Step 2 Studying Continued

A week out, and the nerves are setting in. I don't know what it is about these exams that make me go into respiratory alkalosis (get it? hyperventilation - decreased pCO2 - increased pH...hmm? hmm? Nerd humor...go figure). So hopefully I do well, and then I can upload my study schedule and tell you all what worked, what didn't...but for that I'll have to take the exam first, and get my score, so you'll have to hang tight for about a month or so. For now, lets review 5 things that I learned today:

• Cosyntropin test is used to diagnose and differentiate between the different types of adrenal insufficiency. It involves administering about 250 mcg of cosyntropoin (which is an ACTH analog), and measuring cortisol & ACTH levels about 2-3 hours later. Normally, an individual should be able to make more than 20mcg/dL of cortisol. 
• >20 mcg/dL of cortisol -- This rules out adrenal insufficiency 
• < 20 mcg/dL of cortisol, >50 pg/dL of ACTH-- primary adrenal insufficiency (autoimmune/Tb/hemorrhage)
• <20 mcg/dL of cortisol, <50pg/dL of ACTH--secondary or tertiary adrenal insufficiency (issue with the hypothalamus or pituitary gland)
• Basal cell carcinoma rarely metastasizes! Yay!!!
• For pyloric stenosis, surgery is the immediate treatment, however, make sure the patient (baby) is adequately hydrated and their electrolytes have been normalized. 
• In an elderly patient complaining of progressive visual acuity decline (problems with vision while driving or at night), reporting distorted straight lines... THINK: macular degeneration. The macula is responsible for the fine acuity of what we see, and distorted straight lines is a clue that something is up. 
• Bonus question: What do you see on ophtho exam? Drusen deposits in the macula
• In a patient reporting a tick bite, with jaundice, hemoglobinuria, late petechial rash...THINK Babesiosis! 
• Babesia is a parasite that is found in the northeast, and it has a tendency to enter one's red blood cells and cause hemolysis! This disease is pretty serious in the immunocompromised, asplenic and age>40 population. 
• Treatment: quinine-clindamycin or atovaquone-azithromycin

There ya have it! Enjoy the night folks.

Step 2 studying

Aah..how fast does time fly? This year has been flying by so quickly, and here I am now studying for step 2 already. It truly is a very different experience than step 1 studying (so glad that is over...), since our shelf-exams were basically preparation for this. Anywho, I just wanted to use this time to reinforce some factoids for boards so you and I can remember them! Here are FIVE things I learned from today's studying:

• Mechanisms of Treatment Options for hyperkalemia (high potassium)
• Calcium gluconate -- to stabilize cardiac cell membrane
• Bicarbonate, Insulin, Glucose, beta-agonists--to push K+ intracellularly 
• Kayexalate--to excrete K+ out of the body
• Parkinsonian Tremor
• Tremor seen in elderly at the initial phases of Parkinson's disease
• Characterized as a 4-7 Hz resting tremor that goes away with fine motor movements like reaching for a pen, or writing
• Pediatric Umbilical Hernias!!! 
• These are due to defects in the abdominal wall, and usually spontaneously resolve by the time the child is 1 year old 
• However, if the hernia is still present by age 3-4, enlarging over time, or has become symptomatic (strangulation, etc), the child should be referred for surgical correction
• Somogyi effect
• This is where a diabetic patient has increased fasting glucose levels despite appropriate treatments. 
• Caused by hypoglycemia due to hefty/appropriate doses of insulin or other treatments in the middle of the night (3AM or so) which result in the body to respond with increased levels of epinephrine, norephinephrine and glucagon, which over-compensate for this hypoglycemia with increased glucose levels
• MEN syndromes (i can NEVER keep these straight)
• MEN I (3Ps) -- hyperParathyroidism, Pituitary tumor, Pancreatic tumors (gastrinoma, ZES)
• MEN IIa -- Medullary thyroid cancer, pheochromocytoma, parathyroid adenoma/hyperparathyroidism
• MEN IIb -- Medullary thyroid cancer, pheochromocytoma, mucocutaneous neuroma, marfanoid habitus

Well...these are the 5 things to learn today! I think I'll try and do this over the next few weeks to help keep things in the brain. Wish me luck for studying :)