USMLE step 1 experience by dr.Fawad Khan - score 257

date of exam: 5 dec 2018,

Score: 257

total duration of prep : 7 months approx

materials used: Uworld, Kaplan 2014, pathoma

i had watched pathoma, kaplan videos 2014(except pharma and pathology) during undergraduate years and thus 

i started my preparation after purchasing online uworld in April 2018 and would do it off and on for about 4-5 hours daily and sometimes i would have to skip days because of Job schedule. i would read first aid alongwith uworld.

I would do NBMEs along with it and got dishearted after doing offline NBME 7 , in which i did 39 mistakes.

During the mid of preparation i skipped two weeks because of exhaustion and the whole endeavor seemed fruitless and i was thinking of quitting. but later on i just starts again in September ande this time with greater determination. i kept on doing NBMES the scores of which i would share below and it seemed like my score was stuck in between the range of 230-240.

After the uworld subscription expired i booked the date and had no MCQs pool to solve , thus i downloaded and started doing USMLE rx 2017 offline , after finishing Uworld , just to feel more productive and doing something useful. This Qbank was way too easy and had strightforward questions in comparison to Uworld where the questions were twisted and one had to integrate many disciplines in order to arrive at the correct answer.

EXAM DAY:

Now something about the real exam, the real exam had the same format as that of Uworld, but the questions were way too confusing and one had to think thorougly to arrive at the correct answer. the picture quality of histology images and graphs was poor and one couldnt decipher them easily. it had heart sounds and ECGs which needed proper understanding of ECGs and heart sounds as these questions were not doable just from the provided question stem only. 

Overall in every block there would be 5-10 questions which wouldnt make any sense at all. the rest required good concepts and were doable.

EXAM ANXIETY: (Greatest factor that can mar your score)

Exam day anxiety is the greatest factor that determines your score, the more you fear and are anxious the greater the chances are to do silly and avoidable mistakes, one has to be confident and sure about his knowledge while solving questions. i had 2 juniors along with me and we took the test on the same day and they were well prepared but couldn't achieve their desired target score because of severe anxiety and lack of restful sleep..... And the main factor that my real score came way above my NBMES score is lack of exam anxiety and leaving it to the Luck. i rarely changed my answers while solving questions and would move on to the next block as soon as i would finish marking the answers and giving a quick review. thus i ended up finishing the exam 2 hours before the allotted time.....and my anxiety phase started after finishing the exam as i thought i should have taken more time while solving questions, any how this anxiety kept on bugging me until i got the result on 2nd jan, 2019

I did all of the following NBMEs Offline and calculated the score based upon the formula which is 1.34 * correct answers

NBME 13: 236

NBME 15: 234

NBME 17: 237

NBME 18: 242

NBME 19: 237

UWSA 1: 254

UWSA 2: 254

UW first pass percentage : 79.1%

Step1 Score: 257

hope this helps, Best of Luck,

USMLE step 1 experience - score 239

Step 1 experience

Exam date - 29th January 2019

Exam score - 239

So this post is going to focus on productive preparation in lesser time.

Preparation time -

3 months (dedicated) +

2 months (did just 3 subjects/systems From Kaplan randomly with internship)

Did 2 subjects during medical college in last 2 years.

Though the journey began 3 years ago when I decided to go for USMLE, it was month of September 2018 when I decided to appear for step 1 before my USA visit for rotation and CS ,before 2019 begins.

At that time I was just done with 3 subjects/systems from Kaplan+FA including 1 during my medical college 1.5 years back. That will sound/was sounding stupid thought to many - To go for step 1 in next 4 months.

I was also not sure but started preparing positively. But could do only 1 subject/system (s/s) in September with internship. In first week of October, got A/L for rotation for Feb instead of Jan. That gave me positivity (1 month extra time). But again could do only 2 s/s in October.

Finally all went well and it was my time........ Got time for my dedicated preparation for next 3 months till Jan. It was first week of November already. And at that time I was done with about half of Kaplan with FA. Had a job to do........

Started doing Kaplan videos with notes only superficially (except Biochem and Neuroanatomy) with FA. I always used to correlate the topics from different system while reading FA. That's how you build your clinical acquisition. And I would also add page no. For those correlating topics, and thus revising both topics simultaneously during every revision. That helped me a lot......

Began second revision of FA in first week of December. Now I started Uworld with 1 block from each s/s while revising the same from FA. By this method I was done with 2nd revision of FA with about 10% of Uworld by 26th December. Meanwhile I had to take my date on 23th because of decreasing availability for my desired week.

On 27th I took offline NBME 12. It was just 180. That was something that challenged me to increase my efforts. (I've always been a person who upon facing problems/obstacles, tries to increase efforts rather than decreasing the target.) So that's what I did.

On 28th I started my 3rd FA revision followed by 1 block from each s/s like I did before. The only thing I did differently was, I did 1 extra block of combined s/s after doing every 2-3 s/s. So that's how I was done with 3rd revision of FA and 20% of Uworld by 5th f/b online NBME 13 - which was only 189. This time I personally was about to give up. (Exam after 24 days , Uworld 1st time only 20% done, FA 3 times - M not counting the FA done for Uworld explanation) so this time he was my Dad who brought me out of those negativity and motivated me to keep my efforts 100% till the exam day, and leaving the decision of giving up only up to the last day before exam.

Eventually I realised that I had many silly mistakes on which I had to work apart from lack of knowledge. So from 7th I started doing exclusively Uworld (3 block/day) with explanation and also going through FA for the same. I was done with Uworld on 20th Jan.

Gave NBMEs in between on 15th Jan.

NBME 15 - with about 70% Uworld - 224

NBME 17 - with 100% Uworld - 224

Then on 21st started revising the same, beginning with my oldest block in December. Revised about 35% Uworld and left the rest with NBME 19 - 230 (1 week before exam)

NBME 16 - 230 (3 days before exam)

UWSA 2 - 243 (2 days before exam)

NBME 18 - 242 (1 day before exam)

I think there is no need to explain anything about exam day, everyone must be aware about that, though you can pm me if any q.

So the keys to focus from my experience is

1. It's nothing like you HAVE to work for 8-9 months then only you can appear for exam.

it's about how your efforts, focus and dedication and pattern of preparation are...... Simple concept...... It works like compound interest. If you increase your efforts ×2 , then results will be ×4. Reason is that. If you do the task in 7 days instead of 10 then you have not just saved 3 days. Here, You will also be able to revise the same in 3 days instead of 5 which would have taken otherwise. So by increasing little efforts on daily basis, you will eventually get big results. That was the key which made this possible.

2. Decrease your circle. You may be doing more than people. And knowing that can will Decrease your speed. Remember your only competition is YOU. You need to do more than yourself from yesterday. That's the key to increase your level up and up. Ultimately what matters is, your own people i.e, Family, old friends.

Advice about Uworld- Understand it's not FA. No need to memorize every word/sentence. Just understand every sentence/concept thoroughly during first go thorough. You should memorize only "BOLD text" and "EDUCATIONAL OBJECTIVES". Try to add on from those in FA - only things which are supposed to be memorized, or you think you are likely to forget.

Don't make too many notes.

And also try to make flashcards in Uworld itself. Tag the page number from FA and topic name on them. Will be easier to revise.

Hope that helps. All the best.....👍

USMLE step 1 experience by dr.Shany Cohen - score 224

Hey everyone. I finally got my score this week - 224. It’s not high, but enough for me. 

If you remember, you all advised me to postpone for one more month, and I did, and I’m very pleased with my progress. 

Here are the results of the exams I took in the last weeks - 

December 17 - NBME 19 - 175. 

December 18 - NBME 13 - 198.

January 7 - NBME 11 - 212 (off line, 81% correct).

January 8 - NBME 15 - 210 (off line, 78% correct).

January 18 - NBME 16 - 213 

January 21 - free 120 - 82% 

January 22 - NBME 18 - 209

January 27 - real exam - 224

As you can see my final result was higher than all my NBMEs, so don’t get discouraged. I think this last month of studying made a big difference for me - even though I’ve been studying on and off for a year, and tried to still have a life with 4 kids. I used the last month to go over first aid beginning to end (and memorizing some important things I saw I kept getting wrong), and doing all those NBMEs.

Thank you all for your continuous support. I would’ve given up a long time ago without you. 

Good luck to you all ❤️

USMLE step 1 experience by dr. Neeraj Makheja - score 260

Step 1 Experience :

Score : 260

Exam date : 30th jan 2019

Result : 20th Feb 2019

YOG :2016

Prep time : little over 2 years with many breaks in btw(yes it took longer than what i had expected from reading many experiences and also delayed exam couple of times )

Assessments : In sequence 

UW 82% 1st time

Nbmes 1-5 (Mistakes in 20s ) during initial stages

Nbme 15 >> 248 1st online just after completing uw (6 months before exam )

NBME 6 ,7 ,11(offline)>>14 mistakes each 5 months before exam

USWA 1 >> 269 4 months before exam

NBME 12 ,13(offline)> 10 mistakes 3-4 months out

NBME 17(online) > 265 10 weeks before

NBME 16(online)>246 8 weeks before

NBME 19(offline)>10 mistakes 4 weeks before

USWA 2 > 264 3 weeks before

NBME 18(online)>267 9 days before

FREE 120 > 90% 4 days before

Real deal : 260

Resources :

Kaplan initially but the core material is Uw , Fa ,pathoma (UFAP)

Only after doing so i had to reinforce some subjects with other sources like anatomy shelf notes ,100 cases for ethics , Bs subject review , anki(uw cards)

q banks > UW , RX(around 1200) , medbullets (1000 ques) , kaplan(genetics and behav portion)

INITIAL PHASE: 

This phase was the most difficult one with so many questions on what ,how ,when and which sources to use as there are many of them , so read many previous experiences and found that starting point was kaplan but you have to choose what works best for you as everyone is unique , so do it in your own unique way and having study partner from start is very helpful

>Started with Kaplan plus lectures for most of subjects except for Micro and Patho (kept Fa along with it )

Physio > kaplan plus Brs for cardio , pulmo , nephro.

Biochem and genetics > Kaplan high yeild for this one.

NeuroAnatomy > kaplan initially( later on high yield )

Immuno > Fa is not enough ,kaplan is high yield for this one.

Micro >sketchy plus Fa 

Pharm > 2010 kaplan lectures

Biostats >kaplan initially (its not your usual subject , gave me nightmares initially so its okay to feel that way dont get frustrated at this stage, trust me you be fine at the end . UW , UW for biostat , NBMEs , doing lots of ques and you will figure out how these ques work, so it will take time )

Behav >> Most difficult one for me and one of the most important for exam but still dont know which resource is best for this one . i tried kaplan ,brs some chapters , step2 uw

Pathoma >>Gold standard for patho.

After finishing these started Fa thoroughly but its very difficult to retain info at this stage and takes time to get use to it from subjects to systems and if you are visual learner like me and need some kind of lectures than would suggest doing with 

boards and beyond (Highly under-rated but its more high yield than any other source for fa )if you have enough time for it.

At this stage did 1-5 offline nbmes not predictable but used as a learning tool and what areas i weak in like biostats , behav , skin etc so that i would focus on these more as i moved forward

MOST IMPORTANT PHASE : UWORLD PLUS FA 

>HIGHEST YIELD SOURCE

>how you do it 1st time is very crucial so would suggest doing it online and annotating it on fa at the same time.

>doesnt matter how long you take it to complete it while thoroughly understanding it , use your maximum time of prep doing uw

>subscribed for 6 months

>I am a slow reader so use to do 20q hardly per day completed 1st read in 5 months and 1 month of incorrect/marked .

as soon as i finished it , did 1st online assessment to know what areas to work on and again biostats , behav , skin , repro , genetics were among weak areas so did more ques for these from rx plus read Fa along with annotations

NBMES and USWA:

>one mistake of mine was doing assessments late in prep , will save you alot of time if u start taking these earlier.

>i had booked the date before i had begun these assessments (16,17,18,19)(mistake) so had to delay it because it felt like i was rushing through.

>would suggest doing offline ones with uw and online at regular intervals after completing uw

>makes you orient towards more high yield things later in prep

>Correctly tells you your weak areas cuz i had same problem again and again in each initial nbme

> so worked on those areas by doing many ques as possible from RX and MEdbullets q bank

>Revision is the key , use to review highly forgettable things before every nbme

>Did step 2 ck uw ques for some portions skin , micro , biostat, behav 

>revising fa plus some BNB lectures for rough topics in btw nbmes

LAST WEEK:( these were highly helpful in exam )

>High Yield pages of fa which i had marked during prep

>ECGS

>XRAY CT scans google

>Googling histo pics those that were present in fa

>Youtube high yield images

>Biostat sub reveiw

>Milestones

>FA rapid review

> Some Uw notes

Night before exam :

Sleep is highly important (duh ! no kidding :p ) but wasnt able to sleep for hours , though not recommended but took minimum amount of alprazolam just enough to make me drowsy , thankfully slept for good 4 hours and felt fresh in morning.

EXAM DAY :

>Felt kind of nervous but confident .

>reached around 8.15 

>exam starts around 9 am sharp 

>skipped tutorial part (check headphone before skipping)

>right after few questions your adrenal gland kick in :D and your mind goes into autopilot mode 

>Questions more like uw and uwsa and stem length in btw uw and nbme

>60- % straight high yield concepts of uw and nbme but presented in a twisted manner to distract you.

>30% hard , multistep questions where they want you to integrate ecg , histo , graphs

>10% wtf some of them never even heard of them

>had 5 mins at the end of each block but could review only 2 ques at max

>took 10 mins break after every block

>last block had all the ecgs , audio and behav ques and lack of sleep effect was starting to show so sleep schedule 2 weeks before exam is important

After exam felt kind of good more like relieved as if aim of my life has been completed :p until i started remembering silly mistakes i made and as days went by more and more nervous , i know its normal for people to experience this but still could not resist it .

Mistakes i made :

1 >Breaks from weeks to months

2>Not starting uw earlier

3>Delayed solving nbmes 

4>Not having a proper schedule and targets at regular 

intervals 

5>Didnt have study partner until later in prep

This step 1 journey makes you feel /suffer every human emotion possible and its okay to go through these phases but just keep going , you are not alone :)

ALL THE BEST , GOD BLESS YOU ALL :)

USMLE step 1 experience by dr.gagan aulakh - score 249

So finally its 249 guys

I won’t repeat the same things over and

over again(discussed in this group many times) ,and it will be very honest and non biased

experience.

I forget very easily so Idk the minor details.

In nutshell

1. NBMEs are super underpredictive, so don’t get discouraged.

2. Do UW nicely

At the end of day you should know the educational objectives of UW ques.

3. Final exam will be fully conceptual like uwsa

4. Exam day and your mentality is super important.

Assessments

Somewhere in aug, 2018 Uwsa 1 – 251

Sep, 24 Nbme 17 – 234

Dec, 16 Uwsa 2 – 243

Dec, 30 Nbme 16 - 230

Jan, 13 Nbme 18 - 238

Jan, 18 Free 120 - 77 %

Jan, 21 – Final exam.

Why NBMEs underpredicts and UWSA predicts

This is my very personal opinion. NBMEs will check how well you memorize FA. If you forget

just only one word the question in NBME will be wrong for sure.

UWSA will check the core concepts. You’ve to drive one thing from another and have to

integrate the concepts, and the question won’t be straight forward. The questions are

usually tilted in some way, exactly same will happen in final exam.

How the final exam will be

Don’t worry guys, most of questions you must have seen somewhere in UW. This is for sure.

The most stereotypical case would be presented to you, ex- 40 yr African American female

having some lung problem must be something with sarcoidosis, like this ( Uw will teach

everything about this)

You’ve to think over there,

Like if question stem is easy the options will be tilted in some way,

If options are easy then question stem will be tilted in some way. You just have to think over

there and apply the UW concept on that thing.

Heart sounds will be always on exam, like always, so do prepare for them. ( I wasn’t)

How to attempt a question

I got this in very end phase of my prep, like in last 15 days

This thing is important too,

As I told you, they will ask the same HY concepts in a different way, same stereotypical case

will be presented, so choose the simplest one, don’t over think , don’t think that how

USMLE people can ask this simple thing,

For example, if there is a male patient with some abdominal pain, and you’re thinking about

acute cholecystitis ,so just review it again, because the stereotypical case is fertile fatty forty

female with abdominal pain,

Another example, second newborn female having some obstruction in GIT, and you’re

thinking about pyloric stenosis then review it again man, because the stereotypical case is

first born male newborn usually presented with pyloric stenosis.

These things you will learn while doing UW.

These are just some examples to tell you guys, what I want to say,

Second thing is, you always have to choose the most appropriate option, always exclude

things, exclude the options,

Third is always look over all the options, I mean it always, even if you’re damn sure about

your choice, still do it,

And keep lab values always open, their monitor screen is too big, not like our laptops, so it

won’t compromise your question stem.

If you’re not sure about Heart sound question, do it in last, don’t waste your time over that,

I took 4 minutes, and I got short of time at last, and 2 questions I left unread.

Manage your time properly, in UWSA 2 I mismanage the time, lest 4 questions unread, same

happened in my final one, though it was because of heart sounds, but can’t blame them too.

Mistakes I’ve done

Took a lot of time for prep, delayed my exam

Did NBMEs with explanations, with lot of extra searching, googling and all, I recommend

this, but only if you’re able to revise before exam, I didn’t revise, so at last I forgot the

questions of NBMEs

Didn’t do the Heart sounds

Unable to manage the time during exam

Underestimated the UW a little bit

The question always bogged down me

Do I’ve to know each and every minor detail of UW

The answer is NO, You just have to know the educational objective, that’s it. UW isn’t like

FA, that there are some hidden words, we usually skips, UW is designed this way, the basic

concept or you call it educational objective, If there is “a word” in the explanation that you

don’t get, it’s okay, focus on the basic concept not on the word and just move on. If that

word is important, UW already made a question on that, it’s now UWs responsibility, LOL.

My resources

FA ( I don’t remember how many times I’ve read that, different chapters, different times)

UW (2 times, 2nd one was just my weak areas shown by NBMEs)

Pathoma ( I did it religiously)

Sketchy micro( highly recommend to those, who forgets very easily like me, and are visual

learner like me)

Did neuro from Dr. Najeeb and Kaplan ( you can leave dr. najeeb, but just don’t leave Kaplan

videos of neuro, you will feel the difference)

Started my prep with Kaplan videos, idk those helped or not.

UW and FA

You need to understand FA, and UW will help in this.

Mentality

I could write a whole post on this,

If you’re positive, happy, confident, and having an instinct that you can do it, then nothing

can stop you.

I live all alone, for so many years, my family is with me on and off ( 80% off), this thing

lagged me. Even on result day I was alone, no one was here to celebrate. But, when I

overcame this loneliness then my prep got better. I know so many people who sacrificed

everything, live alone knowingly to avoid disturbance from family, break up in relationships,

etc.

It may seem helpful in short term, but at last you will be exhausted. At the end of the day,

you need someone, with whom you can talk, share. So don’t get hard on yourself, and

everyone needs some kinda emotional support and all.

No one is supposed to know everything, you can search my questions asked in group, so

many simple questions I’ve asked , even on this day I may not answer very simple

question.

How I jumped from 243 to 249 in a month

Guys I’m being honest with you, idk, seriously idk,

I revised FA with annotations in this month, some chapters once and some twice, didn’t do

UW.

I realized that, this is a matter of how you gonna take the exam.

My exam day

My mom visited me for exam purpose, that thing made me so happy, it took my anxiety

away, we went together,

So the point is I was so happy on that day, so much excited that finally step 1 will be over, it

made a difference guys, trust me.

Don’t be anxious, stay cool and calm.

I took break after every block, I used to wash my face, took a bite of chocolate, a bite of

protein bar, some water and red bull.

I talked to myself in mirror, that everything, will be fine, you’re doing great, good luck

sweetie, etc etc, LOL,

So good luck, guys, be positive and optimistic, you will be fine.

Dr. gagan aulakh

USMLE step 1 experience - score 243

Usmle step 1 experience ..

Assessments (serially)

Nbme 13 :25 mistakes (offline ,2.5 months before exam)

Nbme 15 : 246 (online, 45 days before)

Uwsa1 : 247 (38 days before )

Nbme 16 : 240 (online,31 days before )

Nbme 17 : 13 mistakes ( offline ,24 days before)

Nbme 18 : 250 ( online ,15 days before )

Nbme 19 : 25 mistakes , offline.12 days before 

Free 120 : 88 percent (10 days before)

Uwsa 2 : 258 (9 days before )

Usmle step 1 score : 243..

I am happy with my score .i expected more ..but I am happy ..

My exam was in 28th january and my wedding was in 1st february..i was under immense pressure during my study period.I have many health related problems. hypertension for 1 year..i take medicines regularly for this , asthma since childhood ,dns chronic sinusitis (operated once)and many more ..so if I can get a 243 ..then any medical student can do it I believe.

my main score was lower than uwsa 2 and nbme 18 ,which people say are the moost predictive..the reasons are 

-my exam was difficult and different than the assessments ..few questions were easy and concepts were directly from uw and nbme 17 and 18..but there were many new concepts in each block.spent like 2-3 minutes for em...1st block was the hardest .took whole 60 minutes to finish it ..and I couldn’t review any of the questions in any block.

- I got pharyngitis and tonsillitis with fever 3 days before the exam and couldn’t study at all ..just prayed to get well before the exam ..the only positive thing was , I was able to sleep the night before..

Study materials:

Kaplan all books except patho

Kaplan classroom videos 2014 for biochem(this is gold,dr turco is love), pharma (only general pharma, neuro and cardio), behavioral , physio (general physio ,cardio ,respiratory and acid base disorders) ,neuroanatomy 

pAthoma with videos..very good ..

100 cases of ethics by conrad fischer

30 dirty usmle questions for ethics from utube

Study period : 7 months 

Yog : 2017 may..finished internship in june 2018 .took 3 weeks gap from study which i had to .it slowed me down ..try not to take any long break in your preparation.

I studied 10-12 hours a day ..some days even more and some day less than 8 hours..in our country basic science and paraclinical are way different than usmle ..so it took aalmost 3 months for me to capture the concepts ..

Did kaplan with videos with pathoma and first read of fa in first 2.5 months 

Then started uworld online .first pass took 2 months .78%

Then did 2nd read of fa and took nbme 13 ..

Uworld 2nd round (timed and random) took 1 month [80 questions per day] :94 %

Then read fa 3 times with 2019 new additions (didn’t get any questions from them) and tried to do nbmes 1 week apart upto exam.

Kaplan books and videos : read once but biochem , resp and cardio physio twice

Pathoma :twice

Fa: 5 times ..but I recommend at least 7 times read of fa

Exam was mainly concept based and some questions were straight from memorization. I had a question about cyt p450 subdivisions ,answered it with my eyes closed🤪 .i was good in metabolism but got only one question from it and it was an experimental question..i am sure I got it wrong😅 ..

Some advice : 

>study biostat and epidem ..i got many questions from them ..got 3 questions from confidence interval

>Got 1 angiogram pic ..lateral chest xray pic ,brain cut section...i guess you guys should go through uworld pics at least twice .and ct/mri pics from kaplan

>study genetics and molecular biolgy cleverly..got many questions from them

>youtube all heart sounds ..i got 2 ..

> skip tutorial (its similar to free 120) and take 5-7 minutes break after each block .

>try to keep calm during the exam ..its an 8 hour long exam ..getting a low score doesnt mean ure a weaker student than others ..usmle is a game of perseverence ..keep faith in yourself ,cause u know u studied hard..u can do it ..

.ill try to answer any further questions in the comment sections ...thanks everyone.

USMLE step 1 experience by dr.Kaustubh Pandya - score 244

Usmle step1 244. Its been one ride. This group is the best support group for sure. Those crash courses and brain storming sessions helped a lot. It's the grace of God, a hard-working mother behind this to her I dedicate this. This group is one big help. I would be forever grateful to this.

My goal was 250+. I tried so hard to break that barrier but I accept what has been given. I regret making silly mistakes

on easy questions. But it's a learning lesson. Always follow your gut. I remember thinking:" This is wrong and I still marked it". Happy to help. Will try to break 250 on step2 ck. The dreams still on. 

Once again thanks a ton ....

Preparation time: 1 year. 

Uwsa1: 258

Uwsa2: 256

First pass uworld : 79-80%

Free 120:86%

Nbme 16: 244(16 mistakes) 

Nbme 18: 242(18 mistakes)

I also did other nbmes online and was consistent trying to keep wrongs under 20. For me uwsa2 was over predictive. 

1 week before exam was terrible. Anxiety took over. After 2-3 days I started doing few things which I felt I didn't remember. I slept well and didn't read anything afternoon. I feel it's important to built a residual memory. Because that's what helps. Post exam I knew I did terrible. And was going to fail. I felt as if I did 25-30 questions wrong with only 2 WTF questions. I wasn't fatigued at the end. Try cutting down silly mistakes esp. on easy questions

USMLE step 1 experience by dr.Mark Kumar Khan - score 234

Step 1 experience.. 

exam date jan 22..

Total prep time : on and off 1 year

Nbme 16: 226 (10 months before) 

Nbme 17: 243 (6months before)

Nbme 18: 248 (15 days before) 

Nbme 19: 245 (10 days before)

Uwsa2: 258 (1 week before )

real exam : 234 ... as u see my score is low compared to my assessments... your performance on the exam day matters the most...don’t lose focus at the end stage of your preparation and give your best on exam day.... for me, I lost my focus after booking exam date ( I booked 5 days before the exam) , barely read the books last 5 days and exam day performance was bad ( I missed some questions every block and made many silly mistakes as I recalled later)... anyway , the good thing that finally long preparation for step 1 is over and now I am off to prepare for ck.....

Materials used: u world first aid pathoma were the main.

Brs physiology: this book is real gold

Brs behavioural science questions only... anatomy shelf notes...and kaplan videos at the start

Goljan: felt good while studying... but I don’t think It made a difference while solving questions...

Real exam was similar to uworld length wise and uworld and first aid covered maximum of the questions...

NBME 19 Block 3 answers with explanation

ALL ANSWERS ARE CONFIRMED FROM ONLINE NBME

1- a
this woman most likely has urge incontinence
regardless the diagnosis, it is mentioned in the question stem that the drug prescribed affects the normal stimulation of bladder contraction
the bladder contraction (mediated by detrusor muscle) is stimulated by parasympathetic system and inhibited by sympathetic system
internal urethral sphincter is stimulated by autonomic system (sympathetic) while external urethral sphincter (as well as external anal sphincter) have somatic nerve supply (pudendal nerve)
---------------------------------------------------------------------------------------
2- a
the most important principle in ethics is autonomy
even if the patient has no capacity to decide, his family has to come to a consensus based on their perception of patient's wishes not their own wishes
---------------------------------------------------------------------------------------
3- c

Bronchioles are the least resistance due to parallel arrangement but in case of bronchoconstriction, it is the most to be affected due thick muscular layer

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

4- c

flu like illness and rash (erythema migrans) followed by arthralgia in new England coast makes lyme disease a reasonable choice

if it was rheumatic fever ,it would be more specific as sore throat and fever and won't mention a specific location as a camp in new England

the most important key in this question is NEW ENGLAND as lyme disease is common there

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5- a

There is no organic disease here (as evidenced by no anemia, normal scans and endoscopy). The reason to evaluate for major depressive disprder is because she has definite red flags for that(weight loss , increasing fatigability ,need for more sleep), even if not fulfilling all criteria

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6- e

this picture is so bad

diaper rash is most commonly caused by candida,which is normal skin flora

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7- b

an easy question doesn't need explanation as everyone knows that cryptorchidism is a great risk factor for testicular malignancy

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8- b

because the fetus while delivery causes enormous enlargement in the vagina that could damage nearby structures like the anal sphincter
the pressure at a sphincter refers to the inner pressure caused by feces etc...

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9- c

Most likely foreign body reaction(sutures) and granuloma formation

Granulation tissue is formed on ulcers and open wounds by proliferation of capillaries and fibroblasts.

Granulomas are chronic inflammatory lesions seen as a reaction towards any foreign body or fungi or mycobacterium etc.

 The granulomas are composed of giant cells, epithelioid cells and may have central necrosis (caseation)

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10- a

a case of DIC 

following trauma associated with femoral fracture,fat droplets from bone marrow circulate in blood as emboli causeing disseminated intravascular coagulation indicated by multiple ecchymosies ad bleeding from venopuncture sites

although it is called coagulation but this dissemination causes consumption and dilution of clotting factors and platelets so lead to bleeding
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11- f
this man has manifestations of anaphylaxis due to sting.
the toxin released increases capillary permeability leading to edema and severe hypotension
treatment for this case is epinephrine which is a sympathomimetic agent to increase blood pressure
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12- e
The flaccid paralysis especially of lower limbs is most common presenting sign of poliomyelitis and they have mentioned about transmission from another child that also point towards polio because it transmitts via feco oral route whereas west nile virus involves birds as hosts and culex mosquito as vector
Moreover,emigrated from Africa and does not have vaccination history make polio virus most likely

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13- e

picture frame vertebrae=cement lines seen in paget’s disease
you should know that all lab values are normal in paget’s disease except alkaline phosphatase increases

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14- a

adverse effects of aminoglycosides include nephrotoxicity and ototoxicity

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15- d

It increases cGMP in the corpus cavernosa vascular smooth muscle

corpus carvenosum is spongy like structure which will filled by blood from central vessel during erection.

A is dorsal superficial vein & C is urethra

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16- e

the photo shows silver stain. H Pylori.

H.pylori is associated with development of peptic ulcer disease

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17- d

Excessive thirst is a physiological response initiated from the hypothalamus with increased osmolality of the blood. What we see here is a guy who is drinking water regardless of that physiological response. Most of the patients with psychogenic polydypsia drink water to feel well hydrated and not because they are thirsty.

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18- c

sildenafil ,which is a phosphodiestrase inhibitor,is used in pulmonary hypertension as it increases amount of intracellular cGMP causing smooth muscle relaxation

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19- b

frontal lobe is responsible of concentration as well as behavior so lesion in it will lead to inappropriate behavior.

another important clue is (inappropriate use of language) ..remember expressive aphasia (broca's area,which is located in inferior frontal gyrus of frontal lobe)

J is temporal lobe which contains amygdala but it is not the answer as lesion in Amygdala will cause Kluver Bucy = hyperphagia, hyperorality and hypersexuality

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20- d

IgG is the only immunoglobulin that crosses placenta

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21- c
CI=95% is a value set by a researcher that states: i am 95% confident that this OR/RR that i got from my study will between these 2 numbers (interval).
so basically the researcher would accept only 5% mistake that the value is out of this interval.

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22- b

Hyperparathyroidism , PTH increases osteoclasts activity indirectly . first activates osteoblasts which activates osteoclasts (paracrine)
because only the osteoblasts have PTH receptors on them.

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23- b

it is neonatal physiologic jaundice,which occurs because neonatal conjugation enzymes are not fully mature or ready and spleen is removing excess red blood cells that carry Hgb F. so decreased conjugation of bilirubin to glucuronic acid

please keep in mind that it NEVER occurs in first 24 hours. so if you find a neonate with jaundice in first 24 hours,it is always PATHOLOGICAL NOT PHYSIOLOGICAL 

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24- b

the best way to answer arrows questions in the exam in short time is not looking at all values in the same time,but the more important first then the less important.

this is a case of diabetic ketoacidosis (metabolic acidosis condition)

the most important values in diabetic ketoacidosis are :

arterial pH decreases (HCO3 decreases)

serum K+  increases (but total body K+ decreases)

ketone bodies increases

so when this condition is treated ,you will find that :

arterial pH increases as insulin decreases ketones production (this excludes choices a&e)

insulin will shift K+ inside the cell so serum K+ decreases (this excludes choices c,d,e&f)

now you know the answer, IT IS B !

other lab values :

serum HCO3 increases as blood pH increases

blood Pco2 increases as part of compensation

BUN will decrease as renal failure will resolve

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25- c

painful menstrual periods and no pain during the midpoint of menstrual cycle + rectal bleeding episodes associated with menses (due to ectopic endometrial tissues) >>> endometriosis

uterine leiomyoma is usually asymptomatic or may presents with abnormal uterine bleeding

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26- e

T-tubules are extensions of plasma membrane juxtaposed with terminal cisternae of the sarcoplasmic reticulum,allowing for coordinated contraction of muscles.

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27- d

loss of fluid/blood will cause decrease capillary hydrostatic pressure
this will cause less fluid leakage from the systemic capillaries and more fluid reabsorption

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28- c

Water goes through with just simple diffusion from tubular lumen to peritubular capillaries, so it must not have transporters/carriers ---> the ONLY line that goes from one side to other and does NOT have carrier is C.

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29- d

Graves disease,in which anti TSH antibodies are present and thyrotropin is another name of TSH
So thyrotropin receptor anibodies

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30- a

you should know that langerhans cell has Birbeck granules which are tennis rackets or rod shaped on EM 

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31- i
fat soluble vitamins like vitamin A uses intracellular receptor as they penetrate cell membrane without carrier,after that they activate a cascade -or act themselves- that bind DNA increasing or decreasing transcription process (acting as transcription factor).
HOX gene is important in embryo development and vitamin A is very teratogenic due to its effect on developmental genes as HOX gene.
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32- d
patients with scurvy has vitamin c deficiency ,which is very important in collagen synthesis.
vitamin c is important in the step of hydroxylation of aminoacids proline and lysine .
if this process is defective, collagen will be defective leading to easy bruising,poor wound healing,subperiosteal hemorrhage and corkscrew hair.
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33- e
Stage 1: erythema migrans. Fever, headache, fatigue...
Stage 2: myocarditis, meningitis and neuropathies.
Stage 3: Encephalopathy and arthritis

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34- d

dysplastic nevi, which can occur on both sun exposed and no sun exposed areas, can be pre neoplastic lesions that lead to melanoma and they can have genetics mutation inherited in a familiar fashion pattern.

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35- c
it is the most suitable answer as you should start conversation with open ended question
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36- c
trypsinogen is activated to trypsin by enteropeptidase (enterokinase) in small intestine.
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37- d
It is an easy question if you know the normal distribution curve
with a standard deviation of 50 and a mean of 246, concentration greater than 296 means greater than one standard deviation .
one standard deviation = 34%, so above it would be 16%
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38- a
instillation of lipids in the duodenum leads to secretion of cck which causes contraction of gall bladder and relaxation of sphincter of oddi
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39- a
histone acetylation decreases positivity of histone,hence, decreases the affinity of histones for DNA , release supercoils and this will lead to increase transcription
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40- f
after ovulation, corpus luteum secretes progesterone, so it can be used as indicator for ovulation.
progesterone increases body temperature,so some females feel ovulation without measuring hormones concentrations.
estrogen is secreted before and after ovulation
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41- a
B cell activation and class switching depends on interaction between Th cell and B cell,
CD 40 receptor on B cell binds CD 40 ligand (CD40L) on Th cell.
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42- a
vinblastine binds tubulin and inhibits its polymerization into microtubules and prevent mitotic spindle formation >>> decreasing multiplication of cells >>> decreasing number of neutrophils
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43- a
Amniotic fluid analysis is normal but only chorionic Villi sampling shows mosaicism ..chorion is nothing but placenta ..so it’s confined placental mosaicism ..if amniotic cells to have involved it would have been fetal mosaicism 

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44- e

the first step in establishment of viral infection is attachment of viral surface protein to its receptor on host cell.

if this receptor is absent or defective , no infection will occur

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45- c

This is herpes and the image is a tzanck smear. You can clearly see the eosinophilic Cowdry type A bodies within the cell nucleus. 

even if you do not know the image,you can answer,

the question says it is a painful vesicle so Herpes 

candida -- not usually painful 

condyloma  --  a wart not vesicle 

syphilis --- it causes non painful chancre

trichomonas --- causes inflammation and pain but with discharge no ulceration or vesicles

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46- e

history of cystic fibrosis in one sibling is the most important key,

in cystic fibrosis: pancreatic secretions are have low water and electrolytes making making them more viscid >> meconium more hard >> small bowel obstruction

tip:

if in the question the baby fail to pass meconium or has small bowel obstruction in first 2 days of life ,you should think of:

- meconium ileas

- Hirschsprung disease

- duodenal atresia

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47- e

the only gram negative coccobacilli in choices is yersinia pestis

yersinia pestis causes plague which may take three forms : pneumonic,septicemic and bubonic (as described in the stem)

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48- a

during exercise , sympathetic system shifts blood from periphery to skeletal muscle to provide them with fuel and to wash waste products,so,arteriolar diameter is increased,vascular conductance (flow of blood or blood velocity) is also increased.

ATP is metabolized to AMP , so more adenosine is present (this also causes vasodilation)

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49- a

increased level of uric acid in addition to manifestations in the stem >> gout

important note:

we say gout when there are hyperuricemia as well as joint manifestations,but if there is hyperurecemia only with no joint manifestations, it is not called gout, it is called only hyperuricemia !

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50- e

this white exudate is pus.

pus is formed primarily of dead neutrophils

USMLE step 1 experience by dr.Patrick Pathappillil - score 237

Usmle step 1 experience

Step 1 score-237 

I know its not a 250 or an outstanding score but i just wanted to share my experience with everyone, coz it might help some one.

Preparation time - 1 year 2 months

Resources used- First aid & uworld (main)

Becker, rx and kaplan qbank (just for practise) 

Nbme 7- 210(8 months back) 

Nbme 13- 200 (9 months back)

Nbme 15- 221 (7 months ago) 

Nbme 16- 219 (6 months ago) 

Nbme 12- 228(4 months ago) 

Nbme 11- 231 (3 months ago) 

Nbme 17- 242 (1.5 months ago) 

Nbme 18- 246 (1 month back) 

Nbme 19- 246 (1 month back) 

Uwsa 1- 251 (3 weeks ago) 

Uwsa 2- 245 (3 weeks ago) 

Free 120- 75% (3weeks ago) 

I am an average student who used to have fun during med school and just used to study for exams. I started off with first aid but i wasnt able to understand the core concepts. Then i started using rx videos and dit while reading first aid, and that made me understand the concepts upto 70%. After each chapter in first aid i would do the respective uworld topics. My first pass of uworld was 58%.

I was doing well initially and there was increase in my marks till i reached 220 where it started getting stagnant. Then i started analyzing my nbmes and started figuring out why i was getting questions wrong. I would categorize the wrong questions into didnt know, stuck between 2 options and careless mistakes. And the most questions was because i was careless and i wouldnt read the question properly, and there would be some twist in the last line of the question. So i highly advise to read the last line and the options and then read the whole vignette. So then i started doing other qbanks like rx, kaplan and becker on timed mode, so that i dont make careless mistakes. The purpose of these qbanks was not to get extra info but to reduce the careless mistakes that i was making because i was making approximately 12-15 careless mistakes in each exam. When i did these qbank i did it in timed mode, and when i went through the answers i wouldnt bother if its a completely new concept that fa and uworld hasnt mentioned.

Final month

Finished off my remaining nbmes which are 18 and 19. I did uwsa 1 & 2 together to simulate the actual test which is highly recommended. I revised fa 2 more times and noted down the points which i was forgetting on a note book so that i could revise the day before the exam

Advice:

Each persons strategy is different. I feel kaplan is very low yield and not required. FA and uworld is very very high yield. Try to pull out the hidden info in fa and try to understand why each concept given is fa rather than memorizing. After each nbme understand why the answer is wrong, and why the right answer is the right one because those concepts are being asked in the actual exam. During the exam it is advisable you skip the tutorial, so that you can save 15 minutes. You can watch the tutorial on the usmle site the day before the exam. Just do your best and leave the rest to god!!

NBME 19 Block 2 answers with explanation

ALL ANSWERS ARE CONFIRMED FROM ONLINE NBME

1- c

11 year old + warmth and tenderness + mid-diaphyseal lytic lesion + concentric layer of reactive bone (onion like ) >>> Ewing sarcoma

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2- b
it is the mechanism of action of nitroglycerin as it causes release of NO that acts via cGMP
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3- e
gonorrheal infection and other STDs do not require consent in minors so the physician should treat patient without notifying parents
contraception,pregnancy,drug abuse and emergencies do not require consent as well
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4- c

you have to know the definition of confidence interval. The CI = the odds (or likelihood) of finding the true average within a set range. Odds ratio is essentially comparing the odds between cases vs. control for both alcohol consumption and no-alcohol consumption. If one of the answer said, " There is a 5% chance that the true average is not within the range between 1.8 - 6.6" that would be a legitimate answer

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5- c

trauma during mountain hiking + fever + calf swelling and tenderness + crepitus >>> this is a case of gas gangrene which is caused by c.perfringens

the image shows gram positive bacilli

IMPORTANT NOTE :

c.septicum can also cause gas gangrene so why not it ?

the answer is that c.septicum causes spontaneous gas gangrene with rapid onset and hemorrhagic bullae,  BUT it is not associated with trauma (unlike c.perfringens)

in the question,it is mentioned that there was mountain hiking making having trauma more likely and hence c.perfringens is the answer

you should also know that c.septicum can cause colon cancer mostly in presence of IBD&immunosuppresion as risk factors

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6- c

 myopathy&rhabdomyolysis are common side effects of statins particularly when given with fibrates

 myoglobin released from damaged muscle cells may cause acute renal failure

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7- c

efficacy is defined as maximal effect regardless of dose (which determines potency)

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8- e

the graph shows that pressure in left atrium is rising during systole and there is systolic murmur,this indicates mitral valve incompetence

the only choice that can cause mitral valve incompetence is rupture of chordae tendineae 

history of rheumatic valvular disease support diagnosis although it most commonly causes stenosis after many years

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9- a

sweet odor when changing diaber + increased isoleucine in urine >>> maple syrup urine disease,in which,degradation of branched amino acids (leucine - isoleucine - valine) is blocked due to ↓ branched-chain  𝞪-ketoacid dehydrogenase

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10- e

hyperresonance + absent breath sound >>> pneumothorax

in emphysema breath sound is not absent

in all other choices ,hyperresonance does not occur

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11- a
dorsal white matter of the upper thoracic spinal cord has only dorsal column tract which carries proprioception and 2 points discrimination -discriminative sensation- (differentiate if one finger is touching you or two fingers at the same time)
pain and temperature are carried my lateral spinothalamic tract
and motor activity are carried by corticospinal tract
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12- e
this patient has decreased bile absorption due to jejunoileal bypass as blie is absorbed from ileum,a decrease in bile absorption by turn will lead to decrease fat and fat soluble vitamins absorption (K,E,D,A) ,hence fecal fat is increased and fat soluble deficiency will develop
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13- a
bcl-2 is antiapoptotic , so when overexpressed , it will decrease cell death
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14- d
history of severe cramping pain in right flank that radiates to groin + pain not releived by position >>> stone
prophylaxis of stone formation is by drinking large amount of water in order not to let solutes concentrate and form stones
although calcium stones are the most common type kidney stones ,decreasing calcium in diet is not helpful as most cases of kidney stones occur in people with normal calcium level (normocalcemia & hypercalciuria) , and calcium absorption is regulated by vit d
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15- d

Chancre: charachterized by mononuclear cell infiltrate dominated by plasma cells with scattered histiocytes; also obliterative endarteritis with thickened small vessels due to proliferation of endothelial cells and fibroblasts

Condyloma lata: resembles condyloma acuminatum, and charachterized by prominent epidermal hyperplasia, more edema, chronic inflammatory infiltrate, but less keratinization, minimal if any koilocytosis

Gummas: have caseous necrosis, chronic inflammatory cell infiltrate, obliterative endarteritis
Healed gummas: become noncontractile scars with arching fibrosis

for more information :

http://www.pathologyoutlines.com/topic/colonsyphilis.html

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16- e

it is a case of CO poisoning

cherry red skin raises suspicion of either CO or cyanide poisoning

important key to know that headache is the most initial symptom on CO poisoning

in addition to being in a closed cabin in a truck raises suspicion of poisoning with Vehicle exhaust
CO poisoning is treated with 100% O2 + hyperbaric O2
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17- b
it is a case of biliary atresia
in biliary atresia :
- failure to form or early destruction of extrahepatic biliary tree
- leads to biliary obstruction within first three months of life
- normal at birth and then destructed by immune mediated or viral induced
- presents with jaundice (conjugated bilirubin) and progress to cirrhosis
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18- c
the cardiac phonogram shows a holosystolyc murmur
the only choice which causes this finding is mitral regurgitation
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19- c
vomiting associated with cancer chemotherapy is usually treated or prevented with ondansetron as first therapy
metochlopramide is commonly used in diabetic and postsurgery gastroparesis
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20- f
The main function of ATll is vasoconstriction and constrict the efferent arteriole leading to increase GFR with compensatory water and Na reabsorption at the distal collecting tubules
The ACE inhibitor block the conversion of ATl to ATIl so it will block the main function which is the vasoconstriction of the efferent arterioles
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21- d
this case describes xeroderma pigmentosa , in which there is defective nucleotide excision repair  resulting in pyrimidine dimers that are formed due to exposure to UV rays
keep in mind that xeroderma pigmentosa can cause both basal cell carcinoma and squamous cell carcinoma
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22- e
by definition, in situ carcinoma means superficial to basement membrane
if it penetrated basement membrane and reached muscle layer,stroma or venules, it is called invasive carcinoma
certainly you know that metastatic carcinoma is not carcinoma in situ 😄
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23- b
For the new born to be diagnosed with HIV, PCR is to be done for viral DNA

in this case PCR is not done
Antibodies like IgG can pass through placenta can't tell if baby was infected or just they were passed

but this indicates that mother is infected

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24- b

unobtainable blood pressure indicates severe hypotension due to massive hemorrhage after accident,

decreased blood flow and ischemic injury can cause necrosis of tubular cells and their sloughing into tubular lumen obstructing it leading to oligouria 

most affected sites are proximal convoluted tubules and thick ascending limb of loop of henle as they need high amount of energy

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25- c

This patient has Stanford A aortic dissection with bleeding into the pericardial space. This explains the chest pain and low blood pressure 80/40 mmhg. It acts like a cardiac tamponade mainly around the outflow tract of the left ventricles and causes backup of blood in the LV and LA. This increases LA pressure and reduces the pulmonary venous return to left side of the heart.

So pcwp ( an indirect measure of LA pressure) goes up. This pressures back up to the lungs and causes increased diastolic pulmonary pressure and that also backs up to increase RA pressure.

The body sensing decreased blood supply to the tissues ( due to the tamponade effect and low BP) fires reflexly to increase heart rate and vasoconstricts to maintain BP. This explains the increased systemic vascular resistance.

Finally cardiac index is a ratio of cardiac output to body surface area = CO/ BSA. In this case, BSA does not change but due to hypotension, CO reduces. Therefore, the cardiac index also drops.

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26- a
it is a new concept that you should know,but even if you do not know the answer ,you can answer correctly:
by exclusion,central thermoregulation is mediated by hypothalamus,skin graft and burns has no rule with this.
injured and inflammed skin may cause release of mediators that act as endogenous pyrogens but this would be acutely not continuous for years.
there is no large difference between normal skin and grafted or scar skin in sensitivity to heat or sunlight to the degreee that cause hyperthermia
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27- e
it is very very very high yield to know everything about metformin as it is highly used nowadays
it inhibits hepatic gluconeogenesis ,it also lead to inhibition of mitochondrial isoform of glycerol-3-phosphate dehydrogenase & complex 1 in electron transport chain in liver.
if you decided to know one single most important thing about metformin , it would be a side effect of LACTIC ACIDOSIS !!!!!!!!!!
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28- e
rifampin inhibits DNA dependent RNA  polymerase in prokaryotes (this enzyme makes all three types of RNA in prokaryotes unlike eukaryotes that have 3 types of RNA polymerase)
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29- b
bilateral crackles on auscultation >> pulmonary edema >> left side heart failure (most commonly in USMLE)
S3 >> volume overload
pitting ankle edema >> right side heart failure
low blood pressure + peripheral cyanosis with these clues indicates systolic heart failure (diagnosis is supported by pre-eisting hypertension)
in systolic heart failure >> decrease cardiac output (CO)
right sided heart failure >> increased systemic venous pressure (SVP)
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30- b
after circumflex artery angioplasty, blood will increase to regions supplied by it ,which will be left ventricle
NOTE that this patient has a right dominant heart circulation so posterior descending artery arise from right coronary artery, if it was left dominant or codominant,circumflex artery would share in supply of PDA and hence regions supplied by PDA
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31- c
vegetarian for 12 years + macrocytic anemia + neurological manifestations >>> vit B 12 deficiency
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32- f
6-week-old  + projectile vomiting - vomitus free of bile >>> pyloric stenosis
you should know that pyloric stenosis is not present at birth but develops later (within 2 weeks)
congenital megacolon presents in first 2 days of life by failure to pass meconium
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33- a
area postrema is found in medulla and is responsible of vomiting
note that it is one of areas that are not protected by blood brain barrier so it is easily stimulated to produce vomiting by different toxins circulating in the blood.
it is also the target of some antiemetic drugs
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34- d
question stem describes manifestations of parkinsonism disease
in parkinsonism: the lesion is in substantia nigra which is found in midbrain as indicated by the arrow
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35- e
tubular absorption is mostly by active transport using ATP , so high amount of oxygen is used (especially proximal convoluted tubules and thick ascending limb of loop of henle)
while glomerular filtration is a passive process
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36- c
ORS, Oral rehydration solution also contains glucose. This provides energy and helps the sodium–glucose cotransporter protein, which absorbs sodium into the cell much better if glucose is also present. The glucose in the oral rehydration solution ensures that the protein will bring as much sodium as possible into the cell. Bringing more sodium into the cell reduces its water potential, causing water to re-enter the cell from the lumen by osmosis.

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37- a

recurrent bacterial infections after birth indicates immunodefficiency disease

the only immunedeficiency disease in the choices that is associated with absence lymphoid tissue is Bruton agammaglobulinemia 

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38- e

progressive dementia + major depressive disorder + movement disorder + autosomal dominant trait >>> Huntington disease

great variability in the symptom severity and age of onset support the diagnosis

this phenomenon is called anticipation,which means that disease severity increases with earlier onset of the disease with each generation

the cause of this is trinucleotide repeat.

the more the number of triplet , the more the severity and the earlier is the onset.

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39- c

generalized tonic clonic seizures after 3 days of hospital admission with no access to alcohol indicates alcohol withdrawal 

moreover,other choices do not cause seizres in withdrawal.

delta9-tetrahydrocannabinol (9THC) may cause tremors and ataxia but not tonic clonic seizures 

it is very high yield to know manifestations of alcohol withdrawal:

3-36 hr : tremors (the first manifestation) and other minor symptoms similar to other depressants

6-48 hr : seizures

12-48 hr : hallucinations (usually visual)

48-96 hr : delerium tremens

treatment for alcohol withdrawal is benzodiazepines

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40- e

under normal conditions, prolactin secreted by lactotrophs in anterior pituitary gland is suppressed by dopamine secreted from hypothalamus.

dopamine antagoinists as metoclopramide will lead to removal of this suppression ,and increase prolactin secretion from anterior pituitary (adenohypophysis) leading to galactorrhea.

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41- d

treatment and prevention of influenza A and B is oseltamivir ,a sialic acid analog that acts as  neuraminidase inhibitor , decrease release of progony virus

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42- d

both hepatitis A and E are transmitted via feco-oral route,have no chronic state and usually self limited

but the main difference is that hepatitis E have a high mortality rate among pregnant women so they should be advised not to travel to any region that is know to be endemic with hepatitis E 

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43- e

actually,the question asks about the normal histology of the lung

you should know that :

type 1 pneumocytes cover about 97% of alveolar surfaces and their function is gas diffusion

type 2 pneumocytes secrete surfactant and serve as precursors to type 1 cells,proliferate during lung damage

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44- c

The clue is meningiomas are derived from arachnoid cap cells. They occur at Dural reflection, the sulci, cerebellopontine angles and etc.

meningioma progresses slowly - during 1 year only focal signs not exacerbating,

most common type of astrocytoma is glioblastoma multiforme and the characteristic lesion is pseudopalisading necrosis (not mentioned in vignette)

Generally, people with glioblastoma die within 1 year


remember that... the hallmark of meningioma is its relation to a meningeal surface hence relation to sulcus

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45- a

decreasing to 5 mm will automatically include many cases that were left whose induration size was 5-9.9mm, hence prevalance will increase

incidence should also increase as the no. of new cases that will come are said positive if more than 5mm, earlier the limit was 10 mm. so comparatively no. of cases will increase compared to previous data

you should know that:
prevalence = incidence * duration
so when incidence increases,prevalence also increases

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46- a

severe combined immunodefficiency SCID is due to deficiency of IL-2R gamma chain (most common .X-linked) or adenosine deaminase deficiency (autosomal dominant,2nd most common cause)

adenosine deaminase deficiency will lead to accumulation of high amount of adenosine in lymphocytes which is toxic ,so they will not work well

patients with SCID present with recurrent bacterial and viral infections and may also opportunistic infections since birth .

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47- c

pattern of getting HLA from parents when you will do full square you will see that are 4 options (3 numbers from one parent are going always together to one gamet)

to make it simple .....

inheritance of HLA is like blood groups but no dominant effect like (A /B )

so a parent may have HLA-dr ( lets call it A) and HLA-dr2 (B) . other parent have HLA-dq4 (C) HLA-dq5(D )

so inheritance would be A B * C D 

results would be :

AC

AD

BC

BD

each one of the 4 results would be different . so it is 1/4 chance of being the same

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48- g

Proteins Breakdown is done by 2 methods... an ATP independent process by Lysosomes... 

other one is ATP dependent Ubiquitin proteosome system...

Cachexia mean muscle wasting. 

Protein in the muscle is tagged for degradation with small protein called ubiquitin and the final complex is added to proteasome 

So proteasome will degrade the tagged protein 

So increase conjugation of ubiquitin causes breakdown of muscle 

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49- c

It’s damage to internal urethral sphincter not external
And the internal urethral sphincter is innervated by parasympathetic (pelvic splanchnic)

and this will lead to overflow incontinence

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50- e

tetracycline as well as sulfonamides have a side effect of photosensitivity