Hey all. Just took the big test this morning and thought I'd share my experience while it's still fresh in my mind.
Overall: I had the 48 questions per block with 1 A/V question (a heart murmur question that did not require you to even listen... it was all in the history and physical). Overall, I felt that my test was pretty hard. To me, it was not at all similar to any of the NBME forms I did (3, 4, and 6). I also felt that it was overall just as tough, and at times a bit tougher, than UWorld questions. I'll write about what I remember about each subject.
Anatomy: Overall, anatomy was not too tough, but I had some questions I was not prepared for. I had a few abdominal CT scans, a few skull x-rays (one was an epidural hematoma), and one lower extremity question (fibular head injury, common peroneal nerve injury). I got NO questions on upper extremity. No questions about the brachial plexus or it's derivatives (which I was prepared for). I did have a question about lateral epicondylitis and what deficits are seen with it (I was not expecting this). Oh, and I had a foot question (damnit, I'm a doctor not a podiatrist! hehe).
Behavioral science: I had a few of those "what would you say/do next" questions, but not as much as I was expecting... maybe 15 total. Half of them were easy (obvious right choice), the other half were more difficult (narrow down to 2, pick 1).
Biostats: The questions I got were pretty tough. I only got one relative risk calculation, and one true prevalence calculation using the 2x2 squares. The rest of the questions were long experiments with data. Then you'd have to pick "which of the following conclusions can be drawn about the data." You'd be given all this data, with some p-values thrown in and some 95% confidence intervals to spice things up. These were time-consuming and difficult (at least for me). I had no calculations of PPV, NPV, specificity, senstivity, odds ratio, likelihood ratio (which I was prepared for). Overall much tougher than I expected.
Biochemistry: This subject is hard to comment on since it encompasses so many other subjects. However, the bulk of my biochem was actually molecular bio/genetics, signal transduction pathways, and regulation of metabolism. I had one question that asked "glucagon favors gluconeogenesis by decreasing the amount of which of the following." I also got a question asking me to identify a positive allosteric activator of isocitrate dehydrogenase (ADP). I had a few questions on G6PD deficiency. I had a whopping two questions on glycogen storage diseases (types 2 and 5), and ZERO questions on lysosomal diseases. I had ZERO questions on thiamine deficiency, niacin deficiency, or vitamin K deficiency. I had one question on vitamin C deficiency, and one question on vitamin A toxicity (at least I think it was). I had no PKU questions, no homocysteine/methionine stuff, and one maple syrup urine disease (kids diaper smelled like sweet sugar). Overall, biochem turned out to be nothing like I expected.
Embryology: I only had about 3 questions on embryo, and I only used First Aid. All three were pretty easy (had to know the DRG are neural crest, had an annular pancreas question).
Immuno: Pretty straightforward. I just had to be familiar with the various cytokines (TNF-alpha, IFN-gamma, etc.) and the effector functions of the different cell types of the immune system. Also had a few questions about the different types of hypersensitivity reactions, a CGD question, and a X-linked agammaglobulinemia.
Micro: Another straightforward subject. I did have a few of the exotic bugs (meaning Malaria, Marburg virus, and B. anthracis). The rest were pretty common bugs such as S. pneumo, N. meningitidis, N. gonorrhea, Chlamydia, C. diff and a few TB questions. Had a few questions regarding virulence factors (of N. gonorrhea, B. pertussis, and I think C. diphtheriae). I didn't have any questions that asked for specific treatments.
Pharmacology: Overall I thought it was okay. Nothing out of the ordinary. Had to pick a drug that caused SLE-like syndrome (hydralazine), drug that caused G6PD hemolytic anemia (a sulfa drug). A familiarity of the MOAs and distinguishing adverse reactions is sufficient. I had a half-life question, an efficacy/potency question, and a few "drug A is added here... what drug gives this effect" questions.
Pathophysiology: I lumped these two subjects together because they pretty much made up the bulk of my exam. Not only did you have to make a diagnosis of the pathology, you had to know the physiology behind that particular system. So, basically you would have to know all of the feedback loops and points of regulation, especially the endocrine axes. I also had quite a few renal pathophys questions, and not as much cardio, pulmonary, or GI pathophys. I had very few questions which just asked for the diagnosis. Almost all of them required me to make a diagnosis, and then answer questions like "which of the following shows what would be found in the patients serum", then 5 or 6 answer choices with 3 or 4 different hormones and tons of arrows. I had to perform 1 physio calculation, but I can't remember it right now. Very challenging questions, with very few of the pathology that I was expecting: I had no Crohn's, no ulcerative colitis, no liver cancer, no paraneoplastic syndromes, no Osteogenesis imperfecta, no Ehlers-Danlos (but I did have a Marfan's), no adult polycystic kidney disease, no polycystic ovaries, no breast cancer.
Neuro: A lot more than I expected, but luckily I remembered stuff from 1st year neuro. I had a few questions dealing with spinal cord lesions, identifying the substantia nigra in a Parkinson's patient, and one question about the visual deficits found in a right temporal lobe lesion. I would definitely be familiar with all of the tracts in the spinal cord. Overall not too tough, but I can see it being challenging if you weren't expecting so much spinal cord stuff.
Psych: I think I had 3 or 4 questions. One I think was major depression, one was a personality disorder, and the other one was brief psychotic disorder (I think). I had no eating disorders, no schizophrenia, and not much psychopharmacology.
Like I said earlier, I think my test was much harder than the NBME forms. Of all the forms I did, parts of form 6 were similar. However, I did have 2 or 3 questions that were exactly the same. They even used the same pictures. I felt UWorld prepared me not only by adding to my knowledge base, but also by providing long-ish questions that required you to THINK about disease processes. Oh, and almost all of the questions were long. Only 1 or 2 questions per block were less than three sentences. The rest were comparable to UWorld length, and some were even longer. I would definitely recommend skimming the last few sentences of these long ones because a few of them gave a diagnostic statement at the end.
In the end, I'm glad to be finished with this thing. Good luck to those taking the test soon.
