USMLE step 1 experience of dr.Dominik Nakhostin - 236 (4-5 weeks preparation)

Hi guys! I sat USMLE Step 1 on December 4^th, 2018 and decided to write a brief report about my preparation and exam experience.

Background

Year of graduation: 2017

Exams given (and passed): USMLE Step 2 CK (in 08/2017) and USMLE Step 2 CS (in 11/2017). Yes, I sat USMLE Step 2 before Step 1 due to the fact that I could prepare for Step 2 CK/CS alongside my final medical school exams in 2017.

I am from Europe and English is not my mother tongue.

As I already sat USMLE Step 2 CK and CS, it was finally time for me to sit USMLE Step 1 in order to qualify for ECMFG certification. Due to the fact that I started working already in a busy setting (high-volume trauma surgery), I was extremely time and resource constrained. I did not opt for a high score, a pass was enough for me as I already matched into a competitive residency in my home country and merely sat the USMLEs in order to keep the opportunity to go for fellowship training in the US later on.

Preparation

Dedicated study period: 4 (5) weeks.

Due to heavy workload, I did not prepare at all for Step 1 before the dedicated study period. Actually, I didn’t even open First Aid before my dedicated study period began. My dedicated study period started end of October. In the first week, I started with “the basics”: microbiology, immunology, biochemistry etc. It was very tough for me, as the basic science portion of medical school was almost 6 or 7 years ago for me! The second week I was on night shift so I did not have a lot of time to prepare. In said week, I mostly studied the subjects which were “easier” for me (gastroenterology, dermatology, musculoskeletal/rheumatology etc.) and barely did any UWorld questions. The last 3 weeks were very intense studying (12-14 hours a day), basically spent on the rest of the topics. I made it a priority to revise every subject at least once, even if it just was very briefly. Basically I would read a chapter (20-25 pages or so a day) in FA every day, followed by 2-3 blocks of 40 questions on UWorld. I managed to finish all 2500 or so UWorld questions in 4 weeks and I got 69% correct. Unfortunately I did not have the time to do UWSA 1 or 2 or the official USMLE questions. Having already sat USMLE Step 2 CK surely helped.

Resources used: UWorld and First Aid, nothing else. I strongly believe one can achieve a decently high score (up to 245 or so, in my humble opinion) with those two resources alone. I personally think it is a mistake to study with 10 different resources, focusing on two or three resources is key.

Exam day

I was very tired and unfocused on exam day, unfortunately, as I slept very badly the night before. I arrived at the test center approximately 30 minutes before and got settled in.

The first two blocks were quite hard. I took my first break after two blocks, then did another two blocks, followed by a longer lunch break. In the afternoon I took a break after every block. The questions were quite hard and after the exam I was 99% sure I failed.

Score report

Score release: January 2^nd 2019: 236. I couldn’t trust my eyes and was so happy and relieved!

Tips and tricks

·         My personal opinion: limit yourself to 2 or 3 resources only (unless you are aiming at a score of  > 245, then you might want to add some more resources). First Aid and UWorld are a must!

·         Revise!

·         If you are like me and like to study with mnemonics, learn all the mnemonics of First Aid by heart. They are great!

·         I am far from a genius, and this report is not to show off how much of a badass I am, but to prove an important point: It is possible to achieve a very decent score with only a short dedicated study period and limited preparation resources. Step 1 not only tests material that you learned by heart, but also how you apply physiological principles to questions, which brings me to my next important remark:

·         Do NOT go into this exam without having a strong grip on physiology!!! Physiology, especially cardiovascular/pulmonary physiology is key. Thankfully I seem to still remember quite a bit of physiology from my pre-med times which definitely helped me a lot!

·         You will encounter very hard questions during your exam. Keep your cool and don’t freak out! You will do fine!

Try to get a good night’s sleep the night before.

USMLE step 1 experience of dr.Amrut Raje - 240

Hello everyone, 

I would like to share my experience. 

I graduated in 2010 and did post graduation in orthopedic surgery in 2015, then worked for 3 years as a senior resident in India. 

Started preparing for step 1 from September 2018, wrote exam in December. Target was to pass step 1 with a decent score.

Did u world subscription for 2 months, first pass was 60%, then concentrated on questions which I marked wrong. 

Honestly I couldn't read explanation of each and every question, but for wrong questions I did.

Read FA -2 times.

Saw pathoma videos in slightly fast forward mode so that I could save some time. That helped me alot as I was short of time.

I studied with one of my friend who was preparing for step 2, we discussed common topics and asked questions to each other that helped both of us.

Took a pre-preparation test

U-world-scored 198

Took NBME-17 

6 weeks before exam- scored 225.

Exam was tough, it was similar to U world in appearance but slightly different framing and language. 

Some questions we're very factual and straight forward, no scope for logic.

First block was terrible I was thinking of running away, but other blocks were tolerable. When I reached the last block again same thought of running away came in my mind.

Took whole time alotted for every block, couldn't get time to revisit the marked questions, in some blocks I had to hurry in last 7-8 questions and marked answers according to my gut.

Took breaks after each block it's necessary. 

Try to keep breaks as short as possible because lot of time is wasted in security checking and signing etc

Had a horrible feeling after exam as i made many silly mistakes.

I am really very grateful to the admin of this group and all the active members I have gained a lot from here, even I visited this forum after exam to find out post exam feelings of our members and exam experiences, which helped me to cope up the exam trauma.

I just want convey a message that its never too late for anything, hard work and dedication pays always. 

Learning from other's mistakes saves a lot of time and energy.

I am thankful to my parents, seniors and friends for so much patience.

Scored - 240.

Ariya Ria - 250

Got my score this week : 250

Here is my Step 1 experience, I’ve read so many in the past and they really helped me, so here’s mine, hope it helps you out!

Resources:

1. UW qbank x 2

2. FIRST AID x 3

 

3. Kaplan 2014 live online lectures 

4. Kaplan lecture notes

5. Pathoma

6. Goljan Audio lectures

7. Sketchy Micro and Pharmacology

8. B&B videos

9. Rx qbank 7 day free trial

10. Biostats- Randy Neil Videos and UW biostats 

11. 100 cases of Ethics by Conrad Fischer and 30 cases of ethics by dirty USMLE

12. Anatomy shelf notes

Nbme 16 240 (3 mo. before)

Nbme 17 244 (2 mo. before)

UWSA 1 252 (1.5 mo. before) 

UWSA 2 258 (1 mo. before)

Nbme 19 238 (3 wks before)

Nbme 15 262 (2 wks before

Nbme 18 250 (1 wk before) 

Free 120 83%

What I did in the last week

1. Reviewed FA last time focused on weak areas, skimmed though others and made a 1 page list of the stuff I couldn’t remember.

2. Read UW notes that I made. 

3. Did nbme 18

4. Reviewed sketchy images

2 Days before: 

1. Heart sounds (https://www.youtube.com/watch?v=FtXNnmifbhE&list=PL3n8cHP87ijDnqI8_5WQlS4tN37D6P4dHCT&fbclid=IwAR3Yu7LzeEZvHk28PbFgwXtkxyL-MJLNqE47XwmzaGVMeVqxE3DjXU7QZTo… )

2. CT images 

3. Did the tutorial

4. Tried to memorize my 1 page rapid review list.

Day before - BREAK

Morning of the exam:

-Rapid Review in the back of FA

-Read my 1 pg RR 

-Made a small page of formulas to memorize

Main Pointers:

1. Questions are the most important, start as early as possible, and do as many as you can. I did almost 7000 questions before my exam. 

2. Mnemonics helped a lot, if you are a visual learner sketchy is the best.

3. Nbmes weekly to gauge your weak areas and read accordingly in the last stage of your preparation.\

4. Take a break before day before the test to calm the nerves. This was so important for me!

Susu Lily - 246

Hi everyone,
Just wanted to share my experience with you guys , I got my score yesterday, it's 246 ^__^ Alhamdulelah.
I'm thankful to Allah, my parents, my husband and my brother and of course to this wonderful group, your posts gave me hope and motivation though out my journey.

I'm an old graduate, a housewife and a mother of 2 kids, 2 and 3 years old.
Many times I thought that I can never make it and score above 220 because of my busy life, but I kept trying , organized my time and did my best to get this score.
I know it's not 250s or 260s but I'm very happy with it and proud :)

Just wanted to give hope to old graduates and moms, believe me you can do it and beat this exam, with patience and hard working.
You might be very close to your goal when you think that you can't do it. So never give up!

Another important thing I wanted to share, please try to control your anxiety on the exam day, it really really matters.
I scored 225 nbme 18 few days before the exam because I was anxious, it depressed me but I learned a lesson from this experience, that I should be confident and relaxed to give my best on the real exam.

Then did UWSA2 and scored 251 3-4 days before the exam , which was close to the real score.
Wish you all the best in your preparation and exam.
Thank you :)

Kirsten Schubel Graber (mother) - 242

Hey Mamas out there, another Step 1 experience.

My score: 242. Exactly the goal I set up 18 months ago…

I graduated in 2005 in France, practiced until 2014 when I met my American husband and

moved to the USA.

I was burned out and stopped working with pleasure. I got a first baby in 2016 and when he

was a year old, I finally decided to go the USMLE way to be able to practice again one day.

So I began to study in August 2017 while being pregnant with my 2nd baby (due January

18). Studied 4 hours a day while my child was in daycare, 5 days a week.

First I read Kaplan books and did Uworld offline (I know, it’s bad). Planned to finish a first

round before the birth, but the pregnancy was emotionally complicated so I stopped studying

in December.

NBME 1 offline on 12/29/17 66%

I delivered my beautiful daughter in January and she let me work during her nap (I resumed

studying in March). Finished my first round in May. I also began to read from First Aid.

NBME 13 online on 5/19/18 440 (215)

Then it’s Summer break. 2 children at home, and the news that we must move out of our

house. So again I completely stop studying, taking care of my family and a move in the

Texan heat…

Mid August, back to school (both kids in day care 5 hours/day 5 days a week) and to study.

I do Uworld online, 1 block a day and review the wrong questions, the marked ones when I

have time. I use Sketchy micro and a bit of pharmaco. And read First Aid a bit every

evening.

2nd round ends.

USWA 1 on 11/27 560 (241).

Exam is already planned on 12/15, so despite feeling ready, I have to wait (you know,

waiting for husband to be ok with his job, children to be taken care of…)

3rd round : I thought a would redo the wrong UW questions, but instead I concentrated on

studying the weaknesses of USWA 1. I also used Google a lot to look for mnemonics. I had

a notebook with a lot of mnemonics and all the diseases that are named after people, which I

read many times (super useful).

USWA 2 on 12/3 590 (247)

Again I focus on weaknesses, reading and learning about the wrong questions.

NBME 18 on 12/12 570 (242)

One day of reciting mnemonics and formulas (stats and pharmaco). A last day of doing

nothing …

On D-day, I was OK. I slept OK (my children wake me up at least once a night, the previous

2 weeks were even harder with sickness). I spoke to me a lot to stay calm.

First 2 blocks were : “ha! that’s how it is… I can do this”. Short pause to pee (yes I drank a

lot, yes i was pregnant 2 times, no I didn’t think about that during my training).

Next 2 blocks were : ok, you can do it, but when is lunch time?

Then a 30min pause for lunch. I ate while walking in the center, needing to move.

Next 2 blocks were super hard. I think they were a bit harder than the other, but it was also

the first time that I did more than 4 hours of questions. I really had to talk to myself to stay

focused. I took quite a long pause before the last block.

Last block was a bit easier (easier by itself, but also thanks to the pause). I finished nearly

an hour earlier.

Things I would do differently:

I would do a bit more NBME. Just because they look more like the real exam than Uworld

does. I would learn better anatomy from anatomy books, not just high yield stuff. If I could, I

would have done the exam a week earlier (when I was done with my 3rd round).

For the breastfeeding mamas:

I am still breastfeeding my daughter. She was 11 month old when I took the exam. I thought

about asking USMLE for extra-time to pump, but they put you on hold to examine your

demand and this takes time. So at the end I just made it with normal time. I pumped a lot the

weeks before to have milk ready for her (in fact way too much), and was ready to hand

express in the bathroom if I was too uncomfortable (which I didn’t need to).

Et voilà!

Ajay Iyer - 243

Exam date :December 24th

Step 1 Aim :240

Step 1 Score :243

Study preparation time : 8-9 months (with a break of about 1 month in between)

Finally the day is here when I can post my result on this forum. I am not an introvert but i am not someone who speaks a lot on public platforms and social media but i had always thought that if i scored well I'll post about it for sure.. As my preparation went through different phases i used to think that if i actually did end up doing well it's certainly going to be an inspirational read. So here goes :

Firstly Reading material :

Physio :Kaplan 2015 lecture Notes and 2015 videos

Biochemistry :Kaplan 2015 lecture notes and 2015 videos

Anatomy: High yield for gross anatomy, kaplan for neuro anatomy

Pathology :pathoma videos and book

Microbiology :Sketchy Micro

Pharmacology : 2015 kaplan lecture notes and 2010 kaplan videos of Dr Raymon

Behavioral science and biostatistics : kaplan 2015 lecture notes and videos

Immunology :Tried kaplan but didn't like it, i think FA is sufficient

Qbanks : Uworld, Usmle rx, Kaplan (found kaplan to be the least useful one)

First pass Uworld - 77%

Second pass Uworld - 90%

I went through this reference material twice for all the subjects and then had around 5-6 passes of FA before the exam. I didn't know too much about Board & Beyond and other materials when i was preparing but you can give it a try.

I've come to realise that different things work for different people and there's no fixed way of preparing. Some people retain better through questions, some retain better through videos, some retain better through text. You need to realise what's best for you and go for it. Apart from Uworld and FA which are a must , there's no need to follow the herd, just do what you think works for you.

Study period :

I did it subject by subject but people can follow the system by system method too if it works for them. For each subject i read the reference material, read FA and did the Uworld of that subject before moving on to the next subject. I know it can be tiring and boring but please never leave a subject half done and incomplete. Once you've started a subject you just have to finish it, take a short break of 2-3 days if you want to and then move on to the next one.

I completed the first reading of all subjects with the first pass of uworld in around 3-3 n half months.

It's important to have a good and strong base so i would suggest everyone to have read a reference book at least once before moving on to First Aid. First Aid is the most important book for the exam but without reading any reference book you may not understand certain things in the book and you may have to mug up certain things which won't be retained in your long term memory.

Then i started doing the kaplan qbank during my second pass of the study material but found it to be much less useful compared to Uworld

You must always keep in mind that the scores you get on these qbanks aren't that important. Never get bogged down if you aren't scoring well on them. Use them as a learning source and just try to learn from your mistakes and read the very relevant and useful explanations of these questions which you can't learn from your books.

Everything was going well till around 6 months of my preparation when i had to go through a major personal crisis. I don't want to go into details but the thing i wanted the most was now deemed impossible to happen and taken away from my life. Honestly speaking, It was a bad phase for me. It was difficult to concentrate and study through it but once i was able to concentrate on my studies i was able to use my studies as a way of distracting myself from these personal issues. One way it did help me in was the fact that i wasn't scared of the exam anymore. The thing i wanted the most wasn't going to happen and i was still surviving after it so i just had the attitude that i have faced the worst for me so let's see what this exam has to offer.I was working hard and giving my best but i knew that even if the exam doesn't pan out well, it isn't the end of the world.

The Last phase :

I started with usmle rx which i found to be a very useful resource of revising and strengthening my knowledge of FA. And then i started giving the mock tests

Nbme 15 :221 (2 months out)

Nbme 16 :232 (1 month out)

Nbme 17 : 246 (20 days out)

Uwsa 1 :249 (15 days out)

Nbme 18 :236 (12 days out)

Nbme 19 :226 (1 week out)

Uwsa 2 :245 (4 days out)

Free 120 :87%

As you can see my scores were fluctuating quite a bit. I was on an upward curve until nbme 17 but then i started on a downward trend of sorts. Once i had read too much i started overcomplicating the questions and thinking that the answer can't be so straightforward and simple and got easy questions wrong. I started making really silly mistakes as well. Nbme 19 and Uwsa 2 were especially very disappointing for me in this regard. I missed things and hints in the questions which i never used to miss earlier. I didn't have a weakness in any particular subject or system it was just a random collection of silly mistakes!

But i tried to take it in a positive way, i knew that i had the sufficient knowledge of getting the score, i was somewhat lacking in the approach for the questions, not in knowledge. So i used that as my strength and tried to maintain my cool,my confidence and reviewed all my mistakes thoroughly and tried to cut out the silly errors and other minor problems as much as i could.

Remember that the scores of these mock tests are only predictors and they aren't the actual exam. Each exam is different. You just need to understand the pattern and way of questioning and learn from your mistakes until the last day and apply it all on the day of the exam.

If you've gone through the material well enough and worked hard and have above average intelligence then you should understand that around 60-70% of people are in a similar bracket as you. After that it's all about your mental state, mental stability, maintaining your cool and being confident in yourself and your own knowledge. Don't succumb to any kind of peer pressure, believe in yourself that you can do it and i am sure that you will.

I know that exam is very important in where you end up in your career but your own mental health is the most important thing. It's not a life and death situation, you can only study and do your best and do the things under your control. Don't be too stressed and tensed, if you have studied well and gained knowledge it'll be helpful to you and it will shine through at some point in your career if not now, then later.

Giving the exam is a phase and task in itself because you're alone in the process. You have to take your own date for the exam and go through with it which is a very different situation to what we immigrants have been used to. Don't postpone the exam just for the sake of it feeling that you aren't prepared as much as you should be. You'll always feel that you're lacking somewhere and aren't prepared in one or the other subject or system. Select a date, plan it out and give your best. Running away and postponing the exam time and again will only add to the stress.

You'll always feel that you haven't done well after you come out of the exam. I had a few doubts of whether i would even get a score if 220! But after a few days you'll come to realise that you didn't do that badly. Just enjoy and relax until your result comes out. No need to stress during this period because you can't change what has happened. You deserve a break no matter what score you get.

I have a Greencard and i want to get into internal medicine with maybe a fellowship in hemato- oncology later. I think I'll be able to achieve that through this score so i am satisfied and happy with it.

I am really willing to help anyone who has any queries or doubts or who's going through any similar issues to the ones i faced be it personal or academic. It may seem that you're alone and lonely in this process but you aren't :) You can inbox me or contact me at my email id ajjuozil10@gmail.com /ajjuiyer@gmail.com.

Hope all of you can achieve your goals you've set out to achieve. Be brave. Be happy. More power to all of you. Best of luck :)

Becks Bethechange - 245

My experience:
I started dedicated prep in June so I had around 6 months.
First nbme flat out fail (around 170/180 I think- online nbme 13)
I took an nbme online roughly once a month
Nbme 15. ~209
Nbme 16 ~ 221
Nbme 17 ~ 236
Nbme 18 ~ 242
Nbme 19 ~ 238
Uwsa1 ~ 241
Uwsa2 ~ 256

I did ALL offline nbmes and used as study tools
My method of study was qbanks: USMLE-Rx, UWorld (twice) and part of Kaplan inc 1 sim test
UWorld average second pass 78%

I never once used Kaplan videos, I bought the books and did not use bar I looked at genetics, I didn’t like them!
I taught anatomy so I didn’t use a specific resource!
I used nothing for ethics but common sense honestly and FA and qbank questions
I watched Pathoma in medical school but rewatched first 3 chapters and a few neuro videos
I used Boards and Beyond for my iffy subjects like renal, genetics etc
I used Sketchy and Picmonic a lot for retention and had used sketchy in medical school also
I made pretty good notes during medical school and was one of the highest in my class in exams so my foundations were good
I read FA once and once only, reviewing certain chapters when I missed nbme questions and even when I got them correct
I made about 10 flash cards for things I kept forgetting, I didn’t get on with ANKI as I didn’t have the time
I studied 4-6 hrs a day 5 days a week if possible. There were periods I took days if not weeks off due to health.
The penultimate few weeks I tried to do 8-10 hrs for a few days then took a day or two off.
My schedule and life was messy and always will be I’d imagine! I have lots of health issues still but I’m fighting them as ever.
During my 6 months I had to move house, my twin sister had a mental breakdown of sorts and I was unable to study with constant threats and overdoses
I couldn’t study for 10 days as I was admitted to hospital again for suspected subarachnoid due to a severe headache that lasted weeks!
I got engaged
I acquired degenerative hip disease due to my previous paralysis and gait and had more surgery
I suffer extreme OCD and lost hours spraying disinfectant spray meaning my immune system crashed and I had 2 bouts of flu and pneumonia
The last 2 weeks of prep I had to go to in-laws 60th birthday abroad so lost 4 days
I had multiple medical school exams and assignments that obstructed my prep
The week of the exam I had 20hrs sleep total, the day of the exam is a total blur and the 3 1/2 weeks after I feared the worst honestly, it was one of the most stressful yikes I’ve experienced in a long time
My first block was the hardest and due to my exhaustion I didn’t freak out 😂so that’s one bonus

Final score: 245

Brisandi Villar - 257

Proverbs 1:7 The fear of the Lord is the beginning of knowledge:

I can say all the Glory and praise to Jehovah; the only real God creator of heaven and earth; without him and his favor I wouldn't be able to get this score!

Step 1: 257
NBME 13: 184 (6 months before) without UW
NBME 15 (offline) 236 (1 month before)
UW first and only pass: 72%
USMLE Rx: 68%
BoardVitals qbank: 83%
UWSA1: 251 (3 weeks out)
UWSA2: 241 (10 days out)
Free 120: 81%

Materials:
Kaplan LN 2016, videos 2014
DIT 2015
FA express videos (waste)
Boards and beyond (bought subscription) (best resource I could hear Dr Ryan's voice answering questions)

Qbanks
Kaplan online (got a free subscription due to hurricane Maria): physio; anatomy; behavioral;
UW: one round started subject wise but added every subject as I went through FA and finished random
RX/BoardVitals: subject wise time on to improve stamina; BV very useful for cardio ; ethics and anatomy, RX useful for micro and pharma

Other resources
Anki: found out about this 4 months before but just used last 2 weeks (mistake): lolconatops micro; shelf notes for anatomy and Lightyear (BNB) for everything else,
100 cases Conrad Fisher
GOLJAN audios and book (last two months)
Pathoma (I liked it but I found BnB better)
BRS physio

If you are looking for a post about taking the exam after 6 months and just know FA and UW; please scroll down; my journey started on January 2017; studied up to march 2017 and had to stop due to many health issues; got pregnant and had an horrible pregnancy but somehow I managed to keep doing some questions from pastest qbank; started studying again on October 2017 and studied until delivering my baby on Dec 8th; then I had a pelvic fracture and was bedridden four months; I thought on give up but after considering I can't imagine doing anything else and as I am already living here in US due to marriage I had to take the chance and do this. (yes I am another old graduated; mom and housewife); at that time took NBME 13 after 4 months without studying and failed (184); I felt so sad but a friend of mine old graduated like me matched on IM last year with 213 on step 1; I decided to keep pushing; at that time a friend recommended BNB, and I started quizzing FA with SP; I started UW and didn't take any assessment until I decide I was ready; did some old Nbme but got 65 wrong on Nbme 3 (2 months before) i was crushed; I thought I knew stuff; I was expecting 20 wrong or somebut my advisor told me not to do old nbmes because the questions are weird; I focused on BNB fa UW and other qbanks on test day I took propanolol 20 mg; I was calmed; got out 1.5 hours before time; I was feeling confident; I can say the 2 most important resources were BNB (the questions are good; that was the best invested money), and Anki; I didn't do other Nbme because my advisor told me why are u losing 4 hours taking an assessment if you have to reinforce things; I focused on forgettable list from FA; and watched 3 first chapter of pathoma.

I can say I didn't do anything special; I knew I was able to get 230 by myself but God wanted to give me 257; I praise him and give him all the glory!

And yes: we; the old graduated moms; stay at home or working wives can do it!

Things i would do different: not doing Kaplan; repeating BNB and start Anki from the beginning

Bruton's Agammaglobulinemia - 262

Hello everyone. I told people who were inboxing me that I would post my experience. Sorry for the delay. Hope it can benefit as many people as possible.

Score:262

exam date:nov 28th

total prep time:7months(intensive studying hours add upto maybe 3 months)

I am a fresh graduate so my weakest areas were basic subjects like Anatomy and Biostatistics.

resources:

Physiology: one read of BRS physiology(annotated with kaplan physio videos 3 years back). LEARN ALL PHYSIO CONCEPTS IN UW!

Anatomy: my weakest point. read HY gross, HY neuro, HY embryo. except for embryo nothing sticked. HY neuro is an awefully written textbook. So finally I just resorted to KAPLAN NEURO VIDEOS(Dr. JAMES WHITE, author of both kaplan and HY neuro). didnot even properly read the kaplan book but annotated all the video points on my FA. My FA neurology was loaded with cuttings of diagrams from kaplan book and HY book. Embryo:HY+FA.

Gross: FA+ UW(had no time left to even read HY gross again)

Biochem: KAPLAN BOOK+ Dr. Lionel becker lecture annotation( watched and anmotated 3 years back). just read once and jumped straight to FA. KAPLAN+LIONEL are the best learning source but FA biochem is the Syllabus(the topics you must know)

Immunology: Kaplan one read(really good book to brush up on the key mechanisms)then FA(again the ultimate syllabus!)

Microbiology: I read kaplan but its a waste of time.FA has everything important especially if you studied properly(from Levinson) during medschool.

Pathology: my strongest area. I studied selectively from Goljan(plus pathoma videos) in medschool instead of Robbins. So I gave it one read(there was no need, given how much we are drilled in patho during medschool). Then moved to FA.

Pharmaclogy: one read of Kaplan book+ Dr. LIONEL videos(annotated 3 years back) and then sticked to FA

BIOSTATS AND BEHAVIOURAL: struggled with it till the last minute. I dont know whats the formula for this one. watched kaplan videos(Dr. Steven Daugherty), read conrads cases, did UW biostats. UW and NBME Qs plus discussions on forums like this helped.

1st 3 months: just one read of books mentioned above but I struggled to set a constant pace. specially during anatomy. Bought UsmleRx but did maybe 10% of it. its NOT A GOOD qbank at all( you can do it if you want a lot of knowledge and have like 3 years to study). its very low yield from usmle point of view.

next month: started FA with very very selective annotations from the above sources( concepts I didnot know at all or things that were super important). Once you start FA you get properly focused and know what concepts are tested on exam.

next 1-2months: UW QBANK. THE BEST THING that ever happened to usmle! 

timed/ random/single pass only:87%

2 blocks a day. read in depth the concepts that were totally foreign to me(like pten pathway etc) and wrote them down on small A4 paper cuttings and pasted them on relavant FA page. skimmed through learning objectives for topics I had a good grasp on. saved flashcards but never got the time to go through them. BUT UWORLD is really GOLD. SUPER HIGH yield

also tried to do 2nd pass of FA but could only finish like 1/5th of the book.

last 1-2 months:NBMEs online ones only plus 2nd pass of FA with UW annotations in between.

nbme13:259

nbme15:265

then(dont remember sequence for the following but)

UWSA2: 262 and UWSA 1: 271. same day

nbme16:252

nbme17: 257

free 120: 91% . gave it in the last week in the actual Prometric Center to get familiar with the environment. really helps calm the nerves.

nbme 19:259 4 days out I guess.

nbme 18: 257 2 days out

on the last day I found old free 120s, did some of those and revised small topics I had a made a list of that I was weak in or that was pure memorisation like lipid biochem n lipid drugs, P450 inhibitors, developmental milestones, harmone signalling etc.

EXAM DAY: super nice staff and very calm and comfortable environment. 

difficulty level: 60% hard( proper long stem make-you-think hard Qs). 30% medium. 10% easy.

exam was closer to UW but more proportion of hard Qs. somewhat like uwsa2 and some Qs seemed vaguely familiar to free 120 Qs but I cant say if they were exact same Qs. No scary anatomy though that I was anticipating.

Take breaks after every 2 blocks and specially after a hard block. Eat and drink something light in that and move around/stretch your legs, get some air. It will help you stay alert till the last block.

Just stay calm, there will be many Qs you will just have to shoot a guess for. Practise UW in timed random and do online Nbmes. it will develop reflexes to read fast without missing key info and help in time management.

some tips while doing MCQs

-Read as if you are reading for the last time (there is no time to reread a Q)

-make a habbit of highlighting all important info in your single read

-make a habbit of crossing out wrong options

-dont do calculations in your head. always use calculator

-always check labs with the given lab ranges

- always highlight what exactly they are asking(in the last line usually)

This will help you land on the right option and avoid silly mistakes.

GOODLUCK to everyone. Remember its just a licensing exam so dont compare your scores with anyone else. every person has different way to studying and different target. May you all achieve them!

VAISHALI SAHANA MALAVATHU - 249

Greetings! I am a 2017 graduate from Theni Govt Medical College, Tamil Nadu, India. I started my preparation by reading experiences in this group. And here I am posting mine hoping it will help you in some way to achieve your dream.

Duration: 14 months (Including lot of breaks)

Resources:

• FA 2017, 18 (The actual book to master) I did 5 times!

• Kaplan videos (Except pathology and behavioral sciences)

• Kaplan books ( For Anatomy, behavioral science, biochemistry)

• Anatomy shelf notes (Covered essentials...good one)

• Pathoma videos, pathoma step 1 review book once (Excellent resource)

• Goljan audio with Goljan pictures (Listen to them once, along with pictures)

• Khans Ethics (must), Conrad’s 100 cases

• Zanki flash cards (Helped me a lot in active recalling)

• U world biostats review (Did it twice...it all made sense the second time!)

• YouTube channels like Meet Patel, Randy Neil MD and The path to medicine.

Q Banks:

• U world for 6 months(76% only once)

• Kaplan q bank

Initial Preparation: (5-6 hrs a day)

Started with Kaplan videos by July ‘17, did them just to familiarize the subjects. Kaplan notes only for weaker subjects as mentioned above. Then I did pathoma videos with the book. (4 months)

After this started FA and U world at random timed mode 1-2 two blocks per day system wise and I took notes directly on to FA (only essential missing stuff as to not overload). (6 months with lot of breaks)

It was hard to find motivation everyday and I did slow down after that. I started doing Kaplan qbank after May ‘18. It was the first q bank which I bought at the start of prep for one year subscription but switched to U world in the middle. So after U world was over I did Kaplan. It comes with 2 simulations. I barely passed the first one with 194 and the second simulation was 216 one week after the first. This was so shocking but I took it as a challenge, after that I gave FA a 2nd revision, improved my weaker areas.

Exam application:

I applied on august 13, 2018, for eligibility period October to December hoping I would be ready by that time. I had an issue with my form 186, so my application was not approved until September first week. Start the application process 6 months out so that you won’t have to worry about it near exam time!

Final preparation: (9 – 10 hrs per day)

Took nbme 1, then I did FA revision for the 3rd time along with zanki cards. I was able to improve so much with anki because active recall works for me and kept me out of the boredom of passive reading. If you like active recall, anki cards is gold and I would absolutely recommend it.

Nbmes : All online except old ones.

• Nbme 1: 46 wrong (3 months before)

• Nbme 13: 240 (2 months before, online and self paced)

• Nmbe 2,3,4 : 25 to 30 wrong (1.5 months before)

• Uwsa 1: 262 (1 month before)

• Nbme 16: 230 (2 weeks before)

• Nbme 17: 238 (1.5 weeks before)

• Nbme 19: 246 (1 week before)

• Uwsa 2 and free 120: 254 and 84% (5 days before)

• Nbme 18: 246 (4 days before)

I did FA 2 two more times simultaneously with nbmes. For the last 3 days I revised high yield and volatile pages in FA, reviewed nbme and uwsa wrong ones, micro, khans ethics, formulas and u world biostats review( because they were my weaker areas).

One thing we all get scared about is how to spend the last week of prep more productively. Make a timetable and put your full heart to it. You have to push yourself because no one else is going to. JUST PUT YOUR FOCUS IN THE PRESENT.

Day before exam:

The day before exam I went through FA rapid review and was skimming pages though I knew it would increase my anxiety (can’t help it ! ha-ha!) I slept for 8 hours and woke up refreshed for which I thanked myself later! Sleep well even if you didn’t revise what you planned to, because you should feel refreshed on exam day to even remember those things!!

Exam day:

Pack light food which you feel comfortable having and some fruits for instant energy. I reached prometric 45 minutes before. I was like “let’s do it!” Be calm and that way your mind will recollect faster! I wrote some biostat formulas on to the practice sheet before starting my first block.

I took 2 blocks-break-2 blocks-break-1 block-break-2 blocks. However I took a silent 3-5 mins break in the desk in between 2 blocks. Make sure you have fewer pockets in your pants because you will be asked to turn them out while checking in and out.

Questions were a bit challenging, lengthy and I marked almost 10 to 15 qns in each block. I had some time issues, which I never had before. This is not to scare you but try to be in that moment and I had been telling myself over and over to stop panicking and that “every second is precious”, so better make it count. I gave my best and walked out with mixed feelings.

Post exam blues just for two days! No point in whining because it’s done! Spent good time with family and got involved in new hobbies!

Mistakes I made:

• I had spent a lot of time on Kaplan videos which of course I did forget at the later stages. So if you are doing them make sure you keep a track of your time.

• I took lot of breaks in between mostly recreational and some breaks due to lack of motivation and my application delay. My u world 6 month subscription ended by May 18 and I did not renew it. I survived with offline u world (saved money for nbmes). Wish I had properly planned the subscription and exam date!

• I took nbmes late which I should have started at least 4 months out. I recommend starting them earlier and at regular intervals in standard time mode.

• I kept postponing without making a decision for exam date. Please fix the deadline date in your mind and strive hard that you become ready for that date.

General tips:

• Find friends with same goals, from the beginning.

• Motivation is hard to find every day especially in the initial prep time. Only consistency matters. Make each day count and ask yourself everyday “What did I do today to achieve my goals?” That’s a powerful question that helps you to be consistent because everyone is afraid to their conscience and it will not let you sleep until you give it what it wants!

• Personally I believe in prayers. They made me optimistic. If you do believe so, wait not.

• It’s absolutely OK to spend weekends with family and friends, it’s essential for recharging our mind.

• Please do not succumb to discouragement, at such times just visualize the score u want to get, write your score on a vision board so that u keep looking at it often and keep working!

• While doing nbmes or q banks, it’s okay if you score low. Better to commit mistakes and learn from them now rather than on the exam day.

• Find your own way of reading, make a plan and stick to it to the end because you will be comfortable in your style of prep. No one’s plan will be so perfect, trust that it will all workout well at the end!

All that I am now and all that I hope to be, I owe to my family. Without the unwavering support of my parents I would not have achieved this score! And special thanks to my friends who guided and motivated me throughout. You can think, now that I have my score report I am making it seem so easy…. but trust me…I have been so afraid and lost at one point hoping for a lift up. You have to do what you dream of doing even while you are afraid!!

That’s it guys. “MAKE IT HAPPEN”. Remember that the happiness in your beloved’s faces is priceless and that’s the best reward for your efforts. Wishing you all the best for your exams! Be happy and fly high! Cheers!

Dr. Vaishali Sahana Malavathu

‎Shah Zaib‎ - 248

Graduation year : 2018

Step 1 - 248
Step 2 - 254( may 2018 )

Exam date - dec 13, 2018
Result date- jan 9, 2019

Duration : 4 months 6 days (7-8-2018 to 13-12-2018)

Resources :
1- first aid with DIT lectures
2- Uworld
3- kaplan ( just for biochem and neuronatomy
4- anatomy shelf notes

Self assessment scores :
Uwsa 1 - 256 (4 weeks before exam )
Nbme 16 - 252 ( 25 days before exam )
Uwsa 2 - 251 ( 20 days before exam )
Nbme 18 - 242 ( 15 days before exam )
Nbme 19 - offline 20 mistakes ( 13 days before exam )
Nbme 17 - offline 14 mistakes ( 12 days before exam )
Nbme 5 ,12,11,- 10-20 mistakes ( during last 10 days )

Real exam score :
248

I started my preparation from first aid and uworld ,didn't wasted my time on kaplan , brs and boards and beyond , and i will suggest u dont waste ur time on kaplan lecture and videos ,they are very very lenghty and will waste your time . Read first aid atleast 4,5 times ( i read it just two times and never read it completely , ( skipped many things ) that was my biggest mistakes because there were so many question in exam directly from first aid . I did first aid and uworld side by side first read a topic and than did question of same topic from uworld ( i didnot made any notes thats the reason that how prepared from exam in a short duration )
i did first round of uworld in month ( 2 blocks per day ) my percentage of first pass was 77 % )
After that i did uworld second time ( never did it completely just did 85 %)
Than i read important topic from first aid quickley and gave nbme 13 (35 mistakes )
Than i read first aid for final time within 5-7 days and started giving self asseement
So the key point is give ur maximum time to first aid and uworld

1st round of uworld : 77% average ( system wise ,timed mode )
2nd round of uworld : 95% average ( random times mode )

Exam day : night before exam i was not able to sleep becuse i was very nervous , just slept 2,3 hours
Durind exam when i was doing 4th block i was not able to concentrate anymore but somehow i completed the block than took break of 10 minuts washed my face with cold water boosted myself and completed the rest of exam

Advice:
Do first aid again and agian and agian ( if i read it one more time than i can get 260 scores easily )
Master the concepts of uworld
Work smartly and save ur time

Be not afraid of greatness. Some are born great, some achieve greatness and some have greatness thrust upon them

NBME 19 Block 1 answers with explanation

ALL ANSWERS ARE CONFIRMED FROM ONLINE NBME

1- f

it's marcus gunn pupil,you should know that it's decreased bilateral pupillary constriction when light is directed to affected eye.

the lesion is in the right optic nerve(afferent) as the question describes lesion when flash is directed to right eye.

-----------------------------------------------------------------------------------

2- c

odds ratio equals a*d/b*c
it's a direct question,you should know the equation well
2*2 table is present in FA ,please know it by heart

-----------------------------------------------------------------------------------

3- d

let's analyse keys:

alcoholic+foul smelling sputum(means bacterial infection ie.anaerobes)+episodes of unconsciousness

this is most probably aspiration pneumonia which may lead to lung abscess (the x-ray finding in the choice)

if you don't know how abscess looks like in x-ray,google search will help a lot.

-----------------------------------------------------------------------------------

4- e

an easy question,remember that accumulation of lactate causes a decrease in ph and eventually fatigue .

lack or decrease in oxygen supply during heavy exercise will shift metabolism to anaerobic metabolism,which will lead to depletion of glycogen and accumulation of lactate

so in fatigue: lactate increases but ph decreases

-----------------------------------------------------------------------------------

5- b

factors determining risk of postmenopausal osteoporosis are:

ethnicity: african americans have low risk than caucasians 

exercise: decreases risk

diet : high Ca diet decreases risk

although socioeconomic history (choice f) may reflect diet and nourishment status  , but choice b (dietary history) is more specific

-----------------------------------------------------------------------------------

6-d

a typical case of rheumatoid arthritis

middle aged woman + affection of proximal interphalangeal joint with sparing of distal joints
biopsy of RA will show proliferative granulation tissue which is known as pannus (choice d)

-----------------------------------------------------------------------------------

7-c

the x-ray in the question shows hyperlucent area in left chest most likely pneumothorax,

sudden left side sharp pain + dyspnea support diagnosis
in pneumothorax: air entry to pleura will lead to loss of negativity of intrapleural pressure (choice c)

-----------------------------------------------------------------------------------

8- c

Exercise distends the vessels, reducing their resistance to blood flow. Thus, the base of the lung receives more blood flow than the apex. During exercise, vessels can be recruited, increasing the total cross-sectional area and reducing resistance. Lung volume also passively alters pulmonary vascular resistance

------------------------------------------------------------------------------------

9- d

pulmonary hypertension leads to increase right ventricle afterload

------------------------------------------------------------------------------------

10- c

very high beta human chorionic gonadotropin as well as large uterus is most likely a case of mole
in ectopic pregnancy this hormone is slightly increased

------------------------------------------------------------------------------------

11- e

of course it's vit D which is responsible of Ca absorption

------------------------------------------------------------------------------------

12- c

both warfarin and dicumarol are structurally related
they inhibit enzyme epoxide reductase which activate vit K ,inducing vit K deficiency like state

-----------------------------------------------------------------------------------

13- d

metronidazole causes disulfiram like effect,which is shown in the question as vomiting , flushing and headache

metronidazole is the first choice to treat trichomonas vaginalis

-----------------------------------------------------------------------------------

14- c

propranolol is a non selective beta antagonist:

beta 1 antagonism >>> decreases heart rate&contractility >>> decreases cardiac output

beta 2 antagonism >>> vasoconstriction >>> increases total peripheral resistance

-----------------------------------------------------------------------------------

15- b

you should know mechanism of aspirin by heart and the step on diagram

-----------------------------------------------------------------------------------

16- c

The patient will have shallow and rapid breathing to compensate for the decreased tidal volume..as deep breaths will cause pain.

nothing is wrong in the airways (obstructions) the airway resistance remains same !!

-----------------------------------------------------------------------------------

17- e

blood-testes barrier are formed from tight junctions between sertoli cells

-----------------------------------------------------------------------------------

18- a

age is the clue 

after 18 >>> antisocial personality disorder

before 18 >>> conduct disorder

-----------------------------------------------------------------------------------

19- a

AMP stimulates glycogen phosphorylase via addition of the phosphate group on it ( remember it through glucagon pathway),this increases affinity of enzyme to substrate

And as you can clearly see from the enzyme substrate curve that it acts as an activator 

So, it is allosteric activator !

-----------------------------------------------------------------------------------

20- b
heparin induced thrombocytopenia,an easy question

-----------------------------------------------------------------------------------

21- b

US detects nuchal translucency but NT is just screening. Since there is predisposition we should do chorionic villi sampling
Chorionic villi sampling can actually detect chromosomal abnormalities as early as 10 weeks of pregnancy before you have to wait several weeks (15 to 20) to be allowed to do amniocentesis. Testing phospholipids is not gonna tell you anything about the fetal chromosomes just give you idea On their surfactant levels.

------------------------------------------------------------------------------------

22- c

flutamide is a non selective inhibitor at androgen receptor while leuprolide is a GnRH agonist but it action varies with dose fashion:

it has activity of agonist when given pulsatile,but when given continuously,it acts as antagonist as it downregulates GnRH receptors on pituitary

when leuprolide is decided to be given continously,it causes surge at first which will lead to increase LH and androgens,so we use flutamide to block this initial increase

------------------------------------------------------------------------------------

23- e

the debate here is between NRTIs and protease inhibitors 

but there are 2 clues:

- nearly all protease inhibitors cause lipodystrophy while only zidovudine and stavudine from group of NRTIs cause lipodystrophy so the choice of protease inhibitor is more likely the right answer

- protease inhibitors cause hyperglycemia and hypercholesterolemia which are present in the question

------------------------------------------------------------------------------------

24- c

all values indicate obstructive lung disease

------------------------------------------------------------------------------------

25- c

bruit over posterior flank > renal artery stenosis

hypertension supports diagnosis

------------------------------------------------------------------------------------

26- c

this is a case of SIADH as indicated by decreased plasma osmolality and increased urine osmolality

small cell lung cancer can secrete ADH as paraneoplastic syndrome causing SIADH

------------------------------------------------------------------------------------

27- g

the only drug from mentioned drugs that is known to cause osteoporosis is corticosteroid

------------------------------------------------------------------------------------

28- b

it is easy to answer this question as from question stem , it looks like an allergy case,in which histamine is released causing marked hypotension , but the very important concept you should know is that opioids cause IgE independent mast cell degranulation

------------------------------------------------------------------------------------

29- c

3rd pouch forms inferior parathyroids as well as thymus

4th pouch forms superior parathyroids as well as ultimoobrachial body

so if 3rd pouch is defective , there will be no thymus formation but there will be parathyroids (superior parathyroids formed from 4th pouch)

-----------------------------------------------------------------------------------

30- c

dynein arm is know to be responsible of retrograde movement while kinesin is responsible of anterograde movement

-----------------------------------------------------------------------------------

31- e

low back pain + osteoblastic lesions >>> prostate cancer >>> increased prostatic specific antigen PSA

-----------------------------------------------------------------------------------

32- e

it is a case of acute rejection which is mediated by lymphocytes

-----------------------------------------------------------------------------------

33- a

a retrograde study which is divided into two groups according to presence of disease

it would be cohort if the division was according to exposure status

-----------------------------------------------------------------------------------

34- e

a case of androgen insensitivity syndrome

-----------------------------------------------------------------------------------

35- d

serotonin is synthesized from tryptophan ,so increase tryptophan in food will lead to increase serotonin

note that niacin is also formed from tryptophan but giving niacin will slightly affect serotonin level because more tryptophan will be available to form serotonin

so choice d is better

-----------------------------------------------------------------------------------

36- c

from the scenario ,it is motor cortex affection

it is letter c than represent face area

google cortical homunculus

-----------------------------------------------------------------------------------

37- a

A site is empty...waiting for incoming of a charged aminoacid tRNA.

Only first amino acid comes to P site, the rest enter at A site, this is a growing chain hence amino acid enters at A site.

P site occupies by the growing peptide chain

-----------------------------------------------------------------------------------

38- f

at point X ,respiration stops

there are many mentioned drugs that can cause this,but from question,phrenic nerve activity is not affected,so the problem must be in neuromuscular junction

the only drug mentioned that can affect neuromuscular junction is tubocurarine,which act as ACh competitive antagonist

tetrodotoxin will affect the nerve itself not neuromuscular junction

-----------------------------------------------------------------------------------

39- b

It is an easy question

it must received a marrow transplant from a male ,so progenitor cells will give XY daughter cells

-----------------------------------------------------------------------------------

40- a

it is a serious systemic infection and must by treated with systemic antifungal (amphotericin B) 

fluconazole can be given as maintenance therapy but amphotericin B must be given acutely first

-----------------------------------------------------------------------------------

41- b

you should know that kidney also shares in gluconeogenesis

-----------------------------------------------------------------------------------

42- b

Surfactant normally decreases the surface tension on the alveolar walls, thereby allowing them to expand easily. This neonate has decreased surfactant levels due to immaturity, because of which his alveoli will have higher surface tension, leading to higher collapsing pressures. This will lead to more alveoli being collapsed---> leading to less air in lungs ---> leading to decreased functional residual capacity.

-----------------------------------------------------------------------------------

43- a

hemoptysis  + hematuria + linear IgG deposition >>> GoodPasture syndrome >>> crescent formation

-----------------------------------------------------------------------------------

44- d

1. Both parents must be carriers (Aa each) for the disease to be passed onto the brother.

2. For the parents to have a child that has this autosomal recessive disease, both must be carriers.

3. For the parent's punnet square, Aa x Aa,

a. 2 Aa, 1 aa, 1 AA

b. The male must be either Aa or AA as he doesn't have the disease. We need to calculate the odds of the male being a carrier --> 2/3

4. For the 30yo female, the chance of having the disease is calculated via hardy-weinberg; you are looking for 2pq. q^2 = 1/40,000. q= 1/200 and p=199/200 (essentially 1). 2pq = 2*1*1/200 = 1/100 chance of being a carrier

5. The odds of the kid having the disease is the same punnet square from step 3. aa = disease, therefore the odds are 1/4.

Run the final calc:

(2/3) * (1/100) * (1/4) = 2/1200 --> 1/600

-------------------------------------------------------------------------------------

45- b

its so straight forward
CD8 cells attack cells expressing MHC 1 which is seen in virally infected cells and hepB virus is a DNA virus that replicates in the hepatocytes....
Hence the hepatocytes express MHC1 with endogenous processing of viral proteins and attract CD8 t cells

-------------------------------------------------------------------------------------

46- a

Because prinzmental is a neurological construction of coronary vessels (mostly idiopathic and responds to CCBs)

other choices are wrong themselves

-------------------------------------------------------------------------------------

47- b

epigastric pain + irritable&forgetful + distal motor weakness + impairment of consciousness

all of these direct to lead poisonong

in lead poisoning there are :

basophilic stippling in blood smear

sideroblasts in bone marrow

Be careful and read what he asked first ,in blood or bone marrow ?!

-------------------------------------------------------------------------------------

48- a

all lab values indicate anemia

why not b,c,d,or e ? >>> as arterial Po2 &Pco2 are normal 

venous Po2 and o2 content are decreased as tissues try to compensate anemia and decreased o2 amount by increasing percentage of o2 extraction

-------------------------------------------------------------------------------------

49- a

coxsackievirus is the most common virus causing myocarditis and most commonly occurs after upper respiratory tract infection

-------------------------------------------------------------------------------------

50- d

widening of hepatic venules + increased hepatic vein&wedge pressures with normal right atrial pressure >>> Budd Chiari syndrome

if right atrial pressure is also increased , it will be right sided heart failure