Official 2011 USMLE Step 1 Experiences and Scores Thread

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Hello everyone. I am a second year who will write the exam in June 2011. Meanwhile let this be a good thread where everyone share their study progress and recent trend of the exam.
 
Since I got a ton of info from SDN on board prep I think it is only fair if I contribute some. Here is my prep/experience.

Prep Time: 6 weeks
-Did USMLE World (avg. ~75%)throughout school year and a second time during prep.
-Did Kaplan Qbank (avg. ~74%)
-Read FA 3-4 times before the exam.

3 weeks before prep CBSE: 230
After one week of studying, NBME 11: 247
One week before exam, NBME 7: 250
Day before exam free 150: 91% (261)
Took Exam June 11th and waiting for results

Exam impressions: Don't forget to take frequent breaks! I only took three short breaks and hit a wall around block 5. I started the test at 8 and finished at 1:30. I definitely would take more break time if I could go back. The exam was similar to both the kaplan qbank and usmleworld. Kaplan was better for random facts while I feel like world was better for the ridiculously long narrative questions. There were many questions that you couldn't know no matter what you studied beforehand. I feel like 80-85% of the test was in FA though. A couple of the questions felt more like a step 2 exam. I really can't say how I did on the real thing. I am expecting anything between 220-260.
 
Since we're talking about phones, would it be all right if I bring my ipod touch and listen to music during breaks? I'm just afraid they might mistake my ipod for a phone and confiscate it or something...

You just can't bring it in with you. You can take it out of your locker and listen to it if you put it back
 
its time i give back to sdn for helping me for so many years. took my exam on saturday, it was very hard, much harder than i expected, but i didn care cuz the exam is curved and i know people who thought they did horrible but ended up doing very well. Surprisingly I got hardly any neuro, hardly any repro. i got a lot of very tough micro questions-know the stains very well. in one question the image was very fuzzy and the stem was unclear, but i read mucicarmine stain in the stem so i chose c. neoformans, they had another question where u pretty much had to know what the gomori trichome stain did to get it right. behav sci was not bad except for one question where there was a mother who had given birth to a stillborn fetus and when asked if she wanted to see it in the delivery room she refused, question sed what shud you do 2 hours later, i didn know whether you should ask her again or if you shud not ask since she refused the first time. the pharm was ridiculously hard-reminded me of uworld, i mean some were easy like one question was a one liner and asked what drug blocks gp41, but there were hard questions on some anesthetics some of which i couldn recall from first aid. know the formulas in fa pharm i totally blanked on the formula for loading dose and missed a bunny--that got me so frustrated i could hardly focus on that block--this exam is all about bein mentally fit-do not let one bad question get under your skin-jus shrug it off and move on. i had a lotta respiratory--one very long question about a kid with asthma and it asked what drug wud u give to block mast cells or sometin like that, easy. immunology wasn bad, i had a question describing the mechanism of a drug the answer was tacrolimus. i had a lott of gastro but it wasn bad, some were hard. know ur electrolytes very well--fa has a small section on this in renal. i had a hard question--they had a wrestler who overdosed on laxatives to lose weight and asked wat would happen to the serum electrolytes i was stuck between hypokalemia and hyponatremia, but chose the latter. good luck to everyone and don worry if u get hard questions cuz there's a curve and everythinng balances out in the end!
 
You just can't bring it in with you. You can take it out of your locker and listen to it if you put it back

Thanks man, that's good to know. Weird thing about me is I don't drink any coffee or energy drinks (don't like the taste) so I've gotten used to keeping myself awake/alert just by listening to some music. 👍
 
thanks for the mental-attitude advice. i would totally have bombed that hypokalemia/hyponatremia question too. i had to go through first aid and google just to figure out the answer. funny thing... i just did the renal section and didn't even think of the answer. man...

Lol, so it is hyponatremia?
 
Am I correct when I say that the laxative OD caused pt to have diarrhea? If so, I see why its hypokalemia.
 
From up to date:
"For reasons that are not well understood, many patients with laxative abuse present with metabolic alkalosis rather than the expected metabolic acidosis [1,3]. It has been speculated that the alkalosis may be due in part to hypokalemia impairing the intestinal reabsorption of chloride, thereby diminishing bicarbonate secretion into the intestinal lumen via chloride-bicarbonate exchange. Loss of a high-chloride, low-bicarbonate solution can raise the serum bicarbonate concentration, and both volume depletion and hypokalemia then prevent excretion of the excess bicarbonate in the urine. (See "Pathogenesis of metabolic alkalosis".)"

Thanks! How was the anatomy on the test and embryo?
 
Msa786- sounds like we had a lot of the same q's. The stain ones really got me. Had the same pharm. The stillborn one too.
 
Wait..am I missing something? Wouldn't increased laxitive use be like increased diarrhea? and therefore you lose bicarb and get an acidosis which would lead to hyperkalemia bc of the H+/K+ pump in the cells?
 
Wait..am I missing something? Wouldn't increased laxitive use be like increased diarrhea? and therefore you lose bicarb and get an acidosis which would lead to hyperkalemia bc of the H+/K+ pump in the cells?

From BRS Phys: diarrhea leads to ECF volume contraction, leading to a decrease in blood volume and arterial pressure > activation of renin-angiotension-aldosterone system. Increased levels of aldosterone lead to K secretion and hypokalemia.
 
Overall, the exam was fair. I liked it. It's a well-written exam for the most part.

I had a question about osteoporosis and bone density scan. It had a 45ish year old woman asking for a bone density scan. I think she had a history of osteoporosis in her family. What is the age? I picked 50. It seems correct if you go to the USPSTF and radiology college website. This is a step 2 question. Nothing to do with integrating and figuring out things. Sounds experimental. I don't know how it crawled into a step 1 exam.

Also, I am very sure that this was an experimental question. side effect of dpp-4 inhibitors? come on. Wikipedia, medscape, and other sources say that the reports are INCONCLUSIVE. What the heck? Liver made sense. Really idiotic.
 
Overall, the exam was fair. I liked it. It's a well-written exam for the most part.

I had a question about osteoporosis and bone density scan. It had a 45ish year old woman asking for a bone density scan. I think she had a history of osteoporosis in her family. What is the age? I picked 50. It seems correct if you go to the USPSTF and radiology college website. This is a step 2 question. Nothing to do with integrating and figuring out things. Sounds experimental. I don't know how it crawled into a step 1 exam.

Also, I am very sure that this was an experimental question. side effect of dpp-4 inhibitors? come on. Wikipedia, medscape, and other sources say that the reports are INCONCLUSIVE. What the heck? Liver made sense. Really idiotic.

Typically a history in the family would be a risk factor so you would get the bone scan earlier. Was she post meno?

For the dpp-4 the only thing my pharm cards taught me was nausea. Can't thing of anything else.

How was the anatomy?
 
Typically a history in the family would be a risk factor so you would get the bone scan earlier. Was she post meno?

For the dpp-4 the only thing my pharm cards taught me was nausea. Can't thing of anything else.

How was the anatomy?

Not known. She came for a well-visit and asked about the scan and had the family history. So, 50 made the most sense. I checked many websites. I also thought that they are going after early detection hence prevention. So, I chose 50.

Nausea/vomiting was NOT in the answer choices. Yeah....go figure lol. It's a terrible question. Just rote memorization. I think it's an experimental one. The drug category is new and the side effect profile is still inconclusive. Some research says pancreatitis. Lol.

Anatomy was asked in a well thought out manner. Couple of imaging scans here and there and then others were vignette style. Basic stuff. I wouldn't spend too much time on this subject.
 
Overall, the exam was fair. I liked it. It's a well-written exam for the most part.

I had a question about osteoporosis and bone density scan. It had a 45ish year old woman asking for a bone density scan. I think she had a history of osteoporosis in her family. What is the age? I picked 50. It seems correct if you go to the USPSTF and radiology college website. This is a step 2 question. Nothing to do with integrating and figuring out things. Sounds experimental. I don't know how it crawled into a step 1 exam.

Also, I am very sure that this was an experimental question. side effect of dpp-4 inhibitors? come on. Wikipedia, medscape, and other sources say that the reports are INCONCLUSIVE. What the heck? Liver made sense. Really idiotic.

Wiki and some other websites seem to say 65 with no risk factors, 60 if "at risk" (family history, glucocorticoids, etc.)
 
Not known. She came for a well-visit and asked about the scan and had the family history. So, 50 made the most sense. I checked many websites. I also thought that they are going after early detection hence prevention. So, I chose 50.

Nausea/vomiting was NOT in the answer choices. Yeah....go figure lol. It's a terrible question. Just rote memorization. I think it's an experimental one. The drug category is new and the side effect profile is still inconclusive. Some research says pancreatitis. Lol.

Anatomy was asked in a well thought out manner. Couple of imaging scans here and there and then others were vignette style. Basic stuff. I wouldn't spend too much time on this subject.

50 is typical age for menopause so I think you were right because menopause would lead to greatest risk for the osteoperosis.

Wow, then that is definately a screwy question

Great. Do you have any other tips on what you would have focused on? I take mine Wed.
 
50 is typical age for menopause so I think you were right because menopause would lead to greatest risk for the osteoperosis.

Wow, then that is definately a screwy question

Great. Do you have any other tips on what you would have focused on? I take mine Wed.

Um...Just know the basics. Do not get too caught up in the details. (you probably won't since you take the exam in ~2 days from now). You have got to get the big picture of disease processes. If you have focused on details then there are going to be questions which require you to think and knowing haphazard details isn't enough to successfully circle the right answer. Also, know drugs really well. Know mechanisms to the fullest. Don't just stop at insulin release from beta-cell of pancreas for sulfonylureas.
 
Took it yesterday:
Scores:
NBME 7: start of study period: 220 I think
UW1: 1.5 weeks in: 254
NBME 12: 2.5 weeks in: 240
NBME 11: 3.5 weeks in: 242
UW2: 4.5 weeks in: 248
DIT: 4.5 weeks in: 246
NBME 6: 2 days before: 245 or something around there.

Overall: Not too bad. With the exception of not starting the test till almost two hours after i got there, it went pretty smoothly. The exam felt pretty doable..knock on wood.

Anatomy/Neuroanatomy
: I was scared by all these horror stories, but overall this was one of the easier parts of my test. There was alot of arm/leg nerve pathology that was simple. The strokes were pretty simple. No brain stems, but did have a spinal cord that was pretty easy. There was one that I didn't know, but I feel like those better in anatomy may have been able to get it based on the level of the CT, but I pretty much was only able to narrow it down to 3.

Pharm: Overall was not bad, not a single SHIPP question. I think I only had one cancer drug. There were a decent amount of GI drugs and a decent number of P450 interactions (like 3). A few pharmocokinetics (pretty sure I brain farted on one of them..im kicking myself, but I cant remember what i put.)This was also a very doable section of the test.

Micro: Alot of HIV/AIDS path and related diseases, but I think only two pharm questions. Most of it was really straight forward. YOU DO have to know Virus structures and stuff. I had one question that basically required you to know which was encapsulated, one where you had to know which one was segmented (and no it wasnt the flu), and one you needed to know which virus was SS +/- RNA.

Immuno: While my test had a lot of immuno, I thought it was all pretty easy. A few immunodeficiencies, alot of Interleukin/TNF/stuff questions. I think all of it was in first aid, maybe some I knew from Uworld, but not sure.

Biochem: Easier then Uworld. Two questions on interactions with isoniazid (basically the same question twice). Some vitamin deficiencies and toxicities. One question, I felt was unfair and actually had two answers. It was a really simple concept, but just stupid. I did refer a patient in this section, not sure if its the correct answer but I felt it made sense. Otherwise, not too bad.

Embryo: I dont have much recollection of it, I dont think it was too high yield on my test. I did have one tough quesiton saying that an ultrasound of this baby shows___, what serum markers are you most likely to see. They then listed like 6 up/down/normal arrows. 2 of the things I had never heard of, but I think i narrowed it down to two.

Behavioral Science: This is high yield. Know how to calculate the specificity, PPV, NPV, NNT, etc. Alot of ethics questions (idk maybe 15?). I usually do really well on this section on my practice tests, but two of the ethics questions I wasnt sure of, and one It was literally just a blind guess.

Cell Bio/Histo/Inflammation/tissue repair stuff: This was a pretty high yield section, and first aid might not have been enough. I would recommend probably consulting another source for this, but I think I knew most of them, but if I could go back I would have probably spent an extra half day on this.

SYSTEMS:
CARDIO: This felt heavily heavily tested in my test, I even had two questions that were nearly the same in the same section! Thankfully I knew it. This was also the section that I had my two part question in. I had two heart sounds, and while the stem didnt give it either away, im 90% sure I got them both right. Not much pharm in this section, but alot of path.

RENAL: I also had a lot of questions on this, and going into the test was most worried about this section (beside Anatomy). Most were ok, but there was one that I think I may have gotten right, but the only reason why I knew anything about the disease was from the free 150. Alot of arrow questions on this section.

PULM: the next heavily tested system. They werent too bad, but this also had alot of arrows that I hope I got right.

PSYCH: Nothing really stands out in this section. I had some questions but they were ok.

REPRO: Nothing really much to say about this section either. Know whats in First aid, fo sho.

HEME/ONC: A decent amount. One question about Hodgkins that I had no clue about. I literally was only able to eliminate one answer.

ENDOCRINE: Pretty high yield. Be able to interpret Arrows.

MSK/DERM: I had 4 questions that I never saw anywhere in First aid or uworld. One I remembered from DIT, one from Class..one I think I made a pretty good guess on but not sure if it was right, and one I still have no clue on.

EXTRA TIDBITS: Be able to interpret graphs, there are a decent amount of them. I also had a few quesitons that really didnt seem to test much beside high school/college algebra math ( I feel most of you guys would be able to figure them out). I had one extremely LEFT FIELD QUESTION THAT WAS ACTUALLY BORDERLINE SEXUALLY INAPPROPRIATE. I had a good laugh, but it was pretty out there.

OVERALL: long long Day. I marked between 4 and 9 questions a block. (Im sure I made some stupid mistakes or missed some that I didnt mark though)
I usualy finish blocks of questions with like 20 minutes left on UWORLD, after quickly reviewing my answers, and while I never ran out of time on any blocks and had to randomly bubble in answers there were two sections that I would have liked a couple extra minutes to figure a couple questions out. I highly recommend reading the question first if the question is longer then a few sentences..that way you can gloss over the irrelevant info, of which there is much. Also knowing key lab values will help.

Also, make sure you really really read carefully. I had a few questions were the entire stem I was thinking one thing, but then i read one small word or phrase and it changed my answer to something different. READ CAREFULLY.

The test felt in between the difficulty of NBMEs and Uworld with a little more randomness.

I didnt notice any repeats of NBMEs or UWORLD, but similar concepts tested, obviously

Glad its done. Hope I did somewhere around my test scores (of course higher would be great! ha). Good luck yall. Hopefully this is helpful to some. Ill answer some questions till i go on vacation!

Will add study plan, when I get my score
 
Last edited:
Overall, the exam was fair. I liked it. It's a well-written exam for the most part.

I had a question about osteoporosis and bone density scan. It had a 45ish year old woman asking for a bone density scan. I think she had a history of osteoporosis in her family. What is the age? I picked 50. It seems correct if you go to the USPSTF and radiology college website. This is a step 2 question. Nothing to do with integrating and figuring out things. Sounds experimental. I don't know how it crawled into a step 1 exam.

Also, I am very sure that this was an experimental question. side effect of dpp-4 inhibitors? come on. Wikipedia, medscape, and other sources say that the reports are INCONCLUSIVE. What the heck? Liver made sense. Really idiotic.

pancreatitis...they have basically the same MOA as the GLP-1 analogs (they inhibit the degradation of GLP-1) so they have the same side effects.
 
Um...Just know the basics. Do not get too caught up in the details. (you probably won't since you take the exam in ~2 days from now). You have got to get the big picture of disease processes. If you have focused on details then there are going to be questions which require you to think and knowing haphazard details isn't enough to successfully circle the right answer. Also, know drugs really well. Know mechanisms to the fullest. Don't just stop at insulin release from beta-cell of pancreas for sulfonylureas.

Thanks man. Wish me luck and get some rest!
 
Took it yesterday:
Scores:
NBME 7: start of study period: 220 I think
UW1: 1.5 weeks in: 254
NBME 12: 2.5 weeks in: 240
NBME 11: 3.5 weeks in: 242
UW2: 4.5 weeks in: 248
DIT: 4.5 weeks in: 246
NBME 6: 2 days before: 245 or something around there.

Overall: Not too bad. With the exception of not starting the test till almost two hours after i got there, it went pretty smoothly. The exam felt pretty doable..knock on wood.

Anatomy/Neuroanatomy: I was scared by all these horror stories, but overall this was one of the easier parts of my test. There was alot of arm/leg nerve pathology that was simple. The strokes were pretty simple. No brain stems, but did have a spinal cord that was pretty easy. There was one that I didn't know, but I feel like those better in anatomy may have been able to get it based on the level of the CT, but I pretty much was only able to narrow it down to 3.

Pharm: Overall was not bad, not a single SHIPP question. I think I only had one cancer drug. There were a decent amount of GI drugs and a decent number of P450 interactions (like 3). A few pharmocokinetics (pretty sure I brain farted on one of them..im kicking myself, but I cant remember what i put.)This was also a very doable section of the test.

Micro: Alot of HIV/AIDS path and related diseases, but I think only two pharm questions. Most of it was really straight forward. YOU DO have to know Virus structures and stuff. I had one question that basically required you to know which was encapsulated, one where you had to know which one was segmented (and no it wasnt the flu), and one you needed to know which virus was SS +/- RNA.

Immuno: While my test had a lot of immuno, I thought it was all pretty easy. A few immunodeficiencies, alot of Interleukin/TNF/stuff questions. I think all of it was in first aid, maybe some I knew from Uworld, but not sure.

Biochem: Easier then Uworld. Two questions on interactions with isoniazid (basically the same question twice). Some vitamin deficiencies and toxicities. One question, I felt was unfair and actually had two answers. It was a really simple concept, but just stupid. I did refer a patient in this section, not sure if its the correct answer but I felt it made sense. Otherwise, not too bad.

Embryo: I dont have much recollection of it, I dont think it was too high yield on my test. I did have one tough quesiton saying that an ultrasound of this baby shows___, what serum markers are you most likely to see. They then listed like 6 up/down/normal arrows. 2 of the things I had never heard of, but I think i narrowed it down to two.

Behavioral Science: This is high yield. Know how to calculate the specificity, PPV, NPV, NNT, etc. Alot of ethics questions (idk maybe 15?). I usually do really well on this section on my practice tests, but two of the ethics questions I wasnt sure of, and one It was literally just a blind guess.

Cell Bio/Histo/Inflammation/tissue repair stuff: This was a pretty high yield section, and first aid might not have been enough. I would recommend probably consulting another source for this, but I think I knew most of them, but if I could go back I would have probably spent an extra half day on this.

SYSTEMS:
CARDIO: This felt heavily heavily tested in my test, I even had two questions that were nearly the same in the same section! Thankfully I knew it. This was also the section that I had my two part question in. I had two heart sounds, and while the stem didnt give it either away, im 90% sure I got them both right. Not much pharm in this section, but alot of path.

RENAL: I also had a lot of questions on this, and going into the test was most worried about this section (beside Anatomy). Most were ok, but there was one that I think I may have gotten right, but the only reason why I knew anything about the disease was from the free 150. Alot of arrow questions on this section.

PULM: the next heavily tested system. They werent too bad, but this also had alot of arrows that I hope I got right.

PSYCH: Nothing really stands out in this section. I had some questions but they were ok.

REPRO: Nothing really much to say about this section either. Know whats in First aid, fo sho.

HEME/ONC: A decent amount. One question about Hodgkins that I had no clue about. I literally was only able to eliminate one answer.

ENDOCRINE: Pretty high yield. Be able to interpret Arrows.

MSK/DERM: I had 4 questions that I never saw anywhere in First aid or uworld. One I remembered from DIT, one from Class..one I think I made a pretty good guess on but not sure if it was right, and one I still have no clue on.

EXTRA TIDBITS: Be able to interpret graphs, there are a decent amount of them. I also had a few quesitons that really didnt seem to test much beside high school/college algebra math ( I feel most of you guys would be able to figure them out). I had one extremely LEFT FIELD QUESTION THAT WAS ACTUALLY BORDERLINE SEXUALLY INAPPROPRIATE. I had a good laugh, but it was pretty out there.

OVERALL: long long Day. I marked between 4 and 9 questions a block. (Im sure I made some stupid mistakes or missed some that I didnt mark though)
I usualy finish blocks of questions with like 20 minutes left on UWORLD, after quickly reviewing my answers, and while I never ran out of time on any blocks and had to randomly bubble in answers there were two sections that I would have liked a couple extra minutes to figure a couple questions out. I highly recommend reading the question first if the question is longer then a few sentences..that way you can gloss over the irrelevant info, of which there is much. Also knowing key lab values will help.

Also, make sure you really really read carefully. I had a few questions were the entire stem I was thinking one thing, but then i read one small word or phrase and it changed my answer to something different. READ CAREFULLY.

The test felt in between the difficulty of NBMEs and Uworld with a little more randomness.

I didnt notice any repeats of NBMEs or UWORLD, but similar concepts tested, obviously

Glad its done. Hope I did somewhere around my test scores (of course higher would be great! ha). Good luck yall. Hopefully this is helpful to some. Ill answer some questions till i go on vacation!

Will add study plan, when I get my score

Way to go man. I was looking forward to your write up. Thanks for doing such a great job. Go enjoy yourself. I'm pretty sure a 245+ has your name on it.
 
pancreatitis...they have basically the same MOA as the GLP-1 analogs (they inhibit the degradation of GLP-1) so they have the same side effects.

I don't know if "same" mechanism (not exactly the same in this case) equates to similar side effect profile. I mean sulfonylureas 1st generation have sulfa allergy but not the second generation. Ethacrynic acid vs. furosemide. etc. etc. Also, pancreatic toxicity was not in the answer choice. Lol. It's a terrible question. I guess some researcher must have figured out a new side effect in a test tube!
 
I don't know if "same" mechanism (not exactly the same in this case) equates to similar side effect profile. I mean sulfonylureas 1st generation have sulfa allergy but not the second generation. Ethacrynic acid vs. furosemide. etc. etc. Also, pancreatic toxicity was not in the answer choice. Lol. It's a terrible question. I guess some researcher must have figured out a new side effect in a test tube!

Constant erection. That is it.
 
Way to go man. I was looking forward to your write up. Thanks for doing such a great job. Go enjoy yourself. I'm pretty sure a 245+ has your name on it.

Congrats WW! Hopefully I'll feel the same way
Thanks guys. We will see how the curve ends up, and best of luck to the both of you. Try to keep your nerves under control, cause they can really mess with some peoples, but its really nothing to be worried about. (sortof:laugh:)
 
Typically a history in the family would be a risk factor so you would get the bone scan earlier. Was she post meno?

For the dpp-4 the only thing my pharm cards taught me was nausea. Can't thing of anything else.

How was the anatomy?

For DPP-4 .. AE include headache, nasopharyngitis and URI's (baby katzung p366)
 
Thanks for the feedback everything! Can't wait for me to get this over with too!!

I am wondering if anyone can comment on pharmacokinetics? It seems most questions dealt w/ MOA, AE, indications, etc. What about the Km, Vm, Lineweaver Burke, elimination plots, etc etc?

Kaplan pharm seemed to emphasized those!
 
Thanks for the feedback everything! Can't wait for me to get this over with too!!

I am wondering if anyone can comment on pharmacokinetics? It seems most questions dealt w/ MOA, AE, indications, etc. What about the Km, Vm, Lineweaver Burke, elimination plots, etc etc?

Kaplan pharm seemed to emphasized those!
I had a fair number of pharmocokinetics. Two lineweaver burkes, one clearance and one asking about what maintenance dose to give ( i brain farted on this one...so ticked)
 
Hey Vagus,

It's high yield in a certain respect. It's very nitpicky and alone the bank would be insufficient but matched with FA its a really good combo. There are alot of things in that bank that I didn't see. However, I would say that it's high yield in that it'll help you get harder questions that can tweak a simple concept that'd be easy to gloss over in FA (chronic hypercapnic patient going into respiratory arrest after recieving 100% O2). It'll also give you presentations of diseases that are somewhat rare as well (had a question on fanconi's anemia and fanconi's syndrome). Id say around 75% of questions on the test were out of FA and things you couldnt miss. Probably the next 20% was in UW. The last 5% is just random and somewhat impossible to prepare for.

I read RR twice and the only question I can say definitively I got right from that was that you can diagnose CF with serum Trypsinogen.

TL;DR Know FA and UW inside and out and you'll crush this thing

I read on page 308 Goljan RR that CF screening in infants is done using serum immunoreactive trypsin levels.
 
I don't know if "same" mechanism (not exactly the same in this case) equates to similar side effect profile. I mean sulfonylureas 1st generation have sulfa allergy but not the second generation. Ethacrynic acid vs. furosemide. etc. etc. Also, pancreatic toxicity was not in the answer choice. Lol. It's a terrible question. I guess some researcher must have figured out a new side effect in a test tube!


lol what! it wasn't a choice?. I was just going based off what I learned in class... man thats a hard one.
 
Took the exam on June 13, and finally have a chance to post about it.

First, my study schedule was pretty much the same as everyone else. Read RR and FA throughout the school year. Took 4 weeks to study for the exam. Read FA 2-3x during that period and did UWorld once. I usually spent about 6-7 hours on UW and another 2-3 reading FA. I did not read RR during the month because I had added a lot of notes from my readings throughout the year into FA, which was all I read. I personally dislike the BRS series, especially phys, so I avoided that and focused on FA.

NBME12 (5 weeks to test) - 175
UWSA1 (2 weeks to test) - 228
UWSA2 (1 week to test) - 247

I thought that the test itself was not nearly as bad as most people make it seem. I thought that the questions were at least comparable to the questions on UW. I had a good number of questions that I was able to answer about halfway through because I spotted a buzzword and got it. I will say that the questions were somewhat longer than those on UW, especially in terms of lab values (most of which were not important). The questions were also more straightforward than UW and less nit-picky, especially when it came to biochem. There are always going to be questions that completely throw you off, and I definitely had a few of them. But overall I thought that there were more than enough "basic" questions to balance them out.

As for timing, I actually had a good amount of time on all but 1 section. I was generally finishing with about 15 minutes to go and had enough time to review all of the questions and then all the marked questions over a third time. I was taking breaks after every block, usually for about 5 minutes, but took longer breaks after the 4th (for some food) and the 6th (to settle nerves for the last block). I didn't feel rushed in any of the sections, and felt that the break time was more than enough (I skipped the tutorial).

I did have something really strange happen during my exam. All of the computers at the prometric station froze because the server went down. It took about 10 minutes to get it set back up, and fortunately no one lost any material. It was basically a free 10 minute break. I was lucky that I had been in the middle of reviewing the block and not answering question, so I did not have my momentum broken too much.

As a tip for others, I would say that when it gets closer to the test, you might be better off stopping questions and doing more FA, especially taking the time to memorize some of the high yield notes at the back of FA. I picked up a couple of questions from that section that I would not have gotten from anywhere else. I definitely felt that FA + UW was more than enough to prepare me for the test.

Good luck to everyone still to take it.
 
I got a lot out of this board in deciding how to go about my board prep and hopefully this will be useful to some of the MS1s and MSOs out there. I don't really have much advice for my fellow ms2s nearing the test, but i've got my fingers crossed for you

First things First: figure out what your goals are. for a lot of people, going all out to max out their step1 score makes little sense. If you know that you want to do family practice or something that you don't need that really high score, celebrate rejoice and work hard on doing things you think will make you a great doctor. STEP 1 is not the be all end all, but for some people, myself included getting as high a score as is possible is important and this is what I did and it worked for me. I put in an incredible amount of work over the last year and it was worth it for me based on my goals (pretty set on one very competitive field) and strong desire to be in one of a few difficult to match locations for family reasons. I wanted to put myself in a position where I felt confident that I could break 260 on any test that I got and made a year long study plan accordingly. It is not for the faint of heart, but I'm pretty sure that any US medical student will break 250 if they do what I did and the good test takers among us will be over 260 with this type of study plan. Final advice, don't follow anyone study plan exactly, but figure out what you need to use (first aid and uworld) and then tailor the specifics towards what you need.

Things used during the year:
Gunnertraining: Awesome, awesome, awesome. This was a huge part of my success on this exam. It hammers an incredible amount of stuff into your brain and made me a rockstar all year in classes and small groups and payed off big time for board studying. First aid is great, but I would not really have been able to memorize it, but gunnertraining has most of first aid plus a lot of the best tidbits of goljan and other good stuff. If you are finishing up first year and have a goal of a very hight step1 score I would start it now, bank all of the first year stuff over the summer, bank the rest along with classes, but double up at the end of the year so that you have gt fully banked by at least 1 month before your dedicated study period-that way you will be able to keep doing your gt questions, but it will be down to a more manageable 100 or so qs a day.

Kaplan Qbank: Did this along with classes. Did all questions on tutor mode, would do a question read the explanation, flip to the page in first aid, read the appropriate section and annotate if necessary.

First Aid: In addition to the annotations from qbank, i made sure to read the appropriate sections from first aid at least once (usually 2x) along with classes second year. Not to memorize but to get very familiar with all the content.

Goljan audio: This is still great though it has a few errors (but not really more than most up to date written texts). Had a 25 minute commute to school and listened to goljan almost everyday=about 1 lecture a day. I would listen to what we were studying in school and just repeat it until my exam, this meant that i listened to each lecture around 3x at least during the year.

RR path: Also good and a good combo with the audio. I would generally read through each chapter 2 times along with classes. Also it has all the pictures referred to in the audio and has a synergistic learning response when combined.

Robins Q book and webpath: Did these along with classes, maybe a little over the top, but I found it helpful in really nailing down path.

BRS Physio: I would read the appropriate chapters and do the questions at the beginning of each block at school. It is great to be really solid on your physio because it makes a lot of things make sense and the more that you understand pathology and pathophysiology (vs memorize) the better. Plus physio is high yield in general and this is a great book.

Brenner pharmcards and Katzung and trevors examination and board review: My schools curriculum is a little weak in pharm. I don't really know if these books are the best, but they worked for me. Would do the appriate drugs/chapters along with class.

CMMRS: book is gold, read it twice during our ID (micro +micro pharm block)

HY neuroanatomy: read before neurology block, a little overdetailed but very good.

Lily for cardiology: great book, but way beyond what you need for boards

BRS behavioral-read this twice plus all the questions twice during our psych block (final was the BS shelf). Big fan of this book.

Class syllabi and lectures: I read the syllabi and went to or watched all of my class lectures until the end of february. I think that you need to learn things for the first time somewhere and this was good for me, but YMMV. The 20 points above 250 IMO are made up largely of somewhat random stuff and you'll find some of it in your classes. My school is P/F though, so I would go to class, read the syllabus once and did the rest of my studying including the 3-4 days before the test solely w/board level materials




Few months before step1 (while still in class)
UWORLD: the best resource of all, an amazing learning tool-use it that way. I did my first pass of uworld + marked and incorrects during my last two months of classes. All on tutor mode with the same method I used for kaplan qbank (see above). Though I was doing tutor mode, I tried to do the questions quickly (but took my time with the answers) though occasionally i would take 2-3 minutes for a question. remember uworld is a learning tool, not a prognosticator first and foremost, use NBMEs for that.

Rx: did about 1000 questions from it (including all behavioral science) but didn't have time to do more. IMO for qbanks UWORLD >>>kaplan>rx, but kaplan and rx aren't that far apart in quality, what really turned me off to rx was that there were at least 3 or 4 completely incorrect answers which didn't happen in the other qbanks (i.e. in world or qbank there might be an error here or there, but the right answer to the question is still the right answer, whereas the rx questions that were incorrect the actual answer choice was wrong)

Read RR biochem: I liked this book alot, and along w other resources I thought was good, though not super high yield.

Last 23 days (after classes)-beast mode
Would read through the appropriate section in BRS physiology (but not do the questions), then read the section in first aid and do all of the kaplan qbank questions for that subject on tutor mode(some subjects had 2-3 days according to their length in first aid and my gut feeling on strengths and weaknesses), doing the easy questions, then medium then hard (would intersperse reading with questions because I could not read first aid for extended stretches). I would also do 100 UWORLD questions on random tutor mode and my gt questions for the day last once I was thoughouly burnt for the day (would actually do the last 50qs in bed). I only used RR as a reference during this period and referred to other books/wikipedia as necessary. I also listened to goljan while walking to and from the library and got through most of it again.

along the way i did some practice exams

Last 5 days I was done w kaplan qbank and finished UWorld plus incorrects and read through first aid one more time (didn't get fully back through it). I did UWSA 2 one block a day for the first 4 days (i.e. not the day before the test) to get myself back to being used to doing random questions i'd never seen in 46q blocks and then read the answers.

Wasn't able to take the last day off, but stopped studying at 7pm, ate dinner and watched one of my favorite movies in bed and was able to get a good nights sleep the night before (try as hard as you can to do this)



Good luck everybody. for the younguns-set your goals intelligently and do what you need to do to get there. Hard work over a long period of time pays off on this test.

numbers (all qbanks done on untimed tutor mode with annotation into first aid on first pass)
Gunnertraining: 98% banked (didn't bank some of the stuff they added during the last 3 weeks) and about 76% mastered with a peak of 80% mastered
Kaplan qbank along with classes: 81%
1st pass uworld (in the last two months of school): 84.5%
Usmlerx (did about 1000qs):don't remember exactly but around 93%
Behavioral Shelf about 2months before step1-910
Second Pass qbank: around 90%
second pass UW: 97% (though I was recognizing a fair amount of the answers)
NBME 5 4/1: 690: 264 (old scale)
UWSA1 4/13: 265
NBME 12 4/23: 680:264 (missed 9)
NBME 11 5/1: 710: 271 (missed 6)
UWSA 2 (taken as 4 separate blocks):265 (max for uwsas)
STEP1: 5/16: 270

👍 GREAT JOB!!!
 
I got a lot out of this board in deciding how to go about my board prep and hopefully this will be useful to some of the MS1s and MSOs out there. I don't really have much advice for my fellow ms2s nearing the test, but i've got my fingers crossed for you

First things First: figure out what your goals are. for a lot of people, going all out to max out their step1 score makes little sense. If you know that you want to do family practice or something that you don't need that really high score, celebrate rejoice and work hard on doing things you think will make you a great doctor. STEP 1 is not the be all end all, but for some people, myself included getting as high a score as is possible is important and this is what I did and it worked for me. I put in an incredible amount of work over the last year and it was worth it for me based on my goals (pretty set on one very competitive field) and strong desire to be in one of a few difficult to match locations for family reasons. I wanted to put myself in a position where I felt confident that I could break 260 on any test that I got and made a year long study plan accordingly. It is not for the faint of heart, but I'm pretty sure that any US medical student will break 250 if they do what I did and the good test takers among us will be over 260 with this type of study plan. Final advice, don't follow anyone study plan exactly, but figure out what you need to use (first aid and uworld) and then tailor the specifics towards what you need.

Things used during the year:
Gunnertraining: Awesome, awesome, awesome. This was a huge part of my success on this exam. It hammers an incredible amount of stuff into your brain and made me a rockstar all year in classes and small groups and payed off big time for board studying. First aid is great, but I would not really have been able to memorize it, but gunnertraining has most of first aid plus a lot of the best tidbits of goljan and other good stuff. If you are finishing up first year and have a goal of a very hight step1 score I would start it now, bank all of the first year stuff over the summer, bank the rest along with classes, but double up at the end of the year so that you have gt fully banked by at least 1 month before your dedicated study period-that way you will be able to keep doing your gt questions, but it will be down to a more manageable 100 or so qs a day.

Kaplan Qbank: Did this along with classes. Did all questions on tutor mode, would do a question read the explanation, flip to the page in first aid, read the appropriate section and annotate if necessary.

First Aid: In addition to the annotations from qbank, i made sure to read the appropriate sections from first aid at least once (usually 2x) along with classes second year. Not to memorize but to get very familiar with all the content.

Goljan audio: This is still great though it has a few errors (but not really more than most up to date written texts). Had a 25 minute commute to school and listened to goljan almost everyday=about 1 lecture a day. I would listen to what we were studying in school and just repeat it until my exam, this meant that i listened to each lecture around 3x at least during the year.

RR path: Also good and a good combo with the audio. I would generally read through each chapter 2 times along with classes. Also it has all the pictures referred to in the audio and has a synergistic learning response when combined.

Robins Q book and webpath: Did these along with classes, maybe a little over the top, but I found it helpful in really nailing down path.

BRS Physio: I would read the appropriate chapters and do the questions at the beginning of each block at school. It is great to be really solid on your physio because it makes a lot of things make sense and the more that you understand pathology and pathophysiology (vs memorize) the better. Plus physio is high yield in general and this is a great book.

Brenner pharmcards and Katzung and trevors examination and board review: My schools curriculum is a little weak in pharm. I don't really know if these books are the best, but they worked for me. Would do the appriate drugs/chapters along with class.

CMMRS: book is gold, read it twice during our ID (micro +micro pharm block)

HY neuroanatomy: read before neurology block, a little overdetailed but very good.

Lily for cardiology: great book, but way beyond what you need for boards

BRS behavioral-read this twice plus all the questions twice during our psych block (final was the BS shelf). Big fan of this book.

Class syllabi and lectures: I read the syllabi and went to or watched all of my class lectures until the end of february. I think that you need to learn things for the first time somewhere and this was good for me, but YMMV. The 20 points above 250 IMO are made up largely of somewhat random stuff and you'll find some of it in your classes. My school is P/F though, so I would go to class, read the syllabus once and did the rest of my studying including the 3-4 days before the test solely w/board level materials




Few months before step1 (while still in class)
UWORLD: the best resource of all, an amazing learning tool-use it that way. I did my first pass of uworld + marked and incorrects during my last two months of classes. All on tutor mode with the same method I used for kaplan qbank (see above). Though I was doing tutor mode, I tried to do the questions quickly (but took my time with the answers) though occasionally i would take 2-3 minutes for a question. remember uworld is a learning tool, not a prognosticator first and foremost, use NBMEs for that.

Rx: did about 1000 questions from it (including all behavioral science) but didn't have time to do more. IMO for qbanks UWORLD >>>kaplan>rx, but kaplan and rx aren't that far apart in quality, what really turned me off to rx was that there were at least 3 or 4 completely incorrect answers which didn't happen in the other qbanks (i.e. in world or qbank there might be an error here or there, but the right answer to the question is still the right answer, whereas the rx questions that were incorrect the actual answer choice was wrong)

Read RR biochem: I liked this book alot, and along w other resources I thought was good, though not super high yield.

Last 23 days (after classes)-beast mode
Would read through the appropriate section in BRS physiology (but not do the questions), then read the section in first aid and do all of the kaplan qbank questions for that subject on tutor mode(some subjects had 2-3 days according to their length in first aid and my gut feeling on strengths and weaknesses), doing the easy questions, then medium then hard (would intersperse reading with questions because I could not read first aid for extended stretches). I would also do 100 UWORLD questions on random tutor mode and my gt questions for the day last once I was thoughouly burnt for the day (would actually do the last 50qs in bed). I only used RR as a reference during this period and referred to other books/wikipedia as necessary. I also listened to goljan while walking to and from the library and got through most of it again.

along the way i did some practice exams

Last 5 days I was done w kaplan qbank and finished UWorld plus incorrects and read through first aid one more time (didn't get fully back through it). I did UWSA 2 one block a day for the first 4 days (i.e. not the day before the test) to get myself back to being used to doing random questions i'd never seen in 46q blocks and then read the answers.

Wasn't able to take the last day off, but stopped studying at 7pm, ate dinner and watched one of my favorite movies in bed and was able to get a good nights sleep the night before (try as hard as you can to do this)



Good luck everybody. for the younguns-set your goals intelligently and do what you need to do to get there. Hard work over a long period of time pays off on this test.

numbers (all qbanks done on untimed tutor mode with annotation into first aid on first pass)
Gunnertraining: 98% banked (didn't bank some of the stuff they added during the last 3 weeks) and about 76% mastered with a peak of 80% mastered
Kaplan qbank along with classes: 81%
1st pass uworld (in the last two months of school): 84.5%
Usmlerx (did about 1000qs):don't remember exactly but around 93%
Behavioral Shelf about 2months before step1-910
Second Pass qbank: around 90%
second pass UW: 97% (though I was recognizing a fair amount of the answers)
NBME 5 4/1: 690: 264 (old scale)
UWSA1 4/13: 265
NBME 12 4/23: 680:264 (missed 9)
NBME 11 5/1: 710: 271 (missed 6)
UWSA 2 (taken as 4 separate blocks):265 (max for uwsas)
STEP1: 5/16: 270

We have the exact UWSA scores and my NBME score was similar. How many questions did you think you missed after the test? (rough estimate)
 
For DPP-4 .. AE include headache, nasopharyngitis and URI's (baby katzung p366)



Flushing was an answer choice. But, none of the ones listed above were in the choices.
I think seeker is right. Priapism has to be the answer. Lol.

Btw, Good luck to you and Seeker!
 
I took Step 1 two weeks ago and was just getting around to looking up some answers of questions that I marked, probably a bad idea I know but what the hay.

Anyway, does anyone else remember a question about someone who was recently diagnosed with chlamydia and was asking if they should be tested? I don't recall too many other details about the question, but I don't believe that it mentioned multiple sexual partners/drug use/homosexual male type of stuff. If so, did you have any thoughts on the question?
 
I took Step 1 two weeks ago and was just getting around to looking up some answers of questions that I marked, probably a bad idea I know but what the hay.

Anyway, does anyone else remember a question about someone who was recently diagnosed with chlamydia and was asking if they should be tested? I don't recall too many other details about the question, but I don't believe that it mentioned multiple sexual partners/drug use/homosexual male type of stuff. If so, did you have any thoughts on the question?

Always get tested.
 
for all those considering 5hr energy, i wanted to share my story:

i have never tried it before. i always stuck to coffee or sugarfree red bull when things got really bad. but i noticed while studying that i had to pee all the freaking time with red bull so i finally decided to try 5 hr energy bc there is no way i wanted to worry about having to pee during the exam. i really like 5 hr energy now. i was always kinda scared of it, but it doesnt taste bad, its an ok taste, and i did not feel jittery at all. after a few minutes i just realized that i wasnt tired and my eyes werent closing bc i wanted to sleep.
during the actual exam i took 5 hr energy with me in case i was getting tired. i ended up drinking it (its really 2 big sips) after block 3 i believe. i didnt think about hwo tired i was or anything.. but i did think about how dehumanizing that exam was haha


I'm kinda puzzled by all this talk of 5-hr energy being better than red bull/coffee because it "makes you pee less". Caffeine in and of itself has relatively strong diuretic effects regardless of the amount of water you consume along with a dose of it. Drop a NoDoz and trust me, you will be pissing like a racehorse in 30-45 min...especially if you're nervous to boot.
 
I'm kinda puzzled by all this talk of 5-hr energy being better than red bull/coffee because it "makes you pee less". Caffeine in and of itself has relatively strong diuretic effects regardless of the amount of water you consume along with a dose of it. Drop a NoDoz and trust me, you will be pissing like a racehorse in 30-45 min...especially if you're nervous to boot.

Because you still have less fluid in you regardless. I had 2 of them during the exam and didn't have to pee at all until the 5th block.

Take that NoDoz and then take it with a big glass of water and see which one makes you pee faster.

Yes, I know caffeine inhibits Na reabsorption and all that junk, but it is much harder to diuresis someone when there is less fluid in them to begin with.
 
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