2011 COMLEX Level I Experiences and Scores Thread

[bleeker10]

Haven't seen a thread like this for those of us taking the beast this year so I thought I'd make one. When's everyone taking it? I'm taking it May 24th so I now have just over 60 days until I take it.

What materials are being used? I'm using FA, Goljan, BRS Phys, and Savarese along w/ Kaplan COMLEX and USMLE Qbanks (provided by school), USMLEWorld, and COMBANK.

Anyone taking USMLE too? I'm undecided since I'm military. I'll see where I'm at in a month and I can schedule it then.

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[nlax30]

Yea, the book is easily doable in less than a day.

I had one day in between USMLE and COMLEX and just a few hours on that between day reviewing OMM and going through that book.

 

[mabinante]

I am taking this beast tomorrow. Any tip before I go? One more thing, besides the confirmation letter, 2 photo IDs (driver license and US Passport), anything I should bring to the testing center?

Thanks guys

Just to answer a few questions:

I would call your testing center before your test day. Mine told me that the center was packed and if I got there even 30 mins before my test that I would have to be "iced" and have to wait awhile. I showed up at 7 AM and then studied until they let me in at 7:30. Just ask. They also said I only needed one ID and I needed to print out my confirmation email. Again, I would just check.

The 4 pages high yield from Savarese (if you are only going to do a few hours of OMM cram, do these): Sacrum/Innominate, Innervation levels, chapmans points and one other I can't remember right now. . . It was mentioned in an earlier post.

About the unhappy triad. . . I had a question on that. I put medial meniscus. I sure hope it was right. Definitely something that everyone needs to get on the same page about if COMLEX is going to test on it. . .

I didn't look at OMM until two days before my test. Read the 180 pages of material in a few hours. I didn't do the questions, I felt that they were way more difficult than any COMSAE OMM question I had seen, plus I didn't have time.

 

[nbd13]

Just to answer a few questions:

I would call your testing center before your test day. Mine told me that the center was packed and if I got there even 30 mins before my test that I would have to be "iced" and have to wait awhile. I showed up at 7 AM and then studied until they let me in at 7:30. Just ask. They also said I only needed one ID and I needed to print out my confirmation email. Again, I would just check.

The 4 pages high yield from Savarese (if you are only going to do a few hours of OMM cram, do these): Sacrum/Innominate, Innervation levels, chapmans points and one other I can't remember right now. . . It was mentioned in an earlier post.

About the unhappy triad. . . I had a question on that. I put medial meniscus. I sure hope it was right. Definitely something that everyone needs to get on the same page about if COMLEX is going to test on it. . .

I didn't look at OMM until two days before my test. Read the 180 pages of material in a few hours. I didn't do the questions, I felt that they were way more difficult than any COMSAE OMM question I had seen, plus I didn't have time.

Thanks. Also, do you remember if they had a choice with lateral meniscus, MCL and ACL? If not no biggie, I'm sure that's hard to remember out of 400 questions.

It's frustrating because first aid, dit, combank and Uworld all have lateral meniscus, but Savarese has medial....

Thanks,

Nick

 

[mabinante]

Thanks. Also, do you remember if they had a choice with lateral meniscus, MCL and ACL? If not no biggie, I'm sure that's hard to remember out of 400 questions.

It's frustrating because first aid, dit, combank and Uworld all have lateral meniscus, but Savarese has medial....

Thanks,

Nick

Yup. They gave certain Ligs that you could rule out using certain clinical tests and then med. and lat. ligaments were what you could rule it down to and both were on there.

 

[nbd13]

Yup. They gave certain Ligs that you could rule out using certain clinical tests and then med. and lat. ligaments were what you could rule it down to and both were on there.

Great, how awesome of them! Not sure what to put now....oh well I guess.

Thanks,

Nick

 

[smooch01]

Hey guys,

I believe it should be lateral meniscus, in COMBANK it said that COMLEX expects us to be up to date with the changes in practice.

Also our OMM department informed us that that Savarese isn't NBOME approved and that some things in it are wrong (specifically for # 1 below) however this confuses me because its mostly all quotes from the foundations book which is obviously approved.

2 Savarese questions

1. It says that the parasympathetic innervation for the gonads is vagus because the gonad originate in the abdomen and then migrate down (makes sense)...but in NBOME approved books and Kaplan it says splancnics

2. Also I was under the impression from pharm etc that sympathetic stimulation results in light secretions and parasympathetics stimulation results in copious fluids, but savarese says the opposite

Regarding this, there is a question saying that sympathetic innervation for someone with COPD would result in copious thick secretions. That doesn't make sense to me

 

[nbd13]

From wikipedia:

"Parasympathetic stimulation produces a serous, enzyme rich saliva. Sympathetic stimulation leads to the production of a low volume, glycoprotein rich mucous. This is done by vasoconstricting the blood supply to the parotid gland reducing the potential for water collection"

I was also under the impression that sympathetic simulation produced a light watery secretion....but I guess I was wrong?

Any insight on this?

Thanks,

Nick

 

[koojo]

Stimulating the sympathetic nervous system = thick mucous secretion. Think about when you're really nervous, maybe before a big test, you get that taste in your mouth, that no matter how much water you drink, will remain (from DIT). I'm in the military so before our 2 mile runs I always have this taste in my mouth since my sympathetic's have taken over...so I used to drink a bunch of water before hand until I learned that it's not because I'm dehydrated.

Stimulating the parasympathetic nervous system = watery-like secretions. Think about the Trigeminal Stimulation technique. You're stimulating the parasympathetics that run on the all branches of CN V to kick in and produce that watery fluid to clear the sinuses.

Hope this helps



If anyone has any info on the whole gonad thing, please chime in. I'll check in the 3rd edition of Foundations tomorrow at my school's library

 

[smooch01]

Thanks guys! I also read that sympathetic stimulation increases production of goblet cells, just to add to what you are all saying.

I have the 2nd edition of Foundations...(don't even ask I thought it was required haha)

It says "..the origin of this innervation varies according to the embryonic origin of the specific organs. The testis and ovary which arise in the gonadal ridge of the posterior abdominal wall, receive their afferent and efferent supply from the abdominal portions of the abdominopelvic plexus and the remaining pelvic organs of reproduction are innervated from the pelvic portion of the plexus"

In a round about way I think that is saying its vagus. Also my friend that goes to NYCOM said there was a whole argument in their Kaplan course about it and the instructor "made a phonecall" and told them to cross out s2-s4 in the book and insert vagus. Our instructor never said anything about it.

These discrepancies are terrible!

 

[americanpie]

Took it today. It was actually easier than I expected . It was a long 8 hr exam. Hope I rocked it.

 

[nbd13]

Took it today. It was actually easier than I expected . It was a long 8 hr exam. Hope I rocked it.

Congrats! I take my Thursday and I'm ready to get this over with!

How was it?

Nick

 

[Wannashmooze]

Took comlex level1 yesterday. Know the sympathetics levels in savarese cold, there were at least 15 questions from that page alone.

I used Kaplan USMLE step 1,2,3 pharm flash cards for the whole "bugs + Drugs" thing. I only had a handful of those type of Qs.

There was a ton of "patient presentation is xyz, whats the bug most likely involved?" type of questions. at least 20 of those.


overall, not a super hard or tricky exam, i thought the Qs were really similar to COMBANK in difficulty, content, and style. They were not like Kaplan's comlex Qbank in style, but similar in difficulty and content asked.

It was about 50/50 of 1st order and 2nd order Qs, with a few third order thrown in for fun.

 

[Wannashmooze]

From wikipedia:

"Parasympathetic stimulation produces a serous, enzyme rich saliva. Sympathetic stimulation leads to the production of a low volume, glycoprotein rich mucous. This is done by vasoconstricting the blood supply to the parotid gland reducing the potential for water collection"

And COPD is treated with tiotropium, an Ach blocker, presumeably to block parasympathetic stimulation. It was the worst in my school when we had our pulmonary block exam, OMM department had questions that completely disagreed with pharm.

 

[nbd13]

Took comlex level1 yesterday. Know the sympathetics levels in savarese cold, there were at least 15 questions from that page alone.

I used Kaplan USMLE step 1,2,3 pharm flash cards for the whole "bugs + Drugs" thing. I only had a handful of those type of Qs.

There was a ton of "patient presentation is xyz, whats the bug most likely involved?" type of questions. at least 20 of those.


overall, not a super hard or tricky exam, i thought the Qs were really similar to COMBANK in difficulty, content, and style. They were not like Kaplan's comlex Qbank in style, but similar in difficulty and content asked.

It was about 50/50 of 1st order and 2nd order Qs, with a few third order thrown in for fun.

How was the repro on the exam? Doable with the info in first aid?

Thanks,

Nick

 

[detroitdo]

wannasmooze,

were there a lot of lysosomal/glycogen storage disease questions

what about enzyme kinetics (Km/Vmax)

immunodeficiencies?

G-protein receptors and what they're linked to?

 

[Wannashmooze]

wannasmooze,


Not a single Q on G protiens that I recall, for that matter I dont remember seeing too much on autonomics at all.

 

[koojo]

Not a ton of repro, definitely doable from FA repro section. some female hormones physio, e.g. progesterone keeps the milk from being released until delivery, etc. They asked about the most common bug in females with IUD who develop infection- its actinomyces.
Only a few basic Qs on biochem: tay-sachs deficiency is Hexosaminidase A, PKU patients will need tyrosine, MSUD patients have a buildup of branch chain amino acids, thats all I remember from biochem diseases.
Immun- some basic Qs on patient presentation of chronic granulomatous disease, what biochemical defect is present? NADPH oxidase deficiency.

Not a single Q on G protiens that I recall.

I remember seeing most of those biochem questions on COMBANK, may be a good idea to run through those again, thanks!

 

[Wannashmooze]

yea i thought it was fairly similar to combanks biochem

 

[Wannashmooze]

anyone know how long its gona take to get grades?

 

[Wannashmooze]

oh, and I did COMSAE B and C, I thought they were quite similar to the actual exam. Its just a pain that they don't give the answers to those exams.

 

[koojo]

anyone know how long its gona take to get grades?

I believe it can take 4-6 weeks to get the grades. Until then, relaxation!

I take mine on the 17th, can't wait to be done, must feel good

 

[DocEspana]

Yup. They gave certain Ligs that you could rule out using certain clinical tests and then med. and lat. ligaments were what you could rule it down to and both were on there.

the rule on this is if they ask for the "unhappy triad" by name or the "McWilson Triad" (or whatever its called. I'm making up the name) its medial meniscus. If they ask you what is the most common, its lateral.

The COMLEX is aware that lateral meniscus is slightly more common and often asks for whats most common. But they also want you to be able to regurgitate the identity of the "unhappy triad" that is in every textbook if they ask for it by name. They ignore the fact that textbooks are updating the identity of the unhappy triad as it becomes clear its not the most common situation.

Our physio doc went to a meeting of the writers for it and that was one of his questions. (that and apparently they dont ask questions about regional diseases like Lyme or coccidiodes often, if at all, because they are afraid it gives a regional bias)

 

[Wannashmooze]

Our physio doc went to a meeting of the writers for it and that was one of his questions. (that and apparently they dont ask questions about regional diseases like Lyme or coccidiodes often, if at all, because they are afraid it gives a regional bias)

I didn't remember him saying that they still include medial meniscus in the unhappy triad, but I did remember that thing he said about regional illnesses. BTW his pharm flash cards are really good.

The paper that studied unhappy triad and came up with lateral meniscus came out a looong time ago, so its surprising that they hanvt yet updated, COMBANK has a question on it with the updated answer.
On the other hand, my uncle does PM&R and he didn't know about the lateral meniscus thing, so maybe it's just one of those things thats not that well known in the field except by students.

anyhoo, good lucK on ur COMLEX I'm sure ur gona do great!

 

[koojo]

First AID and COMBANK both have the lateral meniscus, and the majority of the students use that to study. If it comes down to being medial or lateral meniscus , then lateral would be the safest choice to go with, considering the facts.

 

[DocEspana]

I didn't remember him saying that they still include medial meniscus in the unhappy triad, but I did remember that thing he said about regional illnesses. BTW his pharm flash cards are really good.

It's true that I didn't see one question on a regional illness, although they did ask about a recent african imigrant with s/s of malaria, PBS showed smiley faces in the erethrocytes, and they asked for the bug- it was P. Falciparum , they only gave that species as a choice and the patient had all the s/s of Falciparum malaria- blackwater fever, neuro signs, etc.

The paper that studied unhappy triad and came up with lateral meniscus came out a looong time ago, so its surprising that they hanvt yet updated, COMBANK has a question on it with the updated answer.
On the other hand, my uncle does PM&R and he didn't know about the lateral meniscus thing, so maybe it's just one of those things thats not that well known in the field except by students.

anyhoo, good lucK on ur COMLEX I'm sure ur gona do great!

I was talking to him after class about it. He didnt say it during the review. I actually don't think he himself asked, but someone at the meeting did cause he was telling it to a few of us after lecture. He's not much of an anatomy guy, so I can't see him asking it.

And I should probably clarify for those who aren't at our school that regional --> US regional diseases. I guess they figure chagas and paracoccidiodes are fair game because the number of COMLEX taking students from South America is low enough not to be a bias, but the number from Lyme disease areas would be a bias.

 

[Montana girl]

Are there a lot of virus and parasite questions on the test?

 

[Wannashmooze]

not really, much more bacteria, culture characteristics and stuff.

 

[linkDO]

I'm going lateral. Dont forget that the Savarese book is a little older too. The info in it is going to be from circa 2002. Other books and resources have had chances to update it since then (COMBANK, Kaplan, Wiki, UW, boards).

mabinante said the OMM on the test was a lot harder than the COMBANK questions. Howd you feel on that schmooze?

 

[ndocy]

Not a ton of repro, definitely doable from FA repro section. some female hormones physio, e.g. progesterone keeps the milk from being released until delivery, etc. They asked about the most common bug in females with IUD who develop infection- its actinomyces.

Only a few basic Qs on biochem: tay-sachs deficiency is Hexosaminidase A, PKU patients will need tyrosine, MSUD patients have a buildup of branch chain amino acids, thats all I remember from biochem diseases.

nothing on enzyme kinetics at all

they asked what "capitation" refers to in medical billing. it refers to when an insurance company pays a fixed amount per month per patient whether they are treated or not. I thought that was fairly random and unfair, I only knew it because my grandma is a receptionist at a doctor. go figure.

Immun- some basic Qs on patient presentation of chronic granulomatous disease, what biochemical defect is present? NADPH oxidase deficiency.

They asked what is the biochem defect in a patient presenting with s/s of G6PD deficiency- its a defect in HMP shunt a.k.a. defect in recovery from oxidative insult.

Not a single Q on G protiens that I recall, for that matter I dont remember seeing too much on autonomics at all.

just a question about one of your questions ha

for the progesterone question was estrogen a choice too? i thought that they both inhibited lactation during pregnancy.

thanks! take this test tomorrow, cant wait to be done!

 

[DMC]

So did any of your guys write anything down on your boards before you started, or did you just use it for scrap?

 

[thevillageidiot]

is there any embryo on comlex? haven't had any questions on it on combank and i was wondering if i didn't have to study it

 

[americanpie]

So did any of your guys write anything down on your boards before you started, or did you just use it for scrap?

No I did not because I could not think of anything I should.

 

[americanpie]

just a question about one of your questions ha

for the progesterone question was estrogen a choice too? i thought that they both inhibited lactation during pregnancy.

thanks! take this test tomorrow, cant wait to be done!

From FA, it's estrogen but from my understanding, it's both since during pregnancy, progesterone (from corpus luteum and later placenta) and estriol (from fetal adrenal gland) both increase and inhibit prolactin level. Prolactin level should be elevated with breastfeeding.

 

[koojo]

not really, much more bacteria, culture characteristics and stuff. like "grows pink on maconky, indole positive gram negative rod, what's the bug?" E. Coli
There were 3(!) questions where the answer was actinomyces israellii, there was a Q about CMV esophagitis in an AIDS patient, there was a Q about candida esophagitis in an AIDS patient. That one was a bit tricky because they said it was gram positive, and not everyone remembers that candida is actually gram positive.
They asked abt the major constituent of fungus cell wall- polysacccaride

Where did you learn that E. coli is indole +? I couldn't find it in FA or Kaplan micro. Could you have answered the question just knowing that it turned pink on Mcconkey's. I guess the only other main one that turns pink would be Klebsiella

 

[nbd13]

From FA, it's estrogen but from my understanding, it's both since during pregnancy, progesterone (from corpus luteum and later placenta) and estriol (from fetal adrenal gland) both increase and inhibit prolactin level. Prolactin level should be elevated with breastfeeding.

I had a COMBANK question on this and they said both progesterone and estrogen inhibit it during pregnancy and both grow the breast tissue as well.

On pages 484 of first aid at the bottom under lactation it says, "after labor a decrease in progesterone induces lactation."

Then it says under Prolactin, "induces and maintains lactation and decreases reproductive function."

So, maybe they only but progesterone on the test and did not have both progesterone and estrogen as answer choices?

Nick

 

[DocEspana]

I had a COMBANK question on this and they said both progesterone and estrogen inhibit it during pregnancy and both grow the breast tissue as well.

On pages 484 of first aid at the bottom under lactation it says, "after labor a decrease in progesterone induces lactation."

Then it says under Prolactin, "induces and maintains lactation and decreases reproductive function."

So, maybe they only but progesterone on the test and did not have both progesterone and estrogen as answer choices?

Nick

My endocrine book (I know. friggen nerd. I shave an endocrine book) says that progesterone just blocks lactation. But it also blocks OT, LH, FSH, GnRH and PRL release. Estrogen generally has very mild-to-no inhibitory actions and increases OT receptor expression across the body which preps the uterus for labor and the breast for lactation. The issue here is that its only inhibition is specifically blocking OT binding at the breast when both exist at the same time. I generally feel the accepted answer to what blocks lactation until after pregnancy is estrogen since it specifically is anti-lactation in a direct manner while progesterone is more of a "decreases the action of any female gender function not related to staying pregnant". Which still means progesterone is a totally fine answer for the question posed above, but would be not as good as estrogen if you were to have a choice of both since estrogen is specifically anti-lactation.

Which is also why the loss of high maternal estrogen at birth is what leads to witch's milk in babies. The estrogen prepped the babies body for milk release (sort of) and once it was removed via cutting the cord the scant amount of PRL and OT secreted was enough to cause newborn lactation. As much as progesterone would prevent that too, it dropped earlier than the cord cutting, and the reaction is tied temporally to a few minutes after cord cutting.

 

[coffeeeandtea]

My endocrine book (I know. friggen nerd. I shave an endocrine book)

i'm curious, how does one "shave" a book, exactly?

 

[DocEspana]

i'm curious, how does one "shave" a book, exactly?

you do some crazy s**t to make sure youve learned enough

 

[DrRoast]

Alright, for everyone that's taken the test. Is the Chapman's points in Savarese sufficient? Or do we need something in addition. I take this thing tomorrow and my biggest fear is be bombarded with Chapman's after only studying the green book, instead of getting the Viserosomatics that everyone else has been getting.

 

[bleeker10]

Where did you learn that E. coli is indole +? I couldn't find it in FA or Kaplan micro. Could you have answered the question just knowing that it turned pink on Mcconkey's. I guess the only other main one that turns pink would be Klebsiella

Yea E. coli is indole positive. I learned it in micro and I think it's in CMMRS. It's a way to help you differentiate between E. coli and Klebsiella.

 

[bleeker10]

So did any of your guys write anything down on your boards before you started, or did you just use it for scrap?

I wrote down the receptors for autonomics. I don't think I wrote anything else down.

 

[bleeker10]

Thanks. Also, do you remember if they had a choice with lateral meniscus, MCL and ACL? If not no biggie, I'm sure that's hard to remember out of 400 questions.

It's frustrating because first aid, dit, combank and Uworld all have lateral meniscus, but Savarese has medial....

Thanks,

Nick

On mine, it was medial meniscus but that was the only logical choice of the answers. The rest were random ligaments/structures in the knee.

 

[nbd13]

I wrote down the receptors for autonomics. I don't think I wrote anything else down.

Did that come in handy? I take mine tomorrow and I'm not sure what to write either....

Thanks,

Nick

 

[koojo]

Did that come in handy? I take mine tomorrow and I'm not sure what to write either....

Thanks,

Nick

How long is the tutorial? Is it 10 min?

I think I might draw the 2x2 table, write out the receptors for autonomics using the (HAVe 1 M&M, MAD 2's).

 

[bleeker10]

Did that come in handy? I take mine tomorrow and I'm not sure what to write either....

Thanks,

Nick

Nope I didn't even refer to it once. But if I had to, it would've been handy. It's just one less thing to remember during the test.

 

[MtHoodWood]

Alright, for everyone that's taken the test. Is the Chapman's points in Savarese sufficient? Or do we need something in addition. I take this thing tomorrow and my biggest fear is be bombarded with Chapman's after only studying the green book, instead of getting the Viserosomatics that everyone else has been getting.

I had one or two CP that were not in Savarese. Overall I probably only had 4 or 5 CP total. And the answer choices were all over the body, so one really just needs to be in the ballpark to get it right.
I think it would be worthwhile to very briefly review a few points not found in Savarese (I came across a list from one of the review programs that had about 15 points on it).
Are Chapman points kind of stupid? Yes. Are they potentially very easy points on COMLEX? Yes.

 

[MtHoodWood]

I found COMLEX to be quite similar to the COMSAE's. Many "what the F" kind of questions followed by question about a viscerosomatic reflex. If you keep your cool and do not let those questions bother you, you will come out ahead.
The one thing content-wise that surprised me was the number of questions on pharmacokinetics and dynamics. Obviously that is fair game, but I was surprised because it was tested so lightly on the COMSAE's.
To me, COMLEX epitomizes where osteopathy is today in that it sorely lacks identity. Some, like myself, would like COMLEX to mirror the USMLE so that DO's match more easily into MD residencies and not have to move to the midwest. Others might want COMLEX to retain traditional content like Chapman points and Cranial to maintain our "uniqueness." As such, there were too many questions on COMLEX like "so and so presents to the ER bleeding and really sick, where would you expect to find a facilitated segment?" And no, "who the F cares, they're having an aneurysm" was not an answer choice. The NBOME appears to be trying to satisfy both parties, often within the same question.
Overall I would say I left the testing center wanting to take another exam like the USMLE to at least feel like my studies were not for nothing. I am not sure if that is worth $525 or not?

 

[DubVille]

Took it today. WTF it was heavy on immuno, cranial, antineoplastic agents, and GI arteries. Make sure to brush up on snake and scorpion venom! Besides that know gram - flow charts, exactly where cranial nerves attach to pons/medulla, and and be utd on different age group algorithm treatments for cervical cancer. Nothing like comsae b or c.

 

[DMC]

Not one single person has said a thing about cardio, respiratory, or renal.

Anyone have any insight on those? Were they even tested heavily?

 

[koojo]

Took it today. WTF it was heavy on immuno, cranial, antineoplastic agents, and GI arteries. Make sure to brush up on snake and scorpion venom! Besides that know gram - flow charts, exactly where cranial nerves attach to pons/medulla, and and be utd on different age group algorithm treatments for cervical cancer. Nothing like comsae b or c.

Hmm, we were told that about 10% of the test questions were just sample questions and don't count toward your score. Those are usually the WTF type of questions. So don't worry too much about it