Aced Step I, having a tough time with Step II CK

[bomgd3]

Hey everyone,
I did well on Step I (257) and right now have 1 month to prepare for Step II. I will be doing a research rotation concurrently so I have ~5-6 hours/day to study. I'm primarily using UWorld (~50% complete at this point) and Master the Boards.

My biggest issue right now is that I am having a very hard time learning the vast range of knowledge that seems to be tested. There is some really pretty esoteric stuff, at least when taken from the perspective of 3rd year knowledge. For example, I did a cardiology sub-I this year, and there are UWorld questions touching upon advanced topics that I would only be able to answer because I did the sub-I. Similarly, there are pretty advanced topics in fields that I have not done in-depth work in, and therefore struggle with those questions.

The hardest questions seem to be in the internal medicine realm for me. I can generally do very well with the more limited surgery/psych/obgyn/peds stuff. The IM questions can sometimes really come out of left field.

Example [SPOILER ALERT]: got a question which asked how to prevent contrast-induced nephropathy, and the answer was "non-ionic contrast". This is definitely not knowledge I picked up during third year, nor is it in any books. I never learned about any difference between ionic and non-ionic contrast solutions. I have no idea where to pick up this depth of knowledge!

Is Master the Boards is just too general? What other resources should I use to learn this material? My school requires me to take Step II early so I don't have time to gain strong experience in the subspecialties through electives.

Thanks in advance for any insight you guys might be able to provide!

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[VCorp]

Looking forward to hearing the responses to your inquiry. I also feel the same that step 2 prep seems more - uncertain and I hate that feeling.

Hoping somebody could provide good info on how to prep for the exam. Need to take it by July of next year.

 

[Food]

I got a 225 on Step 1 and a 254 on step 2. I felt that step 1 was too much of a "memorization test" that tested little factoids that you just had to memorize from reading first aid 50 times and doing Uworld 5 times. Step 2 CK is much more of a problem solving test. I felt a lot like you did, initially. I was getting lots of stuff wrong, and a lot of the Uworld questions did seem super specific. And while there are factoids that you simply have to memorize, the bulk of questions involve diagnosis and then initial management which is something you can learn to think through a lot better. I spent a week reading MTB and doing 44ish Uworld questions each day. I then took an NBME and did w/e-ish (227). Then started re-reading MTB w/ some supplementation from First Aid and did 2ish Uworld blocks a day. Took another NBME 4 days after the first one and got a 227 again, but knew that the main reason for a lack of improvement was not finishing on time. The last week or so I did nothing but Uworld, with some intermittent reading from MTB/FA. For the majority of questions, doing lots of Uworld practice questions definitely helped, as I started to get a lot more accurate towards the end. Granted - a lot of the questions were ones that I had done before (after resetting), but going through the questions that I had gotten wrong before forced me to think about why I had messed up and reminded me of important facts.

Don't get discouraged by random advanced topic questions on Uworld. I didn't need any special rotations, I took Step 2 during my first month of 4th year. Just memorize what you got wrong and move on. I started getting stuff write towards the end when I started developing "a feel" for the test - I was able to think through and think to myself - "there are 2-3 choices that could fit this presentation - however, detail X,Y,Z is trying to get me to go for choice A, so I'm gonna go with that, even though, based on my third year experience, it could totally be choice B". That's when you start doing a lot better. My UWSA was a 251, with 4 days to go before the test. I studied for about 25 days.

 

[VCorp]

I got a 225 on Step 1 and a 254 on step 2. I felt that step 1 was too much of a "memorization test" that tested little factoids that you just had to memorize from reading first aid 50 times and doing Uworld 5 times. Step 2 CK is much more of a problem solving test. I felt a lot like you did, initially. I was getting lots of stuff wrong, and a lot of the Uworld questions did seem super specific. And while there are factoids that you simply have to memorize, the bulk of questions involve diagnosis and then initial management which is something you can learn to think through a lot better. I spent a week reading MTB and doing 44ish Uworld questions each day. I then took an NBME and did w/e-ish (227). Then started re-reading MTB w/ some supplementation from First Aid and did 2ish Uworld blocks a day. Took another NBME 4 days after the first one and got a 227 again, but knew that the main reason for a lack of improvement was not finishing on time. The last week or so I did nothing but Uworld, with some intermittent reading from MTB/FA. For the majority of questions, doing lots of Uworld practice questions definitely helped, as I started to get a lot more accurate towards the end. Granted - a lot of the questions were ones that I had done before (after resetting), but going through the questions that I had gotten wrong before forced me to think about why I had messed up and reminded me of important facts.

Don't get discouraged by random advanced topic questions on Uworld. I didn't need any special rotations, I took Step 2 during my first month of 4th year. Just memorize what you got wrong and move on. I started getting stuff write towards the end when I started developing "a feel" for the test - I was able to think through and think to myself - "there are 2-3 choices that could fit this presentation - however, detail X,Y,Z is trying to get me to go for choice A, so I'm gonna go with that, even though, based on my third year experience, it could totally be choice B". That's when you start doing a lot better. My UWSA was a 251, with 4 days to go before the test. I studied for about 25 days.

So MTB/FA are crucial to doing well on this exam. I have about a year to prep for this exam - so thanks for posting this. I haven't started rotations yet, but want to start off right from the bat and get the best possible score that I can on this exam.

Thanks again for posting this and awesome job on the score...

 

[bomgd3]

Thanks a lot for the encouraging and helpful advice. I just bought FA Cases for Step II to supplement MTB. Hopefully that will help a bit. UWorld just seems very frustrating at times, like there is literally no way during third year to pick up this volume of knowledge.

[Spoilers]
For example: Hodgkin's lymphoma is associated with minimal change disease? *scratches head* What makes it even more confusing is that the management offered by UWorld is often not followed in real life, or things are done concurrently rather than "what is the first step". Today I learned that you should not culture urine for uncomplicated cystitis. Every clinician I have observed in real life will culture the urine in addition to providing empirical antibiotics. GAH!!

As you guys can see I am studying genitourinary stuff. Just needed to vent. Again, thanks for the helpful advice!

 

[anbuitachi]

Thanks a lot for the encouraging and helpful advice. I just bought FA Cases for Step II to supplement MTB. Hopefully that will help a bit. UWorld just seems very frustrating at times, like there is literally no way during third year to pick up this volume of knowledge.

[Spoilers]
For example: Hodgkin's lymphoma is associated with minimal change disease? *scratches head* What makes it even more confusing is that the management offered by UWorld is often not followed in real life, or things are done concurrently rather than "what is the first step". Today I learned that you should not culture urine for uncomplicated cystitis. Every clinician I have observed in real life will culture the urine in addition to providing empirical antibiotics. GAH!!

As you guys can see I am studying genitourinary stuff. Just needed to vent. Again, thanks for the helpful advice!

hodgkin lymphoma associated with mcd was step 1 stuff lol

 

[VCorp]

hodgkin lymphoma associated with mcd was step 1 stuff lol

werd. that's the cause of the mcd where the cd8 t-cells produce cytokines causing effacement of the bm

 

[evilbooyaa]

Thanks a lot for the encouraging and helpful advice. I just bought FA Cases for Step II to supplement MTB. Hopefully that will help a bit. UWorld just seems very frustrating at times, like there is literally no way during third year to pick up this volume of knowledge.

[Spoilers]
For example: Hodgkin's lymphoma is associated with minimal change disease? *scratches head* What makes it even more confusing is that the management offered by UWorld is often not followed in real life, or things are done concurrently rather than "what is the first step". Today I learned that you should not culture urine for uncomplicated cystitis. Every clinician I have observed in real life will culture the urine in addition to providing empirical antibiotics. GAH!!

As you guys can see I am studying genitourinary stuff. Just needed to vent. Again, thanks for the helpful advice!

Uncomplicated cystitis does not require a urine culture. Clinical practice doesn't always do what Step 2 CK states is the best option.

The reason you don't always culture in uncomplicated is because you want to give the patient abx to send home on. If you culture, step 2 assumes you will wait for the results of that culture before providing specific abx, but you need to send them home on empirical abx.