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.