My COMLEX CE experience and breakdown

[osli]

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Thought I'd post while still fresh on my mind. Maybe it will help a few other late takers who are still trying to figure out or what to study.

Subject breakdown impression:
Osteopathic: 100+ questions
Musculoskeletal: 40 questions
OB/Gyn: 50+ questions
Legal/Ethics: 30 questions
Ophthalmology: 20+ questions, no kidding
Pediatrics: 20+ questions
General surgery: 15 questions
Urology: 10 questions
Radiology: 10 questions
EKG interpretation: 10 questions
Cardiology (other than EKG): 10 questions
Emergency med: 10 questions
Oncology: 10 questions
GI: 10 questions
Orthopedics: 10 questions
Family/preventive med: 10 questions
Infectious disease: <10 questions
Pulmonology: <10 questions
Dermatology: 5 questions
Electrolyte/metabolic disturbances: 3 questions
Neurology: 2 questions
Biostatistics: 1 question
Genetics: 0 questions

I didn't list stuff like pathology, physiology, or pharmacology because the lines weren't as clear. A lot of questions wanted you to recognize a disease and then provide an etiology, association, diagnostic modality, management or treatment, or complication. So it was easier for me to think about body systems. I probably left out an important category or two - I'll update if I think of them later.

Something I found interesting was the number of multi-part and matching questions. I'd say that nearly half my test was of that type. In one section I had 31/50, and in another 29/50 that were multi-part or matching. I think all sections had at least 15.

As for more specifics, I'll try to stay vague so as to not step on nbome toes. Osteopathic was huge, and I was nowhere near prepared enough. I used Simmons and Comquest, and felt comfortable with all that was covered there, but still wasn't prepared. I had at least 10 cranial questions that were very specific regarding torsions, inferior/superior/lateral/whatever/sphenobasilar-condylar-compression/junk. Unreal. I was fine with almost all of the sacrum, spinal, and ribs dysfunctions. Comquest's method for remembering viscerosomatic reflexes made it easy for me to remember and score a couple of easy points, but it isn't the magic bullet. Really, when you are given say a T6 dysfunction and given as choices lung, stomach, spleen, liver, pancreas, then what? No idea how to approach those. I knew all of the anterior Chapman points from Comquest. My test liked to give the anterior point, and then ask for the associated posterior point. Oops! And what the hell are Jones points anyway? Can't believe I've made it through most of DO training without ever even hearing of them. Maybe that's just my oversight?

The musculoskeletal stuff seemed mostly step-1 like, and was stuff I didn't remember. I knew all of the common stuff covered in Crush, Comquest, and UWorld, but specific muscle insertion points, very specific peripheral nerve distributions (not associated with all of the common traumas or disorders like fractures, palsies, carpel tunnel etc.), etc. I guess I should have brushed up on basic anatomy more? Wasn't what I was expecting.

OB/Gyn on my exam was ridiculous in scope and depth. That was in many ways my favorite rotation (not that I want to be one), and by far the one I learned the most and worked the hardest on. And the one that I consistently scored the highest on in UWorld and Comquest question sets. But at least half of the many questions I had were beyond my scope of knowledge. Most of them were about conditions I was pretty familiar with and could have answered all the expected questions about, except that they kept going a few steps farther... well into territory I've never been.

Ophthalmology!?! OK, so they are probably getting at what constitutes ophto emergencies. I don't think that requires 20 questions. For a section that received a brief mention in Crush, it was way overrepresented on my test. There were plenty of questions here that were a pure guess. Way over my head, especially since I nor most other students do a rotation, certainly not before boards at least.

For the other stuff, general surgery wasn't too bad. ER management wasn't too bad except for a couple of those very vague questions, like "someone walks into an ER, what do you do!?!" that had seemingly multiple good answers. Some cardiology was a bit picky, but not too unreasonable. I know how to spot AV blocks on EKG easily enough, but I wasn't prepared to know the complete treatment algorithm for each. Radiology pics were of very very poor quality, and while they should have been an "aunt minnie" I'm sure, many were so bad that you couldn't definitively rule out a couple of the answer choices. I think its unfair to ask you to differentiate between bronchogenic CA and cavitary pneumonia on a very bad picture, when the history might be something like "guy who has 100 pack year smoking history, drinks a fifth a day, and does IV drugs...." The specialties in general were pretty picky and overrepresented.

What was utterly lacking was the number of questions I expected on family medicine, general internal medicine, preventive care, etc. There were very few of the general CHF, COPD, pancreatitis, pneumonia, electrolytes questions I expected. They were always slanted toward detailed cardiology pharmaceutical management that was beyond what Crush covered, or detailed surgical techniques that I was only moderately familiar with. And family practice seemed almost missing, at least from what my experience of family med was like. Very few management questions of DM, Asthma, acute UTIs or URIs, or minor trauma. I think perhaps the "family med" portion I simply attributed to other specialty categories since the questions were more on that level of difficulty IMO.

Anyway, hope this helps someone. I felt pretty good about the exam overall, if only because I know everyone else taking it feels like there are plenty of "wtf?" questions too. Overall, I felt confident in answering perhaps 75%, could narrow it down to two reasonable choices and take a guess or lean one way or the other in 10%, and was just flat out guessing or trying to cross out unlikely answer choices in the other 15%. I'd be happy to match my step 1 score.

Oh, and yes, I too had a few of those "wtf are they saying" or "wtf are they thinking" questions. Who the hell says rhus dermatitis!? Why not just say poison ivy, or even just contact dermatitis. Who does lumbar myelograms for spinal cord pathology these days? What family practice doc is out there doing flex sigmoidoscopies!? And should we really have to choose between defibrillation and cardioversion? Doesn't the machine make that distinction these days?

Anyway, my advice if you still haven't taken it and have the time: Crush is a good overall review and good framework. Comquest is as good as it gets for now on osteopathic stuff, some of their random stuff, ethics/legal stuff, and the overall vague style of many of the question (though I underestimated just how bad it could be). I'd also do UWorld if you have time, since it's more detailed and covers much more ground than Comquest. I'd add to those a good review of musculoskeletal anatomy, innervation, etc. as well as the Chapmann points (all of them, front and back), Jones points (wtf?), and especially cranial (all of it). Comquest was adequate for sacral, pelvic, and spinal.

But mostly, I think a good serving of luck would go a long way. 😉

 

[osli]

Oh, and something I forgot to mention:

You will gain a LOT of ground by knowing the four or five most likely causes or consequences of just about everything. Well past the one or two most likely's given in Crush or elsewhere. Many questions could be reasoned out without knowing the list, but it was obvious that it would have been much easier if I had. Many questions would ask you "what is the most likely..." whatever and the stem would clearly rule out the one or two that first comes to mind, leaving you scratching and thinking "what else?"

 

[DemonDeacon]

I agree with a lot of what you said. However, I think you should also learn along w/ dx and treatment the most effective form of prevention for every single disease known to man, at least in the family practice. A ton of the answer choices tick me off - like having primary care docs do sigmoidoscopies in the office - I don't think the American college of gastroenterologists approve of that but yet again, this is a ms4 test, not a pgy4 exam.

 

[osli]

OK, so I asked and apparently the machine doesn't decide whether to sync or not. Oops. Good thing I'm not running codes yet!

 

[badgerred]

I took the exam yesterday. I also want to give back and share my experience.

First of all, this is not the USMLE. It's a completely different exam and it should be approached that way. If you study for this exam like you are studying for USMLE, you could potentially fail this exam because it focuses on completely different topics, and asks questions in a completely different manner. USMLEWORLD was a complete waste for this exam and I'm glad I chose not to focus on it in the months prior to this exam. You will be spinning your wheels if you do UW.

RESOURCES

1. COMQUEST- It's a must! It provides a very similar format to the real thing particularly with the length and style of the questions. It will prepare you very well for the major clinical science concepts and provides more in depth explanations on issues like Ectopic pregnancy, endometriosis, intracranial bleed etc. I LEARNED a ton from this q-bank. The most helpful aspect is they provide a lot of the random clues and clinical signs that are not discussed in text books. They also go into depth regarding management such as ordering the next best test and treatement. If you know the qbank well, you will know all that you need to know for the basic clinical science aspect for the exam.

3. COMBANK - suprisingly, this old stand-by came to play on exam day. I wasn't expecting anything from this q-bank having heard so many people criticize it but it was VERY HELPFUL. It is more comprehensive than COMQUEST and will prepare you well for the "randoms" that you will get on the real exam. The key with COMBANK is to repeat it because the real value to it is in the explanations like another poster once said. You won't get much out of this if you just go through it once quickly. The question stems are short enough that you can easily go through the whole thing in less than a week.

4. SAVARESE and FIRST AID FOR COMLEX( only sections on Chapman, Jones Tenderponts, Parasympathetic viscerosomatic points)- KNOW YOUR OMM COLD - Unlike Part I, it's not just viscerosomatic points. You have to know Cranial, Jones Tenderpoints, Chapman Points, Special Tests (Adson's, Thomas etc.) and Counterstrain. Savarese was 80% of my prep for this. HOWEVER, Savarese doesn't provide any real information on Chapman points, Jonest Tenderpoints and Parasympathetic Viscerosomatic points so I suplemented this information from the First Aid for COMLEX book. You don't need to read both books and I would not recommend doing so. I would use Savarese and then just supplement the missing info from First Aid.

4. Boards and Wards - The questionbanks should be the bulk of your s
tudy but I thought BW was the best text. It's the most comprehensive and clinically oriented book. There was a lot of information in this book that wasn't in Secrets like Torsion of the Testicular Appendage and it has more pictures too. That being said BW isn't perfect and it misses info that Secrets has but if I had to compare both books with regard to COMLEX prep, BW was better. If you can read them both, that would be idea. With the COMLEX, unfortuntely there isn't one text book you can read over and over that will prepare you for the exam like USMLE Secrets.

5. COMSAE - This is the most representative of the real exam since it's produced by the same people who make the real COMLEX. The catch is they use the easiest and most straightforward questions from the exam on COMSAE so it can be misleading because the real test will have more OMM, more random questions and much more ethics questions than COMSAE. It's still worth doing.


TEST BREAKDOWN

20% - OMM
20% - Pediatrics
20% - OBGYN
20% - General Surgery/Emergency Medicine
10% - Medical Ethics/Vitamins-Minerals/Pharmacology/Randoms - adverse effects of medication
10% - Internal Medicine

From the breakdown, you can already see how the COMLEX differs from USMLE because IM was such a small portion of the COMLEX.

STRATEGY

COMLEX focuses on management. USMLE focuses on identification. What I mean by that is COMLEX won't ask a lot of zebras. I had one zebra on the entire exam (Bechet's disease), everything else was pretty basic. The challenge in comlex isn't identifying some zebra but rather knowing your basics well enough that you can identify random facts about it. The challenge in comlex is dealing with their ambiguous question style. For example, I got a question about Downs Syndrome. The only clue the provided was Brushfield spots and a space between the toe and second digits. Then the followup questions required diagnosis/diagnostic tests and treatment. You have to know the Dx, and Tx for everything. Unfortunately, that information isn't always found in the textbooks which is why you need to do COMQUEST to help with this.

ACCEPTANCE

Just accept in advance that you are going to be faced with questions you will guess on due the poor test writing by the NBOME. It's really a crap shoot with many of the questions. Either you will receive a question with more than one right answer or you will get asked a question about some strange topic that isn't discussed any of the major review books or qbanks. For example, I got a question set discussing adverse effects dealing with Copper, Selenium, Zinc, and Manganese. When you get that, you just have to laugh and realize it's COMLEX.

For example, I had a question about a woman with twin babies. She had a high AFP level. The question asked which of these would pose a highest risk to her babies suffering complications. The only two answers that made sense were a) her high AFP level b) the fact that they were identical twins. Well technically both answers could be right. AFP is typically elevated in multiples but if the AFP is high enough, it could still pose with anencephaly and other neural tube defects. Twin births can present with problems depending on whether they share the same placenta but multiple births in general present with a higher risk of pre-eclampsia and pematurity. There are a lot of these types of questions on the exam where there is more than one right answer and you have to make a judgement call. I would say 25% of the test involves questions like this and this is what upsets so many people and why many do so much better on USMLE Step II. It really is a poorly written test but with COMQUEST and COMBANK, it can help offset that.

 

[It'sElectric]

STRATEGY

COMLEX focuses on management. USMLE focuses on identification. What I mean by that is COMLEX won't ask a lot of zebras. I had one zebra on the entire exam (Bechet's disease), everything else was pretty basic. The challenge in comlex isn't identifying some zebra but rather knowing your basics well enough that you can identify random facts about it. The challenge in comlex is dealing with their ambiguous question style. For example, I got a question about Downs Syndrome. The only clue the provided was Brushfield spots and a space between the toe and second digits. Then the followup questions required diagnosis/diagnostic tests and treatment. You have to know the Dx, and Tx for everything. Unfortunately, that information isn't always found in the textbooks which is why you need to do COMQUEST to help with this.

I think you have this reversed. COMLEX deals purely with identification, whereas USMLE is about actual management. Probably 90+% of USMLE questions end with, "What's the next best step in management?".

 

[badgerred]

I think you have this reversed. COMLEX deals purely with identification, whereas USMLE is about actual management. Probably 90+% of USMLE questions end with, "What's the next best step in management?".

I edited my response because I don't want to hijack the thread with this point. We can agree to disagree. I think it will just be exam dependent. I felt like I received more management on comlex.

 

[Doctor4Life1769]

is there a text that deals with stuff like this? i've not read a source that explicitly lists 4-5 things to do "in order" for a certain disease state ...

 

[badgerred]

is there a text that deals with stuff like this? i've not read a source that explicitly lists 4-5 things to do "in order" for a certain disease state ...

I know what you are going through. I couldn't find one either and I looked at several books. There are books that will list a bunch of tests and treatments but won't specify which comes first and management. There isn't a book that provides this. I even bought Step 3 books hoping it would answer this and none of them provide these answers including Crush Step 3 and the Conrad Fisher Kaplan Step 3 book. The COMQUEST qbank was the closest I found to discussing this information. I spent a lot of time reading their answers and taking notes. It took a long time but it was worth it. COMBANK was also helpful to a small degree in this area

 

[It'sElectric]

I edited my response because I don't want to hijack the thread with this point. We can agree to disagree. I think it will just be exam dependent. I felt like I received more management on comlex.

I definitely wasn't trying to hijack the thread. I honestly thought you had them reversed by accident. I won't debate it.

 

[osli]

is there a text that deals with stuff like this? i've not read a source that explicitly lists 4-5 things to do "in order" for a certain disease state ...

I don't think there is one. I think the NBOME writers are trying to get people to combine their knowledge of a disease (pretty much everything about it) with a knowledge of the preferred order of screening tests, diagnostic tests, and treatment/management options in order to come to a correct answer. I usually was pretty confident about the recognition part, but choosing a correct answer from their choices was not always easy. Many times I knew the best screen or diagnostic test, or treatment, and the second best as well. But they would give you five choices of things that were either way down or not on the list, and I think the point is to get you to make a reasonable choice based on costs, complications, and quality of various tests and treatments. Usually it resulted in a question/answer set that was so vague as to be impossible to determine logically how one answer or the other would be correct.

 

[ShyRem]

COMLEX wants you to figure in cost when choosing a treatment. Read the questions carefully - they often stated "most cost effective".

 

[JStub]

I just looked it up on the NBOME website and you are both right. Up to 40% on Level 2 are "what's the diagnosis" (H&P) and up to 40% are diagnostic step and management. So it really is exam dependent. The USMLE 2 does appear to be more identification than management as badgerred stated. Edit: oops I just realized I may have rehijacked a settled discussion... Back to the main topic and thanks for the helpful posts!!

 

[Doctor4Life1769]

Does anyone know about this book series?

1. Rapid Series (Medicine, Differential Dx, Surgery, OBGYN, Psychiatry, and Peds/Child Health)

2. Hands-On Series: Junior Doctors, Clinical Pharmacology, Imaging.

These seem to go into detail about scenarios, dx, management, tx ...

What do you all think about this? I may just read these, much shorter and more concise than Kaplan and Blueprints ...

 

[badgerred]

COMLEX wants you to figure in cost when choosing a treatment. Read the questions carefully - they often stated "most cost effective".

You have to be careful because they will also use "most appropriate next step" which doesn't necessarily mean choose the most cost effective option. It depends on the situation.

 

[ShyRem]

agreed. They like to slip in those small phrases that might totally change your answer.