What a day! Here is my short-term recap before my mind goes blank. First and foremost, if you prepared well for the USMLE, the most important advice I have is to keep your anxiety to a minimum leading up to the test. I tried my best and really felt it let me get through blocks with a more level mind. Additionally, if you just accept the fact that 1/3 of the test is going to be super complicated/unknown things to you (maybe even more depending on the version you get) you will have a much more pleasant test experience. Freaking out every time you see something foreign is just a recipe for disaster (I understand how anxiety provoking this is, but I CANNOT stress this enough). For those wondering about specifics, specifics don't matter. I don't care who says it, but there is nothing you can do to prepare for some questions, so don't even try. The best course of study is to be prepared IN ALL AREAS. I definitely noticed a trend with people suggesting to look a milestones and sexual development before their exam and I can confirm that this can come up. Maybe not on every exam, but I definitely had a few questions that were explicitly asking you to differentiate between milestones and/or sexual development items (actual specifics and not something you could figure out intuitively from the stem).
I barely had any biochem or drug side effects on my exam, which is really a disappointment because I studied so hard for them in the few days leading up to my exam (oh well!). DO NOT neglect those areas just because I say this. Your exam could be very biochem/side effect heavy. I can confirm the trend that I have seen in that oncology specifics seem to be coming up a lot on the exam. I felt FA did an OK job preparing for this, but many questions were so specific about things not in FA or you had to infer outside of your knowledge base (or at least my knowledge base) for many questions, so there is no way to prepare for this. Another bane of my test were the infamous arrow/hormone-regulation questions. It felt like literally every 3rd question for me was a physiologic arrow question. Even on simple concepts, you really need to be strong in knowing how things change in pathological states (looking at you PTH/Vitd/Calcium/Cardiovascular/RAAS topics) and be prepared to see them in NOVEL SITUATIONS. These types of questions can really only be answered intuitively if you know the physiology behind them because they aren't going to give you classical scenarios and many of the answer choices may seem equally correct depending on the pathology behind the question.
Biostats and ethics were equally weird, with a mix of easy and very vague/hard questions. I do not feel there is really anything one could do to prepare for some of these, so know the major concepts and formulas and just be prepared for the WTF questions to move on from. FA and sketchy was more than enough for the Micro on my exam, but that does not mean that your exam version will not have crazy micro questions. My certainly did, but the majority were stuff in FA. More importantly, its very important to know the MOST COMMON of bugs for certain conditions. It is definitely easy to lose sight of this when you are chugging out Uworld 3rd/4th order micro questions and get used to the question stem giving you identifiers for bugs. I had many questions with no identifiers that you just had to know what the most common bug was, so be prepared for that.
Lastly, BE PREPARED TO SEE QUESTIONS ABOUT NORMAL. I realized this doing the Free 120 and confirmed it with my test. Be completely prepared to be given a question stem about NORMAL parameters. We get so used to looking at every detail for some pathological condition that normal variation may slip under you nose without you noticing. DO NOT get tripped up by this on exam day. My best advice for this is just don't overthink a question. If you get a hypochromic blood smear with a 25yo woman at a routine check up with no fatigue and no other identifiers she probably has some simple subclinical Fe-deficiency anemia, not some crazy mutant of Beta-thal that you have never heard of (this wasn't on my test, but just an example!).
I really felt my specific exam was a good mixture of everything. There really is not better advice than to prepare for the worst and hope for the best. There becomes a point where anything after is just useless worry and there is nothing you can do about it. If you prepared properly, the exam is totally manageable so long as you keep a level head and don't get overwhelmed. There will be questions you absolutely know! Hard versions get accentuated by the fact that it is easier to remember the WTF questions than the easy ones. I felt my test was about medium difficulty with a mixture of terribly complex and extremely straightforward questions. That said, there were almost NO 1st order questions on my exam version. Almost everything was at least 2nd, if not all 3rd order. I'll try to update more as I think of stuff, but if anyone has any specific questions just let me know! On to COMLEX this Friday. Thanks to everyone who has given me support for the USMLE over the last months; ya'll the best. Gonna get my relaxing on for the rest of the evening.
