One Stem at a Time: High-Yield Board Review for Medical Students

Shock Talk: Basics of Obstructive Shock

Obstructive shock is one of the most testable—and most misunderstood—shock states on boards and in clinical medicine. In this episode of One Stem at a Time, we break it down from first principles so you can stop memorizing arrows and start understanding them. Through two classic board-style cases—cardiac tamponade and pulmonary embolism—you’ll learn how to recognize obstructive shock, interpret hemodynamic profiles, and confidently work through “arrow questions” involving cardiac index, right atrial pressure, pulmonary capillary wedge pressure, and systemic vascular resistance. We focus on building a simple, powerful framework: follow the flow of blood, identify where it’s blocked, and let the physiology guide you. Along the way, we highlight key distinctions between tamponade, tension pneumothorax, and massive PE, explain why SVR is increased (even in hypotensive patients), and review how PCWP is measured and applied clinically. By the end of this episode, you’ll be able to: * Recognize obstructive shock from clinical presentations and exam clues * Understand the underlying pathophysiology and compensatory mechanisms * Interpret hemodynamic “arrow” questions with confidence * Differentiate tamponade, pulmonary embolism, and tension pneumothorax * Apply high-yield board strategies and clinical reasoning in real time Perfect for USMLE and COMLEX prep, clinical rotations, and rapid review before exams.

Bad Blood Part 1: Primary Hemostasis Disorders

Not all platelet disorders are created equal. We go over the different conditions that involve abnormalities in primary hemostasis for the first part of this miniseries. Here, through practice question stems, we do a rapid-review of what primary hemostasis is, and quickly go over five different potential causes for platelet deficiency or dysfunction in less than 22 minutes. In this episode, we go over: * The physiology and pathology of primary hemostasis, platelets, and its relevant diseases * Comparing and contrasting different primary hemostasis disorders in patient presentation and lab findings * The key treatments for conditions such as ITP, TTP, HUS, and more * Key high-yield USMLE exam traps that often trap students

Everything You Need To Know About Carcinoid Syndrome in Less Than 10 Minutes

In this episode, we break down carcinoid syndrome from the ground up, starting with its underlying pathophysiology—how neuroendocrine tumors produce excess serotonin and other vasoactive substances that drive the disease. We then walk through the key symptoms, including flushing, diarrhea, and bronchospasm, connecting each one back to what’s happening at a biochemical level. From there, we explore complications, including pellagra, and explain how tryptophan depletion leads to this often-overlooked condition. Next, we shift into management, focusing on the role of octreotide and how it helps control symptoms and prevent progression. We also cover carcinoid crisis, a life-threatening escalation of the disease, discussing common triggers and the importance of rapid recognition and treatment. Finally, we wrap up with long-term complications, including carcinoid heart disease and its classic association with tricuspid regurgitation, tying everything back to the systemic effects of prolonged serotonin exposure. This episode offers a cohesive, clinically relevant look at carcinoid syndrome—from mechanism to management to complications.

Water Wars: DI vs SIADH

Struggling to tell DI vs SIADH apart on test day? This episode breaks it down step-by-step—starting with a classic USMLE-style question and ending with the high-yield patterns you need to answer fast and confidently. We kick things off with a patient presenting with polyuria, polydipsia, hypernatremia, and dilute urine after starting a mood stabilizer—can you identify the diagnosis and next best step? From there, we walk through the full framework for approaching water balance disorders. In this episode, you’ll learn: • How to interpret serum vs urine osmolality like a pro • The key differences between central vs nephrogenic diabetes insipidus • Why desmopressin response is the ultimate diagnostic clue • The mechanism behind lithium-induced nephrogenic DI (and why amiloride is the answer) • A clear, test-day comparison of DI vs SIADH • High-yield treatment strategies you’ll see on Step 2

The Bili Breakdown: Disorders of Heme Metabolism

Jaundice questions don't have to be confusing. In this rapid review, we break down bilirubin metabolism and classic disorders you'll see on exams: Gilbert, Cringler-Najjar, Dubin-Johnson, and Rotor Syndrome. Learn how to quickly distinguish between unconjugated vs conjugated hyperbilirubinemia and lock in the diagnosis in seconds. One stem. One diagnosis. No guesswork.