Just took Step 2

I just took Step 2 so if anyone has any questions I'll try my best to answer them. The good news about Step 2 is that you don't have to study for it if you've been conscientious about reading during your clinical rotations. The bad news is that if you did want to study for Step 2, I don't really see any way of going about it. The 2 weeks I studied were pretty much useless. I used Secrets mostly, First Aid a little, and did 3 of the exams in NMS. Secrets was great for answering the NMS questions, but not so great for the actual Step 2. Even the released items are vastly different from the type of questions now on Step 2. If I had to do it again, I would have read Secrets once, completed 1 or 2 NMS exams, and then spent the rest of my time reading about all the rare diseases you never see on the floors. The one hour I spent reading about pediatric immunodeficiencies, X-linked agammaglobulinemia, transient hypogammaglobulinemia, Wiskott-Aldrich, SCID, etc, probably scored more points for me than all the rest of my studying combined. I would have spent more time on management and less time on diagnosis. I also would have reviewed some basic pathophysiology. I had a number of questions that gave you the diagnosis and asked for the mechanism, not only of the disease, but also of the treatment. For a string of questions there I thought I was taking Step 1 again. One question asked about the mechanism behind giving Rhogam, not the principle of giving Rhogam which everyone knows is to prevent a Rh negative mother from developing antibodies, but the actual mechanism by which that occurs, ie, alteration of Rh antigen sites?, complement mediated destruction of circulating Rh positive cells?, sequestration of those cells?, etc. Knowing the mechanisms also helps because the anwer choices to the ostensibly straightforward "What is the Diagnosis?" questions will often be phrased as mechanisms. Hmmm, what else... I would recommend memorizing the normal values for some of the endocrine labs like FSH, LH, TSH, prolactin because they come up a lot and the awkward little window you have to use to look up those normals can disrupt your stream of thought. In general, the way labs are presented is very different from the sample questions available in NMS. NMS only gives you the pertinent labs. Step 2 will try to drown you in irrelevant Chem 7s. I found it helpful to jump straight to the comp or endocrine labs because they would jive better with the history, and then I would screen the Chem 7 for dramatically abnormal values. Borderline values come up occasionally in the Chem 7, but I wouldn't waste too much time fretting over them, unless the question is specifically asking what you should do about a borderline value, ie order another a test, intervene or not intervene. Some of the topics that came up more than once on my exam were blunt abdominal trauma (almost always following a car accident), genetic diseases (especially pediatric immunodeficiencies), third trimester bleeding, dementia (Alzheimer's vs. multinfarct is a big one), testicular torsion vs. epididymitis vs. orchitis, SCFE vs. LCPD, gonococcal arthritis, AML (just know upper+lower motor neuron signs). I had surprisingly few questions about CHF, HTN, MI, COPD, asthma or maybe I just didn't notice them. I had a whole series of technical questions about mechanical ventilation, ie patient is on such and such parameters, ABG shows this, do you increase/decrease rate? increase/decrease tidal volume?, increase/decrease FIO2?, etc. I had no clue. Most questions were relatively straightforward though. The majority of patients will have one overriding symptom, sign or lab value that clinches the diagnosis. It's just a matter of looking for it amongst the tons of BS they throw at you. It takes a lot of effort to sort out the BS from the relevant facts, so the most important factor is probably the fatigue factor. Generally, if the history and PE is classic then go with it and move on, but if it's vague, which is often the case, then you have to muddle through the labs and ancillary studies. Take heed that some things are classically vague on history like pulmonary embolism. In management situations, if the patient is crashing (ie, low bp), DO SOMETHING, and if the patient is stable, order more tests, unless the history, PE and labs are ALL classic, in which case you can treat. Well, anyway, if you've read this far into this post, you'll probably do pretty well on Step 2 because you have a high tolerance for run-on paragraphs, and if you can actually sort out the BS from the useful information in this post, you'll probably do great.