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View Full Version : Int Med Chat: Nephrology (March 31)



Asclepius1
04-04-2005, 04:35 PM
03/31/05 19:09:47 [USMLE_Step_2] ash: hi sammy
03/31/05 19:09:51 [USMLE_Step_2] dua_frank: somethings wrong with me these days
03/31/05 19:10:05 [USMLE_Step_2] dua_frank: whats today's subject?
03/31/05 19:10:07 [USMLE_Step_2] dua_frank: nephro?
03/31/05 19:10:24 [USMLE_Step_2] ash: yeah dua
03/31/05 19:10:31 [USMLE_Step_2] dua_frank: ok
03/31/05 19:11:09 [USMLE_Step_2] dua_frank: n,v, cr-3.6, was normal 2 months ago
03/31/05 19:11:09 [USMLE_Step_2] megs: hi dua sammy
03/31/05 19:11:10 [USMLE_Step_2] dua_frank: dx?
03/31/05 19:11:13 [USMLE_Step_2] dua_frank: hi megs
03/31/05 19:11:47 [USMLE_Step_2] ash: dua wht is it i dont understand the q
03/31/05 19:12:04 [USMLE_Step_2] dua_frank: nausea vomiting sr creatine 3.6
03/31/05 19:12:14 [USMLE_Step_2] ash: oh thanx
03/31/05 19:12:17 [USMLE_Step_2] dua_frank: welcome
03/31/05 19:13:05 [USMLE_Step_2] ash: ARF?
03/31/05 19:13:15 [USMLE_Step_2] dua_frank: right
03/31/05 19:13:40 [USMLE_Step_2] dua_frank: high bun/cr ration, low flow states dx?
03/31/05 19:13:49 [USMLE_Step_2] samantha: hi everyone
03/31/05 19:13:52 [USMLE_Step_2] ash: prerenal
03/31/05 19:13:59 [USMLE_Step_2] dua_frank: right
03/31/05 19:14:00 [USMLE_Step_2] megs: PRE RENAL
03/31/05 19:14:08 [USMLE_Step_2] dua_frank: how will you differentiate this from post renal?
03/31/05 19:14:11 [USMLE_Step_2] ash: hi sam
03/31/05 19:14:13 [USMLE_Step_2] dua_frank: hi sammy
03/31/05 19:14:22 [USMLE_Step_2] samantha: hi dua ash and megs
03/31/05 19:14:27 [USMLE_Step_2] ash: bun /cr ratio is less than 15 and
03/31/05 19:14:37 [USMLE_Step_2] ash: fena is >1
03/31/05 19:15:06 [USMLE_Step_2] ash: urine na is >40 in [post renal
03/31/05 19:15:17 [USMLE_Step_2] samantha: prerenal BUN /cre ratio is high
03/31/05 19:15:23 [USMLE_Step_2] samantha: compared to post renal
03/31/05 19:15:29 [USMLE_Step_2] dua_frank: thats intrarenal i think ash
03/31/05 19:15:34 [USMLE_Step_2] dua_frank: right sammy
03/31/05 19:15:46 [USMLE_Step_2] ash: and urine osm >500 in prerenal and <350 in post renal
03/31/05 19:15:54 [USMLE_Step_2] dua_frank: the way to distnguish is physical, perrectal exam and usg
03/31/05 19:16:04 [USMLE_Step_2] ash: sorry dua it is intrarenal
03/31/05 19:16:22 [USMLE_Step_2] ash: but doesnt post renal give the same values as intrarenal?
03/31/05 19:16:52 [USMLE_Step_2] dua_frank: prerenal and post renal are similar in picture of urinalysis i think
03/31/05 19:16:55 lanny Logs in
03/31/05 19:16:55 lanny Joins Subroom USMLE_Step_2
03/31/05 19:17:02 [USMLE_Step_2] dua_frank: intrarenal is opposite
03/31/05 19:17:03 [USMLE_Step_2] lanny: hello all
03/31/05 19:17:11 [USMLE_Step_2] ash: hi lanny
03/31/05 19:17:28 [USMLE_Step_2] lanny: you guys started?
03/31/05 19:17:38 [USMLE_Step_2] ash: just begun lanny
03/31/05 19:17:48 [USMLE_Step_2] dua_frank: low urine na, low fractional na exc, low flow states to kidneys so kidneys retain more fluids and cause urine to be high in sp gravity and high osmolality
03/31/05 19:17:49 [USMLE_Step_2] samantha: on urine analysis Na is high in prerenal
03/31/05 19:17:51 [USMLE_Step_2] dua_frank: thats prerenal
03/31/05 19:18:02 [USMLE_Step_2] samantha: and low in post renal?
03/31/05 19:18:31 [USMLE_Step_2] ash: dua what are the values in post renal?
03/31/05 19:18:44 [USMLE_Step_2] ash: i thought they were like renal
03/31/05 19:19:15 [USMLE_Step_2] lanny: in prerenal the kidney does not get fluid so it tries to conserve fluid by retaining sodium
03/31/05 19:19:37 [USMLE_Step_2] dua_frank: same as prerenal ash except you will have findings on usg as some kind of obstruction
03/31/05 19:19:40 [USMLE_Step_2] samantha: yes lanny
03/31/05 19:19:48 [USMLE_Step_2] megs: AGREE DUA
03/31/05 19:19:54 [USMLE_Step_2] ash: ok thanks dua i was really confused
03/31/05 19:19:56 [USMLE_Step_2] dua_frank: due to the urine staying in the bladder for too long, the na gets reabsorbed back
03/31/05 19:19:59 wakejefe Logs Out
03/31/05 19:20:14 [USMLE_Step_2] dua_frank: so urine will still present as low in na and na exc
03/31/05 19:20:24 [USMLE_Step_2] lanny: so urine sodium is low not high
03/31/05 19:20:24 [USMLE_Step_2] ash: aha
03/31/05 19:20:25 [USMLE_Step_2] megs: good pt dua
03/31/05 19:20:35 [USMLE_Step_2] ash: yeah thanx
03/31/05 19:20:46 [USMLE_Step_2] dua_frank: except you will not seen any obstruction on usg in prerenal
03/31/05 19:21:32 [USMLE_Step_2] lanny: dua a correctin from your above answer urine sodium is low in prerenal
03/31/05 19:21:33 [USMLE_Step_2] dua_frank: paint an opposite picture now
03/31/05 19:21:45 [USMLE_Step_2] dua_frank: i said its low lanny
03/31/05 19:22:08 [USMLE_Step_2] lanny: no you said high osmolaity
03/31/05 19:22:16 [USMLE_Step_2] dua_frank: urine na high, urine exc high, sp gra low, osmolality low
03/31/05 19:22:27 [USMLE_Step_2] lanny: sodium describes osmolality
03/31/05 19:22:57 [USMLE_Step_2] lanny: are you talking of serum osmol?? dua
03/31/05 19:23:48 [USMLE_Step_2] dua_frank: no urine
03/31/05 19:24:28 [USMLE_Step_2] megs: kidneys try to conserve na...so urine NA will be low in prerenal
03/31/05 19:24:58 [USMLE_Step_2] lanny: no dua i dont agree
03/31/05 19:25:05 [USMLE_Step_2] dua_frank: yes but kidneys also preserve water
03/31/05 19:25:05 [USMLE_Step_2] lanny: right megs
03/31/05 19:25:15 [USMLE_Step_2] lanny: and osmolality wil be low
03/31/05 19:25:32 [USMLE_Step_2] dua_frank: so that will be oliguric as well as low sodium content and high sp gravity and high osmolality
03/31/05 19:25:47 [USMLE_Step_2] lanny: but water follows sodium
03/31/05 19:26:11 [USMLE_Step_2] dua_frank: water is conserved relatively more lanny
03/31/05 19:26:27 [USMLE_Step_2] dua_frank: maybe somebody else can define why osmolality is high in prerenal
03/31/05 19:26:33 [USMLE_Step_2] dua_frank: i'm stickign with what i learnt
03/31/05 19:26:42 [USMLE_Step_2] dua_frank: this is confusing enough for me already
03/31/05 19:26:47 [USMLE_Step_2] samantha: urine is osmol is high in prerenal
03/31/05 19:26:57 [USMLE_Step_2] lanny: ok dua
03/31/05 19:26:58 [USMLE_Step_2] samantha: ???
03/31/05 19:27:09 [USMLE_Step_2] dua_frank: yes sammy as far as i've understood of it
03/31/05 19:27:29 [USMLE_Step_2] dua_frank: i maybe wrong too so please check
03/31/05 19:28:30 [USMLE_Step_2] dua_frank: what kind of RF will papillary necrosis cause?
03/31/05 19:29:18 [USMLE_Step_2] lanny: intrarenal
03/31/05 19:29:27 [USMLE_Step_2] lanny: acute
03/31/05 19:29:32 [USMLE_Step_2] dua_frank: postrenal
03/31/05 19:29:36 [USMLE_Step_2] lanny: tubular necrosis
03/31/05 19:29:59 [USMLE_Step_2] megs: acute tubular necrosis
03/31/05 19:30:31 [USMLE_Step_2] samantha: contrast pigments
03/31/05 19:30:38 [USMLE_Step_2] samantha: drugs
03/31/05 19:31:30 [USMLE_Step_2] dua_frank: mc drug causing allergic interstitial nephritis?
03/31/05 19:32:01 [USMLE_Step_2] samantha: oh oh ...not those
03/31/05 19:32:14 [USMLE_Step_2] samantha: NSAids
03/31/05 19:32:25 [USMLE_Step_2] samantha: penicillins
03/31/05 19:32:37 [USMLE_Step_2] dua_frank: nsaids will cause prerenal
03/31/05 19:32:39 [USMLE_Step_2] lanny: NSADS
03/31/05 19:32:44 [USMLE_Step_2] dua_frank: also ace inhibitors
03/31/05 19:32:57 [USMLE_Step_2] lanny: never heard that dua
03/31/05 19:33:07 [USMLE_Step_2] samantha: sulfas
03/31/05 19:33:08 [USMLE_Step_2] lanny: that NSAIDS cuase prerenal
03/31/05 19:33:16 [USMLE_Step_2] dua_frank: they both cause vasoconstriction of the renal artery lanny
03/31/05 19:33:25 [USMLE_Step_2] samantha: allopurinal rifampin
03/31/05 19:33:39 [USMLE_Step_2] dua_frank: ofcourse eventually they will cause ischemic ATN leading to intrarenal
03/31/05 19:33:52 [USMLE_Step_2] dua_frank: yes sammy those are allergic
03/31/05 19:33:56 [USMLE_Step_2] dua_frank: mc is cephs
03/31/05 19:33:59 [USMLE_Step_2] dua_frank: rx?
03/31/05 19:35:09 [USMLE_Step_2] ash: in prerenal the kidneys lose the ability to concentrate the urine.so the water is not reabsorbed and osmolarity increases.hence the urine sodium is low as the water is high
03/31/05 19:35:39 [USMLE_Step_2] dua_frank: ohhhhhhh
03/31/05 19:35:41 [USMLE_Step_2] dua_frank: thanks so much ash
03/31/05 19:35:47 [USMLE_Step_2] ash: yrw
03/31/05 19:36:07 [USMLE_Step_2] lanny: ash the conc ability of the kidney is working ok
03/31/05 19:36:19 [USMLE_Step_2] megs: agree lanny
03/31/05 19:36:30 [USMLE_Step_2] lanny: in prerenal
03/31/05 19:36:47 [USMLE_Step_2] lanny: in ATN its not working well
03/31/05 19:36:58 [USMLE_Step_2] megs: ash i think u told about the renal..in renal abilty to concentrate goes
03/31/05 19:37:07 [USMLE_Step_2] dua_frank: man
03/31/05 19:37:08 [USMLE_Step_2] lanny: agree megs
03/31/05 19:37:14 [USMLE_Step_2] dua_frank: right that looks like intrarenal pic
03/31/05 19:37:44 [USMLE_Step_2] ash: ok
03/31/05 19:37:51 [USMLE_Step_2] dua_frank: i don't know why but sp gravity and osmolality inc in prerenal
03/31/05 19:37:59 [USMLE_Step_2] dua_frank: along with low urine na states
03/31/05 19:38:01 [USMLE_Step_2] ash: let me see in harrison as kaplan seems odd
03/31/05 19:38:10 [USMLE_Step_2] dua_frank: yeah kaplan is really odd sometimes
03/31/05 19:38:30 [USMLE_Step_2] lanny: ash your explanation was not correct chk it again
03/31/05 19:39:09 [USMLE_Step_2] dua_frank: thats more like a diabetis insipidis picture
03/31/05 19:39:14 [USMLE_Step_2] dua_frank: not any renal failure
03/31/05 19:39:14 [USMLE_Step_2] lanny: the concentration ability is the ability of kidney to reabs water..right
03/31/05 19:39:25 [USMLE_Step_2] samantha: agree conc ability is not lost in prerenal
03/31/05 19:39:39 [USMLE_Step_2] lanny: so in ATN the tubules are not working so the conc ability is reduced
03/31/05 19:39:53 [USMLE_Step_2] lanny: right sam if anything its maintaines well
03/31/05 19:40:05 [USMLE_Step_2] ash: ok guys i am wrong
03/31/05 19:40:06 [USMLE_Step_2] samantha: only in late stages of renal i think
03/31/05 19:40:22 [USMLE_Step_2] ash: i am checking for the right answer now
03/31/05 19:40:25 [USMLE_Step_2] dua_frank: ash did you check harrisons as to the explaination?
03/31/05 19:40:35 [USMLE_Step_2] dua_frank: ok please take your time and thank you for checking for us
03/31/05 19:40:36 [USMLE_Step_2] ash: wait i am reading
03/31/05 19:41:00 [USMLE_Step_2] dua_frank: oxalate crystals in kidney. conditions forming oxalate crystals?
03/31/05 19:41:09 [USMLE_Step_2] lanny: in prerenal i remeber it this way the kidney is fooled that there is less water in the body so it does all it can to reabs water and sodium
03/31/05 19:41:23 [USMLE_Step_2] lanny: malabsorption sds dua
03/31/05 19:41:41 [USMLE_Step_2] dua_frank: ethylene glycol and vit c is all i know
03/31/05 19:41:46 [USMLE_Step_2] dua_frank: dunno about malabs
03/31/05 19:41:51 [USMLE_Step_2] dua_frank: uric acid?
03/31/05 19:43:46 [USMLE_Step_2] ash: oh now i get it
03/31/05 19:45:19 [USMLE_Step_2] samantha: hemolysis
03/31/05 19:45:27 [USMLE_Step_2] samantha: rhabdo
03/31/05 19:45:51 [USMLE_Step_2] samantha: in gout dua
03/31/05 19:45:56 [USMLE_Step_2] lanny: TLS
03/31/05 19:47:34 [USMLE_Step_2] dua_frank: yes
03/31/05 19:47:43 [USMLE_Step_2] dua_frank: also chemotherapy
03/31/05 19:47:51 [USMLE_Step_2] dua_frank: wbc casts in urine
03/31/05 19:47:53 [USMLE_Step_2] dua_frank: dx?
03/31/05 19:48:14 [USMLE_Step_2] megs: pyelonephritis
03/31/05 19:48:33 [USMLE_Step_2] megs: chronic
03/31/05 19:49:10 [USMLE_Step_2] samantha: agree megs
03/31/05 19:49:17 [USMLE_Step_2] ash: in prerenal maximum water is being reabsorbed and also maximum sodium so the urine osmolarity is increased because of the other contents of urine .in renal the kidney loses its ability to concentrate and hence h2o is not reabsorbed and is therefore excreted also sodium isnt reabsorbed but the amt. of h2o exceeds sodium and we get low osmolrity much more
03/31/05 19:49:52 [USMLE_Step_2] ash: please ignore the much more
03/31/05 19:50:01 [USMLE_Step_2] dua_frank: yes
03/31/05 19:50:54 [USMLE_Step_2] dua_frank: so i was right :)
03/31/05 19:51:27 [USMLE_Step_2] samantha: thanx ash
03/31/05 19:51:32 [USMLE_Step_2] dua_frank: glucose and other solutes would add to it's osmolality rather than sodium alone
03/31/05 19:51:38 [USMLE_Step_2] dua_frank: thank you very much ash!
03/31/05 19:51:43 [USMLE_Step_2] ash: yrw dua
03/31/05 19:51:53 [USMLE_Step_2] ash: and sam
03/31/05 19:52:01 [USMLE_Step_2] megs: ash thanx
03/31/05 19:52:06 [USMLE_Step_2] dua_frank: radiation and heavy metal cause what kind of RF?
03/31/05 19:52:34 [USMLE_Step_2] lanny: glucose does not add to osmolarity uther solutes maybe
03/31/05 19:52:42 [USMLE_Step_2] lanny: thanks ash
03/31/05 19:52:48 [USMLE_Step_2] ash: yrw megs
03/31/05 19:52:53 [USMLE_Step_2] ash: and lanny
03/31/05 19:53:18 [USMLE_Step_2] ash: agree lanny glucose is reabsorbed
03/31/05 19:53:36 [USMLE_Step_2] ash: but not all sodium
03/31/05 19:53:56 [USMLE_Step_2] dua_frank: Serum Osmolality = (2 x (Na + K)) + (BUN / 2.8) + (glucose / 18)
03/31/05 19:53:58 [USMLE_Step_2] ash: the water reabsorption excceeds that of sodium
03/31/05 19:54:35 [USMLE_Step_2] ash: yeah dua but in prerenal the kidneys are working and in normal kidneys all glucose is reabsorbed
03/31/05 19:55:19 [USMLE_Step_2] ash: so the value of glucose will be zero
03/31/05 19:55:24 huli72 Logs in
03/31/05 19:55:31 huli72 Joins Subroom Clinical_Skills
03/31/05 19:55:34 [USMLE_Step_2] lanny: glucose is assimiate d into cells and sa such has no contribution to serum osmolarity
03/31/05 19:55:34 huli72 Joins Subroom USMLE_Step_2
03/31/05 19:55:44 [USMLE_Step_2] lanny: it is an effective osmole though
03/31/05 19:55:53 [USMLE_Step_2] ash: it is mainly the na and k and bun that will give the osmolarity in prerenal
03/31/05 19:56:20 [USMLE_Step_2] samantha: interstitial nephritis dua?
03/31/05 19:56:20 [USMLE_Step_2] ash: right glucose makes a difference only in diabetics
03/31/05 19:56:35 [USMLE_Step_2] lanny: right ash in severe diabetic states
03/31/05 19:57:19 huli72 Logs Out
03/31/05 19:57:40 [USMLE_Step_2] lanny: OK HUYS ALL GOT IT NOW LETS MOVE ON :-happy
03/31/05 19:58:06 [USMLE_Step_2] lanny: :box
03/31/05 19:58:48 [USMLE_Step_2] lanny: put down the boxing gloves everyone!!! :box
03/31/05 19:58:56 [USMLE_Step_2] megs: ok lanny
03/31/05 19:59:15 [USMLE_Step_2] megs: lol
03/31/05 19:59:54 [USMLE_Step_2] megs: which is the most common cyst in kidney???
03/31/05 20:00:12 [USMLE_Step_2] lanny: acquired??
03/31/05 20:00:29 [USMLE_Step_2] megs: pl specify the name lanny
03/31/05 20:00:44 [USMLE_Step_2] lanny: medullary
03/31/05 20:01:05 [USMLE_Step_2] lanny: acquired cystic dz post dialysis
03/31/05 20:01:10 [USMLE_Step_2] lanny: ??
03/31/05 20:01:19 [USMLE_Step_2] megs: simple cortical cyst lanny
03/31/05 20:01:29 [USMLE_Step_2] megs: its benign
03/31/05 20:01:39 [USMLE_Step_2] megs: veryu common finding on usg
03/31/05 20:01:40 [USMLE_Step_2] lanny: thats medullary yes??
03/31/05 20:02:09 [USMLE_Step_2] ash: 74 y/o man with lower abdomen pain.periumbilical mass.p/h of HT and DM.H/O diverticulitis.P/E AFEBRILE, MILDLY UNCOMFORTABLE.PALPABLE MASS EXTENDING FROM PUBIC RAMUS TO UMBILICUS WITH SMOOTH contour .lab-BUN-14mg/dl,creatinine -1.8 mg/dl.most appropriate next step in mgt?a)usg;b)catheterisation of urethra;c)ct;d)percutaneous nephrostomy
03/31/05 20:02:11 [USMLE_Step_2] megs: they are generally cortical lanny
03/31/05 20:02:14 [USMLE_Step_2] lanny: maybe not medull is seen in recurrent stones
03/31/05 20:02:27 [USMLE_Step_2] lanny: nephrocalcinosis etc
03/31/05 20:02:51 [USMLE_Step_2] lanny: BPH
03/31/05 20:03:02 [USMLE_Step_2] lanny: catheter
03/31/05 20:03:09 [USMLE_Step_2] megs: catheterization ash
03/31/05 20:03:40 [USMLE_Step_2] megs: chronic urinary retention...is the cause
03/31/05 20:03:57 [USMLE_Step_2] lanny: yes megs due to BPH in this setting
03/31/05 20:04:00 [USMLE_Step_2] ash: good lanny and megs
03/31/05 20:04:55 [USMLE_Step_2] lanny: when do we do percut nephrostomy?
03/31/05 20:05:30 [USMLE_Step_2] megs: in ureteric obsruction lanny
03/31/05 20:05:41 [USMLE_Step_2] megs: may be ureter involved in ca
03/31/05 20:05:44 [USMLE_Step_2] ash: agree megs
03/31/05 20:05:47 shreya Logs in
03/31/05 20:05:59 shreya Joins Subroom USMLE_Step_2
03/31/05 20:06:05 [USMLE_Step_2] lanny: yes megs
03/31/05 20:06:22 [USMLE_Step_2] megs: what is diff bet n medullery sponge kidney and medullerey cystic kidney
03/31/05 20:06:36 [USMLE_Step_2] megs: ???
03/31/05 20:06:46 [USMLE_Step_2] lanny: cystic kidney is acquired from stones...
03/31/05 20:06:54 [USMLE_Step_2] lanny: sponge is congenital??
03/31/05 20:07:23 [USMLE_Step_2] ash: spongy cysts are small and kidney size is normal
03/31/05 20:07:35 [USMLE_Step_2] ash: and the contour is smooth
03/31/05 20:07:49 [USMLE_Step_2] megs: what is associated with ash???
03/31/05 20:08:19 [USMLE_Step_2] megs: nephrocalcinosis...is associated with medullery sponge kidney
03/31/05 20:09:20 [USMLE_Step_2] ash: thanks megs
03/31/05 20:09:22 [USMLE_Step_2] megs: while medullary cystic disaese...have multiple cysts at corticomedullery jun...hence progress to end stage
03/31/05 20:10:20 [USMLE_Step_2] lanny: nephrocalcinosis is seen on x ray in cystic too
03/31/05 20:11:22 [USMLE_Step_2] ash: what vitamins excessive ingestion can cause kidney stones?
03/31/05 20:11:37 [USMLE_Step_2] lanny: vitC
03/31/05 20:11:42 [USMLE_Step_2] ash: right
03/31/05 20:11:44 [USMLE_Step_2] megs: agree
03/31/05 20:12:07 [USMLE_Step_2] ash: what is the first investigation to diagnose?
03/31/05 20:12:26 [USMLE_Step_2] lanny: USG
03/31/05 20:12:40 [USMLE_Step_2] dua_frank: BT?
03/31/05 20:12:42 [USMLE_Step_2] ash: xray
03/31/05 20:12:46 [USMLE_Step_2] dua_frank: oh
03/31/05 20:13:05 [USMLE_Step_2] ash: 85%are seen on xray so the 1st inv.
03/31/05 20:13:15 [USMLE_Step_2] lanny: ash what invest are you asking about??
03/31/05 20:13:29 [USMLE_Step_2] ash: what will you do to treat a stone that is 1cm?
03/31/05 20:13:29 [USMLE_Step_2] megs: which kidney stones are lucent???
03/31/05 20:13:40 [USMLE_Step_2] lanny: uric
03/31/05 20:13:42 [USMLE_Step_2] ash: lanny for stones
03/31/05 20:13:52 [USMLE_Step_2] megs: 1 cm....USWL
03/31/05 20:13:53 [USMLE_Step_2] lanny: ok
03/31/05 20:14:02 [USMLE_Step_2] ash: yes megs
03/31/05 20:14:18 [USMLE_Step_2] megs: CYSTINE STONES ARE RADIOLUCENT...
03/31/05 20:14:33 [USMLE_Step_2] ash: what is the treatment to prevent the calcium oxalate from recurring?
03/31/05 20:14:56 [USMLE_Step_2] lanny: no megs radiopaque
03/31/05 20:15:02 [USMLE_Step_2] megs: ALSO uric acid too...but...i read that they can be seen..as they are associated with calcium deposition
03/31/05 20:15:24 [USMLE_Step_2] lanny: vigorous hydration ash
03/31/05 20:15:34 [USMLE_Step_2] lanny: thiazides too
03/31/05 20:16:02 [USMLE_Step_2] ash: megs cysteine are radioopaque due to presence of phosphorus
03/31/05 20:16:11 [USMLE_Step_2] megs: and spinach free diet ash
03/31/05 20:16:14 [USMLE_Step_2] ash: sorry sulfur
03/31/05 20:16:43 [USMLE_Step_2] megs: got it lanny ash..i was confused
03/31/05 20:16:44 [USMLE_Step_2] ash: yes lanny thiazides are most imp. others are adjuvants
03/31/05 20:17:20 [USMLE_Step_2] lanny: what happened to dua???
03/31/05 20:18:32 [USMLE_Step_2] ash: hey dua where are u?
03/31/05 20:18:34 [USMLE_Step_2] megs: dunno
03/31/05 20:18:54 [USMLE_Step_2] lanny: maybe shes reading the oosmotic stuff
03/31/05 20:18:55 [USMLE_Step_2] megs: what are the indications for dialysis??
03/31/05 20:19:17 [USMLE_Step_2] lanny: acidosis
03/31/05 20:19:27 [USMLE_Step_2] ash: hyperkalemia
03/31/05 20:19:28 [USMLE_Step_2] megs: sorry i mean to ask criteria
03/31/05 20:19:32 [USMLE_Step_2] ash: acidosis
03/31/05 20:19:40 [USMLE_Step_2] ash: encephalopathy
03/31/05 20:19:44 [USMLE_Step_2] lanny: pleuritis
03/31/05 20:19:51 [USMLE_Step_2] megs: yes ph less than7.2
03/31/05 20:19:54 [USMLE_Step_2] ash: fluid retention and pancreatitis
03/31/05 20:20:05 [USMLE_Step_2] ash: pericarditis
03/31/05 20:20:10 [USMLE_Step_2] lanny: uremia
03/31/05 20:20:25 [USMLE_Step_2] megs: yes all right'
03/31/05 20:21:14 [USMLE_Step_2] ash: ok everyone i have to go now goodnite
03/31/05 20:21:30 [USMLE_Step_2] lanny: night ash
03/31/05 20:22:57 [USMLE_Step_2] megs: new onset hypertension in 75 yr old man...refractory to all medical treatment..what is dX???
03/31/05 20:23:57 [USMLE_Step_2] lanny: renal cell ca
03/31/05 20:24:10 [USMLE_Step_2] megs: clue..on usg..both kidneys are unequall
03/31/05 20:24:22 [USMLE_Step_2] megs: no haematuria...try once again lanny
03/31/05 20:24:34 [USMLE_Step_2] shreya: renal artery stenosis.
03/31/05 20:24:37 ash Logs Out
03/31/05 20:24:47 [USMLE_Step_2] megs: yup sherya..v good u got it
03/31/05 20:24:56 [USMLE_Step_2] shreya: thanks.
03/31/05 20:26:14 [USMLE_Step_2] megs: which test is gold standerd for RENAL ARTERY STENOSIS???
03/31/05 20:26:16 [USMLE_Step_2] dua_frank: i always though renal artery stenosis starts in younger individuals
03/31/05 20:26:23 [USMLE_Step_2] lanny: is renal artery sten sweconadary HTN or primary?
03/31/05 20:26:35 [USMLE_Step_2] dua_frank: angiography?
03/31/05 20:26:37 [USMLE_Step_2] shreya: secondary lanny.
03/31/05 20:26:57 [USMLE_Step_2] megs: yes dua
03/31/05 20:27:04 [USMLE_Step_2] lanny: right shreya
03/31/05 20:27:05 [USMLE_Step_2] megs: agree shreya
03/31/05 20:28:13 [USMLE_Step_2] dua_frank: i need to go now
03/31/05 20:28:25 [USMLE_Step_2] dua_frank: will somebody post today's chat transcript if they can?
03/31/05 20:29:10 [USMLE_Step_2] shreya: i dont have the complete transcript.
03/31/05 20:29:42 [USMLE_Step_2] dua_frank: shreya mail me whatever you have till you complete chat
03/31/05 20:29:49 [USMLE_Step_2] dua_frank: can you do it?
03/31/05 20:30:06 [USMLE_Step_2] shreya: ok.
03/31/05 20:30:07 [USMLE_Step_2] shreya: il mail.
03/31/05 20:30:12 [USMLE_Step_2] shreya: bye
03/31/05 20:30:13 [USMLE_Step_2] dua_frank: thank you, see you tomorrow then :)
03/31/05 20:30:16 [USMLE_Step_2] dua_frank: bye all
03/31/05 20:30:19 [USMLE_Step_2] lanny: dua youre leaving??
03/31/05 20:30:22 [USMLE_Step_2] megs: bye dua
03/31/05 20:30:32 [USMLE_Step_2] dua_frank: yes lanny, have a dinner date with my hubby tonight :)
03/31/05 20:30:36 [USMLE_Step_2] lanny: sorry dont know how to do it
03/31/05 20:30:45 [USMLE_Step_2] lanny: ok dua enjoy you need it
03/31/05 20:30:47 [USMLE_Step_2] megs: hehe dua enjoy lol
03/31/05 20:30:57 [USMLE_Step_2] dua_frank: no problem, shreya will be doing it and if she can't i'll bug doc to post it
03/31/05 20:31:08 [USMLE_Step_2] dua_frank: thanks all, bye and enjoy yourselves too :)
03/31/05 20:31:11 [USMLE_Step_2] lanny: ok dua goodnight
03/31/05 20:31:45 [USMLE_Step_2] samantha: bye dua
03/31/05 20:31:49 dua_frank Logs Out
03/31/05 20:31:53 [USMLE_Step_2] megs: what causes renal cortical necrosis???
03/31/05 20:32:43 [USMLE_Step_2] shreya: is it seen in preg??
03/31/05 20:32:51 [USMLE_Step_2] samantha: prerenal causes megs?
03/31/05 20:33:06 [USMLE_Step_2] megs: eclampsia, dic...leads to cortical necrosis...irreverible kidney damage
03/31/05 20:33:14 [USMLE_Step_2] samantha: SORRY
03/31/05 20:35:04 [USMLE_Step_2] shreya: ecg findings in hypokalemia?
03/31/05 20:35:18 [USMLE_Step_2] samantha: u waves shreya
03/31/05 20:35:18 [USMLE_Step_2] megs: tall t wavws
03/31/05 20:35:31 [USMLE_Step_2] megs: and wide qrs comlexes
03/31/05 20:35:35 [USMLE_Step_2] megs: oops soory
03/31/05 20:35:43 [USMLE_Step_2] megs: i told for hyper
03/31/05 20:35:51 [USMLE_Step_2] shreya: uwaves, twave flattening.
03/31/05 20:35:55 [USMLE_Step_2] megs: sammy right
03/31/05 20:36:55 [USMLE_Step_2] shreya: kidney stones seen in which RTA?
03/31/05 20:37:14 [USMLE_Step_2] samantha: what type of kidney damage with aminoglycosides?
03/31/05 20:37:37 [USMLE_Step_2] lanny: type1
03/31/05 20:37:37 [USMLE_Step_2] megs: distal tubular shreya???
03/31/05 20:37:48 [USMLE_Step_2] lanny: ATN sammy
03/31/05 20:37:53 [USMLE_Step_2] shreya: rt. megs
03/31/05 20:37:56 [USMLE_Step_2] samantha: rt lanny
03/31/05 20:38:26 [USMLE_Step_2] shreya: bone lesions in type 2
03/31/05 20:38:33 [USMLE_Step_2] megs: which aminoglycoside is least toxic...
03/31/05 20:38:46 [USMLE_Step_2] megs: among tobra, genta strepto...???
03/31/05 20:39:00 [USMLE_Step_2] samantha: strepto megs?
03/31/05 20:39:01 [USMLE_Step_2] lanny: strep
03/31/05 20:39:20 [USMLE_Step_2] shreya: tobra?
03/31/05 20:39:35 [USMLE_Step_2] megs: yes both right
03/31/05 20:39:40 [USMLE_Step_2] megs: strepto
03/31/05 20:39:57 [USMLE_Step_2] lanny: i have an antibiotic q can i ask??
03/31/05 20:40:06 [USMLE_Step_2] samantha: ask lanny
03/31/05 20:40:13 [USMLE_Step_2] lanny: is vancomycin used for strep dz??
03/31/05 20:40:47 [USMLE_Step_2] samantha: did not understand lanny
03/31/05 20:41:07 [USMLE_Step_2] lanny: is vancomycin used to trt streptococcal dz??/
03/31/05 20:42:06 [USMLE_Step_2] samantha: yes in MRSA's
03/31/05 20:42:42 [USMLE_Step_2] samantha: in methicillin resistant streptoccocal dis
03/31/05 20:42:44 [USMLE_Step_2] lanny: but that is staph samm
03/31/05 20:42:45 [USMLE_Step_2] shreya: im not sure lanny.
03/31/05 20:43:37 [USMLE_Step_2] lanny: i read somewhere that even strep is resistant to cephalo so vanco is used///
03/31/05 20:43:37 megs Disconnects
03/31/05 20:43:50 [USMLE_Step_2] samantha: yes even in strep lanny
03/31/05 20:44:00 [USMLE_Step_2] lanny: ok thanks samm
03/31/05 20:45:46 [USMLE_Step_2] shreya: treatment for type 4 RTA?
03/31/05 20:45:48 [USMLE_Step_2] lanny: fibromusc dysplasia hos w to trt??
03/31/05 20:46:13 [USMLE_Step_2] lanny: fludrocoritsone
03/31/05 20:46:31 [USMLE_Step_2] shreya: rt lanny.
03/31/05 20:46:41 [USMLE_Step_2] shreya: surgery ??
03/31/05 20:46:54 [USMLE_Step_2] lanny: rightt angioplasty
03/31/05 20:47:43 [USMLE_Step_2] samantha: wc lanny
03/31/05 20:48:07 [USMLE_Step_2] lanny: what samm??
03/31/05 20:48:38 [USMLE_Step_2] lanny: how do you trt struvite stones??
03/31/05 20:49:18 [USMLE_Step_2] samantha: welcome lanny for the previous q
03/31/05 20:49:20 [USMLE_Step_2] shreya: percutaneous removal
03/31/05 20:49:34 [USMLE_Step_2] lanny: oh ok sam
03/31/05 20:49:40 [USMLE_Step_2] samantha: antibiotics?
03/31/05 20:49:44 [USMLE_Step_2] lanny: right shreya cause what??
03/31/05 20:49:57 [USMLE_Step_2] shreya: urinary infection
03/31/05 20:50:05 [USMLE_Step_2] lanny: struvite stones are usu large
03/31/05 20:50:10 [USMLE_Step_2] shreya: with urease producing bacteria
03/31/05 20:50:18 [USMLE_Step_2] lanny: yes
03/31/05 20:51:03 [USMLE_Step_2] lanny: ok what ae the sizes of stones ???
03/31/05 20:51:16 [USMLE_Step_2] lanny: pass spontaneously??
03/31/05 20:51:39 [USMLE_Step_2] samantha: <3mm?
03/31/05 20:51:57 [USMLE_Step_2] shreya: < 0.5cm
03/31/05 20:52:12 [USMLE_Step_2] samantha: <5mm pass spontaneously
03/31/05 20:52:21 [USMLE_Step_2] lanny: right sam
03/31/05 20:52:35 [USMLE_Step_2] lanny: for lithotripsy shock wave??
03/31/05 20:52:41 [USMLE_Step_2] shreya: ok.thanks.
03/31/05 20:52:44 [USMLE_Step_2] samantha: shreya rt too
03/31/05 20:53:05 [USMLE_Step_2] shreya: <2cm- lithotripsy.
03/31/05 20:53:20 [USMLE_Step_2] samantha: agree shreya
03/31/05 20:53:25 [USMLE_Step_2] lanny: oh shreya youre talking in centimeters
03/31/05 20:53:35 [USMLE_Step_2] lanny: is it 2 mm
03/31/05 20:53:50 [USMLE_Step_2] samantha: yes 2 mm
03/31/05 20:53:50 [USMLE_Step_2] lanny: < 2 mm
03/31/05 20:53:59 [USMLE_Step_2] shreya: s. i too got confused
03/31/05 20:54:19 [USMLE_Step_2] shreya: in kaplan they said 2cm for lithotripsy.
03/31/05 20:54:23 [USMLE_Step_2] samantha: no it says 2 cm lanny
03/31/05 20:54:26 [USMLE_Step_2] lanny: right need to be sure about theze sizes
03/31/05 20:54:53 [USMLE_Step_2] lanny: ok sammy thanks
03/31/05 20:55:15 [USMLE_Step_2] lanny: i think UW says 2 mm
03/31/05 20:55:23 [USMLE_Step_2] lanny: but kaplan says 2 cm
03/31/05 20:55:34 [USMLE_Step_2] lanny: quite a diff??
03/31/05 20:55:54 [USMLE_Step_2] lanny: will chk again
03/31/05 20:56:04 [USMLE_Step_2] samantha: kaplan says <2cmm for lithotripsy and <5mm for stones to pass spontaneously
03/31/05 20:56:47 [USMLE_Step_2] shreya: thanks sam.
03/31/05 20:57:16 [USMLE_Step_2] shreya: htn with diabetis..what is the trt of choice?
03/31/05 20:57:28 [USMLE_Step_2] samantha: wc shreya
03/31/05 20:57:31 [USMLE_Step_2] lanny: ACE
03/31/05 20:57:40 [USMLE_Step_2] shreya: rt.
03/31/05 20:57:53 [USMLE_Step_2] shreya: post MI ?
03/31/05 20:58:16 [USMLE_Step_2] samantha: Beta blockers?
03/31/05 20:58:24 [USMLE_Step_2] shreya: RT.
03/31/05 20:58:29 [USMLE_Step_2] lanny: agree sam
03/31/05 20:58:48 [USMLE_Step_2] shreya: post MI with decreased l.v function--
03/31/05 20:59:03 [USMLE_Step_2] lanny: HTN from non cardiac problem what drug good perioperative to red BP?
03/31/05 20:59:15 [USMLE_Step_2] lanny: b block shreya
03/31/05 20:59:32 [USMLE_Step_2] shreya: its acei lanny.
03/31/05 20:59:42 [USMLE_Step_2] lanny: ok shreya
03/31/05 20:59:59 [USMLE_Step_2] shreya: b.blocker
03/31/05 21:00:07 [USMLE_Step_2] lanny: rephrasing my prev q??
03/31/05 21:00:46 [USMLE_Step_2] lanny: pt undergo surgery for non cardiac reason has HTN what drug periop will dec BP?
03/31/05 21:00:58 [USMLE_Step_2] lanny: right shreya b blocker
03/31/05 21:01:28 [USMLE_Step_2] shreya: have to add diuretic also lanny??
03/31/05 21:01:56 [USMLE_Step_2] samantha: why beta blocker lanny?
03/31/05 21:02:14 [USMLE_Step_2] lanny: for LV function
03/31/05 21:02:24 [USMLE_Step_2] lanny: for rate too
03/31/05 21:02:40 [USMLE_Step_2] samantha: ok
03/31/05 21:03:03 [USMLE_Step_2] shreya: do u know how to copy this chat?
03/31/05 21:03:11 [USMLE_Step_2] lanny: no shreya
03/31/05 21:03:41 [USMLE_Step_2] samantha: how do you treat hyperkalemia?
03/31/05 21:03:54 [USMLE_Step_2] samantha: i don't know shreya
03/31/05 21:04:13 [USMLE_Step_2] shreya: ca.gluconate.
03/31/05 21:04:18 [USMLE_Step_2] lanny: bicarb
03/31/05 21:04:24 [USMLE_Step_2] lanny: kayexalate
03/31/05 21:04:32 [USMLE_Step_2] lanny: insulin too
03/31/05 21:04:40 [USMLE_Step_2] shreya: glucose & insulin.
03/31/05 21:04:40 [USMLE_Step_2] samantha: V good both
03/31/05 21:04:57 [USMLE_Step_2] lanny: ok guys gotta go bk to my own sced now.. see you all tom
03/31/05 21:05:29 [USMLE_Step_2] shreya: bye
03/31/05 21:05:33 [USMLE_Step_2] samantha: ok bye lanny and shreya
03/31/05 21:05:59 [USMLE_Step_2] shreya: bye







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