Official 2012 Step 1 Experiences and Scores Thread

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I thought the doc just feels if the spleen is enlarged? @ least that is what they did to my college friend that had mono
 
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I also suggest the Katzung Review book. It's second to none if you want a review of all the main concepts, well-written breakdown of drugs by group, and high-yield review questions - in as few words as possible and packaged into as few pages as possible.

As Untraditional said, FA has most of the drugs you need to worry about for the test, however.
 
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lemonade90 said:
What about a physical exam finding of splenomegaly? I would think the bigger the spleen the greater the risk for rupture.
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yeah, this is what I thought about
I just can't see in terms of answer options given by Mdquestion how and what lab test can predict rupture risk
 
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Convalaria said:
yeah, this is what I thought about
I just can't see in terms of answer options given by Mdquestion how and what lab test can predict rupture risk
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Don't think that was one of the choices (physical exam). I also had EBV-mono recently and my doc did none of this for me :laugh:

The only two I was seriously considering was an capsid viral titer (to assess whether or not the virus was still reasonably active) and a Direct Coomb's test. I was thinking that EBV infection can produce abnormal cytokine release and antibody production that might explain why the spleen gets enlarged (i.e. there are immune complexes and antibodies circulating in the blood) and this might be best predicted by looking if there was any antibody attachment to native cells/red blood cells/etc. that would end up in the spleen and cause inflammation.
 
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missmedschool said:
so then pick estrogen? I had a similar question like this on UW; estrogen wasn't an answer choice but progesterone was. I knew it was both of em so I just picked progesterone (which was correct).
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Yeah. No estrogen from what I can remember (and I think it's actually oestreogent variant specifically....not estrogen that elicits the effect...but that's probably too nit-picky anyway). I think I put bHCG, but I knew it must have been wrong. I think the other options were LH, FSH, Oxytocin, HPL, D-HT, GnRH and maybe one more that I can't remember.
 
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ijn said:
We were always taught it's due to disulfiram like effects, so it'd be inhibition of acetyladehyde dehydrogenase. Was that not an option?

Edit: you beat me! 😛
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Yeah, that's what I put I think...it was the only thing that made sense to me. Though, I looked it up and it's not even really clear if that's how it works. I was mainly trying to elucidate the point that it wasn't really just rote regurgitation of the association between side effects and alcohol use...but moreso they always wanted mechanisms of how things worked. That was a general theme of my exam.
 
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Wow. How in the world does the cell decrease membrane bound receptors in such a short amount of time though? Can't even remember what I put for that one. It might have been receptor downregulation just because everything else didn't make sense.
 
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Im guessing through degradation. lol. It is probably a lot faster to downregulate receptors as opposed to the opposite.
 
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mdquestion said:
Don't think that was one of the choices (physical exam). I also had EBV-mono recently and my doc did none of this for me :laugh:

The only two I was seriously considering was an capsid viral titer (to assess whether or not the virus was still reasonably active) and a Direct Coomb's test. I was thinking that EBV infection can produce abnormal cytokine release and antibody production that might explain why the spleen gets enlarged (i.e. there are immune complexes and antibodies circulating in the blood) and this might be best predicted by looking if there was any antibody attachment to native cells/red blood cells/etc. that would end up in the spleen and cause inflammation.
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I guess that makes sense given the positive monospot test has to do with heterophile antibodies. But I didn't think this had to deal with splenic rupture risk, just whether you had the virus.
 
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lemonade90 said:
I guess that makes sense given the positive monospot test has to do with heterophile antibodies. But I didn't think this had to deal with splenic rupture risk, just whether you had the virus.
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In other words...why does the spleen become enlarged during EBV infection? Is there another explanation?
 
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you guys shouldnt be discussing questions that were on the exam

i imagine its not hard for the ppl at the nbme to see what questions you're referring too, look at who's exam had all those questions, and then identify the person.
 
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JasonE said:
you guys shouldnt be discussing questions that were on the exam

i imagine its not hard for the ppl at the nbme to see what questions you're referring too, look at who's exam had all those questions, and then identify the person.
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I disagree. This forum is a tool for sharing as much information as possible without crossing boundaries. We all want to ace the exam and we'll do what we have to to make that happen. Merely talking about questions is more than fine.
 
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JasonE said:
you guys shouldnt be discussing questions that were on the exam

i imagine its not hard for the ppl at the nbme to see what questions you're referring too, look at who's exam had all those questions, and then identify the person.
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Agreed.

Phloston said:
I disagree. This forum is a tool for sharing as much information as possible without crossing boundaries. We all want to ace the exam and we'll do what we have to to make that happen. Merely talking about questions is more than fine.
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It's clear that you aren't supposed to talk about specific questions in the confidentiality agreement. Doing the right thing is more important than acing any exam.
 
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Phloston said:
I disagree. This forum is a tool for sharing as much information as possible without crossing boundaries. We all want to ace the exam and we'll do what we have to to make that happen. Merely talking about questions is more than fine.
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Sorry about sharing exam information- though, I don't think I was crossing any line (it's not as if I'm trying to reproduce exam questions here and distribute them). I won't mention anymore specific questions and I'll try to keep the discussion to concepts rather than questions.
 
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mdquestion said:
Sorry about sharing exam information- though, I don't think I was crossing any line (it's not as if I'm trying to reproduce exam questions here and distribute them). I won't mention anymore specific questions and I'll try to keep the discussion to concepts rather than questions.
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Mdquestion, I think a few of our posters would benefit from a dual MD/JD program. There hasn't been any breach of confidentiality, and we can most certainly talk about questions.

(I'll be away and will post back in 8-12 hours)
 
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no worries. i understand the excitement. just trying to say you should be careful. def dont want the nbme to get involved
 
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JasonE said:
no worries. i understand the excitement. just trying to say you should be careful. def dont want the nbme to get involved
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On a final note though- I will reiterate that probably the most helpful part of my last week of studying was going through the older NBME exams and looking for recurring concepts they liked to test on. Many of those showed up on my exam. It probably netted me about 20 questions on the exam I might not have remembered.

For the actual exam- it's stressful and much more of a time crunch than the practice NBMEs (longer questions, more complicated). I felt like it definitely got to my nerves and I could see myself answering questions wrong during the exam because I wasn't reading things correctly or thinking as calmly as I normally do. For instance, it took my nearly a minute to make the connection that a patient with diarrhea and pain radiating to the back had a pancreas problem (on practice exams, I'd be in the zone and get this in an instant).

My main personal worry is that I missed so many questions on silly mistakes that my board score has very little chance of reaching the levels I was getting on practice tests. Invariably, I expected not to know many of the questions instantly and educated guesses are likely required on a lot of them. This is the same for everyone else taking the exam too. I'm mainly worried because I know I missed easy questions (like really easy questions) for no apparent reason. And enough to add up to it significantly affecting my score (i.e. I could have easily missed 20 easy ones from stress). My personal goal was 80% correct (i.e. 64 or so wrong on the exam)...and I'm pretty confident I came nowhere close to that. I was also marking 15-20 questions/block. And there were probably other ones in there that I wasn't confident about either.

Thanks for letting me vent! Not something you wanna talk about with your classmates.
 
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Phloston said:
Mdquestion, I think a few of our posters would benefit from a dual MD/JD program. There hasn't been any breach of confidentiality, and we can most certainly talk about questions.

(I'll be away and will post back in 8-12 hours)
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Since this is the second time we've had this discussion and you seem to not believe that sharing specific questions is in breach of an agreement:

This is from a company currently being sued for getting information from test takers. Notice the breach is by the USMLE examinees...

The USMLE is copyrighted, and USMLE examinees agree not to disclose secure test questions at any time. Unauthorized access to secure test materials may raise questions about the validity of a test-taker's score.
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The disclosure of secure, copyrighted test questions undermines the integrity of the USMLE and presents the threat that persons without the skill and knowledge required to practice medicine will be licensed as a doctor.
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Btw, I'd love to get a JD.
 
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Phloston said:
Drunk man in fight with dilated pupils --> LSD. If he also had tachycardia/arrhythmia --> cocaine. Nystagmus is PCP, so that can be ruled out, but they may have been trying to trick bc PCP induces belligerence.
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PCP causes pupillary dilation (at least according to wikipedia's source).
 
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IJL said:
first aid.
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Yeah. First Aid was generally sufficient. I thought Pharm was generally the most fair part of the exam. There were a couple of questions that were drugs I didn't know or concepts I hadn't drilled in. I also maybe got a few things mixed up. But, generally, I felt as though pharm was well covered by FA + UWorld. The mechanisms are probably much more important to know than the side effects. Definitely had a lot more questions on those.
 
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For those that did not read the "read this first" sticky at the top of the forum, I would like to remind you that:

The materials (i.e., test questions, clinical computer simulations, and standardized patient cases) of the USMLE, NBME’s self-assessment program and NBME subject examinations are copyrighted. Publishing any ‘remembered’ materials or replicas of these materials on The Student Doctor Network (or any other forum) is an unauthorized reproduction of NBME’s materials, constitutes copyright infringement and is strictly prohibited. Any violation of NBME’s copyrights and trademarks can not only lead to legal sanctions, but can also have professional consequences. Medical students and medical school graduates, prospective students, examinees of the USMLE and NBME self-assessment examinations and subject examinations are reminded that they are bound to the terms they agreed to follow regarding disclosure of intellectual property prior to the administration of one of these examinations. Failure to adhere to the terms of these policies will subject an individual to various penalties up to and including being barred from future USMLE examinations.
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This is no joke. The NBME has tracked down at least one user who in the past was deemed to be in violation of the USMLE test agreement. The consequences can include banning from taking the remaining Steps, which basically means that you will have no pathway to licensure or residency after investing a lot of time and money into medical school.

I have deleted posts that clearly cross the line, in accordance with SDN's own policy on the issue. I also suggest that the benefits of testing where the NBME draws the line with respect to their agreement does not justify the risk to your career.
 
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The rules are the rules. As long as the NBME can easily prove it they definitely will go after you. But if you spill your guts out to Kaplan or the First Aid authors then it's packaged up and sold as a $3000 review course or a $35 review book. The whole system is pretty weird. I guess there will never be legal cases against those companies because it's too difficult to accumulate solid evidence on how the test information was originally leaked.
 
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ijn said:
The rules are the rules. As long as the NBME can easily prove it they definitely will go after you. But if you spill your guts out to Kaplan or the First Aid authors then it's packaged up and sold as a $3000 review course or a $35 review book. The whole system is pretty weird. I guess there will never be legal cases against those companies because it's too difficult to accumulate solid evidence on how the test information was originally leaked.
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👍
 
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ijn said:
The rules are the rules. As long as the NBME can easily prove it they definitely will go after you. But if you spill your guts out to Kaplan or the First Aid authors then it's packaged up and sold as a $3000 review course or a $35 review book. The whole system is pretty weird. I guess there will never be legal cases against those companies because it's too difficult to accumulate solid evidence on how the test information was originally leaked.
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true dat
 
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NBME are some of the biggest Nazis there are. Anyone recall the case with the student with a TBI who wanted time accommodations for his dyslexia and ended up having to sue all the way to federal appeals court after NBME insisted he see three different doctors? I have little sympathy for their practices. (Too bad they have the monopoly on leverage)


lord_jeebus said:
I also suggest that the benefits of testing where the NBME draws the line with respect to their agreement does not justify the risk to your career.
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Unless you're a Radiology resident, amirite?
 
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Banister: PCP causes pupillary dilation (at least according to wikipedia's source).
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First Aid's the Bible (in my case, the Torah). PCP might cause mydriasis, but FA says "vertical and horizontal nystagmus." Right below it, it says "pupillary dilation" for LSD.

I recall having had this distinguishing factor show up in a USMLE Rx question, so by all means, it's high-yield to know the difference between PCP and LSD- they like it.
 
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teenmachinery1 said:
Just got 245 on UWSA1 29 days out.

sigh... I have work to do. Best way to spend these last 4 weeks to break 260?
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245 with over 4 weeks to go? That's not bad at all, so first thing I'd say is take some satisfaction in being in a solid position right now. With that said, I completely understand wanting to do even better, so obviously don't sit back and get lazy now (which it doesn't sound like you will). It would be helpful to know what you've done so far and what you have planned for the next 4 weeks. Have you made a complete first pass through all of UW? If not, finish up UW. That's probably the best generalized info that can be given without knowing more about your situation.
 
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Phloston said:
First Aid's the Bible (in my case, the Torah). PCP might cause mydriasis, but FA says "vertical and horizontal nystagmus." Right below it, it says "pupillary dilation" for LSD.

I recall having had this distinguishing factor show up in a USMLE Rx question, so by all means, it's high-yield to know the difference between PCP and LSD- they like it.
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If you're spending so long doing every resource, why are you going off only what is in FA? PCP causes pupil dilation too. I think people on LSD would be less likely to get in a bar fight.

What is the question you are referring to? If it was just bar fight and pupil dilation, I would think PCP not LSD.
 
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Phloston said:
First Aid's the Bible (in my case, the Torah). PCP might cause mydriasis, but FA says "vertical and horizontal nystagmus." Right below it, it says "pupillary dilation" for LSD.

I recall having had this distinguishing factor show up in a USMLE Rx question, so by all means, it's high-yield to know the difference between PCP and LSD- they like it.
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Phloston, you should get out more. The last place you'd see someone on LSD is ****faced in a bar fight.
 
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VisionaryTics said:
Phloston, you should get out more. The last place you'd see someone on LSD is ****faced in a bar fight.
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haha so true...refer to that episode of Mad Men a couple weeks back. LSD and belligerence just don't really go together. More common knowledge than something you'd find in FA...
 
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VisionaryTics said:
Phloston, you should get out more. The last place you'd see someone on LSD is ****faced in a bar fight.
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Seriously, the last place I'd go on acid is a bar. You're already ****ed up as it is, so there's no need to drink on top of that...I'd probably just go to a park or forest and wander around for hours tasting all the beautiful colors I was seeing...
 
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