View Full Version : Surg Chat: General Surgery

03-22-2005, 08:18 PM
dua_frank has joined the chat.
[wael19664u] hi
[mmw] hi
[waleed33] ya same here what exactly goes on in these chats?
[lugansk_state_medical_uni] good morning people
[lugansk_state_medical_uni] *welcome*
[kevinvo] hello, anyone going to Ross this Sept??
[tito433] hi
[tito433] *bird* *bird* *choochoo* *evil* *evil* *evil* *evil*
[erum] *evil*
[erum] *whip*
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[dua_frank] hi megs
[erum] hi
[megs] hey dua how are u??/
[megs] hi sammy
[megs] hi erum
[erum] hi megs
[samantha] hi megs dua and erum
[erum] hi sam
erum has joined subroom: USMLE_Step_1
[dua_frank] i'm good, how are you megs?
[dua_frank] hi sammy and erum
[megs] fine dua
[megs] so shall we start
[dua_frank] sure
[samantha] ok
[samantha] wonder where the others are?
[dua_frank] they will be coming sammy, they're late usually
[dua_frank] uni works and lanny is having problems getting in chat
[samantha] ok
[megs] a lady came with history of thyroid nodule sine 6 months...with no other symptoms..what will be next step???
[samantha] TSH
[megs] if tsh is normal what next step u will do///
[samantha] FNA megs
[megs] yes sammy u r right
[samantha] thanx
[megs] when will u do radionuclear scann???
[megs] for thyroid
[dua_frank] symptoms?
[samantha] in Graves
nasrin06 has left the chat.
[dua_frank] painless nodule maybe
[samantha] toxic nodule?
[uniteus] hi dua, megs, sammy
[dua_frank] hi uni
[samantha] hi uni'
[megs] hi uni
[megs] what if cold nodule and what if hot nodule???
[dua_frank] whats the next step after you see leukoplakia on tongue?
[dua_frank] cold cancer
[dua_frank] hot graves
[uniteus] biopsy dua
[dua_frank] right uni
[megs] yes dua
[samantha] megs ans??
[samantha] test HIV status dua
[megs] dua told it sammy cold...cancer...hot graves disess
[samantha] no for the previous q
[dua_frank] biopsy as uni said sammy
[dua_frank] rx of tongue cancers?
[samantha] idication for radionuclide scan megs
[samantha] ok dua
[uniteus] hmmm..take it out dua?
[megs] when u get abnormal tsh...either hypo or hyper
[megs] sammy
[samantha] ok megs
[megs] tongue cancer...excision is treatmenbt
[megs] with radical neck dissection dua
[dua_frank] right megs
[dua_frank] also radiotherapy for large tumors
[dua_frank] partial mandibulectomy is included in surgery too
[uniteus] indication for surgery in peptic ulcer disease - gastric /duodenal?
[dua_frank] dysplasia?
[samantha] nissenfundo plication is treatment for what?
[dua_frank] anaplasia
[dua_frank] GERD
[megs] nissens for GERD
[megs] gasric uni
[samantha] rt dua and megs how is it done?
[uniteus] indication for surgery tx for gastric/duodenal tx?
[samantha] gastric uni?
[uniteus] rt gastric...but wen is surgery done?
[megs] ulcer perforation or bleeding ulcer uni
[uniteus] rt megs....n also intractability of symptoms n obstrution
[samantha] agree uni
[dua_frank] oh
[dua_frank] thanks uni
[samantha] in achalsia dysphagia is for solids or liquids ?
[dua_frank] liquids
[megs] achalasia ...liquid
[samantha] rt megs
[megs] and progressively to solids too
[samantha] for ca oesophagus?
[megs] for ca..solid
[samantha] yes and then for liquids and even for saliva later
[dua_frank] what if both?
[dua_frank] solids and liquids
[samantha] ca dua
[dua_frank] sudden onset
[dua_frank] esophageal spasm
[megs] ok dua
[samantha] agree dua
[samantha] which ca has worse prog ?
[dua_frank] in esophagus?
[dua_frank] lower
[megs] adeno
[samantha] correct dua
[megs] why??
[samantha] but it is upper and middle
[dua_frank] :O
[samantha] because in accessibility
uniteus has left the chat.
[uniteus] got kicked out :(
[dua_frank] lower is more accesable?
[dua_frank] awww wb uni
[samantha] yes
[dua_frank] thanks
[samantha] wc
[megs] what investigation u will do first ba swollow or scopy in ca esophagus???
[uniteus] swallow
[dua_frank] swollow
[megs] its ba swollow first. yup
[samantha] ba swallow
[megs] alcoholic pt came with history of bloody vomiting, ...vitals stable likely diagnosis???
[dua_frank] varices
[samantha] mallory weis
[megs] yes sammy
[dua_frank] why not varices megs?
[megs] vitals are stable dua
[dua_frank] oh thanks
[lanny] hey guys
[lanny] i finally was able to log in
[megs] wlcome lanny
[dua_frank] hey lanny, long time no see
[samantha] hi lanny
[lanny] hey dua dunno what happened to my comp
[lanny] oh gosh a relief
[dua_frank] did you do something with your computer these last few days?
[uniteus] hey lanny ..we miss u
[dua_frank] something new i mean
[lanny] donno if a virus hit me just going slower than usual
[dua_frank] oh no
[lanny] and i cannot log into chat last 2 days!!
[dua_frank] we missed you
[megs] yes lanny
[lanny] i need this comp now for my last months test prep
[uniteus] yeah
[lanny] thank you missed you too
[lanny] so surgery eh
[uniteus] yup
[lanny] today is what guys
[uniteus] dua was making fun of u one chat line lol
[dua_frank] general surgery
[lanny] will chk the sched later
[lanny] what did she say??
[dua_frank] uni liar :O lanny don't listen to her, shes such a fight instigator :O
[uniteus] we want to find out ur mode of delivery of baby :)
[dua_frank] lol
[lanny] vagi nal!!
[dua_frank] lanny lol
[uniteus] lol
[lanny] lol lol
[megs] lol
[samantha] :)
[dua_frank] which salivary gland is more prone to cancers?
[megs] ok back to discussions guys
[uniteus] submandibular g
[dua_frank] parotid
[megs] parotid
[lanny] parotid
[lanny] sam how is it coming??
[uniteus] huh? to cancer dua? i though parotid is benign most of th time
[dua_frank] mc tumor in parotid is?
[lanny] pleo
[dua_frank] uni i meant any neoplasm
[samantha] ok lanny
[uniteus] oh..got u..ok thx
[dua_frank] benign or malignant
[lanny] good
[lanny] malig
[samantha] how about u?
[dua_frank] yes lanny pleomorphic
[lanny] good
[dua_frank] second site is submandibular
[megs] which gastric cancer is common next to ademocarcinoma ???
[uniteus] pleomor is benign
[dua_frank] and 60% are malignant here
[lanny] kinda slow but will be off work starting thursday
[megs] adenocarcinoma of stomach
[dua_frank] while 70% of parotid ones are benign
[uniteus] oh..thx dua
[dua_frank] sq cell megs
[megs] nope dua its lymphoma..now a days
[dua_frank] yikes
[dua_frank] thanks
[megs] now a days it is as common as adeno ca if stomach
[lanny] megs is right
[dua_frank] any reason why megs?
[lanny] gastric lymph seen in what pop
[megs] immunocompromised lanny
[lanny] yes
[lanny] HIV
[uniteus] bld grp A n immunocompro
[samantha] h pylori /
[lanny] not sure about grp 1 uni
[megs] we are talking about lymphoma...why gr A UNI
[lanny] sam h pylori seen in lymphoma?
[dua_frank] those are gastric cancers in general uni
[dua_frank] not lymphomas
[uniteus] oops..dat was for gatric ca
[megs] yes agree dua
[uniteus] sorry megs
[megs] no prb uni
[dua_frank] but good point uni, thanks
[lanny] is today oncology??
[uniteus] :)
[megs] which ca metastasise to rt supraclvicular nodes...and which to left supraclavicular nodes???
[samantha] no lanny cause of ga lymphoma is h pylori
[dua_frank] gastric to left
[uniteus] general surgery lanny...i guess almost all
[dua_frank] liver to right i guess
[uniteus] left is gastric ca
[megs] u r right of gastric dua
[lanny] sam not sure will chk
[dua_frank] whats for right megs?
[megs] what about right nodes..its liver o=r lungs???
[dua_frank] lungs
[uniteus] lungs
[megs] i think its lungs...not remembering it right now
[megs] will cxq
[dua_frank] its lungs megs
[dua_frank] liver drains into mesentric lymph nodes
[dua_frank] maybe not
[dua_frank] check :)
[megs] i ckeched its liver..and oesophagus
[dua_frank] why thank you, i was right the first time :P
[uniteus] which part ie,..ant or post ulcer, for perforation of duodenal ulcer?
[dua_frank] post uni?
[uniteus] anterior is the ans
[uniteus] tx of perforated ulcer?
[dua_frank] guess didnt work this time :(
[lanny] posterior
[dua_frank] surgery
[lanny] uni sure about anterior?
[dua_frank] omental patch maybe
[uniteus] aww..dua
[uniteus] yeah lanny..looking at kap right now
[uniteus] rt dua
[uniteus] posterior ulcer is hemorrhage of duodenal ulcer
[dua_frank] meaning?
megs has left the chat.
[uniteus] complication of duodenal....those r the one commonly affected the area...
[uniteus] for the type of complication...
[dua_frank] so is rupture ant or post uni?
[dua_frank] ant perforation post bleeding?
[uniteus] ruptur or perforation....ant is commonly affected
[dua_frank] oh thanks
[uniteus] while post is hemmorhage
[uniteus] urw
[lanny] uni is saying anterior ulcers perforate more so than post ones dua
[uniteus] thx lanny
[dua_frank] which nerve injury results in paralysis of vocal cords?
[lanny] 9th cranial
[dua_frank] recurrent laryngeal nerve
[dua_frank] if both RLNs are damaged, what happens?
[uniteus] airway obstruction
[dua_frank] right uni, rx?
[uniteus] intubate??
[dua_frank] tracheaostomy
[uniteus] i mean tracheo
[dua_frank] can't intubate
[uniteus] oops
[dua_frank] the vocal cords are shut tight
[dua_frank] they adduct
[dua_frank] causing asyphyxiation
[uniteus] oh...thx dua
[dua_frank] welcome
[lanny] ho
[samantha] crico?
[lanny] w do you manage a strang hernia of the bowel
[dua_frank] which thyroiditis may cause tracheoesophageal obstruction?
[lanny] subacute
[lanny] riedels
[uniteus] surgery...try to salvage the bowel if stil viable esle remove
[samantha] surgery lanny
[dua_frank] unstrangulate it look for necrosis, if yes resect the dead bowel
[dua_frank] right lanny reidels
[megs] how do look for viable bowels??/
[lanny] right guys but look if pt is acute or not
[dua_frank] color?
[uniteus] color, vascularity
[megs] good blood supply, pink color.shiny mesentry
[samantha] ca colon to dia what inv first?
[lanny] what if pt is dehydrated and has pain secondary to strangil what do you do next?
[megs] colonoscopy and biopsy sammy
[uniteus] colonoscopy after occult
[samantha] for left colon?
[samantha] correct megs
[lanny] sigmoid or colon
[lanny] do not do colon without looking extent of ca
[samantha] correct lanny sigmoidoscopy first
[lanny] first do a flex sigmoid with biopsy
[megs] why lanny???
[lanny] to avoid perforating a weakened colon ny ca
[lanny] look by sigmoid with biopsy to see extent
[lanny] then surgery
[megs] thanx lany
[samantha] flexible procto sigmoi 45-60 cms first
[uniteus] oh..thx lanny
malak1993 has left the chat.
[dua_frank] how do you rx papillary thyroid ca?
[megs] thyroidectomy+ post op chemo
[lanny] surgery and chemothpy
[dua_frank] subtotal thyroidectomy
[uniteus] thyrodectomy sub
[dua_frank] all others total
[dua_frank] and chemo with radio in anaplastic thyroid ca
[megs] can u explain why its so dua???
[lanny] thx dua never knew
[dua_frank] papillary is usually local
mmw has left the chat.
[dua_frank] 90% cure rate with subtotal thyroidectomy
[dua_frank] others need total
[dua_frank] anaplastic is most aggresive
[megs] ohhh..thanx
[dua_frank] so need chemo and radio
[dua_frank] plus ln dissection
[dua_frank] tracheostomy sometimes too
[dua_frank] how will you rx multiglandular hyperplasia of parathyroid glands?
[samantha] removal dua
[megs] remova;l
[dua_frank] yeah cut all four but leave a little of one of the glands behind
[lanny] right
mmw has left the chat.
[lanny] where do you leave it
[megs] subcuteneous pocket lanny
[megs] may be arms
[lanny] right usu in the forearm
[lanny] right megs
[megs] what is most common site for gastrinoma????
mmw has left the chat.
[samantha] pseudomembrano colitis tx?
[lanny] stomach antrum??
[uniteus] duodenal region
[dua_frank] vanco or metro
[samantha] pancre
[lanny] metro or vanco
[uniteus] metronidazole oral or vanco sammy
[megs] i thoght pan creas
[megs] oral vanco or metro for pseudomem colitis
[samantha] rt dua and megs
[samantha] uni and lanny
[megs] gastrinoma most common site is pan creas
[megs] tumor of pancreas...affects stomach and duodenum....
[samantha] me rt
[samantha] :)
[uniteus] :)
[uniteus] n me wrong
[lanny] carcinoid syndrome affects what side of heart?
[megs] its fussy...name gastrinoma...we think of stomach but its not....
[dua_frank] right
[megs] right side of heart lanny
[lanny] righr dua megs how will pt presnet
[lanny] present??
[dua_frank] tumor of pancreas common site is still pancreas right megs? *)
[dua_frank] valvular defect lanny?
[dua_frank] flushing and all that
[uniteus] pt has sweating, palpation, faintness, nausea right after feeding, dx?
[lanny] right dua plus inc JVP
[samantha] insulinoma uni
[lanny] caarcinoid
[uniteus] ok..has surgical hx
[uniteus] ans?
[lanny] dumping sd
[uniteus] rt lanny...tx?
[megs] post pylorotomy
[dua_frank] dumping
[uniteus] rt dua..
[samantha] and also insulinoma
[megs] multiple small feeds ..is treatment
[lanny] what is short bowel sd?
[uniteus] rt megs n increase fat, dec carbohydrate
[dua_frank] same as dumping?
joyceakwi has left the chat.
[megs] resection of small bowel....leads to diarrhoeal symptoms
[lanny] ok i thought so, but i thought it was diff too
[lanny] right dua
[megs] its diff from dumping....
[lanny] yes megs
[uniteus] sammy dont think so ..cus symptoms occur rt after feeding
[lanny] its diff can you explain
[lanny] i saw a q in UW that i put dumping but it was wrong
[megs] due to recection of bowel...hampers absorption phase...hense diarrhoeal symptoms
[samantha] reactive hypo gylcemia occurs in both uni
[samantha] rt after feeding these sym occur
[lanny] thats dumping sam??
[uniteus] oh ok..sammy..i'll check
[megs] but in dumping just stomach..is small..so early gastric emptying ..so diaphoretic symtoms...
[samantha] and also in dumping synd
[lanny] agree megs
[uniteus] agree megs
[lanny] so what is short bowel sd is the q??
[megs] in shortbowl u see malabsorption too
[lanny] megs you know the cause of short bowel sd?
[megs] necrotising enterocolitis
erum has left the chat.
[megs] surgical recection
jyoti has left the chat.
[megs] and chrohns too lanny...causes short bowel syndrome
[samantha] what is nesidioblastosis?
[lanny] what is afferent loop sd??
[uniteus] which organism is associated with colon ca?
[lanny] streep bovis
[uniteus] rt lanny
[megs] what is blindloop syndrome???
[dua_frank] :scared: so many loops
[samantha] excessive growth of bacteria?
[dua_frank] thats dumping megs
[dua_frank] i hope
[megs] yup sammy...due to intestinal stasis
[lanny] lol lol dua
[samantha] in case of gastric bypass
[uniteus] dua..watch me -->
[dua_frank] arrghh
[dua_frank] whats dumping then?
[dua_frank] i got short bowel, i got blindlood
[megs] yup sammy got it
[lanny] a conseq of bilroth 2 anastomosis dua
[dua_frank] how is it different in presentation lanny?
[dua_frank] i know all these loops are after surgery
[dua_frank] want to know how they are differfent in presentation
[lanny] me too dua i dont know therm i only know dumoing
[megs] dua dumping..will present with sweating...palpitaions ..after food
[dua_frank] ok
[dua_frank] thats coz of a small stomach
[dua_frank] next
[megs] shortbowel...with malabsorption and diarrhoea...
[dua_frank] thats coz of little bowel
[dua_frank] next
[megs] and blind loop due to intestinal stasis ...bacterial overgrowth,,..so fullness in abd...
[dua_frank] nice, thanks megs :)
[dua_frank] thats coz blind end loop
[megs] urw
[lanny] is afferent loop and blind the same??
[dua_frank] many many thanks :-happy
[samantha] :box
[lanny] so whats afferent loop?/
[dua_frank] ooo sammy, you're on :box
[megs] same lanny..blind loop= afferent loop lanny
[lanny] thx megs
[megs] but only diff is
[lanny] what megs??
[megs] they are same...nothing lanny
[lanny] ok megs thx
[megs] migratory necrolytic dermatitis..think of what???
[samantha] just want to try that dua
[megs] clue...related to hormone...
[uniteus] estrogen?
[megs] glucagonoma...
[megs] its wierd ... *) *) *)
[uniteus] nice q megs
[dua_frank] so many bloody hormones :(
[lanny] hey guys gastrinomas are not from pancreas they are from stomach
[dua_frank] gastrin is released from pancreas lanny so from pancreas
[lanny] gastrin is secr from antrum
[dua_frank] no gastrin receptors are at antrum
[dua_frank] next to histamine ones
[lanny] no dua gastrin is released from antrum and duodenum too
[dua_frank] *)
[megs] lanny u r right
[megs] but more common site for tumor is pancreas
[lanny] zollinger ellison is hyper secr of gastrin
[dua_frank] so whats coming from pancreas to stimulate gastrin release?
[megs] then duodenum...and last stomach
[lanny] and it cause peptic ulcers
[lanny] secretin dua
[samantha] in case of metastatic zolinger ellison ? tx/
[uniteus] old pt hx of PVD, has sudden abd pain, fever, bright red blood rectum, dx?
[megs] omeprazole sammy
[samantha] rt megs
[uniteus] omeprazole, n resection sammy
[lanny] no dua gastrin is released in resp to vagal stim and amino acids entering stomach
[samantha] rt ni
[samantha] sorry uni
[uniteus] :)
[lanny] causes acid secr
[megs] mesentric iscemia uni
[lanny] will chk this again dua but i think i remember right
[megs] ischemic bowels i mean
[dua_frank] youre right lanny
[dua_frank] what happens in ZE syndrome?
[samantha] what does latent aberent thyroid mean?
[uniteus] rt megs..n wat else?
[dua_frank] antral cells overreact and inc secretion of gastrin?
[dua_frank] diverticulitis uni?
[lanny] can say so
[uniteus] ischemic colitis is d other ans
[lanny] sam that is nisedioblastosisiright
[dua_frank] what does that have to do with pancreas then lanny? why is gastrinoma common in pancreas then if the cells are in antrum?
[megs] lateral abbrent thyrois..ectpic thyroid tissue along the jugular viens sammy
[dua_frank] its the same thing uni
[uniteus] rt dua
[samantha] there is no aberent thyroid tissue anywhere it means ca thyroid
[samantha] metastatsis
[samantha] no lanny that is excess insulin in new born
[lanny] dua i know that gastrinoma is from antrum hyper secr of gastrin, you may confuse with VIPoma
[samantha] in zollinger ellison syn hypersec of gastrin dua
[dua_frank] whats the cause for hypersecretion?
[dua_frank] and why from pancreas more common
[lanny] in fact if a pt with peptic ulcer dont get better after triple thpy for h pylori you suspect gasrinoma
[samantha] like MEN syn dua
[samantha] sometimes it is isolated
[dua_frank] no no i want to know where the gastrin s coming from
[dua_frank] in ze synd
[lanny] from g cells in antrum
[samantha] from the tumor
[lanny] no g cells in pancreas islets
[dua_frank] so then its an antral tumor
[samantha] gastrinoma is the tumor
[lanny] yes it is
[dua_frank] why did megs say its common in pancreas then?
[samantha] it is in pancreas more
[dua_frank] is it like abnormal occurance of g cells in pancreas sammy?
[megs] u guys dissecting gastrinoma badly...lol
[megs] lol
[lanny] dua i read once something pancreatic gastrinoma
[samantha] the tumor is in pancreas mo;re commonly
[dua_frank] you started the whole thing megs :P
[megs] http://www.chclibrary.org/micromed/00049110.html
[dua_frank] oi megs i can't open sites
[dua_frank] please tell me what it says
[dua_frank] help me understand why pancreas have gastrinomas if no g cells are present normally there
[samantha] no dua the tumor secrets gastrin
[samantha] and causes ulcer in the stomach
[dua_frank] tomor containing the g cells right?
[dua_frank] so that means g cells in pancreas are abnormality
[samantha] yes dua
[dua_frank] causing ze synd
[lanny] better to know it now esp since its tied with peptic ulcer a very common dz
[dua_frank] yeah lanny
[samantha] you are rt
[lanny] dua dont think they exist but maybe so
[dua_frank] ok thanks
[dua_frank] whew
[dua_frank] got that over with
[lanny] my golly!!!!
[dua_frank] i know !!!
[samantha] you think a lot dua
[lanny] whats this megs
[dua_frank] sammy i have an ocd, which is why i get stuck on some topic and remain there sometimes
[samantha] that is good
[lanny] me too dua thats how i learn
[megs] so anybody to summerise????
[dua_frank] yeah megs
[dua_frank] you :P
[lanny] like the loops ill remember for a while!!
[dua_frank] lol lanny
[dua_frank] true
[megs] yup lanny pl summerise
[lanny] oh megs not too fast at typing
[megs] ok i will tell
[megs] u tell me i am right or wrong...or add something
[samantha] thanx megs
[megs] gastinoma...are tomors secreting gastrin ..which affects...the gastric and duodenal mucosa
[samantha] rt
[megs] g cells secretes gastrin..those are located in pancreas..islets...or duodenal wall
[dua_frank] so you mean that gastrin has two normal places to come from?
[megs] but gastrin stimulates cells of somach mucosa...to sectrete gastic acid...hense multiple ulcers
[megs] yes dua..gastrin is secreted from cells situated in pancreas and deudenal wall
[dua_frank] thanks megs!
[megs] and adjacent lymphnodes too
[dua_frank] see now ze becomes more clear in my head
[lanny] megs gastrin is from g cells that are in antrum and duodenum not in islets in fact
[lanny] megs gastrin is not secr by the pancreas, but will chk again
[samantha] in case of ze it is from pancreas lanny
[dua_frank] Gastrin cells: pancreas usually lacks gastrin producing cells, although gastrinomas are common
[megs] i will cq too lanny
[dua_frank] so we're back to the same as before
[dua_frank] its abnormal g cells secreting gastrin in pancreas- ze syndrome
[samantha] not normally but in case of ze it is
[dua_frank] right sammy
[lanny] ok guys i just checked from CMDT
[lanny] let me post what they say give me 2 mins
[megs] go on lanny
[uniteus] r we clear lol kinda got lost for awhile
[dua_frank] mc malignant lung ca?
[dua_frank] uni we're getting there *)
[uniteus] small cell
[lanny] ZE sd is caused by gastrin secr tumors which result in hyper secretion primary gastrinomasmay arise from pancreas25% dudenal wall45% and lymph nodes 5-15%
[dua_frank] adeno or sq?
[uniteus] yes madam..
[uniteus] adenocar dua
[megs] sq dua
[dua_frank] right uni
[lanny] so dua you were right though gastrin is secr from antrum g cells neuro endocrine cells in panceas secr it too
[dua_frank] are adeno centrally located or peripheral?
[uniteus] peripherally located
[megs] peripherally
[dua_frank] right
[dua_frank] thanks for checking for us lanny
[megs] thanx lanny..
[lanny] pleasure
[dua_frank] tell me another lung ca which is peripheral
[lanny] adeno brenchogenic
[uniteus] thx lanny
[dua_frank] another lanny?
[uniteus] large cell
[dua_frank] good uni, another?
[dua_frank] mesothelioma too right?
[lanny] mesoth??
[dua_frank] right
[dua_frank] which is associated with hypercalcemia?
[uniteus] all the small n squamous is SENTRAL while rest not
[lanny] swuamous
[uniteus] squamous
[dua_frank] right
[megs] sq..is associated with hyper cal
[dua_frank] can small also have hypercalcemia?
[lanny] what about ACTH?
[dua_frank] small
[lanny] no small dont secr PTH
[megs] yes if associated with ..ectopic pth prd
[uniteus] small
[lanny] always get confused with ACTH
[dua_frank] yes emgs
[lanny] i think its both
[dua_frank] yes it is lanny but more common with sq ca
[lanny] megs ectopic PTH prod is by SQuam
[dua_frank] anybody know why?
[lanny] so ACTH is squamous
[uniteus] ACTH is small cell
[dua_frank] no lanny, small
[dua_frank] think of it this way, hypercalcemia more common with sq
[lanny] according to dua ACTH is squam
[dua_frank] everything else is small
[lanny] oh ok dua
[dua_frank] but hypercalcemia can be seen even with small, just more common in sq
[lanny] what about ADH
[samantha] small cell
[megs] lany u are right thank u
[lanny] right sam
[megs] there are three paraneoplastic syndrome component...
[lanny] megs right about what ??
[megs] siadh and cushings...by small cell...
[dua_frank] whats with sarcoidosis?
[samantha] breast abscess what does that mean?
[uniteus] Cushigoid, SIADH , eAton-lamber syn
[megs] sq cell...PTH LANNY..U R RIGHT
[megs] YUP UNI
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[lanny] oh yea megs
[lanny] hypercalcemia dua
[megs] why clubbing in ca lung??/
[samantha] in preg it is beningn all other cases sus malignancy
[dua_frank] hypoxia megs?
[dua_frank] thanks sammy
[samantha] wc
[lanny] breast abcess is benign in preg sam??
[megs] they say some sutance reased by malignancy..causes clubbing in ca lung...and other reason as u told dua
[samantha] yes lanny incision and drainage if persis
[dua_frank] thanks megs
[samantha] you also take a biopsy in case of preg also lanny
[lanny] right but i never heard of abscess being benign??
[samantha] osteodytrophy megs?
[megs] lady of 26 yrs with breast lmp of 2cm in outer upper qoadrant..movable.first .investigation ????
[samantha] not 100% benign
[dua_frank] fnac?
[lanny] observe next mens cycle
[megs] present since 6 months lanny...then what
[lanny] FNA or U sound
[uniteus] mammogram?
[samantha] mammorgram
[megs] ultrasonography or fnac...good lanny
[megs] no mammo before 35 yrs uni and sammy...its not diagnostic...
[lanny] 26 mammogram is not helpful
[samantha] from 30 yrs yes
[uniteus] ok..thx megs n lanny
[megs] as the breast is too dense...mammogram is not helpful
[samantha] in case of high risk and large cystic on US
[lanny] ok guysis this it for today?/
[dua_frank] yeah
[dua_frank] it was a good day
[megs] yes
[lanny] so see you all tom
[dua_frank] bye bye all
[megs] bye all
[lanny] tom is general surgery right
[uniteus] bye all
[lanny] bye all
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[samantha] bye all
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[lanny] dua got your e mail
[dua_frank] Surgical Specialities
[lanny] the site guy did not get back but i managed to log in today hope will be ok tomorrow
[dua_frank] hope so lann
[lanny] thanks dua keep it up!!
[dua_frank] welcome
[dua_frank] bye
[lanny] goodnight
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