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

[@rachelwalker8283]

0:56 Criterias 8:11 Cardio 31:49 Pulm 46:39 GI 1:08:16 Endo 1:26:32 CT & Joints 1:33:37 Renal 1:48:22 Fluid/Electrolytes 2:08:16 Heme/Onc 2:29:54 ID 2:51:00 Derm 2:57:18 Ambulatory/Bonus

[@jamesbaxster4756]

You are the best! Thank you.

[@bhavdeeprehal8827]

Thank you! :D

[@jasotasachdev4450]

No neuro?

[@Sexdewana]

Jasota Sachdev there’s a separate neuro video

[@sethturner3245]

Sexdewana Neuro for the neuro shelf or neuro for IM? Or both?

[@AlishaMir]

love this but there's an error at 17:44, 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!!

[@shm4018]

was looking for this comment

[@marinashaji9220]

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.

[@karishmaKumari-wz2sd]

Hey can you tell how did you prepare for ethics? Exam real soon

[@usmleislife3396]

Really.. do u recommend watching this before CK exam ..? I was hesitating about this... plz do response

[@shajiamarunblanco2334]

Hi, my test is in 4 days, it is possible to talk with you? thanks

[@marinashaji9220]

@@usmleislife3396 yes absolutely

[@marinashaji9220]

@@shajiamarunblanco2334 sure

[@bugacuga]

Just a minor correction that a lot of med students understand incorrectly- "pain out of proportion to exam" doesn'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'd expect to really hurt them even on light palpation, but they tolerate deep palpation.

[@nishantpbkn]

THANK YOU!

[@vantidorainc.1608]

Abcense of guarding is the key 🗝️! With the level pain you would expect them to guard. Even involuntary guarding but

[@lastyllobille]

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

[@DeltaCJ]

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.

[@ValentineCrescent]

did it help?

[@CM-tu5wo]

1:01:20 --> Small Correction: Now, according to UWorld, you should image patients even if they have all the classical signs of appendicitis (Alvarado score ≥4) b/c it decreases the # of false positives getting appendectomies. You should use CT for everyone, except pregnant women and children, when you should use U/S. MRI is an ok choice too, but only choose it if the others aren't available. 1:25:35 --> you should also give Potassium with the IVF and insulin, bc total body stores are decreased. (from UW#2185) *Also, thank you so much for these videos. It's a huge relief to have something to go over for that last high yield review.

[@koolaid20100]

UWs algorithm isn't always up-to-date

[@Lenisse0105]

@@koolaid20100 According to UptoDate what @colton is saying is correct. Abdominopelvic CT with IV contrast is the way to go, not immediate surgery, as long as the CT is avaliable in less than 3 hours.

[@taraaziz2199]

correct me if I'm wrong, but didn't UWorld also say that changing respiratory rate is more favorable than tidal volume? thanks

[@mohitgogna9884]

@@taraaziz2199 A bit late to the part, but from the questions I've done they've said that tidal volume is more favorable.

[@hamzaelkasaby8]

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

[@QtipIV]

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

[@vms4861]

im taking mine tomorrow. how much did this video help?

[@QtipIV]

@@vms4861Helped a lot!!! I went through it a few times

[@s3r4ph1987]

​@@vms4861 I hope you passed your shelf exam 😊

[@elaa761]

@@vms4861 how did it go?

[@tyleralger6083]

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

[@AndrewGlerum]

The way he explains calcium oxalate stones and calcium absorption is second to none.

[@mimiodus]

I always saw that concept in uworld but could not understand it until now when watching this video.... so thank you Dr. HighYield

[@MalikKhan_925]

And the goddamn causes of hyponatremia!

[@amineawad]

I recently did Step 2CK and your videos were so helpful, especially for those of us doing these exams at a later stage in life with nobody to do such quick-fire revision with close to the exam. Thank you for doing these!

[@DoctorHighYieldMD]

Anytime. Glad I could help you. All the best!

[@asprucetree]

Used Dr. HY's videos before each shelf and it helped on all of them. Also binged all his step 2ck videos in the week before writing it. I got a 256. These videos are a great complement to Uworld/Amboss.

[@The_Kirk_Lazarus]

1.25x speed is super smooth playback. Thank you for this great source of information.

[@USMLELive]

Thanks for pointing that out!!

[@DrGauravThakur38]

2x bruv

[@matthewpace5451]

Hey Dr High Yield. 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. Overall your videos are AMAZINGLY helpful for a quick refresher before these exams!!! I've definitely benefited like thousands of other students!

[@mimi-my5bl]

IM shelf today. Came all the way back to this video just to say that I only had time to watch 30 min of it, but I swear I got 2-3 answers right because of this legend. Thank you. Will save for step 2.

[@khadija99488]

2:38:42 Listen up, guys! Azithromycin prophylaxis against MAC in those with CD4

[@sumitchauhan6538]

was burnt out, last 5 days only watched your videos on repeat. Got a very good score .Truly thank you for all these videos

[@swuggerman]

Hey Dr. High yield just wanted to thank you for the time and effort it takes to make these videos. Watched them religiously through my ms3 year and during dedicated. ended up with a 260+ and attribute a lot of that to these vids. Thank you for your service to our education.

[@DoctorHighYieldMD]

That is amazing, congratulations on such a high score, I am very proud of u 🙌

[@Goku-zp3ub]

I just completed step2 I can't thank you enough!!I only watched your videos in the last week. For most of the questions I can hear your voice emphasizing the next steps in my head I never realized they could be so helpful I thought they are pretty basic while listening but listening to them made a difference in saving time both during the revision and during the exam. Huge thanks

[@DoctorHighYieldMD]

awesome! so happy I could help out :))

[@digitiminimi5730]

Hey may I ask how was your exam?

[@brucerheaume5232]

For the Gi segment: 57:58 Gallstone ileus will typically present pneumobilia on radiograph or CT (not "gas in the gallbladder wall") 58:10 "...proximal to the ileus (sic)" isn't necessarily true; the stone can get lodged anywhere in the GI tract 1:06:00 Colonoscopy screening guidelines are after 45 now (although still controversial). They'll prob say the patient is over 50 to avoid this.

[@Superfly156]

You are the best, my dude! Third year is such a crap shoot of odd schedules, wide range of resources, and not enough time to get through it all. You give an awesome skeleton to build from.

[@Dukesofhazard94]

I literally have never understood RTA better than after this watching video. Thank you!

[@olabayram]

Keep coming back to this. Beyond Brilliant! Thank you Dr High Yield

[@tateg5692]

THANK YOU!! I have step 2 CK in a little over a week so this was so helpful. If I had watched this before my last practice test I would have gotten at least 5 questions right that I originally got wrong. I know this probably took a lot of effort on your part, so thank you! Wishing you luck with where ever you are on your medical journey!

[@bdgregorybd]

I just want to say, I want over all of your high yield videos two times over the week before step 2 and received a 241, which I thought would never have been possible this time last year. I can definitely say these videos help me organize the content much better and were a reason for my score, so thank you for taking the time out to do them, they're a gift!

[@prajjwalkunwar9287]

My exam is in a month is there something in addition I should add to revision list few days before exam?

[@mentalhygiene1250]

I took step 2 ck today and this video (along with your other rapid reviews) definitely bought me more than a few questions. Thanks for doing these! They’re a big help.

[@edouardaugustin200]

Great video! Minor correction: zoster vaccine at age 50. pnuemovax at 65

[@tooltime4]

Thank you for these videos! I have my STEP III tomorrow and I've hung out with you more this month than any of my friends or family lol. Please keep it going for the next generation of students! :D

[@DoctorHighYieldMD]

No problem and sounds like you are studying hard. Hope you crushed it!

[@shajiamarunblanco2334]

Thanks for the video, was helpful, I watched this video twice before my test, the first one two weeks before and the second time one week before the test. This video helped me to remember the most important concepts. I got my results today and I passed 🥳

[@mimiodus]

I loved that you mentioned Africa as a continent, a lot of people mention it as a country. Thank you!

[@rninski]

Taking Step 2 tomorrow. Just wanted to pop on and say thank you for all your help through third year studying for shelf exams and now for step 2. You rock! :)

[@MarceloSilva-yo8de]

I've just done PNA in Portugal. It was really helpful do watch Doc High Yeld's videos on the last days before the exam. While answering the exam I could listen to your tips in the videos! Thank you so much!

[@instanceofswag]

These are so helpful! Just wanted to point out at 35:01 the most common cause of pneumonia in COPD patients is *not* pseudomonas. Some resources put H. flu at the top, some I've seen say strep pneumo, moraxella, and h. flu

[@doboccaccio]

Super helpful video-- thank you! One small note since I just got a UWorld question wrong on this: even for CD4

[@ShaunAndersen]

I just did this question and got it wrong lol only 18% of people answered correctly that you just need TMP-SMX prophylaxis now!

[@wren_light]

Whaaaaat

[@neeldoshi25]

Can we still use this in 2024?

[@PPRGUN09]

its still like 95% accurate

[@asprucetree]

Sure can! I did and scored 256

[@TheDiensn]

I think recommendations have changed for keratoacanthoma: it is now treated as cSCC, and excision is recommended. Studying for shelf now, thank you for the video!

[@Lenisse0105]

Thanks from the bottom of my heart Dr. High Yield !!!! Your videos are gold. Loved the mnemonic of RTAs. I got this from UptoDate, hope it helps: Although Valve diameter < 1.0 cm is indicative of severe AS, it is not a mandatory criteria to diagnose it. Most important criteria are transvalvular pressure gradient > 40 mmhg or peak aortic jet velocity >0.4 m/s. Others: For gastrinoma, secretin test is the best next step only if gastrin levels are between 110 and less than 1,000. For appendicitis, best next step is CT with IV contrast as long as it is avaliable within 3 hours. Just as a comment: For BBs intoxication IV fluids and stabilization are first before giving glucagon.

[@kristelblack1827]

taking step 2 tomorrow and you have made my favorite videos/resources to use for step 1, shelf exams, and now step 2. your videos are soooo good. best of luck with everything!

[@bogdananton8247]

Thanks for the awesome review videos! According to UW, we now (2020) always image appendicitis before taking a patient to the OR since it can help guide the surgery and management.

[@marcringor4803]

Very good source for Shelf study! There are some inaccuracies, but they're mainly because of recent/relatively recent changes in Medicine. For example, diagnosing appendicitis has changed to include CT abdomen confirmation (according to the new Alvarado scoring system), though a lot of doctors still diagnose clinically (UWorld says get the CT lol). Another discrepancy are the screening parameters, but these regularly change with new research. Otherwise, this video is mainly solid!

[@petergaied5544]

excellent review. 1:12:16 Thyroid binding globulins basically have affinity to bind T4, but the bound hormone is not bioactive, only free T4 is active. high TBG -> low T4 -> hypothyroid state

[@dr.rajshekhar4738]

@ 1:24:30 glucagon is also antidote for hypoglycaemia due to insulin overdose in public setting. In hospital setting u prefer dextrose iv. Deep hi yields from UW

[@dr.pewpew2619]

Glucagon is, relative to D50, expensive. In the ED, with very few exceptions, I've only ever used it for BB OD.

[@adriennejarocki443]

we no longer prophylaxis with Azithromycin for MAC in HIV patients

[@tranquilmind8487]

It's probably still a testable item on Step 2 CK since they are always a few years behind clinical protocol

[@fieldingrichards4638]

@@tranquilmind8487 I recently had a UWorld question that said it is no longer given for risk of drug resistance

[@koolaid20100]

@@fieldingrichards4638 That's UW. NBME will lag a bit.

[@themindofjonathan3686]

@@fieldingrichards4638 Amboss Just gave me a question where the answer has AZITHROMYCIN

[@sachaatv7871]

@@fieldingrichards4638 They don't put controversial questions in exams. Even if those appear, they won't count it.

[@wajihansari363]

Got a few questions correct last week on step 2ck because of this HY series. Keep up the good work!!

[@hutshutrules123]

2:36:56 .. correction: uncomplicated UTI is nitrofurantoin, TMP-SMX, and fosfomycin in nonpregnant women.

[@sevanknerses]

this was the best review video that touched everything needed for a quick pre test self evaluation and fast review , thanks a lot doc and wish you all the best.

[@jonathangyebi-agyepong8625]

Thanks so much for your videos. They helped give me a 29 points increase from my last nbme 4 days to time. Please keep it up

[@DoctorHighYieldMD]

Jonathan Gyebi-Agyepong wow that's incredible. Congratulations!

[@jonathangyebi-agyepong8625]

@@DoctorHighYieldMD thank you 🙂

[@dredakin]

Thank you so much! I watched your videos for step 2 & 3 and passed! Thank you once again! God bless!!

[@AbhishekDharan]

FYI since this video was published the 3:11:00 reference to the herpes zoster vaccine being at 60 years old was in reference to the live attenuated shingles vaccine. In 2020 the FDA removed this from the market and US physicians can only prescribe the recombinant herpes zoster vaccine (trade name shingrex) starting at age 50. The benefit is this new vaccine no longer has any contraindications like the old live attenuated vaccine with regards to PMH for Shingles/Chickenpox (I forget what it was).

[@jacksaczawa1758]

Brah u went off in the endocrine section. Ill never forget the way you taught that stuff

[@blockhead777]

Passed my shelf thanks to you. So for real, thanks man.

[@monye9963]

Thank you for this, you are appreciated by many students around the world

[@danielcastilo1840]

Thank you bro, the video is intensely high yield . You 've managed to cram in a lot of topics that are commonly seen in Uworld , and am sure are actual exam material. I will study the material thoroughly. Hope you continue making these videos bc they are the best. Congratulations and all the best .

[@pinoy7tfc]

minute 57-58: Gallstone ileus is air within the galbladder*** (management is conservative > SBO tx) Emphasematous cholecystitis is air within the gallbladder WALL (mgmt is PCT + CCY)

[@SantiagoMartinez-kd1qi]

Just passed my IM shelf thanks to you! Great video!

[@stellaokafor4713]

this is really good and has been so helpful but UWorld says its normal Ca diet for kidney stones not high Ca. thank you for your videos.

[@ashlee-annrahaman3260]

Thank you bringing up this point. “Low calcium diets increase the risk of calcium-containing stone formation because they increase oxalate reabsorption.” The statement above is from Amboss. Not sure which one is more correct but I hope this is helpful.

[@CrazyCurryKing]

@@ashlee-annrahaman3260 late but low calcium would indeed increase oxalate reabsorption, the main mechanism of concern is with small-bowel resection you have reduced fat absorption, this fat then compounds with calcium leaving the calcium UNABLE to compound with oxalate and get excreted, leading to increased oxalate reabsorption similarly, if you have low calcium in your diet generally it will lead to the same effect.....not enough calcium to bind the oxalate and excrete it in the feces --> increased reabsorption of oxalate --> stones

[@MDPowerhouse]

Really appreciate all the work you put into making all these high yield reviews!

[@chadrichards4681]

Rivals Emma Holliday. So good, so high yield.

[@DoctorHighYieldMD]

Chad Richards Emma Holliday helped me a lot in med school I watched her videos a bunch of times. Thanks for the kind words :3

[@highyields]

@Chad I knew i'd find you here, god speed surgeon

[@chadrichards4681]

@@highyields haha, who are you!?

[@The_Kirk_Lazarus]

I think these are better. He's much more concise and includes images within the presentation.

[@chumadoshi6987]

@@The_Kirk_Lazarus Yes sir

[@michaeloh7487]

This is clutch man. Take Step 2 CK tomorrow and this was super helpful and concise!

[@drsandipchaudhari8636]

Hey dr high yield I got my 2ck score today. it’s 245 …thank you very much

[@DoctorHighYieldMD]

Congratulations my friend 👊🙌

[@drsandipchaudhari8636]

@@DoctorHighYieldMD I got a question similar to asthma(ABG) vignette.It was about ethylene glycol poisoning with elevated Paco2 despite Metabolic acidosis, answer I marked was intubation + mechanical ventilation.....like these so many were there from ur videos...thank u again for all the efforts u put in....God bless

[@aazee36]

Hats off to u for taking the time and effort to make this. I appreciate this a ton This was super helpful for a student like me who has to study with kids.

[@harvey2733]

Can't thank u enough dr. steven. u have been a great help in step2 ck journey

[@TheSteviebobevie]

First off, I love you. Thank you for the video series. Secondly, at 2:13:45 time on the video Hereditary hemochromatosis Type 1 is autosomal RECESSIVE. This is the classic version with HFE gene mutation. Type 2 is an autosomal recessive mutation of hepcidin gene. Type 3 is another autosomal recessive mutation of the transferrin receptor 2 gene. Type 4 involves a mutation of the ferroportin gene and this form is autosomal dominant.

[@KamranAli-gi7yq]

accord to new guide line colonoscopy is done at 45 instead of 50 years Age.

[@American-Dream-Rider]

Lung cancer screening age is 50 Not 55! and should be checked in patients with 20 pack years Not 30!

[@danielsoroudi7149]

so aggro

[@scotb7352]

***Correction 42:20 the hypercalcemia in sarcoidosis is due to excess vitamin D produced in the granulomas (not calcium- you can't make elements)

[@Low_pH]

I feel like for @1:27:12 I remember Uworld saying that at the diagnosis of RA you start DMARDs right away. You don't wait for progression and use NSAIDs only for symptomatic relief. Thought?

[@CrazyAsianDude]

Amazing lecture as always. Hoping you'll be back soon making these types of videos. Very clear and detailed explanations. Thank you! Keep safe and stay healthy doc!

[@antifreezeresearcher]

"starts with p, ends with arvo" "a, b, c- methotrexate, d.. you pick methotrexate" LOLOLOL thank you so much Dr. High Yield

[@HadeerSinawe]

I believe we do CT scans for suspected appendicitis now. It's a new change, like no longer prophylaxing for MAC or no longer using MTZ for C. difficile infections.

[@dr.pewpew2619]

Thanks for this. You beat me to it. We don't do blind appy anymore. Even if they rupture, that doesn't garentee surgery. Only with hemodynamic instability does anything happen without extensive imaging.

[@xrulkaz]

Dresslers is treated with high dose NSAIDs primarily (occasionally aspirin and colchicine)

[@matthewbaska2854]

Please do a High Yield for Step 3 please!!!

[@Jenette818]

You're the GOAT simple as that. I was a big fan of your videos with USMLE Rx and this is even better than that resource.

[@rociodelmararroyoguzman2441]

20/10! THANK YOU! You are THE best!

[@mattvwalsh]

45:45 is outdated info. Aspiration pneumonia is treated as CAP unless an abscess or empyema is present.

[@acpianogrl87]

So high yield!!!!! Thank you! You've definitely helped me out in my clerkships this year!

[@rebeccab7213]

@52:07 Protozoal parasites don't actually cause eosinophila typically. Helminths, however, will.

[@user-fs2uy5ip4b]

Bro Im buying your book just for support - I prefer videos because im lazy, but dude just unreal content. Thank you

[@darkgrls595]

Thank you so much, its cram time for my shelf and this was extremely helpful!

[@GroupSnofu]

Thanks for the video it’s super helpful! One correction I think is pityriasis is treated with selenium sulfide not antihistamines and another is that PT usually isn’t elevated in VWD, just PTT sometimes

[@mimiodus]

you are wrong about pityriasis rosacea and Dr. Highyield is right, you treat with corticosteroid or antihistamines.

[@jp32123]

this man BODIED the explanation on RAAS! 👏🏽

[@MDHolmesMD]

alpha thal *points to self* aplastic anemia bug *starts with "p", ends in "arvo"* appreciate the humor and wonderful review, doc

[@kaimia2010]

You are awesome! Thank you! i will be watching all of your videos again before Comp and Step 2.

[@lizsalgadoromero]

Very helpful even for step 3. Thanks for doing this :)

[@aybikeaydin1446]

Appreciate everything you do for us! Just a quick comment @ 52:08 you say Entamoeba Histolytica will cause eosinophilia but UWorld disagrees with you saying eosinophilia is only seen mostly in helminth infections.

[@riaghosh003]

This is really great! I have gone through ALL your videos and they are just perfect for rapid review and revision for the Step 2CK exam. I was wondering if it would be possible for you to share the notes you have made for all these videos too just for a quick reference. Thank you so much once again :)

[@DoctorHighYieldMD]

Smarajita Ghosh hello yes I am working on putting something together

[@riaghosh003]

@@DoctorHighYieldMD Cant thank you enough!

[@riaghosh003]

@@DoctorHighYieldMD my step 2ck exam is on 3 Sept. Is there any chance I can expect something before that? Thanks again :)

[@DoctorHighYieldMD]

Smarajita Ghosh it won't be ready by then. But if you know the videos well, it's a sign that you are ready! All the best

[@riaghosh003]

@@DoctorHighYieldMD No worries! Thank you so much for the reassurance! Your videos have already helped me immensely in my preparation! Keep up the AMAZING work :)

[@aishwaryasridhar5832]

Update 1. Shingles vaccine starts 50

[@juicy7457]

Using this as a review for step 2 in 2023 and just started cracking up at the anemia talk around 2:16: " What's the answer A, B, C, methotrexate, D, E... well it's methotrexate"

[@proudgh3260]

Thank you very very much for all the reviews I am most grateful

[@DY-ke1di]

i'm struggling with this test. thanks for the help

[@DoctorHighYieldMD]

You can do this 💪

[@sriyaroychaudhuri8812]

Very well made videos! Just what we need in the last few days before the exams. Thanks for taking the effort to explain some key concepts as well.

[@dp_md]

I recognize your voice from USMLE Rx. Great videos. I'm hoping for more of the same when I get around to watching this one. 🙏

[@danielkatigbak8319]

Thanks for this. Im on my first pass in uworld and been doing it by system. This gives me a good recall on what ive previously read

[@gabriellejoy4126]

This is amazing. Thank you!!!!!! High yield review!!!

[@noorkhalil638]

1:38:43 Renal Tubular Acidosis (really nice summary)

[@nxd1141]

Thank you so much for the excellent review. Have you released the notes yet ? I don’t see any links ? Thank you for taking the time to read this , I hope to hear from you soon

[@SlaveofAllahhh]

This was amazinggggggg!!! Thank you so so much for your hard work! :D

[@AmyNguyen-cl5yz]

This is definitely best watched with lots of pauses in between, and referencing Dorian/Uworld/Amboss/First Aid as needed. In terms of using this as a hit list/shit list, it is perfect.

[@maisha531]

At 14:17 I thought diastolic heart failures had preserved ejection fraction and systolic heart failures had reduced ejection fraction?