POPULARITY
13 episodes with qbanks
2 episodes with qbanks
2 episodes with qbanks
6 episodes with qbanks
2 episodes with qbanks
In today's episode, Dr. Paul is going to explain the right way to tackle your question banks for maximum efficiency and results (hint: It's probably not what you think).Learn how you can work with us throughout your USMLE Step 1 or Step 2 CK exam prep by visiting us at usmleguys.comThe Drill Sessions mentioned in today's podcast can be found at usmledrills.comFollow us on YouTube for more drill sessions, USMLE Coaching, & more... Follow us here: https://www.youtube.com/c/TheUSMLEPreparationCompanyFREE RESOURCES:(1) USMLE Step 1 Fast Facts (Study on your phone): https://theupc.net/ff(2) USMLE Step 2 CK Fast Facts: https://theupc.net/ck-ff
In today's episode, Dr. Paul is going to explain why you need at least TWO USMLE qbanks and how to use them effectively to maximize your exam day results.Learn how you can work with us throughout your USMLE Step 1 or Step 2 CK exam prep by visiting us at usmleguys.comFollow us on YouTube for more drill sessions, USMLE Coaching, & more... Follow us here: https://www.youtube.com/c/TheUSMLEPreparationCompanyFREE RESOURCES:(1) USMLE Step 1 Fast Facts (Study on your phone): https://theupc.net/ff(2) USMLE Step 2 CK Fast Facts: https://theupc.net/ck-ff
Video for this podcast: https://mehlmanmedical.com/usmle-do-i-need-to-do-2-or-3-qbanks In this clip I talk about how many / which Qbanks you should do in preparation for USMLE. I will be posting various random clips like this to informally address questions you guys have from the Telegram group. Main website: https://mehlmanmedical.com/ Instagram: https://www.instagram.com/mehlman_medical/ Telegram private group: https://mehlmanmedical.com/subscribe/ Telegram public channel: https://t.me/mehlmanmedical Facebook: https://www.facebook.com/mehlmanmedical Podcast: https://anchor.fm/mehlmanmedical
In this clip I respond to a student's question about when/how to use Qbanks in preparation for USMLE. I will be posting various random clips like this to informally address questions you guys have from the Telegram group. Main website: https://mehlmanmedical.com/ Instagram: https://www.instagram.com/mehlman_medical/ Telegram: https://mehlmanmedical.com/subscribe/ Facebook: https://www.facebook.com/mehlmanmedical Podcast: https://anchor.fm/mehlmanmedical Video for this podcast: https://mehlmanmedical.com/usmle-when-how-should-i-do-qbanks
Intro 3:12 What does your first assessment score mean? 6:30 The Level 1 prioritization checklist 9:16 Primary and secondary resources, Qbanks & integrating them into your study schedule 19:56 Developing your study plan for dedicated 37:40 Alternate Qbank & tips to reach your best score 41:48 Critical things to keep in mind when using UWorld 47:33 Dissecting a USMLE-style question 51:26 OMM-specific tips, resource recommendations & practice questions 1:05:43 Live Q&A - What flashcard decks do you recommend for Step and Level 1? 1:07:15 Parting thoughts
Figuring out how to use your holiday break? Whether you're in med school or residency, this episode is dedicated to helping you navigate your holiday break, especially if you're trying to find a balance between relaxing and looming study deadlines. Topics and times covered below: Intro 1:55 — Tips for pre-clinical students, especially if you're starting to think about the USMLE Step 1 5:03 — Overview of potential Step 1 resources — UWorld, First Aid, Anki flashcards, etc. 5:57 — Tips for third years, including resources for USMLE Step 2 CK, such as UWorld, Step Up to Medicine, Master the Boards, IM Essentials 9:01 — Supplementary resources for third years, e.g. Pestana's Surgery Notes, First Aid for Step 2 CK, AMBOSS, Sketchy, Anki 10:15 — Tips for fourth years 12:09 — Tips for residents, whether you just need rest or if you're feeling ambitious 14:01 — Best general practice for everyone to avoid burnout 15:55 — How Med School Tutors can assist you in achieving your best results Live Q&A: 16:40 — I will take Step 1 in April, currently studying First Aid and Qbanks? What should I do to keep going and convince myself that it's going to be enough? 18:30 — Should I save my Qbank for dedicated? 19:45 — How do I figure out what topics to prioritize when studying?
Session 29 Which of these neurotransmitters is mostly likely causing this patient’s galactorrhea and secondary amenorrhea? Where is it coming from? Dr. Karen Shackelford from BoardVitals. When you're looking to prepare for your Step 1 or Level 1 board exams, check out how BoardVitals can help you. You can find all their amazing QBanks for Step1, Level 1, or even any of your SHELF exams. Use the coupon code BOARDROUNDS to save 15% off. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:37] Question of the Week A 34-year-old woman presents with amenorrhea for six months (secondary amenorrhea). Her menstrual cycles have been regular until this episode. She has, most of her life, a period every 28 days with a menstrual period that lasted three days. Today, on exam, a white nipple discharge is noted. A test for urine hCG is negative. Which of the following neurotransmitters suppresses the release of the hormone responsible for her condition? (A) Dopamine (B) Insulin (C) Serotonin (D) Somatostatin (E) Vasopressin [Related episode: Why Is This Menstruating Patient So Sick?] [02:50] Thought Process Behind the Correct Answer The correct answer here is A. If you think about the treatment for prolactinoma, where prolactin is released from the anterior pituitary, bromocriptine and cabergoline are used to shrink the prolactinoma. They're both dopamine agonists. The patient's symptoms are suggestive of prolactinoma. It's not totally obvious though as there wasn't headaches or visual field issues mentioned. Nevertheless, prolactinoma is the most common of all pituitary adenomas. It's also the most common cause of galactorrhea. The clinical features include amenorrhea, galactorrhea, and infertility. The prolactin normally stimulates the mammary glands to produce milk and inhibits the secretion of gonadotropin-releasing hormone, which results in amenorrhea and infertility. With large tumors, like the compression of the optic chiasm that results in bitemporal hemianopsia. Dopamine is normally used to suppress and release the prolactin. When you're not breastfeeding after birth, this becomes an issue. [05:15] Understanding the Incorrect Answers Insulin is produced by the pancreas and it's necessary for the uptake and utilization of glucose. Serotonin agonist is available in several classes, used as antidepressants. They're used to treat migraines, but not for prolactinoma. Additionally, some antipsychotic agents interfere with prolactin. Somatostatin is a hormone secreted by the pancreas that inhibits secretion of insulin and glucagon. It reduces the activity to digest the system. It's not receptive to dopamine and not related to galactorrhea. Vasopressin is an antidiuretic hormone and it's not affected by dopamine agonist. [06:22] Key Takeaways The key concept is that prolactinoma is probably the most common type of pituitary tumor and is the most common cause of galactorrhea. The symptoms occur because prolactin stimulates the mammary glands and suppresses GnRH, causing amenorrhea and infertility. The dopamine agonist suppresses prolactin secretion and shrinks the prolactinoma. Links: BoardVitals (coupon code BOARDROUNDS to save 15% off)
Session 28 A patient with a 2-month-old kidney transplant has elevated creatinine, fever, and tenderness at the graft region. What other finding is likely present? As always, we’re joined by Dr. Karen Shackelford of BoardVitals as we dig into today’s case to help give you a better understanding. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:02] BoardVitals If you're preparing for your USMLE Step 1 or COMLEX Level 1, check out how BoardVitals can help you prepare for your exam. Use the promo code BOARDROUNDS to save 15% off their QBanks. They have the 3-month version with over 1,700 questions. Once you're in medical school, they also have QBanks for the SHELF exams. [02:24] Question of the Week The patient who has a history of kidney failure as a result of multicystic kidneys has an allograft kidney transplant. Two months later, she presents with fever, malaise, and tenderness in the graft region. Her lab work shows a rise in creatinine. What other finding is characteristic of her condition? (A) Hypotension (B) Decreased graft size on the ultrasound (C) Patchy mononuclear cell infiltrates without tubulitis (D) Urinary obstruction (E) Oliguria [03:20] Thought Process The correct answer is E. The oliguria is a frequent finding. She has fever, malaise, and graft tenderness. Some patients can actually be asymptomatic during acute renal transplant rejection. They usually have hypertension that's why answer choice A is wrong. The graft may actually be enlarged on ultrasound. Creatinine only rises when there's significant histologic damage. If the graft rejection progressed, there would be weakness and fibrosis. You would have a decreased graft size but not at this point. Patchy mononuclear cell infiltrates without tubulitis is a pathological description of something that occurs in patients who have a normal functional renal allopath. So the histopathological findings in patients with rejection may have findings of interstitial infiltration with mononuclear cells, sometimes eosinophils. And the tubular basement membrane will be disrupted by these infiltrating cells. This is tubulitis. Along with inch-small arteritis, it's considered the primary lesion of acute cellular rejection. Acute antibody-mediated rejection is characterized by vasculitis with neutrophils, anti-glomerular and peritubular capillaries fibrin, thrombi, or nephrosis. Then there's interstitial hemorrhage, the presence of CD4 and antibody-specific to the donor suggest an antibody-mediated reaction. In chronic allograft dysfunction, you will see peritubular basement membrane splitting and multi-layering of the basement membrane. The antibody-mediated rejection is an albumin response that occurs as antigen-antibody complex fixes complement with the activation of multiple complement protein. C4D is the component of the normal complement pathway. When C4 is split into C4A and C4B, C4B is then converted to C4D. This binds covalently to the endothelial basement membrane and the collagen basement membrane. In a normal kidney, C4D can be found in the glomerular mesangium and at the vascular pole. But the excessive reduction of immune complex deposition disease results in accumulation in the glomerular capillaries. The CD4 deposition can be seen by monoclonal antibodies staining and fluorescent tissue immunofluorescence. Peritubular capillaries staining is useful in just renal allografts. In acute allogra rejection graft, they appear large. Urinary obstruction is not the mechanism of oliguria in patients with renal allograft rejection. [09:20] Definition of Acute Rejection Graft versus host reaction is an immune condition that occurs immediately after a transplant procedure when the immune cells from the donor attack the recipient patient's host tissue. Acute rejection goes the other direction that is characterized by oliguria, fever, malaise, and graft tenderness. So you're having this inflammatory reaction. When you have chronic rejection, like anything else she developed, there was significant tissue damage from chronic inflammation. The most common cause of graft failure after the first year is called chronic rejection under the Banff classification system. Chronic allograft nephropathy, which is chronic rejection, is characterized by interstitial fibrosis and tubular atrophy. Links: BoardVitals (Use the promo code BOARDROUNDS to save 15% off their QBanks.)
Session 27 A patient with a history of arrhythmia is found to have atrial amyloid deposition on autopsy. Do you know what peptide is associated with this finding? Dr. Karen Shackelford joins us for another round of interesting questions to help you ace your boards. If you haven’t yet, check out BoardVitals and use the promo code BOARDROUNDS to save 15% off. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [02:14] Question of the Week The autopsy of the patient with a history of arrhythmia revealed amyloid deposition in the atria but no other amyloid was found in the ventricles. Which of the following peptides is associated with amyloid deposition in the atria? And what is that peptide's function? (A) Calcitonin and reduction of blood calcium concentration (B) Prolactin and gastric emptying (C) Acetylcholine and positive chronotropy to sinoatrial node (D) Immunoglobulin and cell-mediated immune response (E) Atrial natriuretic peptide and vasodilation [Related episode: Cardiac Electrophysiology—What is it?] [03:15] Thought Process Behind the Correct Answer The correct answer is E. An amyloid is a group of diverse extracellular proteins in variable amino acid sequences and they have common physical properties. Amyloid deposition and the extracellular deposition of the fibrils are composed of the subunit of varied serum proteins that form beta-pleated sheet configurations that lead to the histologic changes seen in amyloidosis. Isolated amyloidosis is found only in a single organ such as this cardiac amyloidosis. Alpha-atrial natriuretic peptide is responsible for deposition in this isolated cardiac amyloidosis. This is what's responsible for amyloid deposition in part. The incidence appears to be maybe part of the normal process of aging. In one autopsy series, 86% of the patients between the age of 81 and 90 had isolated atrial amyloidosis. It may lead to heart failure. Although diuretics are commonly given to patients with heart failure due to cardiac amyloidosis, beta-blockers, calcium channel blockers, and ace inhibitors may be harmful. [05:55] Understanding the Wrong Answer Choices Calcitonin is associated with isolated amyloidosis of the thyroid. Prolactin is associated with lactation found in amyloidosis that is isolated to the pituitary gland. Acetylcholine is the negative chronotropic sinoatrial node in the right vagus nerve. The stimulation of the nerve decreases the firing of the SA nodes, increasing potassium and decreasing sodium and calcium movement to the cell. Finally, immunoglobulin amyloid deposition is widespread and it's the result of its light chain immunoglobulin deposition. The point of the question was that isolated amyloidosis can affect many particular organs. This is different from more widespread amyloidosis related to immunoglobulin in terms of ideology and distribution. [07:10] The Big Takeaway Amyloid is not just that atrial natriuretic factor but you have to ask yourself where is it is as you're reading this question. Is it in the parathyroid for prolactin or widespread for the immunoglobulin or is it in the atrium for the atrial natriuretic peptide? [08:11] BoardVitals Check out BoardVitals for their Step 1 and Level 1 QBanks. Use the promo code BOARDROUNDS to save 15% off. This can be used for your SHELF exam QBanks as well. Links: BoardVitals
Medical Basics Podcast - Tips, Tricks, and Advice for Medical and Nursing Students
In this podcast we talk about some of the best resources for the surgery shelf and what you can use when you’re on the rotation. Learn more about some of the best Qbanks, textbooks, videos, websites and physical resources. Be sure to check out medicalbasics.com for more educational resources! Prefer video, check out the youtube video: https://youtu.be/PzTplPo694k
Session 104 Dr. Bruce Chamberlain tells me why he sees palliative medicine as more of a calling than a specialty. We discuss empathy, communication, and avoiding burnout. Bruce has been out of his training now for 29 years and has been practicing hospice and palliative care medicine all around the country. In case you may not have come across it yet, please do check out Board Rounds podcast, which I do with BoardVitals, a USMLE/COMLEX Step 1/Level1 test prep company. They offer QBanks for both Step 1 and Level 1. They also have amazing QBanks for your SHELF exams for your clinical years. Going back to the episode today, palliative and hospice medicine is a specialty that is important. But not a lot of people know about this and not a lot of people actually consult palliative medicine early enough. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:50] Interested in Palliative and Hospice Care Bruce got into this specialty without a plan, in fact, he had never heard of it before. He was board-certified in internal medicine and practicing in a clinic doing internal medicine. Seeing that the majority of his patients were elderly, he began to notice a trend in his patients. They often had a functional limitation as a result of pain, whether they had osteoarthritis or low back pain. Bruce started self-educating in noninvasive pain management as well as some low-level injections. He partnered with a physical therapist. They started to become more aggressive with pain management and saw great success. As a result, a fair part of his clinic was devoted to geriatric pain management. Through the course of time, one of his patients ended up in the hospice. The hospice called him and asked to help them with pain management. So during his day off, he'd work at the hospice. Bruce considers working in hospice or palliative care as more of a calling than a job. You just feel like this is where you belong and what you're supposed to be doing. And this happened to him. He began looking forward to half-day of the week going to the hospice. It was when he felt it was being the kind of doctor that he wanted to be. Because of this, he slowly increased his hospice time and decreased his clinic time. Until finally, the clinic asked for his commitment and asked him to fish or cut bait. While at that time, the hospice offered him a full-time position so he cut bait. From then on, he never looked back. He has done hospice and palliative care full-time or part-time for over 20 years now. [Related episode: Palliative Care - There is Always Something You Can Provide] [05:20] On Being Around Death All The Time Bruce explains that in hospice, you have to change your mindset in that you have to accept the reality that people die. Physicians are trained in the combat mode, fighting disease. And they are taking it as a personal and professional failure when a patient dies even though that's going to happen to all of us. When you accept the reality of death, then success becomes – was the patient comfortable? Were they able to have closure on outstanding emotional issues? Was the family able to be there? Were they able to die at home as opposed to being plugged into 15 different tubes and monitors in the ICU? Yes, it's sad that they died. But it's great that they died in a way they wanted to and they were comfortable. Moreover, usually at the very end of hospice care, there would be months before death takes places where you just manage their symptoms. It's about improving their quality of life for the time they have left because they were able to aggressively manage their symptoms. And oftentimes, they get positive feedback before the death as well as after the death with family comes up to thank them. [Related episode: This Physician Wants to Change The Narrative Around Death] [08:35] Traits that Make a Great Hospice and Palliative Care Physician You have to be patient and have empathy. But you also have to have the ability to draw that fine line between empathy and getting too emotionally involved with what's going on. You have to be able to relate and have the patients feel like you actually understand them or you're there for them. A good hospice and palliative care doctor is very skilled at pain and symptom management. In geriatrics, you would usually review the patient's medication list. [10:25] Hospice vs. Palliative Care Hospice has been defined by Medicare – a patient with a medical condition that if it continues as anticipated, we expect the patient to die within six months. Bruce doesn't actually like this definition because nobody is that good at prognostication. But Medicare is looking to change that definition to allow for earlier care. Bruce defines hospice as the point of the sphere of palliative care which is an aggressive end of life care. Palliative care refers to aggressive quality of life interventions, symptom management, and communication with the patients and their families. It's important the patient's family knows what's going as you can't have informed consent if you're not informed. They also ask the hard questions such as the resuscitation status that people are often reluctant to do or do incredibly badly. Aggressive symptom management includes pain management with patients who are post-op. Palliative care is a broader spectrum of quality of life interventions and symptom management that includes, but is not limited to, end of life care. Whereas hospice is end-of-life care. It's part of palliative care but palliative care is much more. [13:22] Diagnosing Patients Bruce explains that palliative care is not called upon to be expert diagnosticians. Usually, they already know what's happening. And they work in conjunction with other doctors. For instance, the surgeons are still taking care of the surgical issues while Bruce does symptom management. [14:30] Typical Day Bruce is currently working as an inpatient palliative care doctor. He comes in the morning and works with the nurse practitioner and two nurses who are liaisons with the hospice system. First, they review consults that have come in from yesterday afternoon and after the shop has closed down and through the next morning. Then they make up a list of all their patients for review. They look at the plans and look at whether some other interventions are needed. They then split up the consults. Bruce would usually attend to the multidisciplinary ICU rounds. The rest of the day is spent doing new consults and doing follow-up visits. They also educate them on what their discharge options are from facility rehab to long-term care facility to hospice. They would often have to explain what hospice is as what they have in their minds is the 1960s setting. They have to explain that modern hospice involves aggressive management. You could stay on your medications. They will talk to you about risks and benefits but it's your choice. They try to keep you out of the hospital and go through the benefits involved. Most people are very surprised to hear that this is what hospice is. During family meetings, they would usually discuss the patient's condition, the current treatment plan of care, and then options going forward. Then together they make decisions when the patient is unable to participate in that decision-making process. [17:55] What He Loves About Being a Palliative Care Doctor What Bruce loves about being a palliative care doctor is having enough time. As a hospitalist, you're in and out. You have to see all these patients. You get them admitted and discharged. It's a constant rush. In palliative care, he just spends an hour and a half in a family meeting with a patient in the ICU. There was no rush. He was able to spend all the time that the family needed to answer the questions and give them the information and help them come to a decision. Bruce says there's nobody else in the hospital that can do this. Both in hospice and palliative care, they have a strong emphasis on engaging a multi-disciplinary team. They often bring in a social worker or a chaplain or a spiritual care worker. As a palliative care doctor, he would assess the needs of the patient and access the other resources. And to be able to relieve that by providing information is incredibly rewarding for Bruce. [21:18] Taking Calls In the hospice he's working in, there are only two of them and they provide an 8am-5pm service. They're a very new service to be doing the more aggressive types of interventions they're doing now. That being said, they still have to prove themselves before they can grow and get JCAHO-certified. (JCAHO stands for Joint Commission Accreditation for Hospice Organizations) And to get certified, you have to have 24/7 coverage, which can't be done as of the moment with only two of them. [22:20] The Training Path When hospice and palliative care became an ACGME one-year fellowship, it had more boards that endorsed it than he believes any other subspecialty has. In almost all of the boards you could think of, as you go through your residency, you can then apply for a 12-month fellowship. In short, there are a lot of different paths that you can take to get there. In line with this, they believe that primary care physicians should have basic knowledge of palliative care. They should have basic pain management skills. They should be able to talk through advanced directives. They want to see primary care doctors educate themselves enough to get the basics and know when to defer to a palliative care specialist. So they want more of them trained. Part of this is because there is a growing demand for doctors doing palliative care due to the increasing aging population. Bruce says this is a field in medicine that is in high demand and will continue to be based on just population demographics. [26:00] The Challenge in a Lot of Hospitals In smaller hospitals, full-time palliative care is somewhat limited that it becomes an extra duty for the hospitalist. Previously, Bruce implemented inpatient palliative care as part of his hospitalist practice. The hospital paid him a stipend to manage it. However, it doesn't pay for itself in a silo. Instead, they save a lot of money by getting patients out of the ICU sooner and getting them discharged sooner. In the big picture, every study that has been done has shown that inpatient palliative care saves the hospital money. Unfortunately, hospitals just look at the cost. This becomes challenging for smaller hospitals to want to go out and bring in a full-time palliative care doctor. In this regard, hospitals are using nurse practitioners in that role. And the issue is they don't make tons of money with what they do. [27:44] Working with Primary Care Doctors The first thing Bruce wishes that primary care doctors knew is that they don't have to wait until their patient is actively dying to get palliative care involved. If you have an elderly patient with multiple chronic medical problems, those are patients that palliative care can help with. They can help with symptom management. They can take the time that primary care doctors don't have in the clinic. They can provide this service. Don't wait until end of life and don't let their patients suffer. If they're having trouble managing pain, they can help with this. In fact, this is an increasing problem, with opioids not being prescribed by a lot of doctors anymore because they're so nervous about it. [29:50] Special Opportunities Outside of Clinical Medicine There a lot of academic opportunities for palliative care doctors. Many of them actually move up into administration. Other opportunities include research and teaching. On another note, what Bruce likes the least about being a hospice and palliative care doctor is the fact that most people don't understand what they do. They just see him as the "death doctor" without really understanding the broader picture. He also doesn't like the current financial picture. [31:50] Major Changes in the Field With the workforce shortage and the aging population, Bruce thinks that there has got to be a change in the Medicare regulations for the hospice benefit. Hopefully, there's more involvement in palliative care in residencies and medical schools. This way, there's more exposure and a better understanding of what they do. Ultimately, if he had to do it all over again, Bruce thinks this actually is a hard question. Where he came from, there were very few full-time jobs in hospice and palliative care medicine. So he had multiple job changes and each time, there was significant stress. All those being said, in terms of his personal path, he wouldn't mind doing something more stable and consistent. But in terms of the work he does, he feels this is more of a ministry. He loves what he does. [33:50] Final Words of Wisdom If you're a student doing rotation, go spend some elective time. It's a great way to see what they do. Volunteer with a hospice. They always need volunteers. Go shadow a hospice doctor. Bruce also draws the difference between inpatient palliative care, outpatient palliative care, and hospice. Each has a very special skill set and special population. So go out there and get exposed to it! [34:50] Interview with Dr. BJ Miller I had a previous interview with Dr. BJ Miller, a triple amputee from an accident he had while in college He went on to medical school and became a hospice and palliative care medicine specialist. He has made it his life's mission to help people die in a better way. Check out that interview on The Premed Years Podcast Episode 301. Links: Board Rounds podcast BoardVitals The Premed Years Podcast Episode 301 with Dr. BJ Miller: Near-Death Experience Led This Physician to Help People Die
Session 22 Today, we tackle a pathophysiology question related to pancreatitis. Once again, we're joined by Dr. Karen Shackelford from BoardVitals. Check out their QBanks containing 1,700+ questions for Step1/Level 1. Use the promo code BOARDROUNDS to save 15% off. [01:50] Question of the Week A 45-year-old male presents to the hospital with abdominal pain and vomiting. He began to experience a dull pain in the epigastrium two days prior to admission that has progressively worsened. The pain radiates to his back. He's had several episodes of bilious non-bloody vomiting. He has no prior medical conditions. And he takes no medications. He has a 20-pack per history of tobacco and drinks 6-10 beers daily. The vital signs vary, has a temperature of 100 degrees Fahrenheit, and a heart rate of 102 beats per minute. He appears uncomfortable. On exam, his abdomen is soft and mildly distended, with marked right upper quadrant in epigastric tenderness to palpation. There is no rebound or guarding. He has hypoactive bowel sounds and no palpable masses or hepatosplenomegaly are appreciated. Laboratory studies through the hemoglobin of 12.8 g/dL, leukocytes 14,500 cells per mm3, with 81% PMNs and 16% lymphocytes. Platelet count is 178,000 and total bilirubin is 1gm/dL with the direct bilirubin of 0.4 g/dL. Alkaline phosphatase is 90 IU/L and aspartate aminotransferase (AST) is 88, alanine aminotransferase is 78, and serum amylase is 1,447 IU/L. What is one of the pathophysiological mechanisms of this patient's condition? (A) Pancreatic duct obstruction due to a stone (B) Activation of pancreatic stellate cells (C) Viral infection (D) Intraductal stone formation (E) Toxic fatty acids in pancreatic microcirculation [04:00] Thought Process Behind the Correct Answer Hemoglobin is normally low. White blood cells are minimally elevated. Platelets are normal. Bilirubin is a little bit elevated. Alkaline phosphatase is slightly elevated as well as the aspartate aminotransferase (AST), alanine aminotransferase and amylase. The condition of the patient is actually pancreatitis. The lipase is also slightly elevated which is more specific for pancreatitis and amylase which can be released by other cells as well. The most common cause of pancreatitis is gallstone pancreatitis but this guy has a history of pretty heavy drinking. The second most common cause of pancreatitis is related to alcohol. It's not clear though exactly how they're related but most chronic alcoholics do not end up with chronic alcoholic pancreatitis. But there may also be other risk factors to be considered here. One of the mechanisms is the hyperactivation of the pancreatic stellate cells. These cells that get activated by alcohol as well as by acetaldehyde. They regulate the deposition and the degradation of the pancreatic extracellular matrix protein. They secrete the matrix proteins and metalloproteinases that degrade the matrix proteins. So they regulate all the extracellular matrix proteins in the pancreas. Whenever they're overactivated by phenol and acetaldehyde, the metabolite of ethanol, the matrix becomes fibrotic. That's one of the mechanisms of chronic pancreatitis. Another interesting thing is that the stellate cells also express ADH and whenever overactivated, it seems to perpetuate a cycle of autocrine reactivation. So it's self-perpetuated. Another mechanism of alcoholic pancreatitis is that the alcohol is metabolized by both oxidative and non-oxidative mechanisms. There are changes in acinar cells that increase the activation of intracellular digestive enzymes. Hence, there's an autodigestive component. There is a transient decrease in pancreatic blood flow that results from the action of ethanol. 10:17 There's also an increase in ductal permeability related to alcohol use. It then makes it possible for these improperly activated enzymes to leak out of the duct into the surrounding tissue which just adds to the inflammation and fibrosis. Any of those mechanisms could be asked on the USMLE. [11:00] Understanding the Other Answer Choices It's not completely known what causes pancreatitis. After an obstruction, there's an increase in pancreatic pressure. Studies showed that the flow of biliary salts itself does not cause pancreatitis. This patient doesn't have a previous history given the biliary colic. Bilirubin is relatively normal and patients with a stone obstruction usually have a direct hyperbilirubinemia. The viral infection mumps and Kawasaki virus have been implicated in some sporadic cases of pancreatitis. But this is unusual and this patient doesn't have a history of it. Intraductal stone formation is what causes pancreatitis in patients who have hypercalcemia due to hyperparathyroidism or some other conditions. They usually have additional features mentioned in the history that are associated with hypercalcemia. These may include constipation or kidney "stones, bones, groans, and moans." Finally, fatty acid deposition with ensuing inflammation is the mechanism of pancreatitis in patients who have familial hyperlipidemia. They have those really high triglycerides. They would usually have other features mentioned like xanthelasma or early atherosclerosis or family history. Links: BoardVitals (Use the promo code BOARDROUNDS to save 15% off.)
Session 20 Today, we tackle another maternal-fetal or pregnancy question. We're joined once again by Dr. Karen Shackelford from BoardVitals. They offer a comprehensive QBank for Step 1 and Level 1. And even as you continue on your medical school journey, they have QBanks for Shelf exams as well. Use the promo code BOARDROUNDS to save 15% on your purchase. Or text BOARDROUNDS to 44222 and we'll send you the link and promo code. [01:58] Question of the Week A 39-year-old G1P0 presents at 37 weeks of gestation. She has not noticed any fetal movement for the past six hours. The fetal heart rate is 110 and a nonstress test was performed and it's nonreactive. Which of the following statements is correct? (A) A fetal heart rate of 110 is abnormal. (B) Fetal heart rate acceleration results from dopaminergic stimulation. (C) Fetal hypoxemia usually leads to light decelerations. (D) Fetal head compression results in reflex flowing of the fetal heart rate. (E) Usually, a nonstress test leads to a reduction in neurologic injury and fetal death. [03:10] Thought Process The correct answer here is correct C. The non-stress test should be reactive and a fetal heart rate of varies a bit. And around 110-160 is normal. But the non-stress test is the most commonly used method. There's no evidence, however, that improves fetal outcomes in pregnancy. This is still initiated in women at about 26-28 weeks of gestation. For fetal hypoxemia and high-risk pregnancies, the older patient is a high-risk pregnancy. It actually starts at the age of 34-35. A reassuring test doesn't mean all is well. It only reassures fetal wellbeing in terms of oxygenation. The fetus moving is characterized by two or more fetal heart rate accelerations. And they peak at least 15 beats per minute above the fetal baseline. This would last at least 15 seconds before returning to baseline. That's the over 20-minute interval. A nonreactive nonstress test can reflect fetal hypoxemia or acidosis. It can also be caused by maternal smoking, fetal sleep, fetal immaturity, cardiac anomalies, and sepsis. If the mother is taking on the cardio-acting medication, it will result in changes in the fetal heart rate. But they don't necessarily indicate fetal problems. Links: BoardVitals (Use the promo code BOARDROUNDS to save 15% on your purchase. Or text BOARDROUNDS to 44222 and we'll send you the link and promo code.
Session 19 Today, we have Dr. Karen Shackelford from Bard Vitals, joining us as we break down another question. Meanwhile, have a look at Meded Media for more resources available to premeds and medical student. Another podcast medical students could listen to is Specialty Stories, where I talk to different physicians about their career and their specialty. They talk about why they chose it and what they like about it. Also, learn about what you as a medical student could be doing to make yourself more competitive for this specialty. [01:40] Question of the Week: A young woman is 26 weeks pregnant. She's 25 years old. Gravida 1 Para 0. 26 weeks gestation. She came into the emergency department complaining of leaking vaginal fluid for about three days, not huge, just some leaking. She's had some intermittent contractions but they're fairly infrequent. A sterile speculum exam is performed. It revealed some pale, yellow, watery fluid in the vaginal valve. Her cervix is dilated 4 cm. The vaginal fluid is tested, has a pH of 7.1. This is at an academic center where they still do the Fern test with arborization when the fluid is examined under a slide. An ultrasound is performed and it reveals oligohydramnios. Which of the following measures is appropriate in the management of this patient? Her lab results and her pee is negative for Group B Strep. (A) Ovarian section (B) Flush immediate delivery (C) Antibacterial prophylaxis for Group B Strep (D) Tocolysis (E) Supplemental progesterone [03:30] Thought Process There is a premature rupture of membranes (PROM). If it were a placental abruption, we can take it to a C-section. But for PPROM (preterm PROM) before 37 weeks, you want to delay the delivery as long as you can. So the correct answer here is the antenatal steroid therapy to mature the lungs. Most women who have PPROM deliver within a week. If it is within 7 days, you should initiate the steroid therapy. The management of PPROM would depend on factors like the gestational age, the presence or absence of infection, presence or absence of labor, any sign of abruption. Fetal stability and heart monitoring should also be managed. The American College of Obstetricians and Gynecologists (ACOG) recommends that women who have PPROM who are more than 34 weeks of gestation should deliver. But it doesn't need to be a C-section. Normal spontaneous or induced vaginal delivery is fine. In women less than 34 weeks, the pregnancy should be managed expectantly just until fetal maturity development. As long as the fetus is stable, the fetus will benefit by prolonging time in the uterus. Having the antenatal steroids will improve lung maturation. But you have to balance that with the benefits like expectant management against the risks associated with like a prolonged PPROM. Placental abruption is an increased risk as well as cord prolapse or cord compression. [06:40] Looking at the Other Answer Choices In the lab results, the patient had a negative Group B Strep test. Antibacterial prophylaxis for Group B Strep is indicated if somebody delivers within 48 hours in an unknown status or a positive test. But you give these patients antibiotics as it prolongs the latency of the pregnancy. It's generally associated with better fetal results. It reduces respiratory distress syndrome and neonatal death. It reduces the risk of intraventricular hemorrhage, necrotizing enterocolitis, and all preemie problems. It also reduces the duration of neonatal respiratory support needed. There's no increase in maternal or neonatal infection to balance that. ACOG recommends the corticosteroids that present between 24 and 34 weeks of gestation. And if you had an earlier pregnancy, you would give antibiotics in those cases. So Group B Strep prophylaxis is indicated. ACOG would recommend erythromycin. Some doctors will prescribe Zithromax because it's easier to take. They also recommend IV ampicillin and oral amoxicillin. There are no data to support so it going to cover a large variety of vaginal pathogens. So the antibiotics would not be for Group B Strep but to prolong the pregnancy latency. Tocolysis is inappropriate in this case because the patient is in active labor with cervix dilated to 4cm. With any woman who has more than 4cm of dilation or signs of chorioamnionitis or nonreassuring fetal stress test, these signs of abruption are the same thing. The only setting for tocolysis to be indicated in this setting is to delay delivery again for 48 hours to allow the glucocorticosteroids to take effect. But this should never be given for more than 48 hours. So you're not going to delay delivery that long given that most women deliver within a week. [10:00] BoardVitals Check out BoardVitals and use the promo code BOARDROUNDS to save 15% off your QBank purchase. Whether you're studying for the COMPLEX or USMLE, BoardVitals has the QBank you need to help prepare you the best possible way. Text BOARDROUNDS to 44222. Receive a URL and the coupon code you can use to save 15% off of BoardVitals QBanks. They have some of the most comprehensive QBanks out there. Get 24/7 access to over 1,700 questions in their USMLE Step 1 QBank and get detailed explanations and rationales for all the answers (both wrong and right). A vaccine will be donated with every new purchase. Links: Meded Media BoardVitals (use the promo code BOARDROUNDS to save 15%)
On this episode of Lauren Rei Live, Lauren Rei and Jay "The Gentleman" sits down with philly artist "Q Banks". We discuss his new single, upcoming project, life, and love.
Session 16 We're joined once again by Dr. Karen Shackelford from BoardVitals. This week, we discuss a case about an immigrant from Central America who's pregnant. [01:30] Question of the Week: A 26-year-old, G1P0 female is a recent immigrant from Central America and she presents with crampy abdominal pain and vaginal bleeding. By her dates, because she hasn't received prenatal care. She's of 25 weeks gestation and her past medical history is unremarkable. She takes an over-the-counter multivitamin but no other medication. She denies alcohol, tobacco, or illicit drug use. And she spontaneously delivers a stillborn fetus. The fetus is noted to have microcephaly and imaging performed reveals thinning of the cerebral cortices, ventriculomegaly, and subcortical calcifications. Viral RNA is identified in both maternal and fetal body fluids. The virus is a neurotropic virus that disrupts proliferation migration and differentiation of neural precursor cells in the developing fetus. Which of the following is the most likely pathogen? (A) Herpex simplex virus (B) Rubella (C) Zeka virus (D) Cytomegalovirus (CMV) [03:50] Thought Process The pathogen here is Zeka virus. CMV is a pretty good distraction here since the question mentioned ventricular calcification. But with respect to being a neurotropic virus, Zeka is and has been in the news a lot. It's a single-stranded RNA virus transmitted by mosquitoes. It's also related to dengue virus and the yellow fever virus. The infection results in clinical manifestations in about 20% of people and the rest would not know they've had it. If you're infected, you're symptomatic. You have a low-grade temp. You can develop a maculopapular rash, arthralgia, and conjunctivitis. There are other neurologic complications besides the general microcephaly. You can end up with Guillain-Barre, myelitis, meningoencephalitis, seizures, and congenital spasticity which the mother has vertically transmitted during delivery or it can be transmitted through the placenta. It can also be sexually transmitted and through other body fluids. It can also be caused by laboratory exposure such as the transplant of infected organs. It's fairly infectious. [05:42] Pregnant Women Should Avoid Infested Areas Pregnant women in the United States have been advised across the board to avoid travel in regions where mosquito transmission of Zeka occurs if they're going to be less than 6500 feet in altitude. This is the same thing with malaria in some parts of Kenya. [06:12] Understanding the Other Viruses CMV is a double-stranded DNA virus. The question mentioned specifically that the virus was an RNA virus. So this would be one reason you would disqualify CMV from your correct answers. But general CMV infection can result in chorioretinitis, hearing loss, jaundice, and periventricular calcification on imaging studies. CMV is not associated with tropical travel or immigration. Rubella is a single-stranded RNA virus. Congenital exposure is primarily associated with hearing loss, cataracts and congenital cardiac defects instead of neurological defects. HSV is a double-stranded DNA virus. Congenital exposure is associated with skin lesions and obstruction of brain tissue. The candidate here can rule out HSV for no other reason than it's a DNA virus. [07:55] Expand Your Knowledge and Be Up-to-Date Zeka has been in the news a lot lately. And content gets updated on USMLE. So you should be aware of these things even if you just hear about them once or twice while you're studying. You're more likely to diagnose it than if you don't remember hearing about it at all during your studies. "You have to be aware of what is potentially out there because you can't diagnose something you don't think of." [08:40] BoardVitals Check out the QBanks at BoardVitals.com. With over 1700 questions for Step 1 and over 1500 questions for Level 1, you will have plenty of content to cover to make sure that you are prepared for your board exam. You board exam score is vital for you to be able to match into your specialty of choice. So there is no such thing as being over prepared for your board exams. Start now. Sign up for a 6-month plan or a 3-month plan. Get started early. Get through the content because the more questions you do, the better you do on your board exams. Use the promo code BOARDROUNDS to save 15% off. Links: BoardVitals (promo code BOARDROUNDS to save 15% off)
Session 15 This week, we're joined by Dr. Karen Shackelford from BoardVitals. If you're looking for more prep with your USMLE Step 1 or COMLEX Level 1 training, visit BoardVitals and check out their QBanks for Step 1 and Level 1. Sign up for either 3 months, 6 months, or even 1 month. Your signup will have a vaccine donated through the #GiveVax program. If you sign up for the 3 months and 6 months, you'll get access to Ask a Clinician, where you can connect with the BoardVitals medical experts to answer your content questions. Use the promo code BOARDROUNDS to save 15% off of your purchase. [02:17] About Dr. Karen Shackelford Karen is a former ER clinician. She did her residency in medical school at the University of Mississippi. She eventually moved to Pennsylvania and began working remotely with BoardVitals as a contributor and editor. [03:20] Question of the Week A 35-year-old female patient returned 10 days ago from a mission trip to Nigeria. He was evaluated in the clinic a week ago, complaining of a high fever. She had a rash on the axilla, face, and extremities. The symptoms she had experienced were similar to some she had two years earlier after returning from the same mission trip. Those symptoms resolved with only symptomatic treatment. Today, her husband took her to the emergency department reporting that her fever had resolved two days ago. But she began to complain about abdominal pain and then she appeared very lethargic. On exam, her skin is cool and blocky. She had circumoral sinuses. Her pulse is weak and rapid. And her blood pressure is 80/60 mm Hg. She has a diffused confluent rash and her liver 2 cm below the costal margin. Laboratory studies are significant for a platelet count of 70,000 cells/mL. White blood cell count is 2,000 cells/mL with predominant lymphocytosis. Her serum aminotransferase is elevated. Which of the following is most likely caused by these severe symptoms? (A) Has bacterial super infection (B) Inoculation with a larger viral load (C) Antigenic drift (D) Different viral serotype change [05:08] Thought Process Behind the Answer Antigenic drift is characterized by small changes in the viral structure. It denotes spontaneous changes in the viral type. This is how viruses avoid getting destroyed by vaccines. Serotype is defined as a serologically different strain of microorganism with slight structural differences. They're classified together and have the same type of immune response. But just with a slight variation in their effect on the immune system. The correct answer here is D. The patient, in this case, is her second infection with Dengue Virus but with a different serotype. There are four serotypes of that virus. It's not atypical for somebody to have a mild case that resolves or even asymptomatic initial infection. At that time, the virus presents to a naive immune system. The second time around, it triggers a more significant immune response instead of immunity because of the antigenic differences that the virus responds to. A lot of these viruses are becoming more common in areas that people routinely travel to. A severe viral infection can resolve in hemorrhagic fever and epistaxis, hepatomegaly, circulatory shock. And it resolves through increased capillary permeability because the immune system is having a fluoric response to this second exposure to a slightly different serotype. [10:05] Third Infection If she had a third infection with Dengue Virus, it could be another viral serotype which can be potentially harmful. Although you might have some measure of immunity against the same one. When somebody comes into the office in the Emergency Department with a history of travel to the tropics and they have fibromyalgia, lethargy, and a rash, there are several things that could be wrong with them. Check on Chikungunya fever or dengue fever. They should be considered. But the one that is potentially fatal is dengue. The person could seem to recover. The fever could resolve. They could also become progressively ill and have circulatory collapse several days later. Hence, they should be monitored closely after an episode. The tests for these two are not readily available in those hospitals. So close monitoring should be done if they're coming with acute high fibromyalgia, lethargy, and rash after a trip to the tropics. [11:50] Potential Questions Both fevers are viral and both transmitted by the Aedes mosquito. There's not a vaccine and not a specific treatment. It's just supported. In most cases, the initial infection is asymptomatic or mild asymptomatic. Increased formation in immune complex so she has a pretty flourid response to dengue fever would be the primary mechanism behind it. Again, no specific treatment. Links: BoardVitals (promo code BOARDROUNDS to save 15% off)
Session 13 We have a great musculoskeletal question for today. As always, we’re joined by Dr. Andrea Paul from Board Vitals. [01:30] Question A 27-year-old male is undergoing evaluation for left foot weakness. On his exam, he’s unable to curl his toes. He has one of five strength with plantar foot flexion and five out of five with dorsiflexion. His foot is everted at rest and he has decreased sensation on the sole of his foot. What was the most likely mechanism of his injury? (A) Fibular neck fracture (B) Hip dislocation (C) L3 disc dislocation (D) Knee trauma (E) Pelvic fracture [03:45] Thought Process If you have a fibular neck fracture, this will injure your perennial nerve where you will have lots of dorsiflexion and the sensation on the dorsum of the foot. So choice A is out L3 is too high up as well. This involves the sciatic nerve. The patient would have felt a neuropathic pain down the back of the leg. Hip dislocation is unlikely because the patient is a 27-year-old. This is pretty uncommon. But if he did, then that would have affected the gluteal nerve. This would make it difficult for him to stand up or extending his hip. Pelvic fracture would be more of the femoral nerve, affecting hip flexion and extension. The knee trauma is the right answer here, If they had said posterior knee trauma, this would have made the exam a little easier. Specifically, this is a tibial nerve injury. It typically runs right down the middle of the back of the popliteal fossa. So any knee injury is going to affect the nerves and vessels that run through there. When you have an injury in the tibial nerve, the commonplace for pain is the back of the knee. This is a common sports injury, although other things can cause this too. One example is when you’re wearing shoelaces being tied around the calf. Casks can cause this as well as ankle fractures. [08:47] Tibial Nerve Affecting the Knees and Ankle It’s asking what’s “most likely” so just keep that in mind. And typically, this is a very common injury known as the tibial tunnel syndrome. It most commonly occurs at the back of the knee. The tibial nerve passes right behind the medial malleus before it goes around the foot so the ankle area would be affected here too. [11:44] Board Vitals Check out Board Vitals for some help with your Step 1 or Level 1 exam. They have the 6-month, 3-month, or 1-month access to their QBanks and Practice Tests. Get custom practice test as they simulate real test conditions. Use the promo code BOARDROUNDS to save $50 off your purchase. Links: Board Vitals (Use the promo code BOARDROUNDS to save $50 off your purchase)
Session 11 Today, we discuss a more straightforward, neuro-anatomy question about the glossopharyngeal nerve. As always, we’re joined by Dr. Andrea Paul of Board Vitals. If you’re in the market for QBanks and practice tests for the USMLE/COMLEX, check out Board Vitals. Use the promo code BOARDROUNDS to save 15% on your purchase. [02:00] Question Which of the glands of the options below are innervated by the efferent autonomic fibers of the glossopharyngeal nerve? [02:14] Answer Choices You have to know what the glossopharyngeal nerve and what type of fibers are innervating the glands. Answer choices: (A) Nasal (B) Submandibular (C) Sublingual (D) Parotid (E) Lacrimal [02:45] Thought Process in Answering the Question Glosso refers to the tongue and pharyngeal refers to the pharynx area. So this is somewhere around the mouth. The interesting with glossopharyngeal is that it has a range of effects. Some of the places it touches would surprise you. But first, you can eliminate nasal. But the rest of the choices could be fair game. This specific nerve has a lot of sensory – parasympathetic and motor functions. It's tough to answer so this can be challenging to people. This nerve starts at the medulla and coming out of the jugular foramen. It's traveling through both anteriorly and posteriorly. So it has a branch that goes to the inner ear. Lacrimal refers to the tear ducts so you can get rid of this one too. Now, we're down with three choices. [06:55] Choosing Among the Three First, remember the motor functions. So it's innervating the muscle in the pharynx and then you think through the sensory functions. Glossopharyngeal is sensory to the posterior third of the tongue or the back half of the tongue. If you can remember that section of the tongue, it leads you closer to the location of the gland that may be in that area. It's also going up into the middle ear, the Eustachian tube for sensory function. Anatomically, you start to think more up anterior than sublingual. Think of it as more of in the ear area. So the correct answer here is the Parotid gland, which is the only gland that doesn't receive any autonomic innervations from the facial nerve. So it receives that from the glossopharyngeal nerve. This is the main differentiator. Hence, the exam likes to ask about it. The posterior third of the tongue and the middle ear are things they love to ask about glossopharyngeal. Also, know which muscles are innervated, which is the stylopharyngeus in the pharynx. Also, try to remember the path and the branches. It sends a branch up to the middle ear. There are five other branches. One goes to the stylopharyngeus muscle, one is the pharyngeal branch, one is tonsilar, one is sublingual, and then one goes to the parotid body and sinus. You can draw this to help give you a visualization. Afferent refers to the sensory nerves coming back towards the central nervous system and efferent refers to "going away" for motor function. In terms of understanding parasympathetic vs sympathetic, just remember that most glandular effects are parasympathetic just like most of your organs. [12:24] Board Vitals Check out the QBank and practice tests over at Board Vitals to help you be prepared for your exam. They have over 1,750 questions for USMLE and over 1,500 questions for COMLEX. Get a 1-month, 3-month, or 6-month plan. They all come with a free trial. No credit card required. Use the promo code BOARDROUNDS to save 15% on your purchase. Links: Board Vitals (promo code BOARDROUNDS)
Session 08 Step 1 and Level 1 love to test the mechanisms or side effects of medications that treat diabetes. Follow along to test your knowledge of diabetic medications and side effects. Once again, we're joined by Dr. Andrea Paul, Chief Medical Officer at Board Vitals. Reminder to everyone is that you may know the diagnosis but the question is not going to be that simple. So be prepared for so many different levels of questions and knowledge that you have to know. Use the promo code BOARDROUNDS to save 15% off their QBanks. [02:00] Diabetes Medications There are lots of medications for diabetes so it makes it extra complicated and they have their own interesting set of side effects and mechanisms of action that you want to know because they're commonly tested. As you're studying medications, first look at the overarching category. You don't have to remember every single medication within that overarching category. But in some cases like insulin, it's helpful to know the different preparation because they may ask about short-acting or long-acting insulin preparation. But generally, other medications have the same mechanisms and side effects so you can combine those together and just remember by the generic names. Most often, what the test is going to be asking about is mechanism or side effect. [05:00] Question of the Week It's a 56-year-old man with adult-onset diabetes who's visiting his primary care physician. He's been on medication while controlled and his glucose levels have improved. But now, he is presenting with his glucose levels trending up over the last 6 months. His A1C trending up and they want to add a second medication. There's a worrisome side effect of the second medication and it's asking you to narrow down, looking at the different options of what you could add to what he's already on. So you need to think about which of those has a worrisome side effect. He's on Sulphonylurea and when you think about that category of medications, you start thinking that glucose normally triggers an insulin release from the pancreatic beta cells. They mimic the action of glucose so they close those channels in the cells and that depolarizes them which leads to insulin release. Then when you think about toxicity, that's the category of drugs where you think about disulfiram reaction and hypoglycemia. With insulin, if you take more than what's necessary, there's a worrisome side effect of hypoglycemia. Then you start thinking through which of the other categories have something that they would categorize as extremely worrisome. That would knock out things like hypoglycemia because that's the side effect of almost every antidiabetic medication. You'd start thinking down the path of severe toxicity and the only medication that has that is the Glitazone category. Those are the medications where their mechanism is they bind receptors that modulate insulin sensitivity. They will increase your insulin sensitivity and decrease gluconeogenesis, increase the number of insulin receptors. They're known for cardiovascular and hepatotoxicity which is something you have to remember about that category. If you look through all of the other diabetic medication categories, none of them have as worrisome or a severe side effect as that category does. [08:20] What's the Worrisome Effect? In this case, the answer is hepatotoxicity. The way you can narrow it down is knowing that he's already on a sulphonylurea and they're adding something that causes a very worrisome side effect. You can immediately narrow it down and find the medication in the list of options that fall into that category. Choices: Hypoglycemia Renal dysfunction Liver dysfunction Peripheral neuropathy Gastrointestinal dysfunction [09:30] Getting to Your Answer This is a two-step process where you have to both assume what the next medication to be added is and knowing which category has a worrisome side effect and then coordinating that side effect with the generic name of the medication within that category. It's a bit tricky but once you can cross out the other effects then it could lead you down the right path into the category they're asking for which is the Glitazone category. There are questions along the same lines where they don't say what medication was added to the patient and they come in with say, hepatotoxicity and just give you lab values indicating that. So that's an example of where they may give you a different option of medication and you'd have to identify the one that caused it. So you have to know the side effect as well as recognize the generic name. Not all categories for diabetes medications do have a common ending so there's some memorization required. But most of them have one or two different endings that you can remember. For instance, sulphonylureas tend to end in -ide or -mide. These are little things that can help you remember what category. But if you can remember the overarching categories, that will lead you down the right path where your memory might kick in and remember things. Specifically, the question is looking at adding a second medication and you can already cancel out one with the sulphonylurea. Then look down through the answer options. Just remember what the most severe side effect in each category is and be able to identify which one would be most worrisome or severe. [12:50] Brand Names The test doesn't look at brand names and it's nice there are these naming conventions. Brand names can be much more challenging to remember compared to generic names which have pretty repetitive patterns. In this case, besides insulin, most sulphonylureas and glitazones will have common endings you can remember. [13:30] Strategies for Insulin-Specific Questions Just one thing to note since they like to ask the onset and peak for different types of insulin and just the mechanism. So you should be able to know the mechanism of how insulin works and that cycle in general. Lispro starts to act most rapidly, 15 minutes. Regular insulin is half an hour to an hour. NPH is 1-2 hours and Glargine where the onset is one hour but it actually doesn't peak. This is something they may ask as well. They tend to follow the same pattern for their peak so the more rapid-acting, Lispro, also peaks first and then the peak extends out later as they go through NPH and Glargine. They would usually look for the basic pharmacology and pharmacodynamics and kinetics of medication on Step 1. They'd be probably asking something about the onset or peak of different preparations rather than combining them. Links: Board Vitals (promo code BOARDROUNDS)
Session 05 USMLE Step 1 and COMLEX Level 1 scores can play a major role in the specialty that you match in to. Let’s talk about the score that you want to shoot for! We're joined as always by Dr. Andrea Paul from Board Vitals, a testing platform to help you prepare for every step of your journey as a medical student, whether it's Step 1, Level 1, Step 2, Step 3, or all of the Shelf Exams that you have to take as a medical student, and beyond that once you're out in practice. They offer QBanks and everything they have to offer you, you're sure to be prepared for your test when it comes to test day. Save 15% when using the promo code BOARDROUNDS. [02:12] What Scores to Shoot For Andrea says that USMLE has a secret recipe that they score with but they don't disclose it but the scores range from 1 to 300. (But they won't officially say that.) Most people score between 140 and 260. The average in 2018 was 229 with a standard deviation of 20. So you're looking at a 209 to 249, which is incredibly high. Andrea thinks the reason for the increase in average is that people recognize competition and the high stakes of this test. "People recognize the high stakes of this test more than ever before. We haven't been expanding numbers of residency programs but we have expanded in the number of applicants." [05:40] Average Step 1 Scores for Different Specialties The landscape of competitiveness of different areas has changed for some of the specialties. Anesthesia used to be one of the most competitive. But this changes over time for a lot of reasons. But specialties that have stayed on the top of the list include Dermatology, Orthopedic Surgery, Oncology, ENT, and Neurosurgery. For 2018, the average USMLE score for people who matched in Orthopedic Surgery was 248. Dermatology is not too far off with 249 and ENT was 248, Neurosurgery at 245. Even the least competitive specialties had quite high average scores. Family medicine was 220, the highest it's been. Scores are just continuing to increase. "It's just the sheer number of people competing for these few spots that really require people to study harder and score higher." [08:07] Beyond Your Scores Of course, if you want to get in Dermatology, for instance, then you've got to be aiming for something over that 249. That said, other things still matter like the geographic area you're looking at, your experience, letters of recommendation, etc. Hence, the variation of scores and no specific cutoffs. So even if you're not in the range, it's good to still apply. "It's good to still apply even if you're not in the range. It does not hurt to still try." The Step 1 score gets you in the door for a lot of these areas. But after that, they're not going to pick a 249 over 248 just based on the score. That being said, it's good to aim high. [11:29] Breakdown of COMLEX Scores The scores fall the same way as USMLE does with Dermatology as the highest and Family Medicine as the lowest. Their average score for match candidates was 566 in 2018. For some of the high scoring specialties, Radiology was around 615 while Family Medicine was at 520. [12:20] Data for Osteopathic Students There's anecdotal data that osteopathic students in some geographic areas in some specific institutions have a disadvantage but there's no specific data. If you're an osteopathic student and you want to apply to a more traditional MD institution, you may want to consider as this could help in the institution's diversity. But try to make sure your scores are not only competitive but trying to shine so much that they can't ignore your application. There could also be a lack of information in some geographic areas on what background DOs come in with. Andrea believes that as this merger happens, this may start to change. "Make sure your scores are not only competitive but trying to shine so much that they can't ignore your application." Moreover, if you don't see a DO in a match list, then don't let that be a self-perpetuating prophecy. Reach out to the program and tell them you're an osteopathic student and you want to come to their program due to xyz. Ask them what you should be doing to make yourself competitive and see what they have to say. [16:35] The Next Steps After Having a Fail Grade The pass rates are quite high. USMLE last year was at 94% and COMLEX was at 96%. If you haven't taken the test yet, don't panic. That being said, the biggest mistake people do is they hide and don't want to talk to anyone or tell their school about it to the admissions people at the school because they're embarrassed due to the stigma around. But there's so much help. So get all the help you need to be successful. You'd be surprised at a network of people you can have once you open up. A lot of schools have these remediation programs too that are willing to pay for additional prep materials in some cases. "Every school has incredible resources for people who didn't pass. And you'd be surprised once you open up about it." Moreover, you may want to also change how you study if you feel that your studying strategy was completely ineffective. Or there could be minor tweaks you can do. But this shouldn't be looked at as something negative or a hopeless situation. If anything, you have the advantage to get a high score on your next attempt. [20:30] What If You're Not Ready to Take the Test? Every school is different. Some may require you to not take clinical rotations until you passed Step 1. While others have different rules and guidelines on that. But Board Vitals has worked with students where they took half a year and joined the clinical rotations a few months later so they could retake their Step 1. Again, talk about this to your school as they could help you make accommodations or give you time or whatever else you might need. [22:40] Data for Nontraditional Students There are a couple of studies showing that nontraditional students tend to score lower on both their grades in school and on their USMLE or COMLEX exams. There's no clear reason as to why that is, however. If you're a nontraditional student, it's a good place to look at the various reasons that have been considered such as family commitments. "Look into your family or whatever support systems you have to make sure that you can really maximize that study time and do the best you can." Recognize some amount of time where you might have to shift your focus. Try to look back and think about why or look at what traditional students are doing differently, how much time they're spending or how they're studying. It could be a technology gap or lack of using online resources. [25:55] Other Data Available Based on Gender There's data showing that males score higher on the USMLE and COMLEX. This is an interesting data point they've seen come across many times. As to why there could be so many factors involved such as pay gaps and gender differences that still exist. [27:00] General Tips As with anything else, self-care is important. Taking a little pressure off is the best thing people can do. So much pressure can build up over the years from undergrad to MCAT, the med school admissions process and so on. And if you don't let that ease a little bit once in a while, you'd just end up extremely unhappy and burned out. Identify what makes you feel better and feel better. [28:30] Board Vitals Check out Board Vitals for their QBanks for Step 1 or Level 1. If you're further on in your journey, check out their Shelf Exam materials as well. Use the promo code BOARDROUNDS and get 15% off. Links: Board Vitals (Save 15% when using the promo code BOARDROUNDS.)
Rx Buzz special guest: Anthony J. Busti, MD, PharmD, FNLA, FAHA About High-Yield Med Reviews High-Yield Med Reviews was founded by Anthony Busti, MD, PharmD out of a recognition for the need of high quality, yet affordable review courses and practice test questions for preparing healthcare professionals for licensure, board exams, advanced certifications, and the advancement of clinical competency. Dr. Busti has been involved in the medical education and training of physicians, pharmacists, and nurses for over 20 years. He and his diverse team of faculty, clinicians, editors, and reviewers have strategically put together online and live reviews, online lectures, and Q-Banks that are not only meant to cover "high-yield" concepts, but to also take clinicians to a higher level of critical thinking and application of medical information for the purpose of improving patient care. https://www.highyieldmedreviews.com/pharmacy-select-a-resource See omnystudio.com/listener for privacy information.
Session 04 Every year med students around the world prepare for their boards. Many of those students are making mistakes preparing for USMLE Step 1 and COMLEX Level 1. Once again, we’re joined by Dr. Andrea Paul from Board Vitals. Be sure to check them out because not only do they have the Level 1/Step 1 QBanks, but all of the shelf exams as you continue to move forward through your medical education! [03:03] Mistake #1: Not Giving Your Full Attention Students can find themselves doing so many stuff that they forget to focus on what they really need to focus on. If your mind starts to stray away, then that's a signal that you need to take a rest or break. Reset so you can get back to focus instead of just pushing through. Otherwise, you may just miss how many important points. So get up. Take a stretch. Take a minute. And then come back and be fully focused again. Slow down and it will help you in the long run. "The length of time isn't necessarily reflective of the quality of the time that you're studying." [04:35] Mistake #2: Studying Too Many Days in a Row There's a lot of data looking at how many days the students study per day and interestingly, once people went beyond 35 days, the scores started to go down. This is related to inefficient studying or maybe fewer hours per day. But there's a strong correlation that you can't study for too long. Hence, dragging out the day and staying up all night is only going to hurt you. "You only have so much stamina in a day to sit down and these questions are intensive, they require a lot of thought and you only have so much to do that per day." Board Vitals recommend studying for about 20-25 days with about 8-10 hours a day of studying. All of their data show that below or above it is just going to give them low scores. that said, it really varies depending on how your scores are looking. If you're already on the high range of your goal, then you probably don't need to spend the whole month rehashing everything again. Otherwise, doing so may only hurt you. So recognize where you're at then make a plan on the length of your study based on that. [07:25] Mistake #3: Going Through Content Too Quickly and Missing to Review Have a spreadsheet or notepad beside you so you can keep a list of what you missed and why. Was it an error or did you misread the question? Was it the way that question was worded that tricked you? Maybe you need to pay more attention to questions worded that way. Or it can be a specific piece of knowledge that you missed. Then go through the list at the end of each day or the week and you'll start to see patterns. "Keeping a really good track in analyzing how your own mind is working in answering these questions -- right or wrong -- is really important." Board Vitals provides feedback so you can see which areas you may be stronger or weaker. [09:45] Mistake #4: Thinking It's an Insignificant Amount of Pressure Unlike in high school or undergraduate where you just want to be competitive against others, this is different since it's an individual goal. It's something that's going to affect your life. But you just don't have one option. You may really want to do a certain specialty, but you may be just as happy doing something else. So it's not the be all and end all of life. "You want to stay motivated but not to the point that your nerves overpower your instincts on exam day." People who are scoring so high on their question banks, they get to exam day and the pressure is just so intense. So breathe and relax. Medical school is already an accomplishment. So just do the best you can. The boards actually don't allow retests like they do for the MCAT. For the MCAT, you can void it at the end of the test. I wonder if people are doing this on the boards as well. In fact, Andrea has received questions on whether this is a good strategy to take Step 1 and purposefully fail it to see if they could go in and get a strong score. Unfortunately, the rates for residency matching for people who fail on their first attempt is quite low. So no matter what you get on that second attempt may not outweigh that failure. So it's always best to do the best you can. [14:15] Mistake #5: Spending Too Much Time Studying in Ineffective Ways Several students still use textbooks to prepare but this strategy has never yielded high scores for those Board Vitals has spoken to. Those are not clinically focused but only basic science textbooks meant to get you through that course. That's the purpose of the school component, but not the purpose of the board exam. Instead, focus on things that are meant for preparing for this test. And do it in a way that does the highest yield for you. "Don't waste time on the textbooks that you use in those first two years of school. Those are not geared toward this test." As you go through this process, you need to be self-aware of where you stand. Are you solid enough with your foundation? One of the best predictors is doing well in your classes. Did you do well on those or did you struggle? Do you have that foundation to jump in and do questions and review? Or do you need something more substantial to get you up to the level to get you prepared to do those? [18:57] Be Realistic! If you didn't score well, remember that not everyone is a great test taker or study-er. So if you didn't do well in your preclinical classes, maybe keep a more realistic goal for Step 1. "Be realistic about it and not setting goals that are so far outside that you will only end up disappointed." Additionally, don't look at what other people are doing. By your second year of medical school, you should know what works and what doesn't for you and do that. Don't try and do something completely different now for this test. Stick to what's worked for you in the past. Links: Board Vitals
Medical Basics Podcast - Tips, Tricks, and Advice for Medical and Nursing Students
In this podcast we talk about some of the best resources for the psychiatry shelf and what you can use when you’re on the rotation. Learn more about some of the best Qbanks, textbooks, videos, websites and physical resources. Be sure to check out medicalbasics.com for more educational resources! Prefer video? Check out the youtube video: https://youtu.be/X9IO6dBjF8A
Medical Basics Podcast - Tips, Tricks, and Advice for Medical and Nursing Students
In this podcast we talk about some of the best resources for the neurology shelf and what you can use when you’re on the rotation. Learn more about some of the best Qbanks, textbooks, videos, websites and physical resources. Be sure to check out medicalbasics.com for more educational resources! Prefer video, check out the youtube video: https://youtu.be/2qSaoU90bww
Medical Basics Podcast - Tips, Tricks, and Advice for Medical and Nursing Students
In this podcast we talk about some of the best resources for the pediatric shelf and what you can use when you’re on the rotation. Learn more about some of the best Qbanks, textbooks, videos, websites and physical resources. Be sure to check out medicalbasics.com for more educational resources! Prefer video, check out the youtube video: https://youtu.be/BrglWaITt9E
Medical Basics Podcast - Tips, Tricks, and Advice for Medical and Nursing Students
In this podcast we talk about some of the best resources for the OBGYN shelf and rotation. Learn more about some of the best Qbanks, textbooks, videos, websites and physical resources. Be sure to check out medicalbasics.com for more educational resources! If you prefer video, check out the youtube video: https://youtu.be/rcHmlaqGMV0
Medical Basics Podcast - Tips, Tricks, and Advice for Medical and Nursing Students
In this podcast we talk about some of the best resources for step 1 studying. Learn more about first aid, Pathoma, UWorld and other resources such as QBanks, textbooks, videos and Flashcards. Be sure to check out medicalbasics.com for more educational resources!
© 2020-2025 Ivy Podcast Discovery LLC
