High-Yield Surgery Shelf/Step 2 CK Review

[@deathkissgoodbye]

I think where you shine compared to other medicine KZbinrs is your explanation and logical, common sense thought process and reasoning behind certain things. It really made me understand somethings by logically thinking, instead of regurgitating facts and memorizing uworld table. It’s similar to the way divine teaches and some Emma Holiday, but your even better at explaining in simple terms that any common man could understand without using complex terminology.

[@angelicav40]

For median nerve blue x at 21:15, I think your x should be placed on the more medial nerve. I believe in the diagram, your x is still on the radial nerve that controls hand/wrist extension.

[@subisessdub]

This IS THE BEST VIDEO EVER THANK YOU IT'LL HELP WITH FINALS

[@Doctor_Tim]

Thank you my guy!!

[@MDPowerhouse]

Solid comprehensive review! Super helpful

[@alexkumi6954]

Very Comprehensive…I love it. Can we get the slides?

[@Doctor_Tim]

Thank you! I'm working on a website with the slides, should be done soon!

[@Doctor_Tim]

Just got the barebones website up and running. If you click on the "content" section, you should be able to download the PDF of the slides. Let me know if you have any issues! www.stepbystepmedical.com/

[@usmleislife3396]

This is amazing. Can u make more video like this on surgery and medicine…? It’s very comprehensive.

[@Doctor_Tim]

I appreciate it! For sure, part 2's to these videos are in the works!

[@usmleislife3396]

@@Doctor_Tim great 😊..,

[@megansmith6576]

Awesome videos!!! You're an inspiration Dr. Tim ✨️

[@ajones7713]

Thank you for sharing this, I found it very helpful for last minute shelf review!

[@heather80]

Super helpful! For HDS BAT w/o peritoneal signs, looks like all roads lead to CT? Regardless of whether the FAST is +/- the next step is CT, either to plan surgery or to look for another cause for the symptoms... so why even bother with the FAST? Is it mostly if a patient is borderline going unstable and you want info fast? Otherwise as the algorithm is written it looks like "waste" since it wouldn't alter the diagnostic path. But I could totally see the utility of FAST for quick info incase things went south fast

[@deathkissgoodbye]

Unstable and no peritonitis, but fast scan is positive > laparatomy. Mainly for that, bec there is fluid leakage, no peritonitis, and there unstable, so surgical exploration is needed. Fast scan negative + unstable or fast scan positive + stable = CT bec it’s not urgent danger and have time to investigate further.

[@Doctor_Tim]

The below comment hit it on the head, great point! Imaging is always helpful for localizing a source of trauma but FAST is faster, and done at bedside without any potential delay meanwhile CT may take time to transfer, wait time, and then the process of completing the scan itself. So FAST is a more time-efficient way to confirm that there is significant intra-abdominal injury to warrant surgery. CT will give a more detailed survey but the downside is the time it takes could delay surgery by even a few minutes, so its only ideal when there is time (either the patient is stable, or FAST is negative and there's indeterminate location of an injury).

[@hadassahdasilva]

Thank you so much, Dr. Tim!

[@sy1511]

Hey Tim! Love the videos. Please keep them coming. I do have a question at 38:50 you say that compartment syndrome will be swollen, warm, and red but aren't the 6 P's of compartment syndrome (1) Pain, (2) Poikilothermia, (3) Paresthesia, (4) Paralysis, (5) Pulselessness, and (6) Pallor. So, shouldn't it be cold and pale for compartment syndrome? Please correct me if I am wrong.

[@Doctor_Tim]

Hey! That is a great question and a tricky one. You're absolutely right those are the 6 P's of compartment syndrome. The only trouble is that these symptoms often vary and are sometimes a progression (other such as pallor aren't all that common as well). But as far as my saying "warm and red", that's a bit of a stretch and a misspeak on my part. I was trying to create a visual for a visibly taut compartment from the swelling due to enclosed compartment expansion. Long story short, stick to the 6 P's as you mentioned, but keep in mind they may describe a "tight or swollen" portion of the extremity experiencing compartment syndrome. Again great question!! Hope that helps

[@sy1511]

@@Doctor_Tim It absolutely does help! Thank you! And again, please keep these videos coming!

[@megansmith6576]

I thought those were the 6 ps of acute limb ischemia which can present similarly but the etiologies can be different

[@deathkissgoodbye]

The both have the 6 p’s. Difference is compartment syndrome = tense swelling and pain on passive stretch. Like Dr. Tim said, problem is getting blood out of limbs and returning it back to heart, so swelling happens bec of the blood being stuck in a closed compartment. Acute limb ischemia, problem sending blood to limbs bec there is cardiovascular risk factors like peripheral arterial disease, diabetes, smoker and elderly person.

[@alexanderradaoui4136]

Wouldn't wide-spread vasodilation lead to decreased peripheral vascular resistance and pooling of blood in the peripheral tissues. As a result, wouldn't blood flow to the extremities be compromised? Wouldn't this lead to cold extremities due to decreased perfusion and circulation to those areas?

[@Doctor_Tim]

That's a great question. What you are saying could be possible after an extended period of distributive shock. However, they tend to primarily test the initial insult and the direct cardiovascular manifestations of that dysfunction. And in the short term, the decreased SVR and relative pooling of blood in the extremities is how the extremities stay warm in contrast to the other types of shock.

[@ma53-m4c]

Hey Dr. Timolol, will there be a part 2 of the surgery vids? lols

[@nnn6054]

Very nice review. Appreciate it!

[@aky19832001]

They very much are that nit picky on the shelf.

[@blessonmathew2927]

Can I please connect with you for tutoring for the surgery and IM shelf?

[@Doctor_Tim]

Of course, I'm working on setting that up as well. I hope to have everything ready soon!

[@externaltv7255]

27:27 when do you use a HIDA scan, I thought you use it when you don’t see a stone

[@Doctor_Tim]

That's right, it can be confirmatory if stone isn't visualized on ultrasound. Ultrasound first though, since it's so widely used and quick.

[@drgaurikumar9494]

is this video for revision of step2ck as well?

[@Doctor_Tim]

Great question. Yes this should cover material similarly to since Step 2CK has been updated. However, I will do more content in the future that specifically addresses new updates!

[@E33574]

really solid

[@mayTK]

Thanks

[@Doctor_Tim]

No problem!

[@DeepDiveMystery]

Is there going to be part 2 for this subject?

[@Doctor_Tim]

Great question, yes I plan on doing a part 2 as well!

[@Gela-e7t]

Great❤

[@xxyxexmxi]

Thanks this is awesome

[@Be1smaht]

too easy

[@harrisonzhu3300]

XR is not the first step for suspected aortic dissection lol

[@tylerkennedy1960]

for a stable patient with suspected dissection? It absolutely is. If you’re going to correct him at least know what you’re talking about lmao

[@harrisonzhu3300]

It's not. All you're gonna find is a widened mediastium possibly and then you're just gonna do to CT angio anyways. CT angio is the preferred choice for stable aortic dissection. Source: uptodate@@tylerkennedy1960

[@richarddarrah2014]

Guessing you failed your shelf because that’s basic workup for a stable patient with suspected aortic dissection. And to correct you, it’s CXR. Not just any “XR”.

[@harrisonzhu3300]

@@richarddarrah2014 I honored all of them and am months removed from step but I still recall that CT is first line, hope ur doing ok tho

[@abdullahahmed1251]

Agreed Def not first line CTA is