High Yield Internal Medicine Review for Step 2 CK & Shelf Exam

Comments · 425

• RA

  @rachelwalker8283 · 6 years ago (edited) · pinned

  <a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=56">0:56</a> Criterias<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=491">8:11</a> Cardio<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=1909">31:49</a> Pulm<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=2799">46:39</a> GI<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=4096">1:08:16</a> Endo<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=5192">1:26:32</a> CT &amp; Joints<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=5617">1:33:37</a> Renal<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=6502">1:48:22</a> Fluid/Electrolytes<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=7696">2:08:16</a> Heme/Onc<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=8994">2:29:54</a> ID<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=10260">2:51:00</a> Derm<br><a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=10638">2:57:18</a> Ambulatory/Bonus

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• CM

  @CMoneyMD · 1 year ago

  I used your videos in med school during clerkships and honored all my shelf exams. Re-listened to your videos for Step 2 CK and did very well. Re-re-listened again for Step 3 and passed with flying colors. Now I finished IM residency and am returning to your videos yet again for the IM boards to refresh the basics/ high yield factoids that boards seem to love. You were truly with me on every part of my journey

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• AL

  @AlishaMir · 4 years ago

  love this but there&apos;s an error at <a href="https://www.youtube.com/watch?v=8DTYbxtV7Tk&amp;t=1064">17:44</a>, he says restrictive cardiomyopathy causes decreased EF but it causes preserved EF!! Diastolic dysfunction due to deposits like amyloidosis, sarcoidosis and hemochromatosis cause a filling problem which leads to less blood filling in the ventricles but there is no issue squeezing that blood back out so EF stays the same. sorry to nitpick just wanted to clarify for anyone watching!!

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• MA

  @marinashaji9220 · 3 years ago

  Watched just this for a few days before my test and got a 262… no words to describe how accurate and important the information covered in his videos are. He uploaded these 3 years ago but it stands good to this day. Hands down a life saver.

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• MA

  @matthewpace5451 · 2 years ago

  Hey Dr High Yield.<br><br>It would be great if when you have time, during or after residency, to go through and update your videos with current guidelines now that some are changing. Asthma for instance.<br><br>Overall your videos are AMAZINGLY helpful for a quick refresher before these exams!!! I&apos;ve definitely benefited like thousands of other students!

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• LI

  @LizaR-34 · 1 year ago

  Comment summary as of 6//2/25:<br><br>Cardio<br>* Restrictive cardiomyopathy has preserved EF, since it is primarly a problem with diastolic function. (AHA) <br>* Dressler syndrome is treated with high-dose NSAIDs ± colchicine, like other causes of acute pericarditis, not aspirin alone.<br>* Kussmaul’s sign is absent in cardiac tamponade — it’s seen in constrictive pericarditis, RHF, and PHTN.<br>* Metformin is now considered safe in CHF and may improve survival. The thought process was it was bad bc of lactic acidosis (AHA)<br>* HFpEF diagnosis: EF ≥50%, with signs/symptoms of HF, elevated BNP, and structural heart disease (LAE or LVH). Not just &quot;normal EF.&quot; (AHA)<br>* First step in beta-blocker overdose is IV fluids and stabilization, not glucagon (can be used if IVFs/atropine are ineffective)<br>* Valve area &lt;1.0 cm alone is not diagnostic of severe AS; gradient &gt;40 mmHg or velocity &gt;4.0 m/s is preferred.<br>* Current tx for Infective endocarditis: vanc + ceftriaxone (AHA)<br>* Hypertensive emergency tx: first-line is IV labetalol, nicardipine, clevidipine, or nitroprusside (not hydralazine due to unpredictable hemodynamic effects)<br><br>Pulm<br>* COPD Tx: (GOLD 2025) Rescue therapy SABA or SAMA<br> &nbsp; &nbsp;* &lt;1 exacerbation w/o admission in last year:<br> &nbsp; &nbsp; &nbsp; &nbsp;* A (lower severity): LABA or LAMA <br> &nbsp; &nbsp; &nbsp; &nbsp;* B (higher severity): LABA/LAMA combination therapy<br> &nbsp; &nbsp;* &gt;/= 2 overall or 1 w admission<br> &nbsp; &nbsp; &nbsp; &nbsp;* E: LABA/LAMA combination therapy +/- ICS <br>* Most common organisms in COPD + PNA are H. flu, M. catarrhalis, and Strep pneumo — not Pseudomonas. Best coverage is augmentin plus either a macrolide or doxycycline. <br>* Asthma: ICS over SABA monotherapy even in mild disease. Aka daily low dose ICS + PRN SABA or combined ICS/SABA (GINA 2024).<br>* CAP tx outpatient: amox + macrolide or doxycycline. <br>* Aspiration pneumonia is treated like CAP unless there’s abscess or empyema (cover for anaerobes with add clindamycin or a beta-lactam/beta-lactamase inhibitor). (IDSA)<br>* lung cancer screening at age 50 for individuals with a 20 pack-year smoking history. Low dose CT anually until age 80. stop if they have quit for 15 years. (USPSTF 2021)<br><br>GI<br>* Diverticulosis can present with hematochezia but its really not common<br>* Colonoscopy screening now begins at age 45, not 50. (ACS)<br>* Appendicitis: Get abdominal CT with contrast even if all signs are there. ultrasound as first-line in children and pregnant patients, and MRI as a subsequent option if ultrasound is equivocal. (IDSA)<br>* Gallstone ileus is characterized by pneumobilia (air in the biliary tree) rather than air in the gallbladder wall (emphysematous cholecystitis)<br>* In gastrinoma (ZES), if fasting serum gastrin his elevated, but in the &gt;100, &lt;1000 range, need to do a secretin stim test. Positive test shows serum gastrin rise above 120. (NANTS). This is because of abberant secretin receptor expression. Other causes of hypergastrinemia (atrophic gastritis, PPI use, or achlorhydria) do not respond with increased gastrin secretion.<br>* Hereditary hemochromatosis type 1 is autosomal recessive (HFE gene), not dominant.<br><br>Endo<br>* In DKA, IVF first, check potassium level. K replacement is indicated only if the serum K is below 5.3. Withold insulin if the serum potassium is less than 3.3 mmol/L until potassium is repleted. (ADA)<br>* Hypercalcemia in sarcoidosis is caused by increased production of vitamin D (specifically 1,25-dihydroxyvitamin D) within granulomas.<br>* When TBG increases (estrogen etc), total T4 increases because more T4 is bound in the circulation. Free T4 (biologically active) remains unchanged because homeostatic mechanisms.<br><br>CT &amp; Joints<br>* RA treatment should begin with DMARD (MTX) at diagnosis; NSAIDs/glucocorticoids are adjuncts for flares.<br><br>Renal<br>* RTAs: Anion gap urine (urine Na + urine K) – (urine Cl) is positive in type I and IV RTA, negative in Type II. This is so low yield.<br>* Low dietary calcium increases kidney stone risk by allowing more oxalate absorption since calcium binds oxalate in the gut.<br><br>Fluid/Electrolytes<br>* Tumor lysis syndrome: defined by increased serum uric acid, potassium, and phosphorus and/or decreased calcium (not increased)<br><br>Heme/Onc<br>* HUS is caused by Shiga toxin-producing E. coli (STEC), which includes the subset EHEC.<br>* Von Willebrand disease has normal PT and sometimes elevated PTT (because of factor VIII deficiency)<br><br>ID<br>* Prophylactic azithromycin is not routinely recommended for the prevention of Mycobacterium avium complex (MAC) infection in patients with HIV and a CD4 count less than 50 cells/mm³ if they are virologically suppressed on combination antiretroviral therapy. (IDSA)<br>* Eosinophilia is typically seen in helminth infections, not protozoa like Entamoeba histolytica.<br>* Strongyloides follows lifecycle of hookworms, but is actually a threadworm (also a nematode)<br>* Lyme disease in children &lt;8: Some guidelines still recommend amoxicillin (concerns for teth staining with doxy); others now recommend doxycycline esp if tx duration less than 3 weeks (AAP 2016).<br><br>Derm<br>* Keratoacanthoma is now managed as cutaneous SCC — surgical excision recommended.<br>* Pityriasis rosea treatment varies: antihistamines/topical steroids preferred; selenium sulfide is not established.<br>* Herpes zoster vaccine is now recombinant (Shingrix), starts at age 50 (not 60). the live vaccine is discontinued.<br><br>OBGYN<br>* Cervical cancer screening: Start at 21 regardless of sexual activity. Ages 21–29: cytology q3y. Ages 30–65: either cytology q3y, hrHPV alone q5y, or co-testing q5y. (USPSTF)<br>* Breast cancer screening in average risk individuals: Mammogram is every 1-2 years starting at 40 - 75 (ACOG)

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• BU

  @bugacuga · 6 years ago

  Just a minor correction that a lot of med students understand incorrectly- &quot;pain out of proportion to exam&quot; doesn&apos;t mean the patient winces upon palpation. Rather it means patient is in extreme pain at baseline, but when you palpate them you do not invoke any additional tenderness even if you press very hard. You&apos;d expect to really hurt them even on light palpation, but they tolerate deep palpation.

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• LA

  @lastyllobille · 6 years ago

  Jus wanted to come back here after the test (scored in the 250&apos;s which I&apos;m super happy about) and let you know that I owe a lot of it to you! It&apos;s amazing that you take time to do this for us. Thank you Dr. High Yield!!

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• MI

  @MindandMatterPsychiatry · 2 years ago

  I tell all my med school buddies this is a must-watch review before the IM shelf. Scored above the 70th percentile on it and honored the rotation thanks to you! Now watching it again to prepare for step 2 💯 truly amazing content

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• HA

  @hamzaelkasaby8 · 3 years ago

  I am writing this comment to thank you for your videos they are the best last minute review they helped me a lot the days before the exam I have scored 270

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• DE

  @DeltaCJ · 4 years ago

  Probably watched this video a dozen times studying for step 3 after forgetting everything during two years in surgery. Happy to say that today I passed. Thank you for posting this content.

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• QT

  @QtipIV · 2 years ago (edited)

  Just took my IM Shelf... Lets hope this vid took me to the promise land😅<br><br>***UPDATE: I got HONORS. Thanks man 🙏🏾

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