View Full Version : Surg Chat: Surgical Specialities

03-23-2005, 08:18 PM
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[tito433] hi
[tito433] *bird* *bird* *choochoo* *evil* *evil* *evil* *evil*
[erum] *evil*
[erum] *whip*
[mmw] hi everyone
[cstueck] need to get message to snowrat anyone know how
[cstueck] never mind i found it on the control panel option
[hanna] will i make it in 7 years?
[hainam21] hi all
[ekrules2004] hello
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[dua_frank] hi all
[samantha] hi all
[ash] hi dua
[ash] hi samantha
[dua_frank] how do you rx endometriosis?
[dua_frank] precancerous
[ash] surgical removal
[dua_frank] no progestrone?
[samantha] no dua endometriosis is not precancerous
[dua_frank] yeah i know
[dua_frank] how do we treat it?
[ash] doesnt it depend on the development of scars?
[dua_frank] remind me ash
[samantha] OCP's
[dua_frank] i can't seem to recollect
[dua_frank] ok so ocps
[ash] ok
[dua_frank] what if they don't work sammy? then hysterectomy?
[samantha] pseudopregnancy
[samantha] pseudomenopause
[ash] yes i remember reading this
[ash] thanks sammy
[samantha] wc
[ash] hi megs
[megs] hi all
[samantha] hi megs
[dua_frank] thanks sammy
[dua_frank] hi megs
[samantha] wc dua
[megs] so stareted...or yet to start??
[dua_frank] not yet
[dua_frank] we can start now megs
[ash] shall we start?
[megs] sure dua
[megs] a 18 yr old boy came with history of flank pain radiating towards the testies...whats dx???
[samantha] kidney stones
[megs] yes sammy...
[samantha] ureteric
[ash] a 14 y/o boy comes to your office ,c/o breasts recently becoming tender and slightly swollen.tender mass is palpable in subareolar region of both breasts.what is the best course of action?
[megs] if stone is .5 cm what will be treatment??/
[ash] mass is 2 cm.
[ash] lithotripsy
[ash] oh 0.5 do nothing
[megs] hydration therapy first...
[ash] fluids
[megs] yes
[samantha] IV fluids
[dua_frank] how do you access central and peripheral lung lesions?
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[ash] central bronchoscopy
[dua_frank] right ash
[megs] central...broncheolar lavage...peripheral...percuteneous biopsy
[ash] peripheral thoracostomy
[ash] someone answer my question
[dua_frank] videoassisted thoracoscopic surgery
[dua_frank] leave it alone ash?
[ash] right dua
[dua_frank] maybe normal pubescence?
[samantha] FNA
[samantha] biopsy
[ash] what if the mass is 5 cm and doesnt regress for 2 yrs?
[dua_frank] then access causes
[megs] hormonal study..or liver fun ash????
[ash] it is pubertal gynecomastia and normally regresses in 1 year
[ash] do subcutaneous mastectomy
[ash] if no regression
[megs] dont we investigate for cause ash???
[ash] yes megs you can do those
[megs] ok
[ash] also do karyotyping
[megs] pt has urinery prb tells that air with urine...what do u suspect???
[ash] pneumaturia
[megs] pneumatouria..yup due to what???
[ash] fistula
[megs] yes ash....most commonly due to duverticulitis
[uniteus] hello
[megs] hi uni
[ash] hi uniteus
[dua_frank] hi uni
[samantha] hi uni\
[dua_frank] how do you rx this megs?
[megs] pt came with galactorrhoes amenorrhoea ...u ruled out pregnancy...what do u suspect???
[megs] repair fistula...dua..
[dua_frank] axis problems
[uniteus] hypoThyroid
[dua_frank] hypo too yeah
[megs] why directly hypothyroidismm...
[megs] why not prolactinoma
[ash] a 52 y/o woman with h/o/ mass in rt. breast. she states that it resulted from trauma.p/e shows firm nontender mass with no evidence of overlying skin involvement.ipsilateral axilla clear.contralat. breast and axilla are normal.biopsy shows insitu lobular ca. with traumatic fat necrosis.the physician should also be concerned about what?
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[ash] i would say prolactinoma
[dua_frank] metastasis?
[dua_frank] could be both megs
[dua_frank] anything that affects the axis
[ash] esp. if she also has occular problems
[megs] lobular carcinoma...suspect bilaterality...therefore do bilat mastectomy
[dua_frank] start investigating with tsh or trh levels first
[ash] right megs
[ash] good
[megs] yes dua ..can be both...
[dua_frank] if high thats hypothyroid, if normal check prl levels
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[uniteus] because it can cause hyperprolactin
[megs] yeah uni
[ash] also ask for drug history in this pt.
[dua_frank] right ash
[dua_frank] good point
[megs] when do u medically traet prolatinoma and when surgically???
[dua_frank] i think as soon as we get a q on exam, first rule our drug effects then go ahead with normal investigations
[ash] dopamine and prolactin antagonize eachother
[megs] yes ash
[dua_frank] when meds fail, surgical megs?
[dua_frank] try bromocriptine first
[ash] surgical whjen it has compression side effects
[megs] yes dua...generally they say if size of tumour less than 1 cm treat with bromo
[megs] if more than that then surgically...
[ash] ok
[dua_frank] thanks megs
[uniteus] thx megs
[megs] in case of symptoms of raised ict with uncal herniation..with no breathing prblem..what will u do first ..iv mannitol ot endotracheal intubation???
[megs] in raised intracraniel tension ...
[dua_frank] manitol
[samantha] intratrachial
[uniteus] hypervent, sit up right...then manitol
[megs] good uni
[megs] tell us why???
[ash] 32 y/o japanese woman comes for regular p/e.she has 2 kids,is in full health,doesnt smoke,doesnt drink,leads a healthy life.what will be a significant risk factor for her?h/o ocps?;japanese diet?;late menopause?;h/o endometrial ca.?
[uniteus] :(
[dua_frank] so intubate first?
[megs] yes dua always intubate first...hyperventilation works faster than mannitol
[ash] intubation
[samantha] ca stomach
[dua_frank] thanks
[uniteus] hyperventilate to vasoconstrict so reduce the blood flow..mannitol decrease the edema n
[dua_frank] ah good explaination uni, thanks
[megs] yeah uni
[megs] agree ca stomach ash
[uniteus] hey, i learned this from one of u
[uniteus] :)
[ash] well i have given the options
[dua_frank] :)
[ash] can you select from them?
[dua_frank] you remember how uni?
[uniteus] diet -->japanse
[megs] japnese diet ash
[uniteus] use mi reflex dua
[dua_frank] its those pc02 levels that cause cerebral vasodilatation and when po2 pressures rise, they vasoconstrict
[ash] oh sorry i meant what would be a significant risk factor for her to develop ca. breast from those options
[uniteus] :) the one u thought me
[uniteus] thx
[dua_frank] whats mi reflex *)
[uniteus] :)
[dua_frank] i forgot what i told you :(
[ash] the risk factor would be h/o endometrial ca.
[dua_frank] how come ash?
[megs] ok ash
[uniteus] didnt get ask
[uniteus] ash
[dua_frank] whats mi reflex?
[ash] the question was which of the foll. risk factors will increase the chance of her getting ca. breast
[uniteus] :) dua
[dua_frank] you ate the breast ca part of the q ash lol
[ash] dua i wrote it again
[dua_frank] oh *)
[dua_frank] well then in that case yes endo ca
[uniteus] the one u told me ...whatever comes out first in ur mind....reflex...is usually it...n not the one we think afterwhile
[dua_frank] oh lol
[dua_frank] good lol
[uniteus] u said that...n then that was the next q...so i remember dat incident
[dua_frank] it always works, doesn't it?
[uniteus] yeah..but sometimes scary...u know
[samantha] what are the cynotic cong heart diseases?
[ash] sorry abt the confusion
[dua_frank] in fact sanz's post about her exam said she changed her answers and picked the wrongs ones the next time
[uniteus] all the T's
[megs] what is the no 1 cause for transitional cell ca of bladder???
[ash] tof,tapvc,ts
[ash] tgv
[ash] ebsteins anamoly
[dua_frank] the only time you should change is when you have made a mistake understanding the q or you remembered something new
[uniteus] sammy ..tetratolgy, transposition, tri
[dua_frank] if not go with your instinct
[ash] smoking
[uniteus] agree..thx dua
[dua_frank] :)
[uniteus] :)
[samantha] rt uni ash
[megs] yes ash..smoking
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[ash] what parasite can cause it?
[dua_frank] ebstein's ash? or eisenmenger?
[uniteus] schisto
[dua_frank] never heard of ebstein
[dua_frank] are you sure?
[megs] scisto causes sq cell ca...
[uniteus] schistosomiasis ash?
[megs] not transisional cell ca
[dua_frank] agree with megs
[uniteus] ah..thx megs
[dua_frank] what does chlonorchis sinencis cause?
[samantha] which presents the earliest?
[dua_frank] in the bladder
[dua_frank] gall bladder
[ash] right uniteus
[ash] not ebsteins i meant eisenmangers
[megs] that causes bile duct onstuction and liver prb dua
[ash] got confused
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[megs] sammy tga present earliest???
[uniteus] tetralogy sammy?
[dua_frank] it causes adenoca of the GB and cystic disease megs
[ash] tga
[dua_frank] so we know two bugs now
[megs] ok
[ash] sammy whats the ans?
[megs] got it dua
[samantha] yes megs trans position presents 1 or 2 day
[dua_frank] you know, if we all pass this exam, i'm planning on arranging all of us meeting after we get our residencies, so you better keep in touch :P
[ash] good idea dua
[samantha] tetralogy can present up to infancy
[megs] so sweet of u dua
[uniteus] hmmm.... :nah:
[ash] hehe
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[uniteus] dat will be great
[uniteus] dua
[dua_frank] going to uni's place first :nah:
[dua_frank] lol
[uniteus] fainted !
[ash] :)
[uniteus] :)
[megs] lol
[dua_frank] its been a long association and we're really good together, we should continue this association all our careers
[megs] in usa which skin ca is no 1???
[samantha] :)
[ash] basal cell ca. megs
[dua_frank] basal cell ca megs?
[uniteus] melanoma
[megs] yup
[uniteus] oops
[megs] ash dua correct
[samantha] melanoma
[megs] what is treatment???
[dua_frank] excision
[uniteus] excision
[ash] resection with wide margin
[dua_frank] agree with ash
[megs] basal cell 50%..sq cell 255 melanoma 15%
[dua_frank] wide margin important
[samantha] 1 cm margin
[megs] wide mean how much wide ash???
[dua_frank] thanks megs
[ash] 1 cm i guess
[ash] just quoting samantha
[megs] actually kaplan says if margins are negative ..u can do excision as less as 1mm
[megs] ITS 1MM
[dua_frank] yeah i would agree
[ash] hmmmmm. ok thanx megs
[dua_frank] it depends on penetration of BM
[samantha] sorry megs it is 1mm
[ash] then is the wide margin for squamous cell?
[dua_frank] which is usually intact in basal cell ca, it is usually locally aggressive
[megs] YES DUA
[megs] melanoma needs...wide marins...like 2..3 cm ..for excision
[megs] and sq cells ca needs .5 to 2 cm..wide local excision
[ash] pt. with syncope .vertigo,ataxia,upper limb claudication on exercise.diagnosis?
[samantha] only mm for BCC
[ash] thanx megs
[megs] subclavien stiel syndrome
[samantha] agree megs
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[dua_frank] can you explain please?
[dua_frank] poor lanny, trying so hard to get in
[ash] right megs
[uniteus] yeah..hope his comp is ok
[dua_frank] what happens in this?
[ash] this pt.has neurological as well as upper limb signs which means that the occlusion is proximal to vertebral a.
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[samantha] there is a constriction in the subclavian artery
[dua_frank] ok
[dua_frank] thanks
[dua_frank] why ataxia and vertigo?
[megs] at the origin of subclavien..if there is plauqe..on exercize bld diverted to...upper limbs..from vertibral supply..so poor supply to cns hense those symptoms
[dua_frank] ah
[ash] this pt. has upper limb parasthesias,weakness,cold skin,edema,venous distention on exercise.diagnosis?
[ash] good explanation megs
[lanny] hi guys sorry had diff again
[dua_frank] welcome lanny
[lanny] just got in
[megs] hey welcome lanny
[ash] hi lanny
[samantha] wc lanny
[lanny] dunno whats wrong with this site
[dua_frank] coa preductal ash?
[uniteus] male with painful n swollen rt scrotum, relieved by raising d rt testes, has cremasteric reflex present...tx?
[megs] thorasic outlet syndr ash
[ash] megs right
[dua_frank] oh
[dua_frank] yeah edema
[ash] dua it was in only one limb
[uniteus] hi lanny
[dua_frank] oh
[megs] testicular torsion uni
[ash] agree tortion
[lanny] surgery
[uniteus] nope..read it again
[ash] surgery immediately
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[samantha] surgery untwist and oriectomy
[lanny] emergency surgery uni
[ash] epididymitis?
[megs] oh cremasteric reflex +
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[uniteus] rt ash ...main difference from torsion is
[dua_frank] antibiotics ?
[ash] this is what happens when we dont read a question properly
[lanny] right dua
[uniteus] torsion is not relieved by raising d testes cause it is already tranverse line n no cremasteric reflex
[uniteus] rt dua
[lanny] agree ash
[dua_frank] right ash :scared:
[ash] hehehe dua
[lanny] shame on us all
[uniteus] agre ash
[dua_frank] lanny lol
[lanny] PROPERLY!
[uniteus] Yeah..read it twice if possible...
[samantha] tx is antibiotics
[megs] uni i thought pain of torsion is relived on..lifting up..
[megs] :)
[uniteus] no megs...nothing helps to relieve the pain of torsion except surgery n untwist or remove
[uniteus] epididymis does though
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[lanny] thx uni
[lanny] whats today general surgery guys?
[dua_frank] specialties lanny
[uniteus] n d torsion d testes is already in traverse lie...so it is already raised
[lanny] thx dua
[dua_frank] welcome
[dua_frank] thanks uni, good point
[uniteus] urw
[ash] 47 y/o woman had a mass removed from upper quadrant of her breast.on biopsy the pathologist reports the foll.stage 1:histologic type-infiltrating ductal ca.;grade 2;estrogen and progesterone assay negative;tumor size 1 cm;flow cytometry-diploid tumor with 4%cells in s phase.which of these prognostic factors given will be of the greatest concern to the pt.?
[lanny] i remember now uni cremaster lifts testes horizontal
[uniteus] rt lanny...so no cremasteric reflex in torsion
[lanny] estrogen prog neg??
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[uniteus] estrogen n pro assay ne ?
[lanny] ash wats answer?
[megs] agree uni
[lanny] ash disappeared??????????????
[uniteus] :)
[dua_frank] how will you follow up gastric ca?
[megs] *choochoo*
[lanny] CEA
[dua_frank] right lanny
[dua_frank] i think ash fell asleep with her head on the keyboard
[dua_frank] lol
[ash] sorry was on the phone
[uniteus] :)
[megs] ok
[lanny] oh at last
[ash] :(
[dua_frank] oh :oops:
[lanny] ash i say estro and pro receptor neg??
[ash] yes guys u r right estro and pro. assay
[uniteus] yipee
[lanny] hip hip hip hurray!!!!!!!!!!!!!!!!!!!!!!!
[ash] good job
[ash] :)
[ash] which is the single most reliable indicator?
[lanny] of what
[ash] if these dimentions were not given?
[ash] ca.breast
[lanny] solitary mass
[megs] then infilterating duct ca
[megs] which braest ca has worst prognosis???
[lanny] age??
[uniteus] old man with urinary retention, freq, hesistancy, bone pain , wt loss, what initial test done?
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[dua_frank] plain x ray
[ash] no imean what will you base your prognosis on?
[lanny] PPSA
[dua_frank] spine
[dua_frank] and psa
[megs] psa..and x ray spine
[uniteus] rt dua..PSA ...then xray
[uniteus] rt megs
[ash] answer is stage of cancer
[uniteus] what u c in xray of spine, slerotic or lucent?
[uniteus] rt lanny
[lanny] is it x ray or MRI
[lanny] lucent
[samantha] sclerotic
[megs] scerotic...for ca prostate
[lanny] it is osteoblastic mets
[lanny] so lucent??
[dua_frank] yeah lanny i agree
[uniteus] d inflam one for breast ca worst prognostic
[megs] yes uni right
[uniteus] rt megs...it is sclerotic
[ash] 50y/o pt. with h/o postprandial abdominal pain,fear of food and weight loss.he has h/o hypertension.ct scan of abdomen has negative results.diagnosis?
[megs] lucent means osteoclastic...
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[uniteus] osteoblast is sclerotic
[dua_frank] oops
[ash] prostate has blastic so sclerotic
[dua_frank] thanks uni
[dua_frank] and megs
[ash] what does ca. breast show in bone mets?
[lanny] thought osteoblast is lucent thanks
[samantha] gastric ulcer
[uniteus] lucent ..picture Multiple myelome skull
[ash] no samantha
[dua_frank] gastric ca
[uniteus] ischemic mesenteric
[ash] barium studies also normal
[megs] tell us more ash
[dua_frank] oh
[ash] uniteus right
[lanny] ash tell us about breast cancer and bone mets plz
[dua_frank] nice q ash
[megs] oh ..nice q ash
[ash] in breast ca they can be both
[erum] hi
[uniteus] hi erum
[ash] mostly clastic
[dua_frank] hi erum
[megs] hi erum..are u too preparing for step 2
[ash] gee thanx guys
[lanny] right i think prostate is the exception for osteoblastic
[lanny] is m myeloma osteoclastic??
[erum] very soon
[ash] yes lanny
[dua_frank] so no other cancer that we know of has osteoblastic or sclerotic picture
[dua_frank] rigt?
[ash] lytic shadows
[megs] ok all the best erum
[erum] thanks
[ash] dua rarely breast ca. can have blastic
[lanny] think so dua
[megs] ca breast can have both ..lytic as well as sclerotic mets
[ash] yes megs
[samantha] how do you diff blastic and clastic? :(
[megs] on xray ...radio.opaqe and lucent shadow
[uniteus] just checked -->actually, sclerotic bone lesion occur in breast ca (get both), also osteosarcoma, osteomyelitis (presents with periosteal reaction), healing fracture callus
[samantha] how to tell which is lucent megs?
[lanny] x ray pic will show you sam
[ash] 65 y/o male,sudden onset abdominal pain and distension,bloody diarrhea.no rebound tenderness.absent bowel sounds.increased PNMs,with left shift,raised sr. amylase. most likely diagnosis?
[megs] lucent..is osteoclstic..remember puched out lesions...
[megs] and blastic are like cotton balls...
[dua_frank] acute pancreatitis?
[lanny] diverticulitis
[samantha] thanx megs and lanny
[ash] dua will pancreatitis have no rebound tenderness?
[megs] agree diverticulitis
[dua_frank] will
[ash] lanny will diverticulitis have raised serum amylase?
[uniteus] diverticulitis
[dua_frank] diverticulisis
[uniteus] oops...
[dua_frank] arrrgghhh
[dua_frank] he's faking it :P
[ash] hehe dua
[dua_frank] tell us ash
[lanny] appendicitis
[ash] lanny appendicitis will have rebound tenderness
[megs] is it toxic megacolon???
[ash] and right lower quadrant pain too
[megs] hushhhhhhh
[megs] tell us ash
[ash] it is small bowel infarction
[lanny] amylase inc in it??
[ash] yep
[uniteus] i thought it is raise lipase ash?
[lanny] yea uni i thought lipase
[megs] but it will have tenderness ash...
[lanny] not a fair question
[ash] megs rebound tenderness?
[lanny] ie peritonitis
[ash] sorry i got this question from mksap.
[lanny] ok got your point
[lanny] so what conds we see inc amylase??
[megs] what is mksap??/
[ash] a kind of a qbank megs
[lanny] pancreatitis
[lanny] small bowel infarct
[megs] ok
[ash] in bowel infarction we see both raised amylase and lipase
[lanny] anything else??/
[megs] cpk too lanny
[lanny] in pancr too amylase first then lipase
[ash] salivary conditions
[lanny] whats cpk??
[lanny] oh ok
[ash] creatine phosphokinase
[lanny] what about alkaline phosphatase??
[lanny] inc in??
[lanny] bone
[uniteus] what is migratory thrombophelbitis? cant remember
[lanny] liver??
[dua_frank] pancreatic ca uni
[lanny] it is a coag disorder seen in pancr cancer
[lanny] and another disorder ive forgot
[dua_frank] you will see thromboplhlibitis is different places
[uniteus] thx dua...but how does this migr throm presents?
[lanny] migratory is the key dua
[dua_frank] depening on where the ca travels in bld vessels
[samantha] what is reflex sympathetic dystrophy?
[dua_frank] inflammation and redness over blood vessel area
[ash] a 60y/o man complains of pain and numbness in left leg while walking ,relieved by rest.also c/o impotence.p/e atrophy of leg muscles ,normal reflexes and bruit over femoral a.diagnosis?
[dua_frank] just like normal thrombophlebitis
[dua_frank] but in different areas
[uniteus] thx dua...
[dua_frank] wc
[erum] known as trousseau,s sign
[dua_frank] yeah megs
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[uniteus] thx erum
[dua_frank] i mean yeah erum
[samantha] dia atherosclerosis
[lanny] ash its a spinal cord lesion
[dua_frank] sorry *)
[lanny] forgot name
[erum] *welcome*
[dua_frank] peroneaus disease
[ash] samantha right that is the cause
[ash] but what is the name?
[lanny] leriche sd
[lanny] ??
[ash] it is leriche syndrome
[ash] very good lanny
[lanny] hey hey hey...
[samantha] thanx ash
[ash] what is the impotence in this condition due to?
[lanny] atherosclerosis
[dua_frank] ilioinguinal nerve damage?
[samantha] autonomal insuff
[ash] it is due to the involvement of the hypogastric vessels
[samantha] oh..
[uniteus] pain like affected upperlimb from previous bone fracture ...n cause swelling n pallor sometimes..sammy?
[dua_frank] ash you ask the toughest qs
[ash] the simpler name for leriche syndrome is aortoilitis
[lanny] but it is still due to hypogastric art atherosclrosis
[uniteus] what type of dissection is in Marfan's? ie, prox or dist?
[lanny] prox
[ash] cystic medial
[ash] proximal
[uniteus] rt lanny n ash
[uniteus] tx?
[ash] associated with AR
[samantha] uni did not get your q
[lanny] b blocker
[dua_frank] distal dissection is due to?
[uniteus] oh..the one is the ans for ur q for reflex symp dystropy.not sure of ans
[uniteus] HTN dua
[dua_frank] right
[dua_frank] good uni
[ash] atherosclosis
[uniteus] n atherosl
[uniteus] tx for prox dissection is surgical
[uniteus] while for distal...is antiHTN first then surgery if necessary
[ash] best method for detecting the aneurysm ?
[lanny] b blocker right
[ash] of thoracic aorta
[uniteus] Ultrasound
[lanny] spiral CT
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[samantha] rt uni
[ash] kaplan says transesophageal echocardiography
[uniteus] oh ok..cool sammy
[lanny] thought it was spiral CT
[dua_frank] i would agree ash
[uniteus] for dissection that is the diagnostic tes
[dua_frank] most are proximal
[samantha] it occurs after crush inj
[ash] distal aneurysm if >5cm in diameter do surgery
[lanny] what is spiral CT good for guys??
[megs] what is diff bet n neurologicam..and vascular claudication???clinically..on history??
[dua_frank] i think mri is the best
[megs] spiral ct good for pulm embolism lanny...i think
[uniteus] agree megs
[ash] megs relief on rest?
[dua_frank] perfusion ventillation scans
[dua_frank] for PE
[lanny] yes thats true megs also for an aortic something
[dua_frank] ii don't know about spiral cts
[uniteus] me too :(
[megs] dunno that one lanny
[lanny] i think its for aortic rupture
[ash] oh sorry normal pulse megs
[dua_frank] mri shows the extent of dissection
[dua_frank] followed by angiography
[megs] yes ash vascular claudication goes with contineue walk...and neurological with...resting
[lanny] i remebered guys for dissecting aneurysms
[lanny] can be used
[lanny] MRI good too
[ash] megs pulse normal in neurological not in vascular
[megs] that is also one point...ash..but i asked for the history
[ash] oh thanx
[lanny] relieved pain at rest
[lanny] in vascular
[ash] ok people i have to go now.good night .it was nice chatting with you all
[lanny] hx of atherosclerotic heart dz
[dua_frank] bye ash
[lanny] later ash
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[megs] what factors determines recectability of lung tumor???
[uniteus] FEV1
[samantha] small cell or non small cell
[dua_frank] lns
[dua_frank] more than 1 cm
[megs] yes uni
[samantha] its position
[megs] min fev1 of 800ml is needed
[lanny] det that 800 ml of air will be left after resection??
[megs] then only we can proceed faor recection
[megs] yes lanny
[samantha] agree megs
[samantha] and lanny
[uniteus] what is surgical tx of BPH?
[megs] u determine the total fev1...then do..v/q scann..by that u determine fev1 contributed by each...
[megs] TURP UNI
[uniteus] rt megs
[uniteus] complication of TURP?
[lanny] prem ejaculate
[megs] retrograde ejaculation uni
[lanny] retrograde i mean
[uniteus] rt lanny n megs...tell more
[megs] due to paravascical plexus injury
[uniteus] TURP syndrome ( due to excess irrigation fluid absorption during the procedure), Impotence, Urethral stricture r others compli
[samantha] urinary retension
[uniteus] rt sammy
[samantha] which organ can be donated even in ca pts?
[lanny] eyes??
[megs] cornea
[uniteus] i have q ...dunno...if pt has estrogen or prog receptor pos who has breast ca what does it means...good or bad?
[samantha] cornea uni
[lanny] good
[samantha] rt megs
[megs] good
[samantha] good
[uniteus] ok..but if pt dont have breast ca n has it what it means?
[megs] that means tumor will respond well to tamoxifene therapy
[samantha] does not mean anything uni
[lanny] dunno uni i thougt it is only in breast ca
[lanny] ovarian ca ??
[uniteus] whew..ok..got dat cleared..thx lanny, megs, sammy..
[lanny] welcomw e uni
[samantha] what is perinaud syna?
[uniteus] old man with flank pain, gross hematuria,palpable mass flank...dx? n what disease it is associated wiht?
[lanny] distended bladder BPH
[dua_frank] bilateal opthalmoplegia
[dua_frank] MS
[megs] in pinelloma uni
[megs] upward gaze palsy
[dua_frank] oh yeah penealoma
[dua_frank] ah always get mixed up
[uniteus] upward gaze palsy in pineal tumor sammy
[samantha] rt all
[megs] APKD UNI
[dua_frank] guys what happens in MS thing?
[dua_frank] presentation?
[samantha] RCC
[uniteus] renal cell ca is the ans...n it is associated with von Hippel Lindau disease
[uniteus] rt sammy
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[dua_frank] what does it present as megs?
[dua_frank] no htn megs
[dua_frank] old age key to renal ca too
[dua_frank] apkd usually in late 30s and 40s
[uniteus] i think APKD is common in younger age to middle age
[dua_frank] has to have htn megs
[uniteus] i should have put wt loss in the q...so i have to say..u r rt
[megs] YEAH UNI
[uniteus] sorry for incomplet q..but dua has a point..htn is in ADPK ..thx dua :)
[megs] what is amblypia???
[megs] amblyopia
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[dua_frank] welcome un i:)
[dua_frank] :)
[uniteus] difficult focusing ...lazy eye megs???
[megs] its associated with squint i age of 6..7 yrs...due to strabismus...overlapped images..brins leran to neglect one
[samantha] loss of vision
[samantha] or focusing
[megs] so cortical blindnesss of supressed eye
[dua_frank] my professor had that squint, one of his eye was always staring at me, i wouldn't move all his class lo
[dua_frank] lol
[megs] dua lol
[samantha] that is squint dua
[uniteus] lol
[dua_frank] good q megs
[megs] what is lazy eye uni dunno
[uniteus] i was trying to remember the squint eyes..i think dat is another term they use for it...
[uniteus] cus u have to do cover test ..to make the other eye focus
[samantha] strabismus is it different?
[lanny] in basal cell ca what are margins for biopsy??
[dua_frank] same thing sammy
[samantha] tanx dua
[dua_frank] welcome
[samantha] 1mm lanny
[lanny] conservative width
[samantha] we discu before u came
[lanny] in mm maybe ie small margin
[lanny] what about sq cell ca?
[samantha] .5-2cm
[lanny] oh did you ok sorry for repeating
[samantha] no prob so i remem
[lanny] sam i think that is for melanoma
[lanny] sq is 1 cm
[samantha] melanoma is 2-3 and 3-4cms lanny
[lanny] ok sam thx
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[uniteus] wat is kehr's sign?
[samantha] for levels 1 and 2 and, 3 and 4 resp
[megs] melanoma..acc to clerks stage yes
[megs] kehrs..in bile stones uni
[megs] sorry spleenic rubture
[dua_frank] left shoulder pain?
[megs] shouldepain...
[uniteus] rt megs..but what it means?
[megs] sundiaphragmatic irritation..by abscess or hematoma
[uniteus] rt dua...Left upper quadrant pain n referred lt shoulder pain
[dua_frank] whats right shoulder pain called?
[megs] dunno dua
[lanny] refered pain
[megs] tell us
[dua_frank] due to gall bladder megs
[dua_frank] i don't remembre either
[dua_frank] but theres a name to that sign
[uniteus] yeah..trying to remember it but :( no reflex
[dua_frank] :(
[megs] ok guys..got to go..bye all
[dua_frank] bye megs
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[dua_frank] her husband must be really hungry by this time, she just shoots off as soon as it's 8 pm lol
[uniteus] lol
[dua_frank] how will you differentiate chronic messentric vascular insuff from acute?
[dua_frank] clinically
[uniteus] acute present suddenly
[dua_frank] right uni
[dua_frank] might be with fever, n, v, diarrhea
[lanny] agree frank
[dua_frank] chr will be with pain and fear of taking good
[dua_frank] food
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[uniteus] thx dua
[dua_frank] some triad for that shoulder thing
[dua_frank] fever pain and jaundice
[dua_frank] arrghhh :(
[uniteus] charcot triad? has fever, rt quadrant pain n jaundci?
[dua_frank] yessssssssssss
[dua_frank] uni thanks :)
[uniteus] so this one get the rt shoulder pain dua?
[dua_frank] the sign still remains though, there is a stupid name for that too
[lanny] that pain is referred it has no name dua
[dua_frank] oh ok lanny
[uniteus] oh ok..cool
[lanny] maybe youre thinking of murphys sign or courvoiser sign??
[dua_frank] yeah lanny!!!!
[dua_frank] thanks
[samantha] charcot is ca gall bladder
[dua_frank] so murphys on right, kehrs on left
[samantha] right?
[samantha] murphy for apendix
[dua_frank] corvoisers sign
[dua_frank] for ca bladder
[dua_frank] gbladder
[lanny] but murphys sign is inspiratory arrest when you pal athe RUQ
[dua_frank] helps differentiate it from stone
[dua_frank] right?
[uniteus] no sammy it is courvoiser's sign for gb ca --> just checked
[dua_frank] thats for appendix
[lanny] couvoisier sign isa palpable gall bladder
[samantha] yes uni i agree just realized
[dua_frank] so let me correct myself
[uniteus] ok...
[dua_frank] courvoiser on right and kehrs left shoulder
[dua_frank] one shows gall bladder ca
[dua_frank] other splenic absecess
[lanny] no frank courv oisier has nothing to do with shoulder oain
[lanny] pain
[dua_frank] oh
[dua_frank] never mind then
[dua_frank] forget what i said :(
[uniteus] courvoiser sign means palpable gall bladder...seen in gb ca
[dua_frank] so we are back to sqaure one
[dua_frank] no name for right shoulder pain
[samantha] we will find out dua
[lanny] have not come across a name for shoulder pain due to gall bladder dz, but youre right shouder pain is referred to that area
[dua_frank] how will you dx paralytic ileus?
[samantha] no bowel sounds?
[erum] no bowel sounds
[dua_frank] yes
[lanny] absent bowel sound
[lanny] no flatus
[dua_frank] multiple air shadows on x ray dx?
[dua_frank] abdomen
[lanny] perforation
[samantha] obstruction small intestine
[dua_frank] yes
[dua_frank] which electrolyte imbalance can cause adynamic ileus?
[samantha] K dua?
[dua_frank] hypokalemia yes sammy
[erum] k
[samantha] thanx dua
[dua_frank] welcome
[uniteus] i got to go...thanks n bye
[dua_frank] shall we call it a day guys?
[dua_frank] thanks to all, bye
[uniteus] bye
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[lanny] bye dua
[samantha] bye everybody
[lanny] bye samm
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[erum] bye n tx all
[lanny] bye erum

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