Official Internal Medicine Shelf Exam Thread

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I ended up scoring in the 63rd percentile, 72 raw.

I really don't understand what I'm doing wrong. It feels like my knowledge base is very good, much better than what is reflected in my shelf scores (this is the second shelf that I've scored poorly on). It's not like I'm a bad test taker, either. I did well on Step 1. This is a huge kick to the ego, especially since I'm considering doing IM.
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Finally got my grade back and got a 90. Used only the UWORLD IM questions to study. Finished them at 75% correct.
 
hey guys!

I really like the book Step Up to Medicine, but I dont think I will be able to finish it during my Internal Medicine rotation. It is a bit dense for me.

I still have a few weeks to go but my current plan is:

1- Step Up to Step 2 with DIT lectures.
2- MKSAP (provided to us by the school)
3- As many Uworld questions as humanly possible. If I can finish all of the IM questions I'll do it.

You guys think this will be enough for me to get >5%ile on the shelf (my school's passing requirement)? To those who have experience with the resources i mentioned/the IM shelf (and obv. assuming that we are speaking with objectivity here): do you think I could score in the 90th percentile with this plan?
 
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My friggin head is spinning in regards to this shelf. I've historically been an excellent test taker but these 3rd year shelves are completely OWNING me. And it's not like I'm being lazy and cramming a week before the test; I'm doing bona fide studying 3 weeks out.

Anyone else feel like this?
 
AngryBird69 said:
My friggin head is spinning in regards to this shelf. I've historically been an excellent test taker but these 3rd year shelves are completely OWNING me. And it's not like I'm being lazy and cramming a week before the test; I'm doing bona fide studying 3 weeks out.

Anyone else feel like this?
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I feel the same way. I'm trying to finish the Uworld questions and read MKSAP but it's hard to find time to do both of those and supplement the questions with Step Up material. Also being on wards the month before shelf doesn't help.

Godspeed.
 
AngryBird69 said:
My friggin head is spinning in regards to this shelf. I've historically been an excellent test taker but these 3rd year shelves are completely OWNING me. And it's not like I'm being lazy and cramming a week before the test; I'm doing bona fide studying 3 weeks out.

Anyone else feel like this?
Click to expand...

I just brought this point up with my IM course director. She basically said to not worry about it.
 
which nbme self assessments do you guys recommend? comprehensive clinical medicine (i assume this is for step 2), the medicine forms on the clinical science mastery series, or both?
 
Took it on Friday -- 99. Our school gives one number, and I don't know whether it's the raw or scaled or percentile or what.

MKSAP 5 x2, UWorld IM x1, Step-Up to Medicine at least once through (plus randomly looking stuff up later), plus reading on patients (usually in Cecil's Essentials of Medicine/UpToDate).

Questions were pretty straightforward, nothing too crazy. Preventative health questions were very easy (know the USPSTF guidelines, ATPIII, JNC7, etc). Some weird surgical/procedural questions (what kind of wound dressing in this situation, how would you handle X complication of a subspecialty procedure), but they could be reasoned out. Lots of CP, SOB, joint pain, etc.
 
^Wow you guys got your scores back really fast. I also took the test on Friday and kind of having nightmares about the results. I keep thinking of the 10-20 questions I know I got wrong.

I felt like the exam was very random - UWorld certainly helped but I think having excellent test taking skills and being able to make crucial decisions under pressure are more important.
 
VisionaryTics said:
Took it on Friday -- 99. Our school gives one number, and I don't know whether it's the raw or scaled or percentile or what.

MKSAP 5 x2, UWorld IM x1, Step-Up to Medicine at least once through (plus randomly looking stuff up later), plus reading on patients (usually in Cecil's Essentials of Medicine/UpToDate).

Questions were pretty straightforward, nothing too crazy. Preventative health questions were very easy (know the USPSTF guidelines, ATPIII, JNC7, etc). Some weird surgical/procedural questions (what kind of wound dressing in this situation, how would you handle X complication of a subspecialty procedure), but they could be reasoned out. Lots of CP, SOB, joint pain, etc.
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So would you say the difficulty level was somewhere in between MKSAP and UWorld? And the question length was closer to MKSAP (longer) than UWorld? Taking on Thursday and getting kind of nervous.
 
metallica81788 said:
So would you say the difficulty level was somewhere in between MKSAP and UWorld? And the question length was closer to MKSAP (longer) than UWorld? Taking on Thursday and getting kind of nervous.
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Style is like the medium difficulty UWorld questions. Nothing like MKSAP or the ridiculous UWorld questions.

Questions weren't overly long, but there were plenty of distractors in each question, so it took my some time to kind of make sense of what was going on.
 
exeunt said:
which nbme self assessments do you guys recommend? comprehensive clinical medicine (i assume this is for step 2), the medicine forms on the clinical science mastery series, or both?
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anyone?:confused:
 
VisionaryTics said:
Style is like the medium difficulty UWorld questions. Nothing like MKSAP or the ridiculous UWorld questions.

Questions weren't overly long, but there were plenty of distractors in each question, so it took my some time to kind of make sense of what was going on.
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This sounds like the opposite of the test that I took. I took mine during second block. Are there different versions? I thought that they were outlandishly long and the easiest were at the level of the medium difficulty UWorld questions.
 
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exeunt said:
which nbme self assessments do you guys recommend? comprehensive clinical medicine (i assume this is for step 2), the medicine forms on the clinical science mastery series, or both?
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Take the clinical science mastery one for the medicine shelf. The comprehensive clinical medicine exam is supposed to be practice for step 3 according to the nbme website. The step 2 practice exam is the comprehensive clinical science exam.
 
Does anyone know of a thread where discussion about the question topics for the clinical science mastery series for medicine practice exams is taking place ? I could not find anything. Thanks guys.
 
Anybody know how long we can expect to wait for scores to come back?
 
Originally Posted by VisionaryTics
School dependent. We take our shelves on Friday, and scores are posted Monday morning.
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Isn't that nice? My school doesn't get ours back until four to six weeks later.
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Well it doesn't take 4-6 weeks for results from the NBME. Your school is prob just taking their time. 4-6 wk wait would piss me off. Why would I care about my score when already studying for the next clerkship nbme. Your class should write a grievance letter to the department.

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I used MKSAP and Uworld and looked up stuff on patients for day-to-day learning issues while with attendings on the wards and in clinic.

But with that said here's what I used:

Case Files x1
MKSAP x2
About 30% of Uworld

If you can do this you'll be fine. If you can do more you'll do better. Rock on :thumbup:
 
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Thought I would give back after all the forum has done for me-- I got a 93 raw on the shelf and for what its worth I got a 90 on both of the NBME internal medicine practice tests the night before. I barely touched step up to medicine and instead just did Uworld once throughout and then again in the week before my shelf as well as MKSAP once. Its possible to do well purely from a question based approach.
 
96 percentile.

Did MKSAP the week before the exam from start to finish.
Read Step Up to Medicine within the last 3 weeks before the exam.

Did not do Uworld or anything else, if you can pick apart the MKSAP questions and understand how to approach them in general, the exam will be easy and you'll do very very well, while Step Up gives you the facts/details you must know cold
 
90 raw, 93 percentile

UWorld x 1 (78%)
SUTM x 1.5

I was surprised by the length of the stems. From the people here and at my school, I was expecting overly lengthy stems, but the ones on the shelf were similar to UWorld's. I actually had 10 minutes left at the end to go through marked questions. There were also quite a few (~10) MRI/CT/X-ray questions on mine, and of course, I couldn't tell what was going on for most of them.
 
98% scaled

1x UW
2x SUTM
1.5x MKSAP

Honestly, the key to this test is hammering through questions. They all have long stems, but if you can pick out key words that make the answer obvious (happens often), you can just move on, concentrating on the tougher questions. If you read every stem thoroughly, in it's entirety, you'll run out of time, this happened to quite a few friends.
 
82 Raw.

Uworld x 2 (Did not do electrolytes, derm, optho, ent, neuro, biostats)
MKSAP x .75
PreTest x .5
Case Files x .5
 
I just took one of the NBME self assessment exams. I had a few questions that I'd like help clarifying.

Twenty-four hours after admission to the hospital for treatment of community-acquired pneumonia, a 72-year-old woman's mental status has been fluctuating between barely arousable and alert and oriented. Current medications include azithromycin and ceftriaxone. At 4 am today, she reported to nursing staff that there were men in her room who were trying to steal her possessions and that she was afraid of animals outside her window who were trying to hurt her. Two hours later, she told the physician that she would like to go home. She said, "I know I have pneumonia and haven't been myself, but I'm feeling better now and would like to continue treatment as an outpatient." Vital signs are within normal limits. Crackles are heard at the right lung base. On mental status examination, she is pleasant, alert, and oriented to person, place, and time. Her Mini-Mental State Examination score is 25/30. She repeats that she really wants to go home and will sign out against medical advice (AMA) if the physician does not discharge her. Which of the following is the most appropriate next step?

A) Allow the patient to sign out AMA and document that she should have remained in the hospital
B) Ask the patient's family to persuade her to remain in the hospital
C) Assess the patient's decision-making capacity
D) Contact the patient's family to determine if they are comfortable taking her home
E) Discharge the patient and schedule a follow-up examination in 2 days
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I went with E and that was wrong. She has normal cognition. Treating her as an outpatient seems reasonable if she doesn't want to be in the hospital. Letting her go AMA without followup seems like it'd be wrong. I have no reason to think she's incompetent. Should I have contacted the patient's family?

A previously healthy 32-year-old woman comes to the physician 1 day after a rash developed on her face, neck, and hands. Prior to onset of the symptoms, she was weeding and fertilizing her backyard while wearing a sleeveless shirt and shorts. She used a sunscreen but did not wear a hat or use insect repellant. She reports that she also received several scratches on her hands from the rose bushes. Examination shows bright red papules, vesicles, and bullae, some in linear pattern, on her forearms, neck, and face. There are oozing vesicles over the wrists. Which of the following is most likely to have prevented this rash?

A) Avoidance of contact with fertilizers
B) Avoidance of contact with rose thorns
C) Avoidance of contact with weeds
D) Avoidance of sunscreen
E) Wearing insect repellant
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I went with B and it was wrong. I guess this is contact dermatitis from weeds? I went with the rose bud buzz word association with sporothrix. I guess you can eliminate it because there's neck involvement?

A 20-year-old man comes to the emergency department 8 hours after the onset of severe pain, swelling, and discharge from an area over his lower back. He has a 1-month history of increasing pain in this area with sitting or activity, and the pain became exacerbated during a 400-mile car trip today. He has no history of serious illness and takes no medications. Examination shows an erythematous, fluctuant area of edema in the intergluteal cleft above the sacrum at the midline. The area is tender to palpation, and there is a small amount of purulent discharge from a small opening. Which of the following is the most appropriate immediate next step in management?

A) Sitz baths
B) Topical application of an antibiotic
C) Examination under anesthesia
D) Surgical drainage
E) Wide excision
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Sounds like a pilonidal cyst. I went with wide excision and it was wrong. Should I have drained it first? Seems pointless to make the guy go through two surgeries if it's gotta come out eventually. EUA seems like overkill since this isn't like an internal hemorrhoid which is so painful you can't even get a look at it. The lesion is easily visible.

A 57-year-old man comes to the physician because of a 4-day history of progressive shortness of breath and cough productive of yellow sputum. He has chronic obstructive pulmonary disease treated with an ipratropium inhaler, but he states that the inhaler has not relieved his shortness of breath over the past month. He smoked two packs of cigarettes daily for 40 years but quit 6 months ago. He has worked as a volunteer in a homeless shelter for the past 10 years. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 22/min, and blood pressure is 130/80 mm Hg. Breath sounds are decreased. Scattered rhonchi are heard. Pulse oximetry on room air shows an oxygen saturation of 90%. An x-ray of the chest shows hyperinflation of the lungs. Which of the following is the most likely diagnosis?

A) Asthma
B) Bronchitis
C) Bronchogenic carcinoma
D) Community-acquired pneumonia
E) Tuberculosis
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I went with CAP and it was wrong. 4 day history of purulent sputum sounds like bacterial pneumonia to me. Is it supposed to be viral bronchitis since he's afebrile and there's no consolidation on CXR? I think it's kind of a bull**** question since I've seen plenty of CAP where initial CXR doesn't show consolidation because the guy is dehyrdated. I guess third year has made me forget NBME radiologists are gods and can call 100% of pnuemonia.
 
For the recent shelf takers, what were you averaging on Uworld? I've been doing random blocks of IM Qs, and the average test taker scores have been 55-58% which I thought was kind of low.
 
I went with E and that was wrong. She has normal cognition. Treating her as an outpatient seems reasonable if she doesn't want to be in the hospital. Letting her go AMA without followup seems like it'd be wrong. I have no reason to think she's incompetent. Should I have contacted the patient's family?
Click to expand...

Lack of confusion does not necessarily mean this patient can be treated on an outpatient basis. There is not enough information to actually determine the risk score, but since the patient was initially admitted, that means she had a higher risk for mortality, and that did not change by spending a day in the hospital. That's why I think choice A is more appropriate.

I went with B and it was wrong. I guess this is contact dermatitis from weeds? I went with the rose bud buzz word association with sporothrix. I guess you can eliminate it because there's neck involvement?
Click to expand...

Perhaps the fact they've written that 'the patient comes 1 day after' indicates this is a delayed-type hypersensitivity? Doesn't sound like this is a well written question.

Sounds like a pilonidal cyst. I went with wide excision and it was wrong. Should I have drained it first? Seems pointless to make the guy go through two surgeries if it's gotta come out eventually. EUA seems like overkill since this isn't like an internal hemorrhoid which is so painful you can't even get a look at it. The lesion is easily visible.
Click to expand...

This is an acute pilonidal abscess, that's why it should be incised and drained. If it were a chronic pilonidal sinus, then procedures like marsupialization would have been more appropriate.

I went with CAP and it was wrong. 4 day history of purulent sputum sounds like bacterial pneumonia to me. Is it supposed to be viral bronchitis since he's afebrile and there's no consolidation on CXR? I think it's kind of a bull**** question since I've seen plenty of CAP where initial CXR doesn't show consolidation because the guy is dehyrdated. I guess third year has made me forget NBME radiologists are gods and can call 100% of pnuemonia.
Click to expand...

You're right, because of the lack of fever and CXR appearance, acute bronchitis is more likely.
 
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83 raw

MKSAP + 1/2 Uworld @ 73% correct + Up to Date through 12 weeks of IM
 
How much should I be getting right first pass on MKSAP 4 or 5 to be doing well/OK on the shelf? I'm getting ~80%, regardless of whether I've pre-read on the topic in StepUp or am doing it fresh just based on retained knowledge from MS1/2.
 
Any opinions on using Conrad HY cases for the IM Shelf? IM will be my last rotation of year and considering taking taking Step 2 a few weeks after. So any experience with the Conrad cases and step 2 would be great as well. Thanks
 
88 raw, mksap 4 + 3-400 uworld + case files + step up .. for mksap i def wasn't scoring that well, some sections like gi i was prob in 80% but heme/onc was like a 40%
 
An 82 year-old man is brought to the ED after being found unresponsive in his home by his niece. He has mild HTN, treated with HCTZ, and diet-controlled DMII. His neice reports that he has a 2 year history of mild dementia, Alzheimer type but has been able to live independently. On arrival, he is obtunded, T 38.2, P 118, RR 22, BP 100/60. Dry mucous membranes and poor skin turgor on exam. No JVD. Scattered rhonchi bilaterally. Cardiac exam RRR, normal S1/S2 2/6 systolic ejection murmur at the aortic area. Abdomen s, nt, nd, increased bowel sounds, no masses. peripheral pulses decreased. Labs: WBC 16, Hct 48, Plt 240, Glucose 840, BUN 62 Cr 2.2. FOBT negative, ECG shows no abnormalities. What is the most likely cause of these findings?
A) complete insulin deficiency B) diuretic abuse C) Excessive glucagon secretion D) osmotic diuresis E) Uremia F) valvular stenosis

A is unlikely because why would he go from mild diabetes to complete insulin deficiency. D is possible because they point towards him being dehydrated. What do you guys think. This is a question from the new NBME shelf prep exams.
 
katyperryesque said:
An 82 year-old man is brought to the ED after being found unresponsive in his home by his niece. He has mild HTN, treated with HCTZ, and diet-controlled DMII. His neice reports that he has a 2 year history of mild dementia, Alzheimer type but has been able to live independently. On arrival, he is obtunded, T 38.2, P 118, RR 22, BP 100/60. Dry mucous membranes and poor skin turgor on exam. No JVD. Scattered rhonchi bilaterally. Cardiac exam RRR, normal S1/S2 2/6 systolic ejection murmur at the aortic area. Abdomen s, nt, nd, increased bowel sounds, no masses. peripheral pulses decreased. Labs: WBC 16, Hct 48, Plt 240, Glucose 840, BUN 62 Cr 2.2. FOBT negative, ECG shows no abnormalities. What is the most likely cause of these findings?
A) complete insulin deficiency B) diuretic abuse C) Excessive glucagon secretion D) osmotic diuresis E) Uremia F) valvular stenosis

A is unlikely because why would he go from mild diabetes to complete insulin deficiency. D is possible because they point towards him being dehydrated. What do you guys think. This is a question from the new NBME shelf prep exams.
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I would say D.
 
i am finishing uworld and reviewing my wrong answers...I only have time for mksap or step up *1...aiming for a score in the mid 80s...thanks!!
 
Mksap 4 x2 and several sections of Mksap 5,
Also ~1/2 of SUTM

No UW.

92 scaled, 99.7%ile
 
99 scaled score, whatever percentile

Watched all of the Kaplan Step 2 CK videos (Conrad <3 <3 <3 <3)
Did all of the UWorld IM questions
Read a lot of UpToDate for my own edification, but it probably wasn't helpful on the exam
Listened to the MKSAP 15 audio companion while driving/jogging, learned a lot of useless non-testable information that i'll purge at the end of the year

Took the exam with 3 rotations already under my belt. The test was a joke but I way over-prepared and was going for studentdoctor elite badass status. I credit Conrad with most of my core knowledge. He really does an excellent job at cementing the ORDER in which to do things which seems to be key on third year shelf exams.
 
ijn said:
99 scaled score, whatever percentile

Watched all of the Kaplan Step 2 CK videos (Conrad <3 <3 <3 <3)
Did all of the UWorld IM questions
Read a lot of UpToDate for my own edification, but it probably wasn't helpful on the exam
Listened to the MKSAP 15 audio companion while driving/jogging, learned a lot of useless non-testable information that i'll purge at the end of the year

Took the exam with 3 rotations already under my belt. The test was a joke but I way over-prepared and was going for studentdoctor elite badass status. I credit Conrad with most of my core knowledge. He really does an excellent job at cementing the ORDER in which to do things which seems to be key on third year shelf exams.
Click to expand...

I would say that was a huge factor to your score. Strong work. You're better at having studying discipline than I am.
 
Are you guys buying the Step 2 Kaplan videos or what?

Aren't they like $2,000 or $4,000?
 
You dont need to get 100 out of 100 correct for a 99.

Got that score despite knowing for sure i messed a few up.

(yea yea throw tomatoes my way. just FYI for anyone who wanted to be sure of this fact)
 
I'm planning to only do the 1400 UWorld questions, while going meticulously over the answers and explanations. Does anyone have an idea where would that put me for the shelf? I feel like SUTM isn't helping that much with UWorld questions. A lot of it are minutiae you're only likely to pick up while reviewing cases on the floor.
 
Jorje286 said:
I'm planning to only do the 1400 UWorld questions, while going meticulously over the answers and explanations. Does anyone have an idea where would that put me for the shelf? I feel like SUTM isn't helping that much with UWorld questions. A lot of it are minutiae you're only likely to pick up while reviewing cases on the floor.
Click to expand...

There are 1400 IM Uworld questions?
 
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