02/4/05 19:06:11 [USMLE_Step_2] strug: hi
02/4/05 19:06:27 [USMLE_Step_2] lanny: hi strug
02/4/05 19:06:45 [USMLE_Step_2] lanny: we missed you y .day
02/4/05 19:06:47 [USMLE_Step_2] strug: whats today?
02/4/05 19:06:55 dua_frank Logs in
02/4/05 19:06:59 dua_frank Joins Subroom USMLE_Step_2
02/4/05 19:07:02 [USMLE_Step_2] strug: yes my computer was not working......sorry
02/4/05 19:07:04 [USMLE_Step_2] lanny: think hemato onco and one more thing
02/4/05 19:07:08 [USMLE_Step_2] dua_frank: hello lovely people
02/4/05 19:07:21 [USMLE_Step_2] lanny: thats ok hope you got itfixed
02/4/05 19:07:22 [USMLE_Step_2] dua_frank: endocrine
02/4/05 19:07:26 [USMLE_Step_2] lanny: hello dua
02/4/05 19:07:33 [USMLE_Step_2] strug: yes it working now
02/4/05 19:07:42 [USMLE_Step_2] lanny: ok endocrine hemo oncology
02/4/05 19:07:42 [USMLE_Step_2] strug: so u guys did immuno yester
02/4/05 19:07:44 [USMLE_Step_2] dua_frank: hi lanny, hi strug, missed you yesterday
02/4/05 19:08:07 [USMLE_Step_2] strug: thanks
02/4/05 19:08:12 [USMLE_Step_2] dua_frank:
02/4/05 19:08:20 [USMLE_Step_2] lanny: yes we exhausted allergy immun and neuro hope someone posted it for you
02/4/05 19:08:37 [USMLE_Step_2] strug: yes the transcript is posted
02/4/05 19:08:44 [USMLE_Step_2] dua_frank: i wonder who does it
02/4/05 19:09:23 [USMLE_Step_2] dua_frank: ok so what shall we start with today?
02/4/05 19:09:24 [USMLE_Step_2] strug: its not me....i think its someone from the administration
02/4/05 19:09:36 [USMLE_Step_2] dua_frank: very nice of them
02/4/05 19:10:00 sanz Logs in
02/4/05 19:10:00 sanz Joins Subroom USMLE_Step_2
02/4/05 19:10:05 [USMLE_Step_2] dua_frank: hey sanz
02/4/05 19:10:05 [USMLE_Step_2] lanny: we are all preety much going in march for the test sowe were hoping we can contine this chat at least 5 of us regulars till end march..its helpful...
02/4/05 19:10:26 [USMLE_Step_2] sanz: hey guys... sorry i'm late...
02/4/05 19:10:38 [USMLE_Step_2] dua_frank: i will be here for sure, lets rotate the chat schedule till the very day of our exams please
02/4/05 19:10:40 [USMLE_Step_2] lanny: no probs sanz howre oyu
02/4/05 19:10:54 [USMLE_Step_2] sanz: good... went out for dinner with sis... YUMMY
02/4/05 19:10:58 [USMLE_Step_2] sanz: u?
02/4/05 19:11:01 [USMLE_Step_2] dua_frank: for once i came here before you :P
02/4/05 19:11:12 [USMLE_Step_2] sanz: hehe dua... i blame my sis then
02/4/05 19:11:20 [USMLE_Step_2] lanny: absolutely after peds what OB?can we decide now.
02/4/05 19:11:38 [USMLE_Step_2] sanz: strug, we missed u yesterday ...
02/4/05 19:11:56 [USMLE_Step_2] lanny: strug youre statred the schedule we will go by you
02/4/05 19:11:57 [USMLE_Step_2] strug: thanks sanz....
02/4/05 19:12:44 [USMLE_Step_2] strug: ok.....westill have to do obgyn and surgery and psy then ......we will figure out what to do next is that ok
02/4/05 19:12:58 [USMLE_Step_2] dua_frank: perfect
02/4/05 19:13:27 [USMLE_Step_2] dua_frank: we will be coming back to IM again right?
02/4/05 19:13:30 [USMLE_Step_2] lanny: yes strug is that the order then OB surg PSY
02/4/05 19:13:38 [USMLE_Step_2] lanny: then back to IM
02/4/05 19:13:42 [USMLE_Step_2] sanz: yup good
02/4/05 19:13:44 [USMLE_Step_2] dua_frank: works great for me
02/4/05 19:13:46 [USMLE_Step_2] lanny: and continue the cycle
02/4/05 19:13:52 [USMLE_Step_2] lanny: thats great too
02/4/05 19:13:58 [USMLE_Step_2] sanz: we should discuss CCSSA qs...
02/4/05 19:14:05 [USMLE_Step_2] dua_frank: what are those?
02/4/05 19:14:08 [USMLE_Step_2] sanz: cuz those concepts are high yield...
02/4/05 19:14:19 [USMLE_Step_2] sanz: the NMBE form 1 and 2
02/4/05 19:14:22 [USMLE_Step_2] dua_frank: oh
02/4/05 19:14:28 [USMLE_Step_2] lanny: not done those yet...are they the NBME ones
02/4/05 19:14:32 [USMLE_Step_2] sanz: but i havent done them yet... not for another 2-3 weeks
02/4/05 19:15:35 [USMLE_Step_2] lanny: OK can we start
02/4/05 19:16:03 [USMLE_Step_2] dua_frank: which system first?
02/4/05 19:16:22 [USMLE_Step_2] sanz: dont know.. you guys pick
02/4/05 19:16:25 [USMLE_Step_2] sanz: i'm ok with everything
02/4/05 19:16:37 [USMLE_Step_2] lanny: onco then
7:16 PM [lanny] what is MC tumor in peds
7:16 PM [dua_frank] ok
7:16 PM [dua_frank] AML?
7:16 PM [sanz] ALL
7:16 PM [dua_frank] tumour...
7:16 PM [lanny] MC brain tumor
7:16 PM [sanz] astrocytosis
7:16 PM [lanny] sorry its brain yumour i meant
7:16 PM [sanz] hey megs long time no see!
7:17 PM [megs] hi all
7:17 PM [dua_frank] hi
7:17 PM [lanny] hi megs
7:17 PM [megs] keep on guys
7:17 PM [lanny] MC brain tumour in peds
7:17 PM [dua_frank] ALL is the most common childhood malignancy lanny
7:17 PM [strug] yup i too ALL
7:17 PM [lanny] BRAIN TIOMUR
7:18 PM [strug] astrocytoma
7:18 PM [dua_frank] ok lanny we hear you man :< , don't shout
7:18 PM [strug] ans lanny?
7:18 PM [dua_frank] astro me too
7:18 PM [lanny] not shouting pressed caps lock mistake
7:18 PM [lanny] thought medulloblast
7:19 PM [dua_frank] nope it's astro
7:19 PM [dua_frank] medullo second most common
7:19 PM [megs] no its astro
7:19 PM [megs] most common post fossa is meulloblastoma
7:19 PM [sanz] medullo is second most common
7:20 PM [lanny] ok thanx..
7:20 PM [strug] 5 yr child with anorexia, letharyg...had viral inf few days ago....PS shows blast...diag?
7:20 PM [sanz] megs' right... medullo is the MC posterior foss tumour
7:20 PM [dua_frank] let me ask this question in a different way now
7:20 PM [lanny] ALL
7:21 PM [dua_frank] most common being tomour in kids is?
7:21 PM [strug] right laany
7:21 PM [sanz] rhabdo?
7:21 PM [cyrus1345] Hi all
7:21 PM [strug] i think medulloblastoma is the second most common post fosa tumor sanz and megs
7:21 PM [strug] hi nasi
7:22 PM [strug] cerebral astrocytoma is the most common post fossa tumor
7:22 PM [lanny] yes strug but is it the MC brain tumor overall
7:22 PM [cyrus1345] agree strug
7:23 PM [strug] which one lanny medulloblastoma or astrocytoma?
7:23 PM [sanz] ok strug...
7:23 PM [sanz] dua, what's the ans to yr q?
7:24 PM [lanny] overall i thought medulloblastoma and post fossa MC is astro
7:24 PM [dua_frank] sorry back
7:25 PM [dua_frank] its astro for most common benigh
7:25 PM [dua_frank] but malignant it's neuroblastoma
7:26 PM [sanz] ok
7:26 PM [lanny] ok got you and overall more bening brain tumors right
7:26 PM [lanny] makes astro the MC overall
7:26 PM [dua_frank] yes
7:26 PM [dua_frank] yes
7:26 PM [lanny] thx dua
7:26 PM [dua_frank] welcome
7:27 PM [dua_frank] what is the survival without therapy in ALL cases?
7:27 PM [strug] 10
7:27 PM [sanz] 25%?
7:27 PM [dua_frank] 6 months
7:27 PM [strug] ok
7:28 PM [sanz] with Tx would be 80%
7:28 PM [sanz] 3 yr old boy with abdo mass and HTN... Dx?
7:29 PM [dua_frank] children with solid tumours like hodgkins and wilms undergoing chemo may develop leukemia, which kind more common? ALL or AML?
7:29 PM [strug] Aml
7:29 PM [sanz] AML?
7:29 PM [dua_frank] yes
7:29 PM [megs] wilmstumour
7:29 PM [sanz] good megs
7:29 PM [strug] wilms sanz
7:29 PM [sanz] what other features do you look out for while examing him?
7:30 PM [lanny] what in AML OR ALL
7:30 PM [strug] 1 yr boy bleeds with hernia repari. PT, PTT normal..no F/H of bleeding...platelet count bleeding count normal...diagnoisis?
7:30 PM [lanny] hemophiila
7:30 PM [strug] sanz didnt undersand ur q
7:30 PM [megs] i too sanz
7:31 PM [dua_frank] hematuria, fever, eye problems, mental retardation, polycythemia
7:31 PM [strug] PT, PTT nromal lanny
7:31 PM [sanz] hehe ... ok... i'll rephrase
7:31 PM [dua_frank] hemihypertrophy?
7:31 PM [sanz] dua yes...
7:31 PM [lanny] oh ok...
7:31 PM [cyrus1345] x11 defe
7:31 PM [dua_frank] aniridia too
7:31 PM [dua_frank] no iris
7:31 PM [strug] wilms
7:31 PM [sanz] and also aniridia and genitourinary problems
7:31 PM [sanz] WAGR
7:32 PM [strug] yup
7:32 PM [dua_frank] which chr associated?
7:32 PM [sanz] strug... i'm thinking abt yr q... hang on
7:32 PM [strug] ok
7:32 PM [megs] 11 cr
7:32 PM [dua_frank] yes
7:33 PM [sanz] give up strug...
7:33 PM [cyrus1345] factor 12 defeciency?
7:33 PM [strug] options for my q are 1. prekallikrein def
7:33 PM [dua_frank] preop aspirin? :P
7:33 PM [strug] 2] factro 13 def
7:33 PM [sanz] yup, that's it
7:33 PM [strug] factor 12 def
7:33 PM [dua_frank] oh
7:33 PM [strug] thrombasthernia
7:33 PM [dua_frank] whats it?
7:33 PM [sanz] XIII def i think
7:34 PM [strug] got it sanz great!!!!!
7:34 PM [dua_frank] nice sanz, good going
7:34 PM [sanz] thnx... my mind needs some triggers...
7:34 PM [sanz] which factors are produced in the liver?
7:35 PM [strug] all except 8 and 13
7:35 PM [sanz] yup
7:35 PM [dua_frank] where are 8 and 13 produced?
7:35 PM [megs] 8...endothelial cells
7:35 PM [sanz] 8 in blood ves
7:35 PM [strug] not in liver lol
7:35 PM [dua_frank] strug lol
7:36 PM [dua_frank] 13?
7:36 PM [sanz] in liver failure or cirrhosis... what would be the first coag abnormality? PT, aPTT or BT?
7:36 PM [cyrus1345] PT
7:36 PM [strug] Pt
7:36 PM [sanz] good... reason?
7:36 PM [strug] first and more severe too
7:37 PM [dua_frank] chemo in wilms?
7:37 PM [cyrus1345] 27910 extrinisic way I think
7:37 PM [strug] because 2,5,7,10....ithink its becuse of factor 7 being depleted more
7:37 PM [sanz] cuz out of all the factors that the liver make, F VII is depleted earliest... and it's the intrinsic pathway...
7:38 PM [dua_frank] actinomycin d and vincristine sulfate
7:38 PM [lanny] but is 7 not in the extr ppath
7:39 PM [sanz] sorry it's extrinsic...
7:39 PM [lanny] ok
7:39 PM [cyrus1345] ok
7:39 PM [strug] most common soft tissue sarcoma in kids?
7:39 PM [lanny] and that path is measured with PT
7:39 PM [sanz] rhabdomyosarcoma
7:39 PM cyrus1345 has left the chat.
7:40 PM [sanz] yup... VII is the only one in extrinsic
7:40 PM [sanz] 1 2 5 10 are in common pathway
7:40 PM [sanz] the rest are in intrinsic
7:40 PM [sanz] mnemonic... 1x 2x5 = 10
7:40 PM [dua_frank] 7 9 11 19
7:40 PM [dua_frank] 7 9 11 10
7:40 PM [dua_frank] is that intrinsic?
7:41 PM [dua_frank] oh
7:41 PM [sux] 12,11,8,9 are intrinsic
7:41 PM [dua_frank] right
7:41 PM [sux] 7extrin
7:41 PM [sanz] sux yeah
7:41 PM [dua_frank] thanks sux
7:41 PM [lanny] bur
7:41 PM [sux] 1/5/2/10common
7:41 PM [megs] 12 11 9 8yup intrensic
7:41 PM [lanny] the common pathis 10
7:42 PM [dua_frank] yes lanny
7:42 PM [lanny] 2 5 7 9 10 is ext
7:42 PM [dua_frank] they meet at 10
7:42 PM [lanny] 8 9 10 12 is int
7:42 PM lenhoxung has left the chat.
7:42 PM [lanny] sorry 8 9 11 12 is int
7:43 PM [dua_frank] lanny *)
7:43 PM [lanny] only 10 is in common pathway
7:43 PM [sux] lol
7:43 PM [lanny] you can chk it
7:44 PM [sanz] ALL good prognosis - anoploidy or haloploidy?
7:44 PM [dua_frank] halo
7:44 PM [sanz] sorry i meant hyperploidy
7:44 PM [dua_frank] hyper then
7:44 PM [sanz] gosh, i'm so dizzy today... sorry
7:44 PM [dua_frank] all i know is an is bad :P
7:44 PM [sanz] dua, you're right
7:45 PM [dua_frank] if you had asked me anuploidy or pizza i would have said pizza :P
7:45 PM [sanz] lol dua
7:45 PM [sanz] electrolytes in tumour lysis syndr?
7:46 PM [dua_frank] uric acid phosphates
7:46 PM [megs] uric acid
7:46 PM [sanz] Ca, Po4, K and uric acid... up or down?
7:46 PM [strug] ca down all the rest up
7:46 PM [dua_frank] ca down, po up, k up uric up
7:46 PM [sanz] good job...
7:47 PM [sanz] also BUN and Cr up
7:47 PM [dua_frank] ok
7:47 PM [strug] first steip if u suspect a wilms tumore?
7:47 PM [dua_frank] tx
7:47 PM [dua_frank] ?
7:47 PM [sanz] CT?
7:47 PM [sanz] dua, hydration and allopurinol
7:47 PM [dua_frank] biopsy?
7:47 PM [dua_frank] yes sanz
7:47 PM [strug] first?....no its not ct
7:47 PM [lanny] syrgery
7:48 PM [dua_frank] check the other kidney
7:48 PM [spice] pleylography
7:48 PM [strug] urinalysis is first step
7:48 PM [dua_frank] why pyelo?
7:48 PM [dua_frank] ok
7:48 PM [dua_frank] to check for the other kidney :P
7:48 PM [strug] Pyelo is done to check the functioning of kidney......
7:48 PM [dua_frank] most wilms is unilateral but 10% is bilateral
7:48 PM [spice] it is
7:49 PM [strug] we dont do pyelo in wilms
7:49 PM [lanny] agree with strug
7:49 PM [strug] which type of wilms tumor has poor prognosis?
7:49 PM [lanny] can do chemo to shrink then surg
7:49 PM [dua_frank] some imaging study then
7:50 PM [sanz] the ones which have metast?
7:50 PM [lanny] bilateral?
7:50 PM [strug] yup dua first do urinalysis, then USG / CT...then check out for metasistis.....do biopsy for staging...then RX
7:50 PM [strug] anaplstic wilms and sarcomatous wilms have poor prognosis
7:50 PM [megs] involving renal vein
7:50 PM [lanny] thought the ques was treatment
7:51 PM [lanny] of wilms
7:51 PM [dua_frank] lanny hypoglycemic huh? :P
7:51 PM sux has joined subroom: USMLE_Step_1
7:52 PM [sanz] mum brought 2 yr old girl in... said she has dancing eyes and dancing feet...
7:52 PM [dua_frank] sanz i forgot, in TLS, give ca too
7:52 PM [strug] neuroblastoma
7:52 PM [strug] sanz
7:52 PM [sanz] struf, you're fast!
7:52 PM [sanz] strug i mean
7:52 PM [strug]
7:52 PM [dua_frank] i didn't get it
7:52 PM [dua_frank] why dancing feet?
7:53 PM [strug] myoclonus, opsoclonus
7:53 PM [sanz] they have myoclonus
7:53 PM [sanz] and ataxia
7:53 PM [dua_frank] oh neuro, i'm still stuck at wilms
7:53 PM [dua_frank] <hypoglycemic too now
7:53 PM [strug] what can be other presentations of neuroblastoma at other sitess/?
7:53 PM [sanz] hehe dua
7:54 PM [strug] flank mass: heamturia,
7:54 PM [lanny] depend on where tumor is
7:54 PM [sanz] spine
7:54 PM [sanz] in the lung
7:54 PM [strug] Thoracic mass: posterior mediastimum...rresp distress
7:54 PM [sanz] will also have HTN
7:54 PM [strug] HEad and neck mass: Horners
7:55 PM [dua_frank] epidura
7:55 PM [strug] also raccon eyes, periorbital haeamorrahges
7:55 PM [sanz] Dx test?
7:55 PM [strug] exopthalmos, pailloedema, ptosis
7:55 PM [strug] biopsy will giv histolo diagnosi
7:55 PM [lanny] abdom CT
7:55 PM [strug] sanz
7:56 PM [strug] and acc to site do test...like head andneck CT, or abdo CT
7:56 PM [dua_frank] inc cats
7:56 PM [lanny] also can measure urin homovan acid
7:56 PM [strug] VMA
7:56 PM [sanz] wow strug! You have all the vital info at your finegr tips (no puns intended)
7:56 PM [strug] thanks sanz....u too are really good
7:57 PM [sanz] i cant remember cr*p
7:57 PM [sanz] hehe
7:57 PM [dua_frank] what? am i'm bad here? :<
7:57 PM [dua_frank] :P
7:57 PM [sanz] lol dua, you're the best!
7:57 PM [dua_frank] thanks sanz :P
7:57 PM [sanz] yup VMA is most diagnostic
7:57 PM [dua_frank]
7:57 PM [strug] duas the best
7:58 PM [dua_frank] i love you too strug
7:58 PM [dua_frank] but VMA can't be confirmatory
7:58 PM [strug] dua
7:58 PM [dua_frank] its only diagnostic ok
7:58 PM [lanny] biopsy is usu confirm
7:58 PM [dua_frank] confirmatory is biopsy yes
7:58 PM [dua_frank] love in a good way strug
7:58 PM [strug] Vma is used for diagnois, response to Rx and recurance
7:58 PM [dua_frank] oh
7:59 PM [dua_frank] i didn't knowt hat
7:59 PM [lanny] so is homovanillic acid
7:59 PM [dua_frank] strug's definitely going to be a nephrologist
7:59 PM [strug] thanks dua
7:59 PM [dua_frank] welcome
7:59 PM [sanz] 12 yr old boy with visual field defect... and short stature...
7:59 PM [strug] craniphayringionma
7:59 PM [sanz] headaches at times
7:59 PM [lanny] cranio
8:00 PM [sanz] yup
8:00 PM [sanz] what do you see on CT?
8:00 PM [dua_frank] most common solid malignancy in less than 1 yr old kids?
8:00 PM [strug] empty sella and calificaions sanz
8:00 PM [sanz] excellent strug
8:00 PM [strug] cranipha dua?
8:00 PM [dua_frank] wow strug
8:00 PM [dua_frank] neuro
8:01 PM spice has left the chat.
8:01 PM [dua_frank] its neuroblastoma
8:01 PM [lanny] any boy with short stature eval for?
8:01 PM [strug] solid malig outside CNS would be more specific
8:01 PM [strug] GH? lanny
8:01 PM [lanny] no
8:01 PM [dua_frank] no over all most common solid malignancy
8:01 PM [dua_frank] age is the criteria here
8:01 PM [dua_frank] less than 1 yr
8:02 PM [sanz] ohysical exam lanny
8:02 PM [lanny] cranio pharyngioma
8:02 PM [lanny] any girl with short stature eval for?
8:02 PM [sanz] turner?
8:02 PM [dua_frank] genes?
8:02 PM [lanny] yes turner
8:03 PM [strug] what do u find in bipsy of wilms?
8:03 PM [dua_frank] what is the difference between glioblastoma and astrocytoma?
8:03 PM [lanny] capsular invove
8:04 PM [dua_frank] spindle cells
8:04 PM [sanz] embryonal neph cells
8:04 PM [megs] rhabdomyocytes and prem glomeruli
8:04 PM [dua_frank] malignant is the glio form
8:04 PM [dua_frank] they're generally not resectable
8:05 PM [strug] spindl shaped cell, striated muscle, anaplasia, fibrillar inclusions in histo of nephroblastoma
8:05 PM [dua_frank] early morning vomiting in kids, what do you think of?
8:05 PM [sanz] cns tumor
8:05 PM [dua_frank] more specifically/
8:05 PM [lanny] agree
8:05 PM [dua_frank] ?
8:05 PM [dua_frank] astro
8:05 PM [lanny] astro or
8:05 PM [strug] post fosssa
8:05 PM [lanny] medull
8:06 PM [dua_frank] no vomiting in medullo
8:06 PM [megs] medullo
8:06 PM [strug] tumor lanny
8:06 PM [strug] post fossa tumor lanny
8:06 PM [lanny] dont get you strug
8:06 PM [dua_frank] most common location of tumour in kids?
8:06 PM [dua_frank] in the brain i mean
8:06 PM [sanz] infraten
8:06 PM [strug] 4th ventrilc
8:06 PM [dua_frank] right sanz
8:06 PM [strug] sorry sanz righ
8:07 PM [strug] what do u see in bipsy of neuroblastoma?
8:07 PM [lanny] strug post fossa tum includes astro meddulo ependymoma gloima
8:07 PM [dua_frank] rosettes?
8:08 PM [sanz] yeah.. thos endochromaffin stuff
8:08 PM [megs] yup dua right
8:08 PM [strug] yes lanny thats right
8:08 PM [dua_frank] which is the only brain tumour that can metastasize?
8:08 PM [strug] dua u right, u get roseets with central fibrillar mat
8:08 PM [lanny] medull
8:09 PM [megs] yup
8:09 PM [dua_frank] yes
8:09 PM [lanny] mnemonic medullo meddles in other organs business
8:09 PM [dua_frank] metastasis through?
8:09 PM [dua_frank] lanny nice lol
8:09 PM [lanny] CSF
8:09 PM [strug] csf
8:09 PM [dua_frank] yes
8:09 PM [megs] spinal column
8:09 PM [lanny] this is all step 1 dua
8:10 PM [strug] good pt dua
8:10 PM [dua_frank] having n-myc in neuro a good or bad prognosis?
8:10 PM [strug] bad
8:10 PM [dua_frank] yes bad
8:10 PM [dua_frank] being older than one year or yound, good prognosis?
8:10 PM [sanz] bad
8:10 PM [strug] yes good
8:11 PM [lanny] what was the diff bet glio and astro anyone pls ?
8:11 PM [dua_frank] being old is bad yes
8:11 PM [dua_frank] less than one good prognosis once on therapy
8:11 PM [dua_frank] glio is malignant lanny
8:11 PM [megs] glio stage 4 asrocytoma
8:11 PM [dua_frank] nonresectable too usualy
8:11 PM [dua_frank] most astros are all benign
8:12 PM [dua_frank] risk factors for ALL?
8:12 PM [lanny] thx dua
8:12 PM [dua_frank] welcome
8:12 PM [lanny] radiation
8:12 PM [megs] downs radotion
8:12 PM [lanny] down sd
8:12 PM clover has left the chat.
8:12 PM [strug] ,downs, sojogran, sideroblastic anemia
8:12 PM [sanz] white boy
8:12 PM [lanny] atax teleanm
8:12 PM [strug] myelofibrosis, turners
8:13 PM [lanny] some viruses
8:13 PM [dua_frank] yes as secondary ALL lanny
8:13 PM [dua_frank] yes strug
8:13 PM TTW has left the chat.
8:13 PM [dua_frank] von reckling, bloom synd, ataxia telan, fanconi too
8:13 PM [lanny] is there primary risk f
8:13 PM [megs] cromosomal instability syndromes dua
8:13 PM [strug] also hogkins and wilms
8:13 PM [dua_frank] being a twin of an ALL patient less than 4 yrs of age is a risk too
8:14 PM [dua_frank] not hodkins and wilms
8:14 PM [dua_frank] those are only after intense treatment
8:14 PM [lanny] so xhromosome abn can be primary dua
8:14 PM [strug] yes
8:14 PM [dua_frank] as secondary complication of chemo or radio
8:14 PM [dua_frank] yes lanny
8:14 PM [lanny] thx dua
8:14 PM [strug] first test? for all
8:15 PM [dua_frank] sites for relapse of ALL?
8:15 PM [lanny] bone marro
8:15 PM [sanz] CNS
8:15 PM [strug] testis most common
8:15 PM [lanny] biopsy
8:15 PM [dua_frank] yes strug and CNS
8:15 PM [lanny] strug right
8:15 PM [lanny] CNS no 2
8:15 PM [dua_frank] sanz right
8:15 PM [dua_frank] BM and peripheral smear
8:15 PM [strug] first test is PS
8:16 PM [dua_frank] ok
8:16 PM [strug] BEST?
8:16 PM [sanz] BMA
8:16 PM [lanny] bone marrow biopsy
8:16 PM [strug] no.....hhhmmmm m not sure but i think its monoclonal antibody test....
8:16 PM [dua_frank] oh?
8:16 PM [strug] because bone marrow cannot differentiat between AML and All
8:17 PM [sanz] yes you can... AML wont have blasts cells
8:18 PM [sanz] or would it?
8:18 PM [sanz] hhmm... i dont know anymore... ignore me.. hehe
8:18 PM [strug] blast means acute leukemia
8:18 PM [strug] but not which one
8:18 PM [megs] agree strug
8:18 PM [strug] u need to do monoclonal antibody test to find out the type
8:19 PM [lanny] ALL has > 30 % blast
8:19 PM [dua_frank] so you're saying you cannot differentiate between lymphoblasst and myeloblasts
8:19 PM [megs] more than30%blasts acute'luekelia
8:19 PM [dua_frank] ok
8:19 PM [lanny] these blast in periph blood
8:20 PM [dua_frank] supperative lymphedenopathy, purpura, pulmonary infiltrates, anemia, thrombocytopenia, inc Hb F, inc mono and granulocytes what am i talking about?
8:21 PM [strug] options please?
8:21 PM [dua_frank] leukemias
8:21 PM [dua_frank] its Juvenile CML
8:21 PM [megs] blast crisis????
8:21 PM [lanny] ALL
8:21 PM [dua_frank] how do you differentiate this from Adult CML?
8:21 PM [sanz] HbF?
8:22 PM [dua_frank] no philadelphia chromosome
8:22 PM [strug] HBF
8:22 PM [dua_frank] yes that too
8:22 PM [dua_frank] more importantly no phil chr
8:22 PM [dua_frank] so having phil chr is good or bad?
8:22 PM [sanz] bad
8:22 PM [dua_frank] good sanz
8:22 PM [megs] good
8:22 PM [lanny] bad
8:22 PM [strug] good
8:22 PM [dua_frank] its bad
8:23 PM [strug] its good
8:23 PM [dua_frank] bad prognosis
8:23 PM [dua_frank] does chemo help in CML?
8:23 PM [sanz] yes
8:23 PM [dua_frank] nope
8:23 PM [strug] are u sure dua...acc to me phila chorom is good
8:23 PM [dua_frank] strug my book says that
8:24 PM [strug] which book dear
8:24 PM [dua_frank] so i cannot say its correct or not until i check another book
8:24 PM [dua_frank] it's some study material i have
8:24 PM [dua_frank] kaplan
8:24 PM [lanny] there are 2 bad prog mature B cells present and phila chrom
8:24 PM [strug] i will check out too
8:24 PM [dua_frank] i can check another book if you want
8:25 PM [strug] yes pl dua that would be great
8:25 PM [megs] acc to goljan prognosis is bad if ph cr absent
8:25 PM [dua_frank] sure
8:25 PM [lanny] good prog is CALLAantigen positiv
8:25 PM [dua_frank] so lanny agrees with me?
8:25 PM [lanny] agree with megs
8:25 PM [dua_frank] if all disagree with me then maybe my book is wrong
8:25 PM zoya has left the chat.
8:26 PM [lanny] agree with you dua
8:26 PM [sanz] CALL is ALL... we're talking abt CML...
8:26 PM [dua_frank] then you cannot agree with megs lanny, she said the opposite :P
8:27 PM [megs] you can cq goljian i am 100%suure
8:27 PM [dua_frank] megs i'm sure you are right
8:27 PM [lanny] is phila chr seen in AML?
8:27 PM [dua_frank] no lanny
8:27 PM [lanny] know it is seen in ALL
8:27 PM [dua_frank] its seen only in adult cml
8:27 PM [megs] not in aml its in cml
8:28 PM [lanny] yes CML but when seen in ALL prog is bad
8:28 PM [dua_frank] ok issue resolved
8:28 PM [dua_frank] without phil chr bad prognosis
8:29 PM [dua_frank] just check oxford handbook
8:29 PM [lanny] no dua i think the presence of phila chr is bad prog
8:29 PM [lanny] will chk again
8:29 PM [lanny] are we sure were not mixing up the acute from chronic here
8:30 PM [sanz] lanny, we're talking abt CML... with phil c'some it's good Px
8:31 PM [lanny] finally i thought so i was answering for ALL
8:31 PM [dua_frank] i guess there was yes sanz
8:32 PM [lanny] yes in cmlphila chr is good prog
8:32 PM [dua_frank] lanny i think CML patients can have ALL blast crisis?
8:32 PM [dua_frank] or somethign like that
8:32 PM [strug] AMl blst crisi lanny
8:33 PM [dua_frank] that can explain the prognosis part which is bad in patients with ALL and 9;21 translocation
8:33 PM [strug] cml willhave aml
8:33 PM [lanny] yes blast crisis is > 70% myeloblast
8:33 PM [dua_frank] i'm not sure though
8:33 PM [lanny] blast crisis in CML
8:33 PM [dua_frank] 9 22
8:33 PM [dua_frank] sorry
8:34 PM [sanz] LAP score high or low in CML?
8:34 PM [megs] low
8:34 PM [dua_frank] low
8:34 PM [sanz] good
8:34 PM [strug] low
8:34 PM [sanz] Rx?
8:34 PM [lanny] mature neutrophils have LAP and since they dont mature think low
8:34 PM [dua_frank] hydroxyurea
8:34 PM [megs] usulfan hydroxyura
8:35 PM [megs] busulphan
8:35 PM [strug] lap score high in what?
8:35 PM [sanz] and the new drug Gleevac (imitanab mesylate)
8:35 PM [megs] yup sanz
8:35 PM [sanz] leukemoid rxn
8:35 PM [lanny] leukemoid rxn>
8:35 PM [strug] yes sanz
8:35 PM [dua_frank] found it
8:35 PM [megs] luekemoid rean high LAP
8:35 PM [sanz] when do you see leukemoid rxn?
8:36 PM [megs] infection
8:36 PM [lanny] when very high wbc
8:36 PM [strug] isnt it something like for stage 1 and2 its chemo for 3 and 4 srurgery for CML?
8:36 PM [dua_frank] transformed CML with lymphoblastic characteristisc ( ALL) is poor prognosis
8:36 PM [lanny] think its > 30 thosuand wbc
8:36 PM [sanz] lanny, yes... and also in stress, chr infection/inflammation
8:36 PM [megs] whatsurgery for CML??/ STRUG
8:37 PM [lanny] yes sanz
8:37 PM [sanz] strug, i think you meant CLL
8:37 PM [sanz] they have 4 stages...
8:37 PM [sanz] stage 1 is just lymphocytosis...
8:37 PM [sanz] adn 4 is worst with thrombocytopenia
8:38 PM [strug] yes guys i was thinking ClL.....oops everthing is geting mixed up
8:38 PM [lanny] CLL has stages
8:38 PM [sanz] how to Dx CLL?
8:38 PM [dua_frank] i have a problem with this
8:38 PM [lanny] PBS
8:39 PM [sanz] me too dua...
8:39 PM [strug] first PBS
8:39 PM [dua_frank] i don't think you can treat CML in children the same as in adults
8:39 PM [megs] smudge cells
8:39 PM [dua_frank] chemo is not curative in children
8:39 PM [lanny] inc lympho WBC inc
8:39 PM [strug] what prob guys?
8:39 PM [dua_frank] only BM transplantation can help
8:39 PM [dua_frank] that too if done in chronic phase
8:39 PM [strug] if a donor is availabe thats the first choic BM
8:39 PM [sanz] strug, i want to know definitive Dx of CLL... PBS, LN Bx or BMA?
8:39 PM [dua_frank] ok
8:40 PM [megs] PBS SANZ
8:40 PM [dua_frank] is CLL seen in children at all?
8:40 PM [sanz] or cytogenetics? cuz CLL has CD5 expression...
8:40 PM [lanny] usu older males > 60
8:41 PM [strug] I would go for BMA though not very sure
8:42 PM [sanz] i guess in real life we do all... hehe
8:42 PM [megs] BONE MARROW PIC OF CLL RESEMBELS LYMHOMA...i guess so not diagnstic for cll
8:42 PM [sanz] ok megs
8:43 PM [sanz] so maybe cytogenics? or PBS?
8:43 PM [dua_frank] meaning they have lymphocytosis?
8:43 PM [dua_frank] is that what you are saying megs?
8:44 PM [megs] bone marrow infilteration by lymholytes
8:44 PM [sanz] anyway, shall we do another topic?
8:44 PM [dua_frank] ah
8:44 PM [megs] ok sanz
8:44 PM [dua_frank] not finished with onco :O
8:45 PM [sanz] oh ok... cont then
8:45 PM [dua_frank] not done bone tums or hogkins and nonhodkins
8:45 PM [dua_frank] i hate these the most
8:46 PM [sanz] variants of Hodgkins?
8:46 PM [dua_frank] how can you different NHLs in adults and children?
8:46 PM [dua_frank] lp, mc, ld and ns
8:46 PM [strug] A child with recurrent URTI, T cell B cel normal....had delayed separaion of umblical cord.....diagnoiss? P.S its not relaated to oncology
8:46 PM [sanz] yup dua... which is best Prgx?
8:47 PM [dua_frank] ns
8:47 PM [strug] ns
8:47 PM [sanz] leukocyte adhesion disorder
8:47 PM [megs] agree sanz
8:47 PM [strug] amazing sanz....u r too good!!!
8:47 PM [sanz] ns seen in young females
8:48 PM [sanz] what's the defect strug?
8:48 PM [dua_frank] sanz any more step 2 they have to make a different percentile range for you, above 100 that is...
8:48 PM [strug] adhesion....thats all i know sanz
8:48 PM [sanz] lol dua... i wish
8:48 PM [lanny] agree 150 percentile .....
8:48 PM [dua_frank] chomokinins?
8:49 PM [sanz] strug, it's a protein defect on phagocytes...
8:49 PM [dua_frank] oh
8:49 PM [sanz] they also have early loss of teeth... hehe
8:49 PM [dua_frank] ugly tootless girl with URTI :P
8:49 PM [dua_frank] LAD :P
8:49 PM [sanz] hehe
8:50 PM [strug] do u know the name of the proten? sanz
8:50 PM [dua_frank] ok how to different NHL... its extranodal in presentation
8:50 PM [sanz] wait... i'll go check for you strug... i dont remember
8:50 PM [dua_frank] highly aggressive, rarely nodular, equally T and B cell variety
8:51 PM [lanny] i think its in lippincott biochem can chk strug
8:51 PM [strug] its so nice of u ssanz
8:51 PM [sanz] LFA 1 adhesion protein defect on phagocytes
8:51 PM [dua_frank] what does LFA stand for now :P
8:51 PM usmle_guy has left the chat.
8:52 PM [dua_frank] go check again :P kidding ... lol
8:52 PM [sanz] dua, so extranodular presentation is adult?
8:52 PM [dua_frank] yes sanz
8:52 PM [sanz] thnx dua i didnt know that
8:53 PM [sanz] lol dua... LFA stands for leukocyte something
8:53 PM [dua_frank] also if it's abdominal mass, its B cell lymphoma and if it's anterior mediastenal mass it's T cell lymphoma of NHL variants
8:53 PM [dua_frank] t for thorax, b for belly
8:53 PM [sanz] ok
8:54 PM [dua_frank] markers for reed sternberg cells?
8:54 PM [dua_frank] hodgkins, a or b good?
8:55 PM [strug] a good
8:55 PM [dua_frank] yes
8:55 PM [dua_frank] b is with symptoms and is BAD
8:55 PM [dua_frank] b for bad :P
8:55 PM [sanz] ok
8:55 PM [sanz] CD something!
8:56 PM [dua_frank] 15 and 30
8:56 PM [strug] cavrnous hemangiomas., thrombocytopenia, anemia,megakraryoctytes on BM....diagnsois?
8:56 PM [lanny] sturge weber
8:56 PM [megs] srug weber syndrome
8:56 PM [strug] MEGAKARYOCYTES?????
8:57 PM barsobia99 has left the chat.
8:57 PM [sanz] Von Hippel Lindau?
8:57 PM [strug] Kasaback meritt syn
8:57 PM [dua_frank] man
8:57 PM [dua_frank] never even heard of it
8:57 PM [megs] whats that strug??/
8:58 PM [sanz] http://www.emedicine.com/med/topic1221.htm
8:58 PM [strug] its one of the causes of thrombocytopenia....rapidly enlarging cavernous hemagioma, consumptive coagulaopathey
8:59 PM [sanz] i just cheked it out from google...
8:59 PM [megs] thanx sanz
8:59 PM dua_frank has left the chat.
8:59 PM [sanz] thnx strug
8:59 PM [strug] megakaryoctes on bone marrow
8:59 PM [dua_frank] i kicked myself out
9:00 PM [sanz] lol
9:00 PM [strug] Rx is laser, high dose corticosteroids and interferon
9:00 PM [strug] How do u do that dua? lol
9:00 PM [dua_frank] clicked on one of these buttons above and i got kicked out
9:01 PM [strug] dua are u hurt? lol
9:01 PM [megs] ha ha dua
9:01 PM [dua_frank] do not touch anything while you're in this chat, everything's danagerous
9:01 PM [lanny] ok lannys time for food will be back and forth wile i make dinner
9:01 PM [strug] u make dinner!!!!!! who eats?????// lol
9:01 PM [dua_frank] whatch ya cookin lanNy?
9:02 PM [lanny] all here present
9:02 PM [dua_frank] strug lol
9:02 PM [lanny] chiken breast sauted with mushrooms tomatoes egg plant...
9:02 PM [strug] Ok guys ans this q whats TAR syn?
9:02 PM shreya has left the chat.
9:03 PM [lanny] some digits fingers thing
9:03 PM [strug] my mouth watering lanny
9:03 PM [lanny] lol
9:03 PM [lanny] absent digits strug
9:03 PM [strug] Thrombocytopenisa absent radius
9:03 PM [sanz] strug, something like T... Abscence Radiii?
9:03 PM [dua_frank] wow
9:03 PM [sanz] yup that's it...
9:03 PM [lanny] thanks
9:04 PM [sanz] has ASD
9:04 PM [strug] really sanz didtn know that
9:04 PM [sanz] yup,,, it's associated with ASD and other limb abn
9:05 PM megs has left the chat.
9:06 PM [strug] hey guys are we done for today?
9:06 PM [strug] its almost time
9:06 PM [sanz] looks like
9:06 PM [sanz] any more qs anyone?
9:06 PM shreya has left the chat.
9:06 PM [strug] tomorrow newborn, nutritin growth and deverlpment
9:07 PM [sanz] aye aye strug
9:07 PM [strug] and the rest of peds whatever
9:07 PM [strug] i will put the timetable for OBGYn on value md
9:07 PM [dua_frank] ok
9:07 PM [strug] ok then bye all
9:08 PM [dua_frank] bye strug
9:08 PM [strug] any more q?
9:08 PM [strug] yup bye dua
9:08 PM [sanz] dua, we didnt get to do your NHL and HD...
9:08 PM [sanz] do you still wanna do them?
9:08 PM [dua_frank] sure
9:09 PM [dua_frank] i finished with NHL and HD :P
9:09 PM [sanz] oh...
9:09 PM [dua_frank] only bone tumours left now
9:09 PM [sanz] ok... shoot
9:09 PM [dua_frank] onion skin appearance on x ray/
9:09 PM [dua_frank] ?
9:09 PM [strug] osteosarcoma
9:10 PM [sanz] ewing
9:10 PM [dua_frank] right ewings
9:10 PM [dua_frank] with sunburst
9:10 PM [sanz] sunburst is osteo
9:10 PM [strug] yyyyaaaaa
9:10 PM [sanz] i remember as onions smell bad... so eeeewwww
9:10 PM [strug] wow good one
9:10 PM [dua_frank] lol
9:10 PM [strug] i will remem it for ever now sanz
9:10 PM [sanz] hehe
9:11 PM [strug] ok next q dua
9:11 PM [sanz] things we do to remember
9:11 PM [dua_frank] most common primary malignant bone tumour in children?
9:11 PM [strug] age group for ewings and osteo?
9:11 PM [sanz] osteo teenagers
9:11 PM [strug] ewings is most commonnnnn i guess
9:11 PM [sanz] ewings are younger like 6-9
9:13 PM [sanz] ewings has presentation like osteomyelitis with fever, incr ESR and so on... but osteo just presents as bone pain..
9:13 PM [sanz] dua, i dont know
9:13 PM [dua_frank] yes right sanz
9:13 PM [dua_frank] osteogenic sarcoma
9:13 PM [strug] site for ewings and osteo? i mean epiphusis or meta ?
9:14 PM [sanz] ewing diaphysis of long bone
9:14 PM [sanz] osteo meta
9:15 PM [sanz] 20 yr old female with bone pain... soap bubble appearance in epiphysis... what bone tumour?
9:15 PM [strug] giant cell
9:15 PM [sanz]
9:16 PM [dua_frank] whats a good way to emember this ?
9:16 PM [sanz] female like soap bath
9:16 PM [sanz] i just made that up... hehe
9:16 PM [strug] def diagno for bothe?
9:16 PM [dua_frank] giant female LIKE SOAP BATH?
9:16 PM [sanz] biopsy?
9:16 PM [strug] biopsy
9:17 PM [strug] Rx for bothe?
9:17 PM [dua_frank] SURGERY
9:17 PM [sanz] chemo... if not need to amputate
9:17 PM [strug] surgery and chemo
9:18 PM [strug] osterosarcoma is associated with...
9:18 PM [dua_frank] i'm done with bone
9:18 PM [dua_frank] onco over and out
9:18 PM [sanz] ok...
9:18 PM [strug] rhabdomyosarcoma
9:19 PM [strug] sorry retinoblasoma
9:19 PM [sanz] most common presentation?
9:19 PM [strug] opps
9:19 PM [strug] bone pain which wakes at nigh
9:19 PM [dua_frank] gaint abnormalities?
9:19 PM [dua_frank] oh
9:19 PM [sanz] white eye reflex
9:20 PM [strug] oh u meant retinoblasotam..........
9:20 PM [sanz] what are we talking abt now?
9:20 PM [sanz] hehehe
9:20 PM [dua_frank] yeah children with retino have inc incidence of osteosarcomas
9:20 PM [dua_frank] linking gene is on chr 13
9:20 PM [sanz] yup
9:21 PM [dua_frank] most common site?
9:21 PM [sanz] grape like vaginal mass in a girl... Dx?
9:21 PM [sanz] dua, dont know
9:21 PM [strug] sarcoma botyroids
9:21 PM [dua_frank] around knee
9:22 PM [sanz] ok
9:22 PM [sanz] yup strug
9:22 PM [strug] hey guys we havnt done infectious disease which is very imp....we shoudl do that first tomorrow
9:22 PM [lanny] agree
9:22 PM [sanz] ok i dont mind... you guys decide
9:22 PM [strug] tomorrowis last day for peds
9:22 PM [dua_frank] ok
9:23 PM [lanny] neonatology too
9:23 PM [strug] ok so done dua and sanz
9:23 PM [dua_frank] strug can we stay longer then?
9:23 PM [strug] tomorrow yes
9:23 PM [dua_frank] i mean 2 hours won't be enough to cover rest of peds
9:23 PM [lanny] agree
9:23 PM [strug] yes definatley dua
9:23 PM [strug] we cand o for 3 hours if u guys dont mind
9:23 PM [dua_frank] so everybody be prepared to stay lat. lanny we will give you half an hour for your dinner break :P
9:24 PM [sanz] lol dua
9:24 PM [sanz] you're strict
9:24 PM [lanny] sounds good lol
9:24 PM [strug] bye allfor today then....or are we continuing?
9:24 PM [dua_frank] lol
9:24 PM [dua_frank] my computer's freezing, i think i'm going to have to go
9:24 PM [sanz] i'm gonna have my Bens and Jerrys Half Baked now... hehe
9:24 PM [dua_frank] see you all tomorrow
9:24 PM [sanz] bye bye all
9:25 PM [dua_frank] bye sanz bye all
9:25 PM sanz has left the chat.
9:25 PM [strug] bye all
9:25 PM strug has left the chat.
9:25 PM dua_frank has left the chat.
9:59 PM manleyjb has left the chat.