Alright, here's my writeup of Step 1.
I'd say 25% of the exam was easy gimmes. Like, no way you should miss this question. To give a couple examples, I had a question that asked what does the liver secrete when hormone X levels are high, or what is this organism that stains as a coccus and only one of the answer choices was even a cocci.
The majority was basically your average Uworld question. Drug interactions, two step reasoning, diagnosis, complicating factors, etc etc. "Next step in management" was either commonsense or required clinical experience (eg dude has a headache, what imaging modality do you use, MRI, CT, Xray, etc).
Then 5-10% was ridiculous minutia that I saw in my graduate studies, one liners on powerpoints/review books, random minutia. Stuff like mechanism of random enzyme or splicesome constituents, random metabolic pathway not in FA, or some weird hormone/cytokine/mediator that you've probably never seen before or at least studied in depth. This stuff is basically either a stupid one-liner in Robbins or required you to eliminate all other answer choices. It's very difficult to prep for these questions, so just make a best guess, move on and don't let it faze you.
On subject specific stuff -> Calculations were easy peasy. I had maybe 2 or 3 calculations total; one was a straight up mode calculation. One was a GFR calculation and one easy Hardy-Weinberg. The rest of biostats was interpretations, like PPV, NPV, meta-analyses, study design, etc etc. I had like 4 questions on meta-analyses, which was odd considering that all of Rx and all of Uworld had maybe 1 question between them.
Ethics was 90% easy peasy bull****, 10% "wtf is this real-life". Don't dwell on it too much, just pick the least dickish answer and move on. You can't really prepare for these types of ethics questions because the scenarios were ridiculous.
Safety science -> common sense. I had one question that had two good answers in them. The rest were common sense. It'd be 4 or 5 answer choices and 4 of them you would be embarrassed to even consider them as answer choices.
Anatomy -> 90% was in FA, 10% you can't prepare for. I mean, you cannot prepare for them. It was like, what is this specific lymph node within the axillary lymph system called. Or what is this segment of this artery called, and the terms were **** I never seen before. Lots of images (MRIs, CTs) but nothing you couldn't orientate yourself to. Pay attention to the answer choices, because I had one question that needed you to know left/right on a CT scan because the answer choices were exactly the same except one said left kidney and the other right kidney.
Biochem -> straightfoward. Mine was heavy on experimental stuff, but the questions were actually well-worded and laid out controls nicely, which allowed for easy points.
Everything else -> 80-90% was in FA or Uworld/Pathoma. Some things won't be and you have to deal with it. I got like 4 questions on super obscure paraneoplastic syndromes and only got a couple of them right because our pathology class actually discussed them. They weren't in FA, Pathoma or Uworld, so I was like "**** this ****" during the school year. I had a few heart sounds, only one was like "Pt comes in for annual checkup, here is the heart exam". The rest gave a decent enough history. My exam was crazy heavy on viruses. I had maybe 2-3 questions on fungus/bacteria and like 25 on viruses.
Time management was a bit of a problem; I finished each section with about 10-20 minutes to spare. Question length was nothing out of the ordinary. Most were 3-4 sentences long, some were 1 sentence, some were like a goddamn novel.
Overall, I didn't feel too bad walking out. I was actually surprised by the exam, considering some of the doom and gloom here. Yea, it's easy to get hung up on some random cytokine's MOA, but in the end, it was just one question. Pick your best answer and move on. The meat of the exam was straightforward, fair and pretty much to the point. Overall, I'm kind of pissed at how narrow the exam is. You spend so much time hearing "high yield" and 90% of what you think is high yield doesn't even show up on the exam and some ridiculous minutia covered in class but not review books comes up multiple times.
Finally, trust your goddamn self. The one thing I've learned from doing Uworld/NBMEs is that your gut is often right and then you trick yourself out of the right answer. I trusted myself on this exam and so far, I'm batting like 90% on the questions that I was hesitant on.
