Any pgy1 or ms4 advice on chronic kidney disease mineral bone disorder and anemia? Trying not to burn out here

Idk why my brain refuses to hold onto chronic kidney disease mineral bone disorder and anemia. Every time I review my missed qs, I see it was secondary hyperparathyroidism from phosphate retention and low 1,25-OH vitamin D -> dietary PO4 restriction + sevelamer or checking iron stores (ferritin and TSAT) and repleting IV iron BEFORE starting erythropoiesis-stimulating agents (ESA), and I tell myself I wont miss it again, then 3 days later I do the exact same thing.

Especially when the stem sets up giving active calcitriol when serum phosphorus is still 7.2 mg/dL which risks vascular calcification. What helped this click for you guys?

Context: currently on a Saturday full-length simulation testing my endurance across 7 blocks.

Honestly the trick that saved me on chronic kidney disease mineral bone disorder and anemia on a Saturday full-length simulation was focusing 100% on targeting Hb 10-11 g/dL on ESAs bc normalizing Hb > 13 increases stroke and thrombosis risk. Dont try to memorize a massive table while you are tired testing my endurance across 7 blocks.

Instead, split the stem into two quick checks: (1) is secondary hyperparathyroidism from phosphate retention and low 1,25-OH vitamin D -> dietary PO4 restriction + sevelamer present, and (2) how does checking iron stores (ferritin and TSAT) and repleting IV iron BEFORE starting erythropoiesis-stimulating agents (ESA) change the next step? 90% of the time people miss this bc of giving active calcitriol when serum phosphorus is still 7.2 mg/dL which risks vascular calcification. Write a 1-line contrast note on an index card and read it before your morning block tomorrow, it clicks super fast.

What helped me lock in chronic kidney disease mineral bone disorder and anemia on a Saturday full-length simulation testing my endurance across 7 blocks was making just 2 quick contrast cards comparing secondary hyperparathyroidism from phosphate retention and low 1,25-OH vitamin D -> dietary PO4 restriction + sevelamer vs checking iron stores (ferritin and TSAT) and repleting IV iron BEFORE starting erythropoiesis-stimulating agents (ESA) instead of re-reading the whole chapter.

Adding onto what was said above: for chronic kidney disease mineral bone disorder and anemia, if you ever get stuck b/w two choices on a Saturday full-length simulation testing my endurance across 7 blocks, go back to targeting Hb 10-11 g/dL on ESAs bc normalizing Hb > 13 increases stroke and thrombosis risk and pick the option that addresses secondary hyperparathyroidism from phosphate retention and low 1,25-OH vitamin D -> dietary PO4 restriction + sevelamer directly.

If you are on a Saturday full-length simulation testing my endurance across 7 blocks, dont beat yourself up over chronic kidney disease mineral bone disorder and anemia misses rn — missing checking iron stores (ferritin and TSAT) and repleting IV iron BEFORE starting erythropoiesis-stimulating agents (ESA) on qbank today means you will spot it immediately on exam day.