my recent medicine shelf experience

[TheCat]

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well sorry if this is not in the right place but i wanted to post my shelf experience for medicine. First off the test is tough but I would say fair-there was not ONE question that required you to memorize anything. I would say its ridiculous in the fact that, I knew everything pretty well and even when I got home and had access to texts, uptodate etc-i still could not find the answer to 90 percent of the questions that I did not know. There is a lot of "subjectivness" i want to say if thats the right word I was surprised actually that there were quite a few ambigous questions. What I am saying is its a test of thinking and nothing that you can look up in a book. A lot of integrative systems where there is no clear cut answer- Poeple with multiple diseases are presented and then they will ask questions about which diseases to take care of first and how that would effect other diseases-stuff like that.
seriusly atleast 50 percent of the questions, which is 50 questions totaly dealth with SHORT OF BREATH/copd presentation-so if there was one piece of advice I would give is to read over uptodate- DIfferential of SOB-and know every disease listed pretty cold. That would have been a super high yield thing to do had i iknown this. THere was a million SOB questions with blood gases given- so if you arent comfortable with SOB questions you will get punished
Second-25 or so chest pain differential-all pathologies of chest pain , again know EVERY disease and characteristics of chest pain-
THird is over half the questions were- what would you do next questions. None of the easy ones where you could figure out he disease stopped at hat-basically if you were able to figure out the diagnosis easily that did you know good since they would then ask what the next step is. The questions where you were unable to clearly know what was wrong would be the ones they asked what the disease was.
So bottom line know differential, workup, symptoms of SOB and chest pain and know how to deal/treat every disease in the differential. I think doing just that would give you 75/100 on the exam
Other things-maybe 3 micro questions that were easy. 1 aids related question knowing which bugs that poeple are at risk for at which T levels. 2 leukemia/lymphoma diagnosis. 1 stats questions dealing with specifi v sens. NO drug side effects question and maybe 2 pharm questions having to know which drug to use for the person-quite straight forward. That is what i like about NBME tests is they never give any choices that are tricky. for example if the answer is a beta blocker, they only list one beta blocker in the choices, not 3 and you have to know which one specifically to use.
2 ethical questions regarding taking care of your patients and ethical decisions involved. OH ACID BASE- atleast 7 questions on acid/base recognition-know when its metabolic acid v resp acid v alkolosis etc. AND RENAL FAILURE-know how to determine why someone is having acute renal failure from lab values/urine values-is it prerenal, renal, or post renal? there is atlesat 5 of those where they give you lab values and you have to figure it out from that. ok good luck -if anyone thinks i gave too specific questions let me know-i tried to keep this general and in no way tryin togive out specific questions but if anyone thinks i did that let me know as i dont want to violate any rules or anything. okk good luck

 

[JMD]

I totally agree with you, TheCat. I feel that I knew the material pretty well, but even if I had a few more weeks to study I would not have been able to do much better on the test.

Like you said, even if you knew Tx for diseases inside out, it wasn't just a matter of Txing one disease. You had to decide which of the pt's 2-3 diseases to Tx first. Only a few questions seemed really straightforward.

My advice is also to know the symptoms, diff, Dx, and Tx for the big diseases and go into the test with a good night's sleep and clear head so that you can navigate/think through the questions quickly (I finished the exam w/ about 3 minutes left). I dont recommend First Aid as I think the "Treatment" sections are way too vague for this type of exam.

I may have some better advice once I know for sure how I scored.

 

[46&2]

Finished the test and a few beers earlier (the later after the other). I appreciate TheCat’s post and comments; they were good to read prior to the exam. I think, however, TheCat is overreacting. While we probably had different questions on our exam, there certainly aren’t a ‘million SOB questions with ABGs given’. Maybe 5 or so questions on my exam had an ABG, and even then only a couple of those were tough to interpret (i.e. if they have low pH and high pCO2, they’ve got respiratory acidosis, not too bad).
The test I took seemed really balanced. If you were weak in a major subject error, they would make you know it. I had a lot of rheumatology, a few derm, and some GI along with some acute critical care issues that more about ABCs than treating the underlying disease. They liked thyroid disease on my test as well. There were many more Chem 10s than ABGs to analyze. I thought there was little renal or neurology, however (but you still have to study it).
It is true that many of the patients presented in the rather long stems had multiple medical problems, but a lot of times this just helped frame the overall picture. You usually don’t have to worry about the presenting patient’s diabetes, obesity, or even renal failure- you just have to figure out how it helps you form a differential or say pick a particular medication to treat hypertension. Usually you have a decent idea of what the main problem is, and then you make your differential from there.
The types of questions they asked were quite varied as well. They would ask for a straight up diagnosis (but there would be 10 answer choices for those), particularly at the end of the exam. Or maybe they wanted a causative agent or what med could cause this side effect. Sometimes they wanted the next step in terms of treatment, sometimes the first thing you should get on imaging. In some ways, you didn’t have to have a diagnosis but more of a concept of what to do with certain presentations (somebody with an acute abdomen should get a KUB to rule out stuff like pneumoperitoneum, even though we usually CT the hell out of everything in the end). I also had a couple of more Ob/Gyn questions.
I didn’t have any derm pictures, to my surprise, but one radiograph which didn’t help much and an EKG that looked more like a seismograph reading.
I wholeheartedly agree with TomCat that you have to know discern certain common diseases well, because they will make you choose between a PE and an MI and give you a presentation that makes you want to pick both. Tachycardia and tachypnea are unfortunately common to a lot of diseases, and the key would be how to use other information given.
All in all, I would start with a broad foundation (which is where First Aid helps) and then focus on how to differentiate diseases. If you don’t know something in First Aid, know that first before getting in detail with other things. Kaplan CK question book, which as other posters stated, did a pretty good job with mimicking the style of questions and the format of the test. I thought MKSAP was a great learning tool, but while MKSAP had a lot of questions dealing with cough, asthma, HIV, etc, I hardly saw any of those.
Of course, the test you take may be the opposite of mine and focus a lot on cough etiologies, renal, and infectious disease. I would just be prepared in all subsets of medicine, and not necessarily burrow through UptoDate to focus on a few albeit common things.

Hopefully I didn't blow this one like my surgery shelf. 🙄

 

[zeloc]

Great posts TheCat, JMD, and 46&2. I start Internal Medicine tomorrow and it was useful reading over your posts.

 

[ddmo]

I thought the Medicine shelf was almost exactly like step-1. I think there were more Rheumatology questions than cardiac ones. At least they were all about big catch-phrases and weren't trying to trip you up. ex. Morning stiffness=RA, malar rash=lupus, etc.

The MKSAP3 CD was awesome prep for the exam.

 

[Paws]

Thanks for posting this guys, I appreciate reading these tips.

 

[DCMDtobe]

Any more advice on the Medicine shelf? I'm doing MKSAP 3 and Case Files.

 

[osar92]

im doing mksap 3 and casefiles... reading a few things here and there in Step Up. Anybody else have any thoughts about studying or the exam.
Thanks.