Sie sind auf Seite 1von 30

Tips for USMLE Step 1

Presentation by: Joe Walsh


For educational purposes only


Test Format
350 questions
7 sections of 50 questions at 1hr each (one section does NOT
count).
8hrs total time. 45min of break to distribute.
Add 15min to break if you skip tutorial (recommended).
Finishing a section early adds remaining time to break.
Register by Dec & ideally schedule for mid-June.
Need 3-4mos of hardcore study time.
Register online at www.nbme.org - schedule 3 mos elgibility
Eligibility period with NBME, Scheduling Permit with prometric.
Types of Questions
Example Question 1 What are the calcium-dependent proteins
responsible for cell-to-cell junctional adhesion?
A. Cadherins
B. Collagens
C. Integrins
D. Connexins
E. Occludins
Factual Questions
Example Question 1 What are the calcium-dependent proteins
responsible for cell-to-cell junctional adhesion?
A. Cadherins
B. Collagens
C. Integrins
D. Connexins
E. Occludins
Factual Questions
Example Question 2 A 34-year-old Brazilian housewife from Rio de
Janeiro complained of a cutaneous ulcer on the left forearm and
palpable subcutaneous nodules. Her illness had begun as a small
pimple about 2 months prior to presentation. On physical exam she
presented with a 10 mm ulcer on her left forearm and subcutaneous
nodules ascending linearly towards the axilla. Mycological cultures
yield Sporothrix schenkii. What do you prescribe as treatment?
A. Mebendazole
B. Actinomycin
C. Teraconazole
D. Itraconazole
E. Nystatin
Factual Qs with a Trick
Example Question 2 A 34-year-old Brazilian housewife from Rio de
Janeiro complained of a cutaneous ulcer on the left forearm and
palpable subcutaneous nodules. Her illness had begun as a small
pimple about 2 months prior to presentation. On physical exam she
presented with a 10 mm ulcer on her left forearm and subcutaneous
nodules ascending linearly towards the axilla. Mycological cultures
yield Sporothrix schenkii. What do you prescribe as treatment?
A. Mebendazole
B. Actinomycin
C. Teraconazole
D. Itraconazole (Potassium Iodide)
E. Nystatin
Factual Qs with a Trick
Example Question 3 A 32-year-old woman with type 1 diabetes
mellitus has had progressive renal failure over the past 2 years. She
has not yet started dialysis. Examination shows no abnormalities. Her
hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean
corpuscular volume is 94 m
3
. A blood smear shows normochromic,
normocytic cells. Which of the following is the most likely cause?
A. Acute blood loss
B. Chronic lymphocytic leukemia
C. Erythrocyte enzyme deficiency
D. Erythropoietin deficiency
E. Immunohemolysis
F. Microangiopathic hemolysis
G. Polycythemia vera
H. Sickle cell disease
I. Sideroblastic anemia
J. b-Thalassemia trait
Reasoning Questions
Example Question 3 A 32-year-old woman with type 1 diabetes
mellitus has had progressive renal failure over the past 2 years. She
has not yet started dialysis. Examination shows no abnormalities. Her
hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean
corpuscular volume is 94 m
3
. A blood smear shows normochromic,
normocytic cells. Which of the following is the most likely cause?
A. Acute blood loss
B. Chronic lymphocytic leukemia
C. Erythrocyte enzyme deficiency
D. Erythropoietin deficiency
E. Immunohemolysis
F. Microangiopathic hemolysis
G. Polycythemia vera
H. Sickle cell disease
I. Sideroblastic anemia
J. b-Thalassemia trait
Reasoning Questions
Example Question 4 A 68-year-old male with a history of type 2
diabetes and peripheral vascular disease develops abdominal pain
from bowel ischemia. Exploratory laparotomy revealed a 4-cm region
of necrotic colon, which was subsequently resected. Where was this
ischemic region most likely located?
A. Ascending colon
B. Hepatic flexure
C. Splenic flexure
D. Descending colon
E. Sigmoid colon
Reasoning Questions
Example Question 4 A 68-year-old male with a history of type 2
diabetes and peripheral vascular disease develops abdominal pain
from bowel ischemia. Exploratory laparotomy revealed a 4-cm region
of necrotic colon, which was subsequently resected. Where was this
ischemic region most likely located?
A. Ascending colon
B. Hepatic flexure
C. Splenic flexure
D. Descending colon
E. Sigmoid colon
Reasoning Questions
Example Question 5 A 46-year-old male presents to the emergency
room with tearing pain in his chest radiating towards his back and
blood pressure 84/40. He is pale and diaphoretic but remains
conscious. He tells you that he is a Jehovahs witness and refuses to
receive any blood products before or during surgery. What do you tell
the patient?
A. Your request is against my ethics, and I feel that I must find another
doctor for you who is willing to comply with your request.
B. I insist that you receive a blood transfusion because otherwise you
will probably die.
C. We will only use blood products as absolutely necessary to save
your life.
D. We will comply with your request because your condition does not
appear life-threatening.
Ethics Questions
Example Question 5 A 46-year-old male presents to the emergency
room with tearing pain in his chest radiating towards his back and
blood pressure 84/40. He is pale and diaphoretic but remains
conscious. He tells you that he is a Jehovahs witness and refuses to
receive any blood products before or during surgery. What do you tell
the patient?
A. Your request is against my ethics, and I feel that I must find another
doctor for you who is willing to comply with your request.
B. I insist that you receive a blood transfusion because otherwise you
will probably die.
C. We will only use blood products as absolutely necessary to save
your life.
D. We will comply with your request because your condition does not
appear life-threatening.
Ethics Questions
-Do NOT use common sense for these.
-Learn medicolegal rules (Hi-Yield or BRS Behavioral
Science).
-Dont take into account sounding mean.
Ethics Questions
Meaning of Scores
Passing score was raised from 174 to 182 in May 2003.
Average is usually ~215 and each standard deviation is ~20
points (theoretical max 300 but curve exists).
Mean & SD for your specific test will be given with your score.
If normal distribution, 68% of values are within 1SD and 95% are
within 2SD.
Two digit score (1-99) does NOT equal percentile.
215 235 195 175 255
N
u
m
b
e
r

o
f

S
t
u
d
e
n
t
s

Mean
(50
th
percentile)
+1SD
(84
th
percentile)
-1SD
(16
th
percentile)
+2SD
(97.5
th
percentile)
-2SD
(2.5
th
percentile)
215 235 195 175 255
N
u
m
b
e
r

o
f

S
t
u
d
e
n
t
s

Mean
(50
th
percentile)
+1SD
(84
th
percentile)
-1SD
(16
th
percentile)
+2SD
(97.5
th
percentile)
-2SD
(2.5
th
percentile)
Meaninglessness of Scores
Be careful judging advice based on scores (target, styles).
Set a realistic goal for your needs and abilities (stepping stone).
Competitive residences include Ophthalmology, Orthopaedics,
Neurosurgery, Emergency Medicine, Radiology, etc.
Also competitive to go to top 10 programs or desirable geographic locations
in ANY field.
Usually breaking 1SD is sufficient.

Creating a Goal
Different studying strategies based on goals:
Passing the test (master core high-yield info)
Breaking 1SD (high-yield plus know some low-yield)
Breaking 2SD (high-yield plus lots of low-yield info)

Risky if you create an unrealistic goal.


Creating a Goal
How do you know what goal you can achieve?
Honoring classes is sometimes unrelated.
People who did well in classes may do poorly on Step 1 and
vice versa.
Luck component (many different test versions; different
score distributions & curves)
Diagnostic Exams
Free Kaplan diagnostic test (% correct x3) = Starting point
Can realistically increase score by 10% raw score max (or 30
points max) each month.
NBME diagnostic test 1-2mos before test (evaluate progress
& effectiveness of study plan).
Adjust studying in final month based on diagnostic.
Only use First Aid or other general source in final week.
Check-out testing site (can walk around inside).
COMMON SENSE: Sleeping & Eating (physical = mental)
Kaplan or NOT?
Boxers or Briefs?
DEPENDS!!
KAPLAN or not
Pros:
Keeps you on track
Extrinsic motivation
Proven record
Skilled teachers
Geared towards achieving a good score

Cons:
Expensive
Not unique or individual preparation
Geared towards passing or 1SD
Stifling towards additional independent study
General Study Strategy
Content Questions
General Study Strategy
Choose books for content review
Format your comfortable with/used in M2 classes
High yield without extraneous info
Class notes NOT BEST SOURCE
Dont spend too much time on anatomy, Biochem, Behav.
Sc.
Emphasize ACTIVE reading - Ask questions to reinforce
what youve learned
Gradually work questions into study plan
Start w/ 1 block of 50 q and inc q week
Read explanations carefully - write down wrong answers
Constantly reassess strengths and weaknesses


GENERAL SOURCES
-Dont write in First Aid until last 2-3mos.
-Read multiple times
-Use as starting point for content review
Content Review
Consensus must read books
Micro Ridiculously Simple
Constanzo BRS or Physio text
BRS Path
Pathophysiology for Boards and Wards
Pharm Cards
Question Review
Kaplan Q-Bank
2000+ questions: excellent stratification by
subject, organ system, etc..
NMS question book
Blackwells free test online
NBME tests(2)
Robbins question book


-Board Simulator Series (BSS): organized by Organ Systems.
-5 books of questions & explanations, four-and-a-half tests per book.
-Reading explanations is more painful than doing the questions.
-90% of those who start BSS never finish (too painful).
Specific Books Used
ANATOMY: Hi-Yield Gross Anatomy
BEHAV SCI/PSYCHOPATH: Hi-Yield Behav Sci
BIOCHEMISTRY: BRS Biochem(didnt like HY)
EMBRYOLOGY: Hi-Yield
HISTOLOGY: Hi-Yield (nothing is needed)
IMMUNOLOGY: Hi-Yield (nothing is needed)
NEUROANATOMY: Hi-Yield, Ridiculously Simple (BRS = too detailed)
MICROBIOLOGY: Ridiculously Simple, Micro Cards
PATHOLOGY: BRS, Pathophysiology for B & W
PHARMACOLOGY: Lippincotts, Pharm Cards
PHYSIOLOGY: Costanzo Text
AUDIO SOURCES: Goljan, Gold Standard
WEEK/DAY OF TEST ADVICE
Week of:
Get up early and be active during day
Go over first aid slowly one last time
Review pictures, notes, wrong answers
Day of:
Pack lunch, bring layers(cold test center)
After:
Run, dont walk, to pub

Das könnte Ihnen auch gefallen