drsujitvasanth] yep frank
[dua_frank] i thought you said deficiency for a second thee
[dua_frank] there
[dua_frank] whats the ECG picture like in hypercalcemia?
[drsujitvasanth] 1st degree block (prologed PR)
[drsujitvasanth] something with T waves...
[drsujitvasanth] QRS not sure..
[dua_frank] short OT
[drsujitvasanth] !
[samantha] short QT
[drsujitvasanth] oh..
[rockafella] hi guys
[dua_frank] hi fella
[uniteus] short qt
[samantha] interval
[drsujitvasanth] oh..
[rockafella] any internal medicine
[drsujitvasanth] yes
[rockafella] i have a question
[drsujitvasanth] go for it!
[rockafella] whats the minimum score img's need for in residencys
[drsujitvasanth] The main ECG manifestation of hypercalcaemia is a shortened QT-interval, sometimes associated with a slight prolongation of the PR and QRS-intervals.
[drsujitvasanth] posted form internet...
[dua_frank] thanks
[samantha] thanx sujit
[ash] hi all i will just listen today i dont know the topic
[ash] of discussion
[drsujitvasanth] not sure rockafella...
[rockafella] like in a ballpark range
[rockafella] im a u.s citizen attending a foreign med school
[lanny] guys have a problem with your anser for vit D vit Dinc absorption of diet po4 so in def of vit d PPo4 is low not high
[lanny] vit d also inc bone resorptton of Ca and Po4
[drsujitvasanth] lany: q was about vt d toxicity...
[lanny] oh thought it was vit D def
[samantha] lanny in vit d def po4 is low
[drsujitvasanth] no problem :)
[lanny] thats what i said sam
[samantha] ok
[dua_frank] how does plicamycin or mithramycin help in hypercalcemia?
[lanny] but it was another q sujit asked i didnt see that
[lanny] help in resorption
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[dua_frank] but PTH is already doing that lanny
[samantha] in PTH def po4 is high
[dua_frank] which is why urinary calcium levels are normal
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[dua_frank] rx of hyperparathyroidism?
[lanny] oh i think plicamycin inhib osteoclast activity dua????
[drsujitvasanth] so whats the mode if action dua?
[dua_frank] i don't know sujit but might be the same as lanny said
[drsujitvasanth] how do palmidronates lower calcium?
[lanny] yea they inhibit the osteoclast
[lanny] pamidrona is bisphosphonates?????
[dua_frank] deposits calcium back into bone
[lanny] thats for plica dua
[drsujitvasanth] thanks dua
[dua_frank] no lanny plica decs calcium flux out of bone
[dua_frank] calcitonin and biphosphose inc calcium flux into bone
[samantha] yea dua
[lanny] yes by dec osteoclast activity
[dua_frank] one is depositing action, other is dec resorption action
[lanny] ok i see now
[dua_frank] one is making the bones suck calcium and the other prevents bone from losing ca
[lanny] resorption is taking calcium out of bone
[dua_frank] yes
[drsujitvasanth] you know..i dont think they will ask this on part 2...
[lanny] agree dua nicely put!
[drsujitvasanth] get clinical lol
[lanny] they do ask mech of actions dujit
[lanny] and side effects!!!
[dua_frank] you'd be surprised how much of step 1 is on step 2 sujit
[lanny] so know them esp for the regular used drugs
[drsujitvasanth] true..but how can they ask that question in a vignette?
[drsujitvasanth] its not a clinically relevet fact..
[lanny] oh easy sujit think!!!!!!
[lanny] sooooooooooooooo many ways!!!
[dua_frank] they will put a patient who is hypercalcemic without hyperparathyroidism
[dua_frank] some other mechanism
[rockafella] Question? when in IM residency, it easy to go into a subspecialty like >>ex. cardiology or hematology?
[dua_frank] select the wrong drug in management, you'll be in trouble
[dua_frank] fella *)
[dua_frank] lol you're asking the wrong people fella
[samantha] how will u differentiate hyperca from PTH and other causes?
[lanny] GO TO A STEP 3 SITE
[dua_frank] try the forums please
[dua_frank] pth levels sammy
[dua_frank] will be low or normal in other causes
[dua_frank] also less bone resorption
[lanny] agree dua
[samantha] correct dua in all other causes PTH will be low
[samantha] what is hungry bone synd?
[samantha] how do u tX?
[dua_frank] medullary ca thyroid?
[drsujitvasanth] its something to do with rapid corrction of hyperparathyroidism?
[drsujitvasanth] doyou give calcium?
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[samantha] it is hypocal occuring after surg parathy removal
[dua_frank] oh
[dua_frank] calcium gluconate iv i guess
[dua_frank] with magnesium
[samantha] yes IV calcium
[samantha] yes dua
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[dua_frank] can you think of some condition where you can have a lot of PTH
[dua_frank] active working PTH
[samantha] not sure about mg?
[drsujitvasanth] why Mg?
[dua_frank] but the body is so overwhelmed with hyperphosphatemia that it becomes hypocalcemic
[dua_frank] you routinely give mg for caclium loss
[dua_frank] pth needs mg to work on receptors
[samantha] oh...
[drsujitvasanth] i treated a lot of hypocalcaemias
[drsujitvasanth] we never gave Mg
[dua_frank] we always did sujit :P
[drsujitvasanth] lol
[drsujitvasanth] oh well...
[dua_frank] tumor lysis , acute renal failure and rhabdomyolysis
[drsujitvasanth] its not in the oxford handbook anyway :-happy
[dua_frank] all these can present as hypocalcemia
[drsujitvasanth] ARF?
[drsujitvasanth] surely depends on the type....
[drsujitvasanth] ostructive ARF?
[drsujitvasanth] obstructive
[dua_frank] well any renal failure that causes hyperphosphatemia
[dua_frank] let me put it this way
[drsujitvasanth] ah...
[drsujitvasanth] ok
[drsujitvasanth] lol your right
[dua_frank] also acute pancreatitis
[drsujitvasanth] yep...
[dua_frank] so what will ECG show now?
[dua_frank] in hypocalcemia
[drsujitvasanth] not sure
[uniteus] prolonged QT interval
[dua_frank] long QT
[dua_frank] yep
[samantha] yea opp
[drsujitvasanth] its usually detected by Trossaues sign, and paraesthesia in lips/hands...
[dua_frank] right
[dua_frank] conditions that have low calcium and high phosphorus
[dua_frank] name them
[drsujitvasanth] ouch :)
[dua_frank] you already know them all
[drsujitvasanth] hypoparathyoidism
[samantha] hypo para
[dua_frank] and all those hyper po4 conditions
[uniteus] secondary hyperparat
[uniteus] for low Ca n high P
[drsujitvasanth] good call uni
[samantha] renal fail
[dua_frank] renal failure, tumor lysis, rhabdomyolysis, acute pancreatitis
[dua_frank] and pseudohypoparathyroidism
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[drsujitvasanth] ah
[dua_frank] low cal and low phos
[drsujitvasanth] what is pseudo hypo pth
[dua_frank] conditions?
[drsujitvasanth] osteoperosis?
[drsujitvasanth] diabetes insipidus?
[dua_frank] absent of ineffective vit d
[samantha] end organ insensitivity sujit
[lanny] comatose pt eith signs of menengitis whats the causative agent???
[drsujitvasanth] thanks sam :)
[lanny] with signs
[drsujitvasanth] lannynot enough info
[dua_frank] how will you rx a hyper po4 condition?
[drsujitvasanth] dont know...duirectics?
[dua_frank] diet restriction (don't know how)
[dua_frank] and po4 binders
[drsujitvasanth] ah...
[drsujitvasanth] Ca resonium?
[dua_frank] like caco3 and alluminum hydroxide
[dua_frank] yes
[drsujitvasanth] k
[drsujitvasanth] more info lany...
[uniteus] hmmm
[uniteus] dunno
[samantha] meningo lanny?
[drsujitvasanth] could be any cause of meningitis, or i/c bleed
[uniteus] dec diet p, al hydroxide, hydration, acetazolamide fot tx hyperp
[lanny] yes but which of them can cause coma
[drsujitvasanth] ag yes acetazolamide...
[drsujitvasanth] carbonic anhydrase inhib?
[dua_frank] why aceto?
[drsujitvasanth] smthg to do with Po4 transport and hco3?
[uniteus] dunno due --> just repeating from bk
[drsujitvasanth] <-- never understood kidney phys
[dua_frank] thanks uni
[dua_frank] maybe it works like pth
[uniteus] oops ..means dua :)
[dua_frank] dumps phosphate out of kidneys
[uniteus] probably
[drsujitvasanth] whts the answer lanny?
[drsujitvasanth] lanny..thay all cause coma...
[lanny] dunno thats why i asked
[dua_frank] oh lanny....:)
[dua_frank] :)
[drsujitvasanth] oh...was it a question in an exam?
[lanny] not all do
[samantha] :? good q lanny
[lanny] was a q not sure from what source
[drsujitvasanth] depends surely on the severity...
[lanny] will have to research
[drsujitvasanth] k...
[dua_frank] which oral hypoglycemic drug is used in nephropathy?
[lanny] metformin??
[samantha] metformin
[dua_frank] and?
[dua_frank] how about in sulfonylureas?
[samantha] gliburide?
[dua_frank] tolbutamide. all others are renally excreted except this one
[drsujitvasanth] ah...
[lanny] if pt is going to have a contrast study on renal function and on metformin what do you do?
[uniteus] agree dau
[samantha] yes dua
[uniteus] dua
[dua_frank] tol is through liver
[drsujitvasanth] stop metformin 1-2 days previously, rehydrate...
[drsujitvasanth] consider non contrat study
[lanny] right sujit first guess was right lol
[drsujitvasanth] lol...it was on my hospitals Xray card for contrast studes...
[lanny] oh you cheat!!!
[uniteus] which drug helps prevent dm nephropathy?
[dua_frank] why?
[drsujitvasanth] ACE i
[lanny] ACE inhib
[dua_frank] ace inh
[lanny] bradykinin and vasodilation??
[samantha] agree
[uniteus] huh lanny?
[drsujitvasanth] frank: contrast is nephrotoxic, the studies show that toxicity is icreased with concomittent metformin
[uniteus] rt it is acei
[drsujitvasanth] risk best reduced by agresive iv fluids
[drsujitvasanth] (within reason)
[dua_frank] oh
[lanny] sujit is right concom use of metformin and contrast can cause tubulo interst dz
[drsujitvasanth] thanks lanny :)
[dua_frank] so i guess only tolbutamide is totally safe in neprhopathy
[drsujitvasanth] a lot of RF patients get metformin
[drsujitvasanth] doesnt seem to do them any harm
[dua_frank] yeah
[drsujitvasanth] CRF
[dua_frank] i thought biguanides are safe
[dua_frank] for renal failure patiehts
[lanny] agree metformin is safe dua just stop 2 days if pt needs contrast
[dua_frank] i guess it interacts with contrast
[dua_frank] and thats the only problem
[dua_frank] ok lanny, thanks
[dua_frank] it was nice q
[lanny] biguanides are safe dua
[drsujitvasanth] important side effect o metformin (always asked on baords)
[samantha] which is the commonest porphyria
[dua_frank] lactic acidosis
[drsujitvasanth] yep! @ frank
[dua_frank] acute intermittent?
[lanny] lacticx acidosis
[drsujitvasanth] yes @lanny
[samantha] porphyria cutanea tarda is the commonest
[drsujitvasanth] [email protected] lanny
[dua_frank] ayyo
[drsujitvasanth] oops @ sam
[dua_frank] didn't know that, thanks sammy
[samantha] wc dua
[dua_frank] glucose as high as 1000mg/dl
[dua_frank] dx?
[samantha] causes ch blisering and crusting lesions on sun expose areas
[drsujitvasanth] HONK
[dua_frank] right
[dua_frank] sammy whats the lab like?
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[dua_frank] i mean what do we look for in urine?
[dua_frank] urine porphyrins?
[dua_frank] or something else?
[drsujitvasanth] bcc?
[uniteus] which one dua...got kicked out agian
[dua_frank] wb uni
[dua_frank] cutanea tarda uni
[dua_frank] whats bcc?
[drsujitvasanth] reply to sam's q
[uniteus] bladder cell ca bbc?
[drsujitvasanth] basal cell
[drsujitvasanth] of skin
[uniteus] or basal cell ca ?
[drsujitvasanth] sam?
[dua_frank] she was talking about cutanea tarda
[samantha] defective enzyme is uroporphyrinogen decarboxylase
[drsujitvasanth] oh lol
[dua_frank] yes sammy thats the defect, but what are we looking for in the urine?
[uniteus] oops :oops:
[dua_frank] like prophobilinogen in urine for acute intermitten
[uniteus] color change
[drsujitvasanth] OK ive done 30% of qbank and have seen virually NO enzyme's anywhere....
[dua_frank] sujit i did kaplan q bank today first test
[dua_frank] this was in the test
[drsujitvasanth] im 100% sure you dont need to know that lol
[uniteus] in urine there is color change wen left in to stand under sunlite?
[dua_frank] you do you do
[drsujitvasanth] ! :o
[dua_frank] enzyme would be the hint
[dua_frank] the q was what will you find in urine
[dua_frank] enzyme tells you which type
[drsujitvasanth] what exactly did they ask...
[dua_frank] urinalysis
[samantha] not sure dua
[uniteus] red?
[dua_frank] let me check
[drsujitvasanth] i remeber htat q vaguely...
[dua_frank] here
[dua_frank] fecal porphyrins for cutanea tarda
[dua_frank] plasma porphyrins for cut and erythropiotic porphyria
[drsujitvasanth] ok so you just need to know that its a type of porohysria...
[dua_frank] fecal is second line
[dua_frank] first is always urine porphyrins
[dua_frank] to screen cutanea tarda
[lanny] dua you seem to like porphyrias.....lol
[drsujitvasanth] lol
[dua_frank] i hate them lanny :(
[dua_frank] but like they say, no pain no gain :(
[dua_frank] this is pain :(
[drsujitvasanth] i remember that q and i guessed right i think...
[drsujitvasanth] y dont you post the q here?
[samantha] yea i found it in q book
[dua_frank] i guess we are clear then
[uniteus] ahh..too much pain dua..need some narcotics..pls send some :(
[dua_frank] lol uni
[samantha] i have to study porphyrias
[drsujitvasanth] sam: dont lol
[drsujitvasanth] its not worth it...
[samantha] why sujit?
[drsujitvasanth] its looow yield
[dua_frank] ok 30 yr old woman in ED, severe abdominal pain, n, v, diarragea. had so many different surgeries for abd, found nothing. vitals normal. minimal abdominal tenderness and rebound tendernes. which will confirm dx
[dua_frank] that was the q
[samantha] we will get aleast 1 q
[drsujitvasanth] thats clearly a diagnosis of porphyia
[drsujitvasanth] always presents women with abdo pain
[dua_frank] choices were erythrocytic porphyrins, fecal porphyrins, plasma porphyrins, urine porphobilinogen and urine porphyrins
[dua_frank] look at the choices sujit
[dua_frank] if you didn't know which type
[uniteus] Acute interm porph dua
[dua_frank] would you be able to answer that question?
[drsujitvasanth] i would have put urinary...
[dua_frank] there are two urinary
[dua_frank] porphyrins and porphobilinogen
[dua_frank] which one?
[drsujitvasanth] urinary porphyrins....
[dua_frank] wrong!
[drsujitvasanth] i bet i got it wrng :)
[dua_frank] its urine porphobilinogen
[dua_frank] see why type is important now?
[drsujitvasanth] ok :)
[dua_frank] lol
[drsujitvasanth] your right
[dua_frank] no pain no gain buddy lol
[drsujitvasanth] <-- still is not going to learn porphyria...
[dua_frank] lol i won't remember this by tomorrow
[drsujitvasanth] :p
[dua_frank] i don't think i will learn more on porphyrias after today either
[dua_frank] i hate them
[drsujitvasanth] low yield..learn sob instea lol...
[drsujitvasanth] instead..
[dua_frank] rx for neuropathy?
[dua_frank] yeah
[drsujitvasanth] porhyria neuropathy?
[drsujitvasanth] :o
[dua_frank] lol no
[drsujitvasanth] lol good
[dua_frank] just regular neuropathy
[samantha] inc uroporphrins in the urine dua i just checked
[drsujitvasanth] depends on the cause...
[lanny] carbamazepine TCA
[dua_frank] thanks sammy
[drsujitvasanth] good anser @ lanny
[dua_frank] yes lanny
[dua_frank] how about for gastroperesis?
[samantha] inc urinary delta aminolevulinic acid and porphobilinogen for AIP
[lanny] trt of hyponatremia
[dua_frank] na lanny? :P
[uniteus] carbamazepine dua
[drsujitvasanth] Fluid restrucs or N saline
[dua_frank] yes sammy thanks
[drsujitvasanth] restict
[lanny] what dua/?
[samantha] wc dua
[dua_frank] normal saline
[drsujitvasanth] gastroparesis --> eat samll meals?
[dua_frank] metoclropramide
[drsujitvasanth] dua: dependson cause..
[drsujitvasanth] ie. SIADH --> low Na
[drsujitvasanth] needs fluid restriction
[dua_frank] which is true hyperglycemia, smogi effect or dawn?
[lanny] dawn
[drsujitvasanth] lanny: hypertonic --> pontine demylination syndrome from rapid overcorrection
[dua_frank] right
[uniteus] dawn
[dua_frank] right sujit
[lanny] right sujit can cause central pontine myelonisis
[dua_frank] so slow correction
[dua_frank] first fluid restriction ofcourse
[lanny] with normal saine
[drsujitvasanth] thats why N saline isnt always the right answer...
[lanny] right
[uniteus] dua what is the ans?
[dua_frank] whats honeymoon period?
[lanny] what other cond we dont give hypert saline?
[dua_frank] answer to what uni?
[uniteus] true hypergly?
[dua_frank] i said right to you
[dua_frank] its dawn
[drsujitvasanth] lanny --> goljan says for boards purposes hyoertonic is never the right answer
[uniteus] oh ok..i wasnt sure
[uniteus] thx
[dua_frank] welcome
[lanny] agree sujit
[samantha] occurs in diabetic prone due to stress like inf
[uniteus] honeymoon...dka then period of no symptoms
[lanny] hyper is not given
[samantha] and normal afterwards
[lanny] to trt hyponatremia
[drsujitvasanth] [email protected] lanny
[dua_frank] yes good
[dua_frank] why does this happen?
[lanny] also in chronic liver dz
[drsujitvasanth] Na overload in Live dx...
[samantha] because the level of insulin dec in times ofstress
[drsujitvasanth] thats why no N saline
[drsujitvasanth] ! :o
[drsujitvasanth] @ sam
[drsujitvasanth] insulin increases intimes of stress
[dua_frank] its blocked by epi
[drsujitvasanth] insulin requirements increase in times of stress and diabetics fail to produce reuired insulin dose
[samantha] insulin req inc
[drsujitvasanth] lol ok @sam
[dua_frank] actually epi blocks insulin release
[dua_frank] during this syndrome
[drsujitvasanth] epinephrine?
[dua_frank] due to stress
[dua_frank] yes
[drsujitvasanth] noooo
[drsujitvasanth] :o
[drsujitvasanth] oh well :))
[samantha] actually it starts with any inf and is called insulitis
[samantha] and the level declines slowly when there is a stress situation DKA manifests
[dua_frank] ever wonder why dka patients have sweating tremor and anxiety sujit?
[dua_frank] see now why? :)
[samantha] and becomes normal only to get dia later on
[drsujitvasanth] its because theyre fluid depleted
[drsujitvasanth] by about 6 litres
[dua_frank] its epi excess
[uniteus] agree dua
[dua_frank] right sammy
[drsujitvasanth] :an :)
[samantha] :)
[uniteus] i got to ....
[uniteus] what we planin to do tom
[dua_frank] will post on forum by tomorrow uni
[dua_frank] check schedule there tomorrow
[dua_frank] will be obgyn
[uniteus] ok..thx dua
[dua_frank] welcome
[drsujitvasanth] thanks dua
[uniteus] bye everyone
[drsujitvasanth] bye uni :)
uniteus has left the chat.
[dua_frank] bye
[dua_frank] welcome sujit
[drsujitvasanth] hi
[drsujitvasanth] did i go?
[dua_frank] no you're still here
[drsujitvasanth] k
[dua_frank] failure to suppress c peptide
[drsujitvasanth] 1 more topic....
[dua_frank] inc insulin
[dua_frank] dx?
[samantha] insulinoma
[dua_frank] yes
[drsujitvasanth] ah...
[drsujitvasanth] didnt know that
[dua_frank] how does ethanol cause hypoglycemia?
[drsujitvasanth] good q dua
[drsujitvasanth] competes for NADH
[dua_frank] yes, blocks gluconeogenesis
[drsujitvasanth] (Goljan step 1 audios lol)
[samantha] did'nt know that dua *)
[drsujitvasanth] OK covered some Endocrine...
[dua_frank] what other cause mimics insulinoma except yuo'll detect the cause in urine
[lanny] drugs
[lanny] sulfonamide
[drsujitvasanth] seiptitous inculin use
[dua_frank] good lanny
[dua_frank] nope sujit, in that c peptide would be low
[drsujitvasanth] oh
[dua_frank] sulfonylureas have high c peptide
[drsujitvasanth] oh...
[drsujitvasanth] OK got it..
[drsujitvasanth] good q again lol
[dua_frank] whats the mc cause of cushings syndrome?
[drsujitvasanth] steroids
[drsujitvasanth] iatrogenic
[dua_frank] right
[dua_frank] whats cushings disease?
[drsujitvasanth] pit tumor secreting ACTH
[dua_frank] right
[samantha] pituitary cause
[drsujitvasanth] whats the screenin test for Cushing's?
[dua_frank] dexamethasone
[drsujitvasanth] k
[drsujitvasanth] yes thats righ
[samantha] 1mg dexa
[dua_frank] overnigth dexa
[samantha] is it 1mg or overnight?
[lanny] suppress then its c syndrome
[drsujitvasanth] yep @ lanny
[dua_frank] how will you differentiate cushings synd from cushings disease?
[lanny] high dose dexa suppresses c disease
[drsujitvasanth] ACTH and dex supp test
[dua_frank] yes lanny
[samantha] ACTH
[lanny] what about ectopic cushings?
[dua_frank] that will be cushings syndrome too
[dua_frank] can't suppress with high dose dexa
[drsujitvasanth] good call @ dua
[samantha] will not be suppressed with high dose
[drsujitvasanth] high dose dexa is best
[lanny] ACTH is suppressed by high dose dexa in c disease
[lanny] ACTH is suppressed by low dose dexa in c syndrome
[dua_frank] thanks sujit
[drsujitvasanth] lanny low dose AND high dose...
[dua_frank] how will you differentiate cushings syndrome due to adrenal neoplasia or from adrenal hyperplasia?
[samantha] or ectopic sujit?
[samantha] sorry dua?
[drsujitvasanth] sam: ectopic isnt supressed by dex
[dua_frank] let me rephrase
[drsujitvasanth] renal US / CT
[dua_frank] diff adrenal neoplasia from adrenal hyperplasia due to acth producine tumours
[samantha] yes sujit i know that
[drsujitvasanth] sorry sam...ui missuderstood your q
[drsujitvasanth] i
[drsujitvasanth] hi shreya
[shreya] hai
[samantha] no prob
[drsujitvasanth] step 2 discussion on int med
[dua_frank] acth level
[shreya] wht did u discuss 2de??
[drsujitvasanth] topic is cushings dx/syndrome
[dua_frank] low in adrenal neoplasia
[shreya] ok.
[dua_frank] high in pit tumors and ectopic tumors
[dua_frank] basically high in all acth producing tumors
[drsujitvasanth] ah [email protected] frank
[lanny] which drug is a neuraminidase inhibitor anyone knows??
[samantha] sure dua
[drsujitvasanth] amantidine?
[dua_frank] how will you diff primary from secondary aldosteronism?
[drsujitvasanth] renin level
[dua_frank] aminoglycoside?
[dua_frank] yes sujit, low in primary
[lanny] no sujit
[samantha] nice q dua
[lanny] oseltamivir
[lanny] or zanamivir
[dua_frank] hypernatremia in which one?
[drsujitvasanth] ah @ lanny
[dua_frank] thanks lanny
[dua_frank] aids drugs?
[samantha] i thought it is a protease inhi
[drsujitvasanth] primary definitely @ dua
[samantha] lanny
[lanny] no they are neraminidase inhibitors
[dua_frank] so nucleoside inhi and neuraminidase inhis are the same?
[dua_frank] ok different
[lanny] used for influenza a and b
[drsujitvasanth] active against influenza = neurminidase
[dua_frank] thanks lanny, good q
[lanny] no diff dua
[dua_frank] thought of influenza
[dua_frank] i remember that from micro
[samantha] ok lanny
[lanny] amantadine is only for a
[drsujitvasanth] ah...
[dua_frank] hypernatremia in primary
[dua_frank] aldo
[lanny] so if pt with influena dont get better with amantadine try zanamavir
[drsujitvasanth] y not 2ndry @ dua?
[drsujitvasanth] got in lanny...
[dua_frank] coz sujit main reason why secondary aldo happens is due to low na levels
[drsujitvasanth] got it oops
[drsujitvasanth] ah...
shreya has left the chat.
[drsujitvasanth] e.g. CHF has low NA...your right :)
[dua_frank] body has decreased intravascular volume
[dua_frank] tries to save water by retaining na
[dua_frank] right
[drsujitvasanth] OK what are the high yield med topics....
[drsujitvasanth] 1 want a list lol
[dua_frank] is there edema in primary?
[lanny] diff gitelman from barters?
[lanny] all high yield look at first aid
[dua_frank] no hypertension or edema?
[lanny] or kaplan books
[lanny] thats for both
[drsujitvasanth] lanny - First Aid step 2 is like a textbook - its not highyield lol
[samantha] barters is dec na absortion in ascend loop of henle
[samantha] lanny
[lanny] gitelman is defect in Na CL transport in distal tub
[lanny] same mech sam
[drsujitvasanth] i never heard of barters ir gitelman..can someone explain them?
[samantha] thanx lanny
[lanny] diff by callcium hyper in barter hypo in gittel
[lanny] hypercalciuria
[lanny] in barter
[samantha] ok lanny
[dua_frank] so na is low in barters?
[lanny] hypocalciur in gitt
[dua_frank] even though renin is high?
[dua_frank] i know there is no hypertension but i didn't know there was no na either [

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