Official Internal Medicine Shelf Exam Thread

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There was definitely some neuro on pretty much all shelves. Sucks b/c we take it (clinically) as 4th years at my school. As for the question type, I didn't use timed tutor until Step 2 studying, where I found it super useful. At this stage, UWorld is still going to be teaching you things, and thus I think timed tutor is fine if you're sitting at a computer. If you're doing questions on your phone, I'd crank out 5 of them quickly. Make sure you're reviewing those UWorld questions in decent detail.
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evilbooyaa said:
There was definitely some neuro on pretty much all shelves. Sucks b/c we take it (clinically) as 4th years at my school. As for the question type, I didn't use timed tutor until Step 2 studying, where I found it super useful. At this stage, UWorld is still going to be teaching you things, and thus I think timed tutor is fine if you're sitting at a computer. If you're doing questions on your phone, I'd crank out 5 of them quickly. Make sure you're reviewing those UWorld questions in decent detail.
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Thanks, I appreciate the advice!! I've started using timed tutor over the regular timed blocks, and it does seem to be way more useful for 3rd year stuff.
 
would it be possible to honor with just doing questions (uworld + mksap)?
 
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evilbooyaa said:
Anything is possible :idea:

Just read SUTM. If you can't stomach doing that, then read MKSAP/Case Files.
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It's going to be hard for me to get through step up to medicine and uworld. But I can probably do uworld + mksap questions + explanations
 
JP2740 said:
It's going to be hard for me to get through step up to medicine and uworld. But I can probably do uworld + mksap questions + explanations
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I'm like you... I work 10-12 hours every day in the hospital. I've made it my goal to read the cards, pulm, GI, renal, and fluid and electrolyte section of SUTM and thats pretty much all as far as that book... the rest of my time I'm doing about 35 uworld questions a night and going through the explanations....

That takes me about 3-4 hours a night to do... which is all the time I essentially have to study in a day.
 
For those who already took the shelf, how helpful was MTB 2 or MTB 3? I'm looking for some reading material other than SUTM.
 
Does anyone know what a decent UWORLD average is in relation to the IM shelf? I'm talking just IM questions obviously.

I find some of these UWorld questions to be ****ing ridiculously random and esoteric at times, and my percentages are not as high as I want them to be. Starting to get a little worried and not sure if I'm studying and preparing correctly.
 
I need to get in the 55th percentile to honor medicine in this rotation. What averages should I be looking to hit in UWorld, MKSAP, NBME, etc?
 
I recall getting 60-70% of questions right on USMLE qbank and then doing well enough for honors in my medicine rotation. The medicine shelf is sort of like Step 1, a lot of random stuff and I found doing more questions to be really helpful.
 
I think the exam was really straightforward stuff. Maybe because I just took step 1? All I did was 500 uworld questions. No reading material lol, and I was very comfortable. I think compared to what other people do, if I honored with only doing 500 uworld questions, then that would be amazing.

Anyone who thinks they need anything besides SU2M + uworld is way, way overdoing it. Read SU2M (I didn't) the first month, and do uworld the second month, you'll kill this exam.
 
primarycaretodd said:
I recall getting 60-70% of questions right on USMLE qbank and then doing well enough for honors in my medicine rotation. The medicine shelf is sort of like Step 1, a lot of random stuff and I found doing more questions to be really helpful.
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This is encouraging. I'm averaging ~64% with >1000 questions done and reviewed... read about 240 pages of Step up to Medicine (just because I got tired of just doing uworld).

Hoping to have done at least 1200 by the time I take my shelf on Friday with the pulm section of step up re-read (I thought that was one of the better sections of the book.)
 
JP2740 said:
I think the exam was really straightforward stuff. Maybe because I just took step 1? All I did was 500 uworld questions. No reading material lol, and I was very comfortable. I think compared to what other people do, if I honored with only doing 500 uworld questions, then that would be amazing.

Anyone who thinks they need anything besides SU2M + uworld is way, way overdoing it. Read SU2M (I didn't) the first month, and do uworld the second month, you'll kill this exam.
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I imagine that for most people, doing SUTM + All of UWorld IM will all but guarantee a 85+ on this shelf.
 
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Are people not using MTB for IM boards? Is SUTM the way to go?

Thanks.
 
Can anyone please comment on how predictive the Clinical Mastery Exams the NBME offers for Medicine are?

I've gotten a predicted scaled score of 82 on both of them. I'd be totally fine with that... and will hopefully do a little better than that as I am going to be cramming for the next two and half days before our shelf on Friday.

Anyway, hopefully someone can answer my question.
 
This is for those who keep asking what they need to do to just pass...Took it last week, got the score yesterday.

This shelf was much easier than people made it sound... maybe its because I was right out of Step 1 studying

Didn't study at all for the first half of my rotation... got SUTM, passively read a chapter or 2 and didn't retain any of it. I still looked up things for my patients and paid attention during rounds... Just couldn't get myself to sit down and study for another big test at home

Started freaking out about potentially failing during last 2 weeks. Got UWORLD, did 1000 questions in 10 days, took notes on questions and reviewed my notes daily. Started and finished at around 60%

walked in hoping I'd pass

Shelf was very similar to UWORLD, question stems were NOT longer... some questions on my test were quite literally out of uworld and most questions were high yield topics

Score: 77 (couple of points above national average and enough to HP)
 
Took the shelf exam one week ago at the end of my 8 week rotation. Medicine was my first rotation of third year. Took step 1 about 3 months ago.

So, I think I rested on my laurels a bit in the wake of a satisfying board score... but still managed an acceptable shelf score.

First 4 weeks - MKSAP 5 questions w/ SUTM as my major resource
Last 4 weeks - 400 UWorld questions annotated into SUTM

Other major resources - FA for step 1

What I would have done differently - More UWorld questions

Final score - 79 (the minimum needed for honors at my school! YES!)
 
PlayUltimate15 said:
Took the shelf exam one week ago at the end of my 8 week rotation. Medicine was my first rotation of third year. Took step 1 about 3 months ago.

So, I think I rested on my laurels a bit in the wake of a satisfying board score... but still managed an acceptable shelf score.

First 4 weeks - MKSAP 5 questions w/ SUTM as my major resource
Last 4 weeks - 400 UWorld questions annotated into SUTM

Other major resources - FA for step 1

What I would have done differently - More UWorld questions

Final score - 79 (the minimum needed for honors at my school! YES!)
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Oh and I also took both practice NBMEs.

NBME 1 - 80
NBME 2 - 74

... Seems like they were relatively predictive for me.
 
normtheniner said:
Can anyone please comment on how predictive the Clinical Mastery Exams the NBME offers for Medicine are?

I've gotten a predicted scaled score of 82 on both of them. I'd be totally fine with that... and will hopefully do a little better than that as I am going to be cramming for the next two and half days before our shelf on Friday.

Anyway, hopefully someone can answer my question.
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Sorry I couldn't respond to this before you took your shelf but maybe this info will be useful to someone else. Sounds like I had a similar schedule to PlayUltimate. First rotation of third year and took Step 1 in May. I took both Clinical Mastery exams from the NBME for medicine.

NBME 1: 82
NBME 2: 85
Actual shelf: 80 (minimum to honor at my school is a 79 for this quarter as well)

The prep I did for the shelf was all of the Uworld internal medicine questions. I would reference Step Up if I really had no idea what was going on with a question I got wrong from Uworld. Step Up is a great book I just did not have the time to read through it.
 
besides UWORLD questions didn't anyone find any overview sources useful? I'm the type who likes to to prelim reading before applying info. Step up is just too ridiculous to start out w/. I've heard great things about the step 2 ck videos by kaplan and was wondering if anyone else had an opinion. I'm also watching videos from http://www.onlinemeded.org/ which are great but slightly limited in scope.
 
I have my wards based IM rotation next month. I'm currently doing a cardio rotation which is not too demanding right now. I have quite a bit on my plate at the moment since I'm preparing for usmle step 1 (I'm a DO student and took COMLEX already).

I'm not looking to honor this shelf but would like to at least pass. I will probably be working 12 hours a day next month and considering how long it takes me to get through uworld questions, I would prefer something more concise (uworld is great but it takes a ton of time to get through the details).

I am also not the type who likes to read big books (I was terrible with getting through first aid for COMLEX) and I don't think I'll get through all of Step up to medicine.

I have the Second Edition of the book, do you guys think it is absolutely necessary to buy the current edition? Or is the 2nd pretty decent?

Also, for my last shelf, I absolutely loved Case Files and did quite well on the Peds shelf. I know that the gold standard is uworld but would case files also be decent in terms of passing? Additionally, I definitely plan on reviewing the topics of Cardio in SUTM for my current shelf as well as some other topics when I encounter patients on the wards.

Since I'm very slow with uworld, is MKSAP better in terms of being more concise and covering the broad range of topics necessary? I don't foresee getting through 1,000 of the uworld questions in a month given the hectic schedule I will have, and I need a basic framework before jumping into questions. So I was tentatively thinking of jamming through case files and then attacking uworld/MKSAP.

Thanks for any advice.
 
Took the 2nd practice NBME and got a 96. I have done 1000 IM Uworld questions and overall just read a lot during the rotation.

I will update if I take the next practice test and my real score so it helps others see a correlation.

Edit: practice nbme 1: 85 practice nbme 2: 96 real IM shelf: raw 86 percentile 86

Our school clerkship avg was 80! So high so sweatin' a little bit for honors. There is no set score needed to achieve honors in this clerkship and it is cumulative based on evaluations, clinical performance, and shelf.
 
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dragon529 said:
Is it the comp. clinical medicine SA? form 2 and 3?

You're a rockstar btw, startswithb. nice job.
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It's Clinical Science Mastery Series. They are $20 and 50 questions and 1 hour and 15 min.

Thanks 🙂 I did well on step 1 but not crazy, so it's still possible to keep improving! Uworld is what I'm using. I gave up on MKSAP because Uworld is harder therefore I learned more.
 
I'm about half way through my IM rotation (4 weeks in with 5 weeks left) and just started doing UWorld questions a few days ago. I haven't read any of step up to medicine and don't plan on reading much of it besides where I feel like I need assistance but I am going to try and get through all of the UWorld questions. I've been scoring around 60% on the UWorld questions but I"m not sure if this is a good score. What does this correlate to on the real test. I'm assuming my score will still go up because I have just started going through UWorld.

My school says we need to be 1 standard deviation above the mean to honor so based on some previous posts it looks like that's about a 86 on the shelf. Is this correct?
 
We took the shelf Friday and got the scores back today! I updated my post above with practice scores and official score and percentile.
 
Can someone tell me what textbook the Kaplan high yield videos (2012) follow?
I know it says master the boards but what edition?
 
Got my exam score back! Scaled score 97 (scaled mean is 70 with SD of 8). My CSE score was 77, which I hope is still good enough for honors.

Did all the Uworld Qs (73% correct) and some MKSAP 5 (~75% correct). Read through some Step Up and Master the Boards. I think MTB was a great resource, with annotations from Uworld Qs.
 
If you have a pt who is 5 days post-op (invasive surgery) who develops multiple PE's, what is the treatment? Thrombolytics, anticoagulant, or embolectomy?
 
incubusfanclm said:
If you have a pt who is 5 days post-op (invasive surgery) who develops multiple PE's, what is the treatment? Thrombolytics, anticoagulant, or embolectomy?
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This depends on a lot of factors but in general, you give heparin (anticoagulation). You definitely wouldn't do an embolectomy for multiple PEs. If the patient is truly hemodynamically unstable, you consider thrombolytics but that's not classical for PE. The classic presentation is sudden dyspnea with, if anything, mild sinus tachycardia.
 
Dumb said:
This depends on a lot of factors but in general, you give heparin (anticoagulation). You definitely wouldn't do an embolectomy for multiple PEs. If the patient is truly hemodynamically unstable, you consider thrombolytics but that's not classical for PE. The classic presentation is sudden dyspnea with, if anything, mild sinus tachycardia.
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Pt post highly invasive surgery - aren't thrombolytics contraindicated?
 
Wordead said:
Pt post highly invasive surgery - aren't thrombolytics contraindicated?
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No, but again it depends on a lot of factors. Therefore, it's controversial and unlikely to be on the shelf. To answer your question though, even recent major surgery is not an absolute contraindication to the use of thrombolytics in the appropriate clinical setting. (There are exceptions to this, like recent major brain or spine surgery, among others, but the point remains.) As far as your shelf is concerned, thrombolytics are rarely if ever the answer.
 
30yo pt with no medical history or family history, perfect health. Undergoes conservative surgery for hiatal hernia. No post op complications. Other than early ambulatory, is any other anticoagulant prophylaxis required? If so, what?
 
Confirmed pubic fracture after motorcycle accident.. how do check for urinary tract damage? retrograde urethrogram, transrectal US, CT scan, etc?
 
incubusfanclm said:
30yo pt with no medical history or family history, perfect health. Undergoes conservative surgery for hiatal hernia. No post op complications. Other than early ambulatory, is any other anticoagulant prophylaxis required? If so, what?
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Generally the test answer is SubQ Heparin. In real life, some people don't bother with it if the patient is extremely low risk for DVT/PE.

incubusfanclm said:
Confirmed pubic fracture after motorcycle accident.. how do check for urinary tract damage? retrograde urethrogram, transrectal US, CT scan, etc?
Click to expand...

Retrograde urethrogram, even before a foley is put in. You want to rule out urethral damage before you try shoving a foley into the pt and mess stuff up worse.
 
I don't usually post here, but I read the forums a lot and was nervous before my medicine shelf because I didn't read any textbooks. All I did was QBank, I did all the 1300 UWorld questions and then redid all the ones I got wrong until I got them all right. I didn't take notes on the questions, just did them until I got them all right. Then, I had a couple days before my exam and went through as many USMLE Easy questions as I could (I think about 400, we get this for free through our school... it's not the best QBank but it has super short stems which is nice for doing a lot of questions in a short period).

I got a 97 and honored medicine. Anyway, I wanted to post because (as has been noted before) everyone has a different learning style and you can do well on the shelf without reading and highlighting all of Step Up or Case Files. I bought them both and never opened them.
 
Heck yea! Congrats! This is encouraging to hear as I am about to take the shelf soon. My prep as well has been UWorld (1.5x). I am a question based learner so hopefully I'll hit the high mark like you did.
 
massmocha said:
I don't usually post here, but I read the forums a lot and was nervous before my medicine shelf because I didn't read any textbooks. All I did was QBank, I did all the 1300 UWorld questions and then redid all the ones I got wrong until I got them all right. I didn't take notes on the questions, just did them until I got them all right. Then, I had a couple days before my exam and went through as many USMLE Easy questions as I could (I think about 400, we get this for free through our school... it's not the best QBank but it has super short stems which is nice for doing a lot of questions in a short period).

I got a 97 and honored medicine. Anyway, I wanted to post because (as has been noted before) everyone has a different learning style and you can do well on the shelf without reading and highlighting all of Step Up or Case Files. I bought them both and never opened them.
Click to expand...

My earlier post was in reference to you.
 
I feel like a dolt, but I can't figure out which version of MTB people are referring to? Step 2, 3, or IM boards? Thanks!!
 
Well even after going through uworld 1.5x times, I still felt uneasy after medicine shelf this past weekend. Time mgt was killer as I rushed through last 10. Will post score once received. Hoping for a mid 80s score. Why did this feel harder than step 1? This was my 1st shelf.
 
Just took it. It went pretty well. I mainly did UWorld, didn't compete it , but it seemed to serve me very well
 
I am about to take the NBME for the medicine shelf and I was wondering if anyone knows somewhere where I can find the answers to the ones that I miss. I didn't see a separate thread for it like there was for the Step 1 practice tests and wasn't sure if there is somewhere that I can find answers/explanations for the questions I miss. Thanks.
 
MDSlacker said:
I am about to take the NBME for the medicine shelf and I was wondering if anyone knows somewhere where I can find the answers to the ones that I miss. I didn't see a separate thread for it like there was for the Step 1 practice tests and wasn't sure if there is somewhere that I can find answers/explanations for the questions I miss. Thanks.
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There are some in this thread. Otherwise you'll just have to post missed questions and hope someone responds in time.
 
Just got shelf results today. You have to make 85+ baseline to honor at my school, and a 93+ if you haven't gotten all honors evals.

Scaled: 99, 97%(dunno if this is raw score or percentile?)

I did SUTM, UWorld, MKSAP. Did each resource 2x, looking through stuff I highlighted in SUTM and my questions and answers for UWorld, MKSAP5, making notes about stuff I kept forgetting. Also reading up on my patients of course. The day before I looked at this resource, which I found extremely helpful.

http://atsvid.uthscsa.edu/Mediasite/Play/e18ac39b61e74147a92557429c4672ff

I also did the 2 NBME practice tests, got 99 on both, one taken two weekends before the test, the other taken one weekend before. They were helpful to review and remind me about some obscure stuff that wasn't in other resources.



Didn't really have an issue with time, I had been practicing spending a minute or less on each question. Ended up taking a bit longer than that on the real thing, but had about 30 minutes to review my test which was enough.


Not too many suprises, lots of cardio, pulm, renal. I recall maybe two surgery questions thrown in. Three questions regarding DVTs. There was also a question about recognizing Wallenburg's syndrome. Also recall some electrolyte questions I didn't know(tremor in a rehabilitating alcoholic that wasn't delirium tremens).

Know that beta blockers should be titrated to HR around 60, and adding more won't be effective to treat HTN past that.

Good luck to everyone who still has medicine to come!
 
just got my results back. Got 100 (not sure, this might be curved by my school), 96th Percentile. I watched kaplan videos at 2x speed and rushed through like 1000 uworld questions. i also read a few chapters of step up. there was also a clutch medicine shelf review by Dr. Ramahi that got me a few questions on the exam. overall i felt like i was making educated guesses throughout the test; i'm not sure how much any of these resources helped me in the end.
 
I just took the first NBME for the Internal Medicine shelf and had a question that I couldn't find the answer to that I was hoping someone might know the answer to.

1. 82 year old man who has fatigue for 2 months. Weight loss and decreased appetite. BMI is 21. BP is 90/50. Lungs and heart normal. Labs show WBC count 7500, increased eosinophils (23%), lymphs (14%), hyperkalemia (6.0), BUN 30, Cr 1.6. What is the next step in diagnosis.
a. ACTH stimulation test
b. stool ova and parasites - this is what I put
c. measure urine pH
d. blood culture
e. HIV test
f. renal ultrasound
g. bone marrow biopsy

Just a general question also. There was one question where the clinical picture was basically pyelonephritis (CVA tenderness, fever, etc) but they said urine showed granular casts. I put tubular necrosis as the answer but I'm guessing it was pyelonephritis. I always thought granular casts meant ATN but is that not true?
 
MDSlacker said:
I just took the first NBME for the Internal Medicine shelf and had a question that I couldn't find the answer to that I was hoping someone might know the answer to.

1. 82 year old man who has fatigue for 2 months. Weight loss and decreased appetite. BMI is 21. BP is 90/50. Lungs and heart normal. Labs show WBC count 7500, increased eosinophils (23%), lymphs (14%), hyperkalemia (6.0), BUN 30, Cr 1.6. What is the next step in diagnosis.
a. ACTH stimulation test
b. stool ova and parasites - this is what I put
c. measure urine pH
d. blood culture
e. HIV test
f. renal ultrasound
g. bone marrow biopsy

Just a general question also. There was one question where the clinical picture was basically pyelonephritis (CVA tenderness, fever, etc) but they said urine showed granular casts. I put tubular necrosis as the answer but I'm guessing it was pyelonephritis. I always thought granular casts meant ATN but is that not true?
Click to expand...

The clinical picture is adrenal insufficiency (hyperkalemia, weight loss, fatigue, low BP). Eosinophilia is very non-specific but can occur in this setting. Basically, eosinophilia can occur in a number of conditions other than parasitic infections. The vignette would've likely included travel, abdominal pain, and diarrhea in that case.

Same with your second question. Granular casts are a common cast and pretty non-specific, but they imply renal involvement, helping make the case for pyleo vs cystitis. "Muddy brown" granular casts are the specific type of cast in ATN.

Hope this helps.
 
Hi,

I took the second Medicine NBME exam and had some more questions that I was hoping someone could help me out with. Thanks in advance.

1. Overweight 65 year old male who smokes 1 pack per day. Brother died of CVA and parents died at 40. BP is 150/102, he has grade 2 hypertensive retinopathy, and PMI is displaced 2cm laterally. Which lab test is best for initial assessment?
a. Plasma renin
b. serum aldosterone
c. Serum creatinin
d. urine metanephrine
e. urinary sodium/creatinine ratio

2. 47 year old women with 10 week history of cough. Had a DVT treated with warfarin 6 months ago. Non-smoker. Examination has no abnormalities. Chest X-ray shows 3-cm peripheral lesion. What is the diagnosis?
a. Adenocarcinoma
b. bronchiolitis obliterans with organizing pneumonia
c. chronic idiopathic pulmonary fibrosis
d. pneumoconiosis
e. sarcoidosis
f. small cell cancer
g. squamous cell cancer
h. TB

Guessing this one is adenocarcinoma but I didn't go with that one originally because age was 47

3. 37 year old female with 6 week history of puffy eyes and swelling of her legs. Heavy bleeding with menses and increasing pain in arms and legs for the past 6 months. Menses are regular 28 days. No PMH. Takes a multivitamin and calcium carbonate. Had 12 pound weight gain in last 3 months. BMI is 25. Pulse 55, BP 100/70. Exam shows periorbital edema, distant heart sounds, mild tenderness in upper/lower extremities, 2+ edema to calves. Pelvic exam normal. Labs show Na 130, K 3.8, BUN 10, Cr 1, Cholesterol 300, CK 130. What is next best step in diagnosis?
a. HIV
b. CA 125 concentration
c. Serum FSH concentration
d. Serum Glucose
e. Serum TSH
f. Muscle biopsy

Hypothyroid?

4. 62 year old women with 2 day history of confusion. Has HTN and DM2. Takes ramirpril and glipizide. Oriented to person but not time or place. Physical exam including neuro is normal. Hematocrit 24%, WBC 3400 (65% neutrophils, 35% lymphs), Ca 13.0, Cr 2.0, Total Protein 9.5, Albumin 4.5. What is next step in management.
a. CT scan of head
b. cefepime
c. IV normal saline
d. lumbar puncture
e. hemodialysis

5. 22 year old man 2 days after closed head injury in MVA. CT scan on admission normal. Received D5 with .45% normal saline. Mental status last 12 hours has been normal. Urine output 50ml/hr last 24 hours. Physical is normal. Labs show sodium 120 and urine osmolality 340. What is next step?
a. fluid restriction
b. CT head
c. ADH
d. bolus normal saline
e. bolus 3% saline

I put 3% because it was a head injury and thought you didn't want to risk cerebral edema but I'm guessing they were looking for fluid restriction?

6. 52 year old women with polyuria and polydipsia. Takes HCTZ for HTN for 8 years; current BP 120/80. Labs show Na 148 and Cl 110. Water deprivation test done. Over 5 hours urine osmolality increases from 200,250,300,380,400,400 and serum 285, 288, 290, 295, 298, 300. Given desmopressin and urine osm increases to 1000. What is cause of polyuria?
a. HZTZ induced nephrogenic DI
b. Central DI
c. idiopathic neprogenic DI
d. primary polydipsia
e. salt-losing nephropathy

I'm guessing the answer is central DI but I wasn't sure because the urine osm was increasing. I always thought it had to increase less than 50 for it to be considered DI.

7. Lady weeding and fertilizing and develops rash on face, neck and hands. She used sunscreen but no insect repellant. Was scratched by multiple rose bushes. Has bright red papules, vesicles, and bulla, some in linear arrangement on forearms, face, and neck. Wrist has oozing vesicles. What caused this?
a. fertilizer
b. weeds
c. rose bush
d. sun
e. insects
 
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