I'm Khaled, an internal medicine resident physician in the US, and I make videos on quite a few different topics within the scope of medicine. I hope that my videos benefit you in any way, shape, or form and that you enjoy them. Medicine is quite the challenging topic, but I don't see why we can't enjoy it together!
If you'd like to get in touch with me, feel free to message me on Twitter or Instagram. 🐦 Twitter: Khalemedic 📸 Instagram: Khalemedic
Hello Dr. Khalid I am new subscriber to your channel I like it so much, very simple and to the point for new img doctors who want to train at us I have questions for you. I like to do subspecialty in (cardio or pulmonology), so if you could make comparisons from your experience in us about each field 1. Which one has friendly Community 2. Which one has more intervention experience 3. Salary, of course 😂. And job availabilities. Thank you .
Here is a summary of the entire first part of the video (some of this is abbreviated so hopefully it makes sense, but you can watch and read along) CCS Cases Things to look for initially (brief skim of H&P) - write these on scratch sheet 1. Age 2. Gender 3. Allergies 4. Brief skim of hx 5. Screening/vaccines/social hx (smoke, drink, drugs, sexual hx) **skimming hx - buzzwords (they don’t want to trick you, dx is sometimes very very obvious) ex: RUQ pain exacerbated by fatty foods - gallstones They want to see if you can put in orders correctly, in correct order, and rule out other scary things (i.e ACS, pancreatitis etc) VS Exam: 1. If pt stable (i.e. in clinic and HDS) - complete physical (especially hitting the things they present with) 2. If pt unstable - not doing complete PE, wastes “simulated” time, need to “act fast” and do a focused PE Disposition - Where do you want the patient to be? 1. Home 2. ED 3. Admit 4. ICU STAT orders - Do you want to place any emergency orders? Mnemonic - MAVOCC + F (not all needed, but reminder of some HY examples) 1. Morphine 2. ACC (gives you IV access and glucose accuchecks) 3. Vitals check 4. Oxygen/oximeter 5. Cardiac monitor 6. C-spine 7. Fluids (NS) Orders (mnemonic) - tailor these tests to your ddx, don’t order all every time for every patient CCCMP CUAEH LLUSCENT 1. CBC 2. CMP 3. Creatine phosphokinase (CPK/CK) 4. Magnesium 5. Phosphate 1. CXR (or any XR) 2. US 3. ABG 4. ECG (other cardiac tests - echo, troponins) 5. B-HCG (repro age like <45-50 yo) 1. Lactate 2. LFT/PT/PTT/INR 3. UA/cx/UDS (or toxicology) 4. Stool cx/pH/Ova etc 5. Culture (blood, sputum etc) 6. ESR/CRP 7. Neuro checks 8. TSH Ex: 20 minute case (real-world time) - Takes you 10 minutes to complete (real time) - You treat pt perfectly - Case will end early - If you get major big things, haven’t done anything super wrong, and pt is improving -> case will end early and you have 2 minutes at the end to put in extra orders **refer back to scratch paper for quick reference for these below 1. Screening tests - i.e. colonoscopy, Pap smear, mammography 2. Vaccines - shingles, tetanus, pneumococcal 3. Counseling patient - i.e. smoking/drinking/drug cessation, medications, compliance, side effects, safe sex (if STI case), seat belt SITPM CPM ISSSAD SITPM Vax - based on case, age, gender etc 1. Shingles - zoster max - >50 yo, 2 dose series, now then in 2-6 mo 2. Influenza/COVID - fall/winter season (RSV >60 yo) 3. Tetanus - q10years 4. Pneumococcal >65 (or susceptible to encapsulated organisms) 5. Meningococcal - 2-dose at 11-12 yo and 16 yo CPM Screening 1. Colonoscopy - 45-75 yo (q10years if no abn) 2. Pap smear - (21-29 yo) q3yr w/ cervical cyto alone - (30-65) q3yr w/ cervical cyto alone, q5yr w/ high-risk HPV testing alone, or q5yr w/ hrHPV w/ cyto (co-testing) - Chlamydia/gonorrhea - all sexually active women <24 yo and >25 yo at increased risk for infection 3. Mammography - 50-74 yo - biennial screening ISSSAD Instructing patient - when you type “instruct” into order search, gives you lots of options 1. Instruct 2. Smoking 3. Safe sex 4. Seatbelt 5. Alcohol abstention 6. Disease specific instructions
Key points: 1. Timing (1:01) Real time = the actual time/real world time, which is 10-20 min. Simulated time = hypothetical time, which can last from hours to days to weeks. 2. What to look for in case's introduction (2:18) Age Gender Allergies Main HPI points Screening (vaccinations, pap smear, colonoscopy, etc) 3. Physical exam (3:45) Complete physical exam --> if patient is stable or in the office Focused physical exam --> if patient is unstable or in the ED; you can always do a complete PE later in the case after putting in emergency orders! 4. Disposition (4:35) Where do you want the patient to be? Options: home, ED, admit to inpatient, admit to ICU. 5. Emergency orders (5:55) MAVOCCF, which stands for: Morphine Acc (gives you IV access and glucose accucheck) Vitals check Oxygen/oximeter Cardiac monitor C-spine Fluids (normal saline) 6. Routine orders (6:51) CCCMP CUAEH LLUSCENT stands for: CBC, CMP, Creatine phosphokinase, Magnesium, Phosphate Chest x-ray/other x-rays, Ultrasounds, Abg, Ecg/other cardiac tests, Hcg Lactate, Lft/pt/ptt/inr, Urinalysis/culture/toxicology, Stool culture/pH/ova/etc, Culture (blood), Esr/crp, Neuro checks, Tsh 7. You should land on a diagnosis by this point and thus, a treament (9:09) 8. Case might finish early if you have managed the patient correctly (9:27) 9. Once the case finishes, you have 2 minutes at the end to put in last minute- orders (10:00). These can be pap smears, colonoscopies, vaccinations, counseling the patient on various topics. SITPM (vaccines) CPM (screening tests) ISSSAD (counseling) Shingles Influenza Tetanus Pneumococcal Meningococcal Colonoscopy (50-75 yrs, every 10 years) Pap smear (21-65 yrs, every 3 years) Mammography (50-75 yrs, every 2 years) Instruct Smoking cessation Safe sex Seatbelt Alcohol abstention Disease specific (diabetes, medication side effects, etc)
I have an issue with the re-evaluate case, can you please explain how to use the "on" "in" and the others to really maximize time, I hope you see this, thank you for the video also!
I think you’re referring to when you click on the clock and run the time forward. If this is what you mean, I usually click “next available result” because it saves me time from typing exactly how far ahead I want to go. On refers to a certain time you want to go forward to; for example, if it’s 10:15 and you want to skip to 10:45. You would just write “10:45”. In refers to how much you want to skip ahead, using the same example, to skip ahead 30 minutes, you would write “30”. I don’t like to use these because you have to check exactly how far you want to skip ahead and to check you have to click around a lot which will cost you some time (especially with input delay).
@Khalemedic Thank you so much, just saw this! Do you have any websites where I could purchase materials for you just to gain more knowledge? Really appreciate you!
Sir you are an amazing teacher, thank you for you content. Helped me a lot! Eventhough first aid is a very good book, you managed to explain these concepts even better and that says a lot!
Enjoy your time in Atlanta! I would just try to meet some new colleagues, reconnect with old friends, and learn about exciting new things happening in the world of cardiology!
Super Helpful. Instead of trying to memorize those terrible acronyms, I changed a few. Emergent orders : FAV-MOCCA Workup orders: LUNCHMEATS 4CLUE-P Admit/Treatment orders: CICADA FLAB Closing orders: STIMP shots and CP SADISMS The admit/treatment one I made up: Consult, Insulin, Counsel meds, Abx, Diet, Acid, Fever/pain, Laxative, Activity, Blood (T/S/Transfuse)
Will this help to imgs giving usmle ? Anyone can tell question distribution of questions of each topic in usmle ? Like how many questions come from this biostatistics part
Biostatistics is tested in step 1, step 2 CK, and step 3. The distribution of questions can be found on the official USMLE page. You just have to go searching for them a little.
Obviously, these videos are super helpful. JFYI, these videos are supplemental study material for an A.I. study group that I'm mentoring. Your slides are so nicely laid out. I suspect that you really wanted to be an industrial designer but your parents made you go into medicine. :) Many thanks!
It depends on your background and free time. Some pass with around 2-3 weeks of serious studying. Some may feel more comfortable with 1-2 months of studying. Personally, I had a good foundation of step 1 and step 2 and biostats, so I spent a little short of a month of studying. Bear in mind that because I did the exam prior to starting residency, I had much more free time everyday to study. I hope this answer helps.
Transcripts remain a difficult part for programs to use in order to judge part of an applicant’s application. There’s no standard and IMGs may suffer the most in this regard if they come from lesser known medical schools (if known at all). There are no statistics about the importance of the transcript so no one can say for sure how much they affect your score. However, I do think if you have a few questionable scores in some of your grades, I would make a conscious effort to prepare for any questions about it to demonstrate your strengths and opportunities of growth. I hope this answers your question!
