Not improving

[tortuga87]

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Need some help guys...

I haven't been improving on my UWorld scores. I'm sitting at around 63% and am not sure how to improve

Went through FA 2.5x - not the best memorizer so then starting doing Qbanks. Finished:

USMLERx
Kaplan QBank (easy and medium only - heard hard didnt really apply to the USMLE)
Robbins and Cotran Review of Pathology

I pretty much know these Qbanks now. When I redo the questions, I click through them easily, since I have a sheet where I keep track of all the concepts I got wrong and go over it everyday

The questions I am getting wrong on UWorld mostly seem to be wtf questions that I have never heard of before. Not sure what else to do...

 

[Charlie Hustle]

How much of UWorld have you completed? How much more time do you have until your exam? Have you taken any NBMEs yet?

I think there are several different approaches you could take here depending on what kind of a time frame you're working with.

 

[tortuga87]

40% so far and have 3 weeks

havent taken an NBME yet (I assume the 63% on uworld correlates to something in the 230s?)

 

[Charlie Hustle]

I think at 63% you've got a pretty good knowledge base to work with, but there are probably some gaps that still need to be filled in. Since you still have a few weeks to work with, it might be worth taking a day or two to really brush up on your weak subjects.

It might be a good idea to evaluate how you're using the practice questions, too. Is there anything you could be doing to make your test blocks a more active learning process (i.e. taking notes on key points, referencing FA while going through the explanations, examining the entire explanation rather than just the correct answer)? I know for me, the more I actually do while studying (writing notes, annotating into FA, talking out the explanation to myself), the more I retain.

Just some food for thought. I'm by no means an expert, but that's what I would do if I was in your situation. Phloston will probably tell you to just read more FA and do more questions because that's what he did. You've got to figure out what works for you.

Good luck!

 

[tortuga87]

The last 5 questions I got wrong:

1. what causes decreased PCO2 and PO2? pulmonary thromboemoblism (not in FA)
2. where is renal clear cell carcinoma located? proximal convuluted tubule (not in FA)
3. what enzyme activity do auer rods have? myeloperoxidase (not in FA)
4. what are penicillin binding proteins? a variety of transpeptidases (not in FA)
5. what causes focal dimpling of breast skin? suspensory Cooper ligament infiltration (not in FA)
etc.

damn it, how do people know these things lol

Most of the time these are the type of things I get wrong. There are the occasional questions that can be answered with FA or have complicated connections between concepts that get me, but the majority are these "how in the world could someone know this?" questions. I guess they remember it from second year or use extra books?

 

[Zzmed]

I think you should calm down.
I am nobody to judge you, i want to help you..
No1 and 5 are pretty much basic stuff in path and clinical medicine. They are stated very precisely in Goljan. So, if you continue and miss such questions just start scanning through a path source (e.g. Goljan blue margin notes.)
The others that are minutiae in a way, just annotate them in FA and move on. Just don't miss the big picture (eg, concepts such as no1).
And you are doing great. Do what i told you and you 'll improve.

The last 5 questions I got wrong:

1. what causes decreased PCO2 and PO2? pulmonary thromboemoblism (not in FA)
2. where is renal clear cell carcinoma located? proximal convuluted tubule (not in FA)
3. what enzyme activity do auer rods have? myeloperoxidase (not in FA)
4. what are penicillin binding proteins? a variety of transpeptidases (not in FA)
5. what causes focal dimpling of breast skin? suspensory Cooper ligament infiltration (not in FA)
etc.

damn it, how do people know these things lol

Most of the time these are the type of things I get wrong. There are the occasional questions that can be answered with FA or have complicated connections between concepts that get me, but the majority are these "how in the world could someone know this?" questions. I guess they remember it from second year or use extra books?

 

[John 117]

Tortuga, as a second year yes I know the answers to these because of review books I read during the year. With 3 weeks left I'm not sure if I can recommend actually reading review books because your retention probably won't be that good and you'll be sacrificing a lot of time for FA/UW, however if you choose that route I think your path might need some review (just based on those 5 Qs) and will help decrease your frustration with at least the basic concept questions. Hope that helps.

 

[Zuhal]

Need some help guys...

I haven't been improving on my UWorld scores. I'm sitting at around 63% and am not sure how to improve

Went through FA 2.5x - not the best memorizer so then starting doing Qbanks. Finished:

USMLERx
Kaplan QBank (easy and medium only - heard hard didnt really apply to the USMLE)
Robbins and Cotran Review of Pathology

I pretty much know these Qbanks now. When I redo the questions, I click through them easily, since I have a sheet where I keep track of all the concepts I got wrong and go over it everyday

The questions I am getting wrong on UWorld mostly seem to be wtf questions that I have never heard of before. Not sure what else to do...

Hey there!
I'm in a very similar situation...also not improving very much in Uworld but I have come to realize and accept that we won't be able to "know" everything for this test. I hate to say this but my friend who took the test 1 month ago and got their results back recently had 68% on her uworld by the time she wrote the test and she walked out with a 229. So I'm not sure I trust that popular correlation of anything in the 60s on uworld gets you a high 230s on the real deal. Of course thats just one incident...there are the few exceptions scoring in the 250s with a 68%on uworld. Why don't you take an NBME to see where you're really at?

 

[Zuhal]

The last 5 questions I got wrong:

1. what causes decreased PCO2 and PO2? pulmonary thromboemoblism (not in FA)
2. where is renal clear cell carcinoma located? proximal convuluted tubule (not in FA)
3. what enzyme activity do auer rods have? myeloperoxidase (not in FA)
4. what are penicillin binding proteins? a variety of transpeptidases (not in FA)
5. what causes focal dimpling of breast skin? suspensory Cooper ligament infiltration (not in FA)
etc.

damn it, how do people know these things lol

Most of the time these are the type of things I get wrong. There are the occasional questions that can be answered with FA or have complicated connections between concepts that get me, but the majority are these "how in the world could someone know this?" questions. I guess they remember it from second year or use extra books?

some extra book

 

[tortuga87]

g** damn, freaking med school - apparently memorizing 500 pages of lists is not enough


all right, i'm finishing uworld and blitzing through the blue terms in rapid review pathology

 

[Morsetlis]

The last 5 questions I got wrong:

1. what causes decreased PCO2 and PO2? pulmonary thromboemoblism (not in FA)
2. where is renal clear cell carcinoma located? proximal convuluted tubule (not in FA)
3. what enzyme activity do auer rods have? myeloperoxidase (not in FA)
4. what are penicillin binding proteins? a variety of transpeptidases (not in FA)
5. what causes focal dimpling of breast skin? suspensory Cooper ligament infiltration (not in FA)
etc.

damn it, how do people know these things lol

Second year taught me all these things, whether I wanted to know them or not...

 

[tortuga87]

Just went through an NBME (13) to see what's up

Interestingly seems like almost every question in there can be answered with FA whereas that's not really the case with UWorld

Not sure if the interpretation is incorrect but that just makes me want to perfect FA rather than go through another source. Seems like UWorld wants you to get it wrong to go back and check over the new detail + everything in FA

 

[hrain]

I think you should calm down.
I am nobody to judge you, i want to help you..
No1 and 5 are pretty much basic stuff in path and clinical medicine. They are stated very precisely in Goljan. So, if you continue and miss such questions just start scanning through a path source (e.g. Goljan blue margin notes.)
The others that are minutiae in a way, just annotate them in FA and move on. Just don't miss the big picture (eg, concepts such as no1).
And you are doing great. Do what i told you and you 'll improve.

I agree that going through Goljan or Pathoma would be helpful.
I also understand the frustration of getting seemingly minutiae questions wrong, it can be very frustrating. However, I'd also hazard a guess that there is a *lot* more in FA than many of us realize. I can't tell you how many times I've gotten a question wrong, thought 'that's definitely not in FA,' and then lo and behold, it's right there. For instance, I'm looking at the microbio section right now. In the pharma part, under Penicillins, it says: "MoA: binds
Penicillin-binding proteins (transpeptidases)". Now, I probably would have never noticed that were it not for your post. And when I got that UW question, I probably would have had the same reaction as you. But a lot of times, the answer *is* in there,
But we just don't realize it.

 

[Turtlespeed]

Yeah you would be suprised to find whats actually in FA. First line of FA about renal cell carcinoma entry "originates from proximal tubule cells"

Its frustrating as this keeps happening, best thing is to keep chugging along during the study period and hope for the best on test day. Keep calm and believe that you know the answer to the vast majority of the questions.

 

[calvnandhobbs68]

Yeah you have to read every line of FA man. The Auer rods thing? It has a whole little section devoted to it under CML on page 365 FA 2013. Yes, it doesn't specifically say "myeloperoxidase" but it does say "peroxidase positive". Just make sure you're reading every word and annotate in anything that isn't there.

Might want to listen to Goljan audio too if you're really crunched for time but you're still missing path questions. Lots of high yield stuff and you can get through all of it quick if you listen at 2x.

 

[Orthojoe]

g** damn, freaking med school - apparently memorizing 500 pages of lists is not enough


all right, i'm finishing uworld and blitzing through the blue terms in rapid review pathology

that's correct!!! memorizing is never enough and FA is NOT a comprehensive memorizing tool.

You'll find when you sit for the USMLE there is a lot less memorizing questions than ones that require you to think critically through. This is why I loved the USMLE because I understood physiology and usually you can work through the questions if you do. It gave me a chance because I am not the best "memorizer" but understand how things "work". UWorld had a lot more straight up memorizing questions than USMLE step1/2 -

I think you are focusing on nailing these questions straight up memorization.. not gonna happen. slow down and rethink physiology,anatomy,etc Try to train yourself that this is a critical thinking test, not a memorization test. I believe you will be overwhelmed and anxious if you feel like you have to memorize everything. Most questions can be worked through by thinking - what concept are they testing and running through the mechanisms in your head.

examples
Question #1 -- think what would cause hyperventilation (obviously raising pH)....metabolic acidosis, PE, anxiety, respiratory alkalosis, etc.. do any of the answers match (i guarantee there is one that causes hypoventilation - eliminate it) now then think through what would also cause a low oxygen tension because rarely do both occur (eliminate those that don't - ie anxiety).. that will help you eliminate wrong answers and most likely you'll end up with 1-2 good answers. this in reality is a must know concept of taking the steps.

#2 - this in reality is a histology/anatomy question. think what is "carcinoma" -- cancer of epithelial cells. now think through your histology/anatomy of the renal system. where are the most epithelial cells or you can think why are their epithelial cells in the renal system. Second think what causes cancer in majority of individuals -- free radical damage/injury.. where are the the epithelial cells in the renal system most likely subjected to these -- that may help you eliminate.

I agree with the above posts.. stop uworld and stop FA ffor the time -- listen to gojan audio for the week, he helps you develop your knowledge base into critical thinking skills. I listened to him in 1.6X speed twice two weeks before taking the test. PM me on this -- if you catch my drift 🙂

Also take one full day off, go hiking/fishing - whatever to get your frustrations out.

 

[Greenbayslacker]

2. where is renal clear cell carcinoma located? proximal convuluted tubule (not in FA)

Page 494 - top

3. what enzyme activity do auer rods have? myeloperoxidase (not in FA)

Page 365 - middle - Auer bodies are peroxidase-positive
Also both RR & Pathoma mention they are MPO+ - very characteristic of AML

4. what are penicillin binding proteins? a variety of transpeptidases (not in FA)

Page 176 - bottom - definitely not clearly stated but it's there - "penicillin binds penicillin-binding-proteins (transpeptidases)"

5. what causes focal dimpling of breast skin? suspensory Cooper ligament infiltration (not in FA)

i personally remember this from anatomy in MS1, but i'll check RR again tonight

1. what causes decreased PCO2 and PO2? pulmonary thromboemoblism (not in FA)

this is the only one i didn't even know. i will flip through BRS physio in a little bit and report back.
Edit: From BRS Physio: "If blood flow to alung is completely blocked (eg by an embolism occluding a pulmonary artery) ... there is no gas exchange... PO2 and PCO2 of alveolar gas will approach their values in inspired air" -- this makes sense to me for a decrease in PCO2 since PCO2 will be higher in the alveoli than in inspired air (normally 0) BUT..
PO2 alveolar air = 100, inspired = 150-160.. so how is that a decrease in PO2??

i also just want to point out that all of these answers are in the UWorld explanations, if you are using that are a learning tool.

 

[normtheniner]

Yeah you have to read every line of FA man. The Auer rods thing? It has a whole little section devoted to it under CML on page 365 FA 2013. Yes, it doesn't specifically say "myeloperoxidase" but it does say "peroxidase positive". Just make sure you're reading every word and annotate in anything that isn't there.

Might want to listen to Goljan audio too if you're really crunched for time but you're still missing path questions. Lots of high yield stuff and you can get through all of it quick if you listen at 2x.

I'm pretty sure he says this in pathoma like 5 times. Myeloperoxidase is only found in myeloid stem cell lines... They're everywhere in Promyelocytic 15/17.

With that said, if you're going to use another review book maybe something more concise like Pathoma would be more do-able that Goljan. At the very least you can go through your weak areas in path.

 

[calvnandhobbs68]

I'm pretty sure he says this in pathoma like 5 times. Myeloperoxidase is only found in myeloid stem cell lines... They're everywhere in Promyelocytic 15/17.

With that said, if you're going to use another review book maybe something more concise like Pathoma would be more do-able that Goljan. At the very least you can go through your weak areas in path.

For sure, I'm a big fan of Pathoma and I think he does say it in there. I agree if you want to go through an actual path book pathoma would be the better choice right now when time is short because it's much shorter than Goljan and you get the videos.

 

[Orthojoe]

Page 494 - top


Page 365 - middle - Auer bodies are peroxidase-positive
Also both RR & Pathoma mention they are MPO+ - very characteristic of AML


Page 176 - bottom - definitely not clearly stated but it's there - "penicillin binds penicillin-binding-proteins (transpeptidases)"


i personally remember this from anatomy in MS1, but i'll check RR again tonight


this is the only one i didn't even know. i will flip through BRS physio in a little bit and report back.
Edit: From BRS Physio: "If blood flow to alung is completely blocked (eg by an embolism occluding a pulmonary artery) ... there is no gas exchange... PO2 and PCO2 of alveolar gas will approach their values in inspired air" -- this makes sense to me for a decrease in PCO2 since PCO2 will be higher in the alveoli than in inspired air (normally 0) BUT..
PO2 alveolar air = 100, inspired = 150-160.. so how is that a decrease in PO2??

i also just want to point out that all of these answers are in the UWorld explanations, if you are using that are a learning tool.

Ok so think about it this way... blood flowing to the lungs is CO2 rich.. our lungs exchange O2 for CO2 ( simplified version). If blood is restricted to certain alveoli by a PE then no gas exchange can occur.. therefore PO2 would decline right? PCO2 will also increase initially.. which drives our respiratory centers to become tachypneic -- blowing off CO2 leading to low PCO2. Also eventually with low PO2 lactic acid will build up giving a metabolic acidosis.. compensation therfore is to blow off CO2

?? thats how I thought about it

 

[Greenbayslacker]

Ok so think about it this way... blood flowing to the lungs is CO2 rich.. our lungs exchange O2 for CO2 ( simplified version). If blood is restricted to certain alveoli by a PE then no gas exchange can occur.. therefore PO2 would decline right? PCO2 will also increase initially.. which drives our respiratory centers to become tachypneic -- blowing off CO2 leading to low PCO2. Also eventually with low PO2 lactic acid will build up giving a metabolic acidosis.. compensation therfore is to blow off CO2

?? thats how I thought about it

If no gas exchange is occurring then you cannot blow off CO2 though..

 

[stormchao]

If no gas exchange is occurring then you cannot blow off CO2 though..

There is a difference between a PE that knocks off a a part(say 10%) of a lung and a saddle emboli that blocks most(90%) lung blood flow. If someone shows up in an ED with shortness of breath then it's gonna be the 10% case. If someone falls over dead all of a sudden it is the 90% case. Everything makes sense when you separate the scenarios.

 

[Phloston]

Need some help guys...

I haven't been improving on my UWorld scores. I'm sitting at around 63% and am not sure how to improve

Went through FA 2.5x - not the best memorizer so then starting doing Qbanks. Finished:

USMLERx
Kaplan QBank (easy and medium only - heard hard didnt really apply to the USMLE)
Robbins and Cotran Review of Pathology

I pretty much know these Qbanks now. When I redo the questions, I click through them easily, since I have a sheet where I keep track of all the concepts I got wrong and go over it everyday

The questions I am getting wrong on UWorld mostly seem to be wtf questions that I have never heard of before. Not sure what else to do...

1) I would have said you need to read FA more, but you've covered it well so far. Have you ACTUALLY been reading it, or are you quickly breezing through it? Reading FA = doing some really annoyingly slow memorization, not just "reading."

2) I would have said do USMLE Rx / Kaplan QBank, but you've done those.

-----

Therefore I'd say you need to build your pathology because path is the bulk of the Step1 and your points. You've gone through the Robbin's questions but those are a mere adjunct. Have you read BRS Pathology? That book is a must for the Step1.

FA + practice questions are the top priority, but it seems as though you need to self-remediate by doing some side-readings. If you're weak in micro, memorize the Microcard tree algorithms. If you're weak in pharm, go through the Lange pharm cards. But definitely read BRS Path if you haven't already.

 

[hrain]

I may be wrong, but I think in the original post he forgot to include a couple "big A, little a" after the partial pressures.

At least, in the question/answer I'm thinking of, it specified that in pulmonary embolisms (ie with poor alveolar perfusion)
PAO2 and PACO2 approach those of inhaled air - ie PAO2 increases closer to the normal 150mmHg, whereas PACO2 decreases down to ~5mmHg.

PaO2 and PaCO2 would approach the values in mixed venous blood, since they're not getting perfused in/out at all. So, PaO2 would be DECREASED compared to normal, whereas PaCO2 would be INCREASED compared to normal.

That's my understanding, at least.

EDIT: To clarify, I *think* that the question actually says something to the extent of "What causes a decreased PaO2 and decreased PACO2?" I'm not entirely sure, but I vaguely remembered being pissed early on b/c I completely missed the alveolar vs arterial designations when I read it.

and one more edit: Decreased PaO2 AND PaCO2 would indicate high altitude blood gases - PaO2 decreases because of decreased partial pressure in the air breathed in, and then PaCO2 decreases due to hyperventilation from hypoxic stimuli.