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Author27 Posts
  #1

Hi everyone

I have been visiting this forum throughout my studies to learn from people's experiences. I took the exam a couple of days ago, so here's my opportunity to help out those who still haven't taken step 1.

I would say the closest thing to the actual exam are NBME and Qbank, from the style of questions to the overall topics covered. The material on BSS are representative but the questions are not similar to the style of USMLE (e.g. no matching or EXCEPT questions on step1...also I found BSS q's to be much more challenging). I still think BSS is helpful since it covers the same important topics and prepares you in dealing with difficult questions. Also, for those who would like to do some challenging path questions, I recommend Klatt and Kumar's Robbins Review of pathology. Overall, I would rate Qbank to be the most helpful factor for my preparation for the exam.

Heme (man, lots of heme): pregnant woman with megaloblastic anemia but with normal B12 levels is at the risk of what? I said fetus with neural tube defects since she was probably folate deficient. All the other answers I just remembered not being relevant. Man comes in with osteolytic lesions, infections,and funny looking lymphocytes? I picked multiple myeloma. One question about woman treated for AML being at the risk of what and I picked DIC. A patient with purpura and normal PT and PTT (so not DIC)and normal looking erythrocytes (so not TTP) has the following bone marrow biopsy and I swear I didn't know what the heck it was but there were a lots of large cells, so I figured there was overproduction of megakaryocytes and picked ITP. Some question about a patient with bleeding problem but I don't remember details, just that it was vWF deficiency. Handyman with neurologic, GI problems and a slide of basophilic stippling of rbcs and I picked lead poisoning. Other topics that I recall were the following: Wiskott-Aldrich, Fe deficiency anemia, One question describing a kid with lymph node with cells that really sounded like RS cells, so I picked Hodgkin's. Question on mono.

Respiratory:Few graphs on pulm. function tests but were pretty basic. One of them asked to calculate FRC! some questions on physical exam of the thorax. Basically they gave you a situation were the guy had a pneumothorax, or pneumonia (of course, they didn't tell you outright) and you had to figure out whther there would be unilateral/bilateral increased/decreased fremitus, resonance, hyperresonance, etc (I also got similar questions on NBME, so I wold encourage you to familirize yourself with these). Others: paraneoplastics of lung tumors (SIADH, but they would just give you the labs and you had to figure out that it was SIADH...I just saw a low plasma sodium conc. and high urine osmolality and clicked on the answer), what to prescribe for season rhinitis, acute asthma. Thay had a hayday with pulmonary infections: Histoplasma, klebsilella, staph, two strep pneumo, one kid with cough attacks that ends up vomiting (pertussis I guess), one question on the rationale of triple TB therapy (resistance), several q's on TB (esp. granulomas: how are they formed, major cells involved, major cytokines). AIDS patient with pulmonary issues and CD count of 50 and I picked MAI (all the other choices didn't cause pulmonary problems as far as I knew).

Neuro: I had so many neuro questions, I actually got the same exact question TWICE! Unfortunately it was something that I had doubts about (figures, huh?). Most neuro stuff was basically, symptoms and then you would have to figure out the lesion out of a whole lot of answer choices (5+). Guy with swallowing and speech deficits and unilateral paresis and point to the correct artery that is occluded on the picture (basilar, PICA, and other non-relevant structures were labeled). Woman has extinction on the left side , so which lobe on which side is affected? Guy has unilateral paresis and contralateral loss of sensation of his face and weak mastication muscles, so is the lesion on right/left medulla, pons, or midbrain? Lots of spinal cross-sections (at least 5-6). Asking you to point out lower limb posterior coulmns, spinothalamic tract, and one asked to interpret what looked like a degeneration pattern that looked like Fredriech's ataxia but I'm not sure if that was the correct answer. Guy with meningtis (inset a gram stain of g+ diplococci) and what virulance factor helps this organism in establishing infection (capsule?). AIDS patient with crypto meningitis and how does this organism gains access to CNS (hematogenous I guess?). Others were a post-mortem on a guy with plaques and CNS degen but Alzhimer wasn't on the choices so I picked Down's. Other topics were: thiamine deficiency in alcoholics (wernicke-Korsakoff), ALS, post-infectious Guillian Barre, two huntington cases, a few brain MRI's (gave you symptoms and asked to point out which structure would degenerate. On one of them it sounded like HD so I picked the caudate), and much more but I will post if I remember.

CV: Coarctation of aorta, catheter with such and such pressure reading and saturation so where in the heart is it located, one basic cardiac enzyme question (you had to know that CK-MB was more specific to cardiac muscle). Lots on hypertension (sorry don't recall specifics). Lots of diagnostic type questions: They gave you symptoms and you had to figure out whether it was right/left sided failure, tamponade, or valve problmes (based on various types of murmurs). One question on rheumatic heart disease (but it was pretty straight forward-had to know that the long term sequalae was mitral stenosis). Classic case of hypertrophic cardiomyopathy, and two questions on what drug to pick that improves mortality in heart disease (ACE inhibitors?). Basic cardiac cycle pgraph and asked me to point out S2.

Renal: Lots on diagnosing primary/secondary hyper/hypo parathyrodism or renal osteodystrophy based on serum/urine Ca, phosphate, PTH profile. Make sure you know this one. Woman with increased frequency and dysuria and you have to figure out whether it's cystitis or pyelonephritis based on dipstick and microscopy (basically, no casts= not pyelonephririts, I guess). Gross picture of hydronephrosis and what is the predisposing condition in a 67 y.o. male (BPH but not sure). Most common type of bladder cancer (I picked transitional cell)

Repro: Lots of STDs, including LGV, gonorrhea, PID complication (infertility?), endometriosis (chocolate cysts), polycystic ovarian disease (hairy female patient with bilateral adnexal masses), several on prostate cancer (but I just can't remember exactly what). Lots on people coming home from the far east or the caribbean (boy, talk about stigmatization) with a painful/painless papule/ulcer/plaque on their genitalia and can you guess the organism type of stuff. Two on the pathogenesis of syphillis (arteritis of the vasa vasorum). Several acid-base problems but very basic stuff. Be familiar with the acid-base graph on FA and you're set.

Endocrine: After neuro, this was it. Androgen insensitivity, thyroid issues (mostly focused on figuring out whether serum T4/T3/TSH/TBG would be elevated/decreased/same due to hyperthyroidism, cretinism, pregnancy, hypothyroidism). Maternal diabetes, hyperthyroidism and how it affected the fetus (sorry don't recall specifics). Various types of coma in type I/II diabetes (ketotic, osmotic).

Soft tissue, bone: Various bone tumors (I really tanked it here!) where they gave you the histology in text, and you had to figure out the type of bone tumor. Since I really sucked at this, I kind of blocked those questions out of my mind (denial is a gift). myasthenia gravis-like illness that improved with effort so against what receptor are the antibodies generated (I figured it had something to do with Calcium so I picked Ca channles but who knows?), X-ray of vertebral fractures and guess the disease in an elderly female? osteoporosis.

Behave: Honestly, I could have gotten by with Q bank ONLY. Almost all were doctor-patient relations and the style was also very similar to Qbank. I personally don't think there is any way to study for these types of questions (If you can, then you're one step ahead of me). I just went for the choices that addressed the medical issue at hand, were the most sensitive and encouraged communication. Whther these were the RIGHT choices, though is a whole different story. Oh there were two questions on narcolepsy but pretty basic. Stats was basic stuff: A big graph that seemed intimidating but really you just had to figure out the relative risk. One that looked just like a question on the sample CBT CD(if you decreased the cut-off point, how would it affect sensitivity or specificity).

Biochem: HGPRT deficiency (lesh-Nyan disease) and if you gave the patient a labeled Glycine what would happen (holy cow!!!) I figured purine salvage problem, so increased denovo pathway would mean increased incorporation but I might be wrong. Almsot NO pathways, some basic glycolysis stuff (regulation). I had very little biochem on the exam (which is a good thing since I only went over first aid and q bank).

Immuno: Focused on inflammation, types of hypersensitivity, and basic cytokine functions (again, qbank and first aid would have covered this topic completely).

Genetics: LOTS of genetics problems (very similar to kaplan q bank). Basically you had to figure out whether it was x-linked, mitochondrial, etc... a few on rflp mapping and you had to figure out which alleles carried the disease. One on gene frequency but very basic. Also lots of molecular bio problems. These were somewhat difficult and required you to be patient and figured them out. One question gave you a wild type sequence and told you that there was an insertion AND a deletion of a single nucleotide and pick the correct mutation pattern from the following choices. Honestly I was tempted to agonize over this problem but I just figured insertion and a deletion would restore the correct reading frame and just picked a sequence that ended with a wild type reading frame. Others were less difficult, but still required you to be familair with this concept: apoptotic v. antiapoptotic molecules, insulin receptors, two questions on the type/function of retinoic acid receptors and lots more but I don't remember.

Anatomy: Mostly imaging, but altogether I didn't get more than a handful images. Maybe 4-5 X rays and the same number of CTs TOTAL. Almost no embryo and histo (okay maybe 4 or 5).

Physio: Lots in the context of pathophys (mentioned above). Baic physio stuff. Costanzo is much more than enough. More important to understand graphs rather than memorize stuff.

Pharm: Adverse effects and mechanisms of antihypertensives, antiasthmatics, antidepressants, antipsychotics, and most of all antibiotics. But nothing more detailed than first aid,

Micro: First aid and q bank is enough, one q on viral structure, surprisingly NO HIV questions, lots hepB, HSV, VZV (picture of shingles). Couple of q's on toxins (TSST-1, diphtheria, cholera) but there were gimmes.

Alright since I'm seriously running out of juice, I'll be brief with the next few but will post more later on. I won't insult your intelligence by saying that the exam was hard. But more importantly, I think it was doable. If you finish qbank and go over all the expalinations, you will be ready for it, I promise.

Good uck to you all

Max




  #2

hi......

i am cent % sure that u will ace the exam ..so advance congradulations.....what a great post on exam experiance...hope i will also post such a useful post smiling face ...it is very useful..to look thro which area i have not done yet...although u have clearly told they covered all areas....thanks a lot..max...god bless u..


  #3

thanx for posting such a detailed exam experience.wish u all the best with your result!!!


  #4

Hi

Thanks guys. Glad to be able to help

Best of luck to you on your exams

Max


  #5

Hi, Maxb
I can't express my thanks to you in words!! your experience really gave me the direction for my study. For so many topics, sometimes I'm really puzzled where I should focus on, but thanks to you and many others who shared the experience with us.
With my best wishes to your step 1 and future exams!!


  #6

How much time did u take to prepare ? which year u graduated? what was the source of your study?


  #7

Hello Max,
Thank you soooo .... much for your time and effort to help us! Seems you did a great job! Wish you the score you wanted! Here is one Q you mentioned...[/quote] In Myastenia graves there is antibodies against ACh receptors, and improves with AChE inhibitors. But what exactly was the illness?( because you said some Myastenia-like illness) and this illness improved with what? Sorry I am just curious.Thanks again! God bless!!!


  #8

Hi

Thank you again everyone for your kind posts. I basically prepared for about 3 months (average 10-12 hours; sometimes more or less) with a few days in between that I just didn't have the motivation to study (no more than 5 or 6 days) so I tried to do something to avoid burnout (watched a game, etc...). Also, I am a Caribbean student so I have not graduated yet. If you are an IMG and it's been a while since you've studied this stuff, you might want to spend a bit more time on reviewing, depending on your areas of strength or weakness.


Alright here's what I did, but honestly since I don't know my score I don't recommend this:

Path/physio: BRS
Micro: Made ridiculously simple
Behave/Neuro: High yield
Immuno: Javetz

Everything else I used first aid.

Question sources: Q bank (I thought this was very important in preparing). I also did a few tests from BSS (4-5 altogether) and didn't have time to do them all. for some path sections that I was weak at (heme, respiratory, immunologic disorders) I did Kumar's review of pathology. These questions were hardcore! So don't be intimidated by them because most path questions on the actual exam are more straight forward. Same goes for BSS.

For the 1st 6 weeks, I focused on path, phys, and pharm. I reviewed the three subjects once except for a few path chapters that I went over twice. Basically I focused on understanding rather than trying to memorize everything at once (which I knew would be impossible for me). For pharm, I bought lippincot but was so intimidated by its bulk that I just took the path of least resistance and stuck to 1st aid. Costanzo is a good book and does a nice job in explaining physio but I do believe that it goes into much more detail than the actual exam. I would recommend again using it to get an understanding of physio rather than worrying about knowing it word by word (that's my personal opinion of course). BRS path was very helpful. On the downside, it's more surgical rather than medically related but overall I thought it helped me a lot.

After this, I took about 2 weeks and covered micro/Immuno. Made ridiculously simple is a very fun but also an extremely detailed book. Don't be misled by its title. The micro questions on the actual exam are 90% of the time asking you to identify an organism based on presenting sympotms and simple lab techniques (gram stain, etc...), meaning that I could have gotten away with just doing 1st aid. Immuno used Javetz and the same goes for immuno.

For behavioral, I took 5 days and read high yield. Good book but since behavioral questions on the exam are mostly focused on doctor-patient relationships, I'm not sure how useful going over this book was. Definately not as useful as qbank.

Neuro high yield made me feel very dumb. I think this guy Fix is on a whole different level than all the other humans. I don't know how to explain it but I didn't find his style of writing very user friendly. Anyways, if you are using this book, make sure to focus on the medically related topics (lesions, MLF, etc...) and the diagrams rather than the neuro jargon.

The rest of the time was spent on doing qbank. I guess it would be about a month or so. I timed myself for doing every block (so 60 minutes for every 50 questions) and stopped at the end of each block and read all the explainations. I also included the questions that I got wrong in the available slot so I would be exposed again to the topics that I was weak at. which means that I did a lot of questions twice over! I started around 8-9 everyday and did q bank until late afternoon (5-6)...with a lunch break in between of course. Then from 8-11 I just reviewed stuff (but without any structure or form...for example, one night I just went over all the glycogen storage diseases and next I went over opioids).

I simulated the full exam about 3 times. Once I did Kaplan CD, the next two I did the NBME self assessment tests. Once I did the NBME test in the beginning of March and I repeated it a few days before the exam. If you want to get a feeling of the real exam, there is nothing closer than doing the NBME questions. On the downside, they just give a score analysis with NO explainations, so I would use it as a practice tool rather than for learning purposes.

Well, that's it. Please note that this was a style of learning that I was comfortable with. Overall, I also tried to clear up some misconceptions about what to focus on for step 1. Hope it helped.

Max


  #9

Hi ELM

Sorry if I was unclear. Basically the question gave you a patient with symptoms that sounded like it was myathenia gravis (ptosis, generalized weakness, etc...), but also that as she used the muscle more and more throughout the day, muscle strength actually increased which is exactly opposite to MG (I think that muscle strength decreases in MG the more its used).

That's what I meant by saying that strength improved with effort. Then it went on and asked that antibodies against which of the following receptors (choices A-D) would cause these symptoms. Since I had no idea what disease this was, I figured since more muscle contraction builds up more calcium in the muscle cell, hence, imrpoving strength, her problem might be due to insufficient number of Ca channels on the muscle membrane. So I picked anti-Ca channel antibodies. By the way, I have no idea whether this entire line of reasoning was right or not (I would bet that I missed the correct choice).


  #10

max thanks you very much for your effort and hope you will have a great score!
thanks a lot smiling face


  #11

Hi Mistral

Thanks for your post. Wish you the best on your exam.

Max


  #12

Thanks max for your post , I wish you all the best for result and step 2 smiling face


  #13

hi maxb

you are generous, you are great and helpful... thankyou very much hope meet you in us...

bye


  #14

Thank you Asmi and Dr. Shar. Likewise I look forward to seeing you in the US. Good luck with your tests.


  #15

hi max, thanx for a detailed description, its great, i am a caribbean student as well, so reading your messages kinda motivated me a little. I am taking my exam in june, but i feel like its not enuf time, what do you think?


  #16

Hi

Sure. Considering your background, I think that's enough time to prepare.

Best of luck


  #17

thanx a lot


  #18

about myastenia like syndrome :arrow:
i think it was eaton-lambert syndrome(small cell ca) were mm strenght improves with repeated stimulation. There is impaired release of Ach from presynaptic nerve terminal, ab against voltage gaited Ca channels smiling face


  #19

oh yeeaah :idea: NOW I remember (Duh!). Thanks for the pointer Ane.

max


  #20

where did you do genetics from?there are no questions in kaplan notes,i did the q bank &found them soo difficult &even molecular biology,very depressed thinking of them,just scored like 60 in them wht to do now?have very few days for exam to go,is it a lot on the step1?
:cry:





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