#i really need a better system for remembering my prophylaxis meds

[fiadhaisteach]

Is it a head cold?

Is it just a headache?

*turns on the bedroom light*

*horks*

It is another flippin' migraine.

Yay.

[wishbone-md]

An MS3 Guide to IM Clerkship: Resources

I made 92nd percentile for the IM shelf exam which I was very proud of because I busted it during this rotation. It was a very broad exam so here are my tips for success for the test along with the resources I used.

Link to my first post on how to excel at wards: http://wishbone-md.tumblr.com/post/170700142647/an-ms3-guide-to-internal-medicine-wards

UWorld

UW is king. Do all 1200+ questions. It takes so freaking long to finish it and it feels like you’re in step 1 dedicated period all over again. UW is the number one resource. It sucks confronting how many questions you miss, because trust me, there will be many questions in which you’re filled with despair.  We had weekly lectures based on the major organ systems and I would do UW on tutor mode for the corresponding subjects. These questions made the shelf exam look like a joke. 

I typically did questions on downtime on wards like at lunch, in the afternoon while waiting for results to come back, or during primary care clinic. If I didn’t do it while at the hospital, I would do it while eating dinner to multitask. I probably did around 15-20 per day on average. I made around 70% correct. 

I reviewed my questions by pulling up UW and OneNote side by side. I took notes on each question and tried condensing the answers to one single high yield fact that I would type up. I did the same thing for step 1. It personally works for me to write up this small summary because questions start to blend together and it’s easier for me to remember something I put into my own words.

Step Up to Medicine

I have heard mixed reviews for this book but I personally liked using it as I like review materials in the form of an outline. It was especially useful on subjects that you don’t really encounter much on general medicine wards like dermatology/ambulatory care, neurology, renal, and heme-onc. I’d recommend it if you like physical textbooks to write in.

Online Med Ed

I didn’t use this resource much except for when I was on cardiology subspecialty service so I could watch the cardiology related videos. I thought I had plenty of materials as I was using UW and SU2M but many of my classmates loved OME.

NBME Practice Exams

Take at least one halfway through the clerkship. I did a total of 3 out of the 4 offered. They’re $20 each and worth it in my opinion. Even better if your class bands together and makes screenshots of the questions. This shelf is broad so it’s worthwhile to see the range of topics before the real thing.

Up To Date

Learn from your patients. Read UTD every day on them, especially new ones. Questions ask for the next best step either to diagnose someone or to treat someone. UTD has great articles on the work up of common conditions and what you would expect to see on labs. I would only use this as supplementary information though since UTD can be somewhat verbose and talk about research studies.

Emma Holliday Video

Emma Holliday has a great 2 hour lecture (you can do 2x speed) on a high yield review for the shelf exam. Definitely worth watching the day before the test as a summary.

Video: http://atsvid.uthscsa.edu/mediasite/Play/e18ac39b61e74147a92557429c4672ff

Powerpoint slides: http://som.uthscsa.edu/StudentAffairs/documents/HighYieldInternalMedicinecompatibleversion.pdf

High Yield Tips

Hypercalcemia was all over my review materials and practice exams. It showed up on the real thing and I was ready for it. It’s easy to miss that lab value when you’re scanning quickly through the labs. Stones (renal), bones (pain), groans (abdominal pain, constipation), thrones ( urinary frequency), psychiatric overtones (anxiety, altered mental status). 

Biostats stuff didn’t really show up for me except for sensitivity and specificity -> need to know what lowering the threshold for a test does to change the sensitivity and specificity 

Basic neurology like strokes and headaches showed up

You better learn those nephrotic/nephritic syndromes and those vasculitides. I actually pulled out First Aid for these.

Winter’s formula: Expected PaCO2 = 1.5*serum HCO3 + 8 +/2

Preventative health since this is primary care

TB and when to treat or prophylaxis

Light’s criteria for pleural effusions

Pleural fluid protein/serum protein ratio > 0.5

Pleural fluid lactate  dehydrogenase/serum LDH ratio > 0.6

Pleural fluid LDH > 2/3   of the ULN for serum LDH