Tips for USMLE Step 1

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Tips for USMLE Step 1

• Presentation by Joe Walsh
• For educational purposes only

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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.

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Types of Questions
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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
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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
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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 E. Nystatin
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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
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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 µm3. 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
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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 µm3. 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
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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
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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
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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.
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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.
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Ethics Questions
-Do NOT use common sense for these. -Learn
medicolegal rules (Hi-Yield or BRS Behavioral
Science). -Dont take into account sounding
mean.
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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.

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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.

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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.

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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)

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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)

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Kaplan or NOT?

• Boxers or Briefs?

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• DEPENDS!!

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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

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General Study Strategy
Content
Questions
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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

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GENERAL SOURCES
-Dont write in First Aid until last
2-3mos. -Read multiple times -Use as starting
point for content review
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Content Review

• Consensus must read books
• Micro Ridiculously Simple
• Constanzo BRS or Physio text
• BRS Path
• Pathophysiology for Boards and Wards
• Pharm Cards

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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

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-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).
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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
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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