my step II experience

[inscape2004]

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hmmmm...... MotherF@#$$R

just took it today. YEah, it's a hard test, no joke. The problem with it is that it is so different from step I. On step I a lot of Q's were like - "25 yo male comes in today blah blah blah .. then a basic science question that you could have answered without really reading the blah blah blah" or a clinical question that asked for a diagnosis based on the blah blah blah (which we all assumed was advanced stuff fitting for stepII -- I mean, we all know the breakdown, step I basic science, step II diagnosis, step III management). On this exam, the questions were very different. most questions follow the following pattern -- "25 yo previously healthy male comes in today with c/o abdominal pain, diarrheah, shortness of breath, chest pain, ... he has some erythema on this, and some excoriations on that, and some cracles on this, and some bleeding on that, and just in case u were not confused enough, there is a fungating something or other sticking out of his rear end .. and always finishes with a phrase,"but other than that he is healthy" regardless of whether or not the pt is on respirator by the end of the vignette.... and then the question is never straighforward (like what's the Dx) but usually is ass backwards like "this condition could have been prevented by ..." or "the lab abnormality he is likely to develop in the next 24 hrs is...." In general questions are looooong, answer choices frequently A through like J or whatever (messes with your whole 1/5 shot). I personally didnt study very much compared to step I (step I I read like 4-5 different books, memorized a lot of First Aid and Step Up, and did probably like 80% of the qbank). for this exam, I just did all of Qbank and read secrets. Just like step I, this exam is hard to study for. I remember walking out of step one and thinking that most of the answers I knew during the exam I knew simply because I either firgured it out right there and then or knew from the two years past. It was really the same deal here, it's really hard to study for these things.. u just gotta be good at taking tests. Welll, this was one lengthy f....ing explanation (tangentiality, anyone?) but hope this helps...

 

[Zeffer]

I feel your pain especially as we wait for our scores hoping we passed.

 

[Mirror Form]

I took step II a couple days ago and I'm just praying that I passed it. Although I definitely didn't study as hard as I should have for it, a lot of the questions were just F'ing ridiculous. For example, I just finished my third year OB-gyn clerkship two weeks ago, so I figured I'd do well on the ob-gyn questions. Man was I wrong! A few of the OB-gyn questions on step II were harder then the ones on the frickin shelf!

 

[Ursus Martimus]

Bunch of BS that exam.

Case in point someone has hypecalcemia due to malignancy. Most appropriate phramacotherapy:

Saline
Mitomycin
Mannitol
Bisphoshonate

Dang I answered saline,but is that pharmacotherapy? Well then niether is manitol. I wasn't going to answer alendroinate.

So i was feeling ok until in another block same type of question, now what is the most appropriate 1st intervention: Same answer choices.

I have met people who write USMLE questions, most are ******ed and can barely hold down their pathetic PhD jobs. There I have vented.

 

[Doc Ivy]

Just a lowly M2, but why would bisphosphonates be bad answer? These patients are resorbing bone like crazy, don't you want to prevent osteoporosis?

Bunch of BS that exam.

Case in point someone has hypecalcemia due to malignancy. Most appropriate phramacotherapy:

Saline
Mitomycin
Mannitol
Bisphoshonate

Dang I answered saline,but is that pharmacotherapy? Well then niether is manitol. I wasn't going to answer alendroinate.

So i was feeling ok until in another block same type of question, now what is the most appropriate 1st intervention: Same answer choices.

I have met people who write USMLE questions, most are ******ed and can barely hold down their pathetic PhD jobs. There I have vented.

 

[Ursus Martimus]

Just a lowly M2, but why would bisphosphonates be bad answer? These patients are resorbing bone like crazy, don't you want to prevent osteoporosis?

Eventually someone will be put on bisposhonates but if they present with hyper Ca bisposhos don't work that fast. Unless there is a fundamental misunderstanding in the medical management is fluids, then mannitol, more fluids, maybe furosemide, .....then bisphosphos, so you are not incorret. However in the acute setting you have to fill the tank. That is alomst always the right answer. The thing that pisses me off is that I am suppose to decide whether saline counts as pharmacotherapy or not.

 

[spacetygrss]

I took the test on 12/30. The whole thing was uncalled for. 😱


On the bright side, two of the practice questions for the usmle/nbme site showed up on my test. 👍

 

[Cristagali]

Saline is a drug my friends! As a tech on the MICU unit before I went to med school, some nurses were up in arms because I was flushing the art line with the saline after I drew labs! They said I was an unlicensed care provider and SHOULD NOT administer a drug (saline)ie, flushing the line. can you belive that? I'm busted my a-- to draw THEIR labs and they come up with that crap. But I did such a good job on the unit, the management blew it off and I kept on "flushing those art line"!!! 😀

 

[medstudent2005]

hey, i'm feeling a little comforted by the fact that others have thought the exam was pretty hard. i did pretty well on step 1 and didn't feel so bad when i had left the exam...this time around, i was like "oh crap, did i pass it???" i had one crazy question that was straight out of embryology asking me to identify the cell from a diagram of an embryo that would lead to a certain tissue/organ. so i was like "WHAT?" well that turned out to be the least of my problems as the exam went on...i also happened to miss some questions that i SHOULD NOT have missed at all...if i had studied enough, hehe.

aight, hope the best!

 

[Doc Ivy]

Thanks for the clarification, so I guess in a pt who presents with DKA don't answer insulin but fluids instead? (I got this question today in Qbank)

Eventually someone will be put on bisposhonates but if they present with hyper Ca bisposhos don't work that fast. Unless there is a fundamental misunderstanding in the medical management is fluids, then mannitol, more fluids, maybe furosemide, .....then bisphosphos, so you are not incorret. However in the acute setting you have to fill the tank. That is alomst always the right answer. The thing that pisses me off is that I am suppose to decide whether saline counts as pharmacotherapy or not.

 

[Dramkinola]

To the guy starting this thread: Dude, that's exactly how I felt...
I was doing pretty well on Qbank... I didn't take the time to do USMLEWorld... maybe I shold have... I took it on 12/09... How long do y'all think it takes for the scores? Does that 2 week vacation on testing in the beinning of January apply to score reporting too?
and what's up with the apply after 3 weeks to see if you passed? is that glitch still there?
Oh, the agony... I gotta cut back on the coffee... I think I'm giving myself an ulcer...

 

[scootad.]

Took Step II in early december, got my score back today - 245. I thought I had done better, walked out of the exam thinking it was pretty easy. Maybe b/c I had an easier test, my curve wasnt as generous? I give up trying to make sense out of this crap.

 

[scootad.]

They say not to release your step II scores if you did worse than step I. I got a 246 on step I, now 245 on step II. Should I release it, or does it not make any difference? Im applying rads

 

[DRealDrZ]

Good crap...246/245 I think you're ok with releasing both. If it were more around 220 maybe not for rads, but a friend of mine did well on step 1 (I think around 245 actually) and got exactly a 220 on step 2, decided to report and still got his first rads choice...so who knows.

 

[1Neuro1]

With regard to the acute management of hypercalcemia of malignancy: the patient is hypercalcemic presumably from bone resorbtion/destruction at the tumor-osseous interface, which is an entirely pathologic process not dependent upon normal osteoclastic bone resorbtion. Common in multiple myeloma or even bone mets. Bisphosphonates are an adjunt treatment to lower systemic calcium levels by altering physiologic circulating calcium replenishment, an entirely different mechanism than this patient's hypercalcemia. Saline and mannitol are the acute treatment to 'flush the system' (saline) and subsequently drain the fluid and calcium (mannitol), any diuretic would work for this. Bisphosphonates may be instituted as a chronic treatment for mild to moderately elevated calcium levels, but they do not cause any significant hypocalcemia in any patient as far as I remember, so i find it hard to believe they would do much to lower this patient's circulating calcium level. Whatever, call an endocrine cosult anyway.

BTW- saline is indeed pharmacotherapy, as is oxygen. No need to interact with a receptor etc to be considered a drug.

Just my 2 cents.

-R
UMDNJ-New Jersey Medical School '05

 

[scootad.]

Here's what I did for Step II.

Here's what I did. Took 2.5 weeks of dedicated study time (had no scheduled clerkships or electives). Spent 5-8 hours per day reading First Aid for Step 2 as a primary resource and Boards and Wards as a secondary resource. Took bulleted notes on minutiae and associations I knew I would easily forget (e.g. erythrasma associated with DM, recurrent erythema multiforme assoc w/ Herpes, etc). Started Qbank 1 week into my studying (after I had done 2/3 of First Aid. Then did 2 sets of 50 questions per day and finished Qbank while only going over my notes (not reading the entire FA/B&W again). Qbank average was 74%. I also did NMS question book (which I didnt feel was very helpful and had a few errors).

Thats all I did. My test was fair and pretty much bread and butter. I thought I had done 250+ b/c I walked out of the exam thinking I killed it, but perhaps b/c my test may have been "easier" I didnt have a generous curve to help my score.

 

[medstudent2005]

Here's what I did for Step II.

Here's what I did. Took 2.5 weeks of dedicated study time (had no scheduled clerkships or electives). Spent 5-8 hours per day reading First Aid for Step 2 as a primary resource and Boards and Wards as a secondary resource. Took bulleted notes on minutiae and associations I knew I would easily forget (e.g. erythrasma associated with DM, recurrent erythema multiforme assoc w/ Herpes, etc). Started Qbank 1 week into my studying (after I had done 2/3 of First Aid. Then did 2 sets of 50 questions per day and finished Qbank while only going over my notes (not reading the entire FA/B&W again). Qbank average was 74%. I also did NMS question book (which I didnt feel was very helpful and had a few errors).

Thats all I did. My test was fair and pretty much bread and butter. I thought I had done 250+ b/c I walked out of the exam thinking I killed it, but perhaps b/c my test may have been "easier" I didnt have a generous curve to help my score.

wow, you really put in some effort there. I only did 5 days of half assed studying and thought the exam was damn tough...i am applying to rads and got a 243 on Step 1. I took the exam late in december, and i'm hooooping i at least passed it! what happens if i don't release the score? don't the programs need to know that i passed? and did i have to fill out something beforehand in order to not release my score?

muy gracias

 

[scootad.]

You should have already clicked on the option not to automatically retransmit your USMLE transcript on your ERAS application. As far as yer other question, I have not heard of any rads programs refusing to rank for lack of step 2 score.