Official Internal Medicine Shelf Exam Thread

[medstudent7860]

Anyone know if there is any biostatistics on the IM shelf?

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[operaman]

Anyone know if there is any biostatistics on the IM shelf?

I don't remember any.

Did you check the NBME's website? They have content outlines for all the shelves with distributions of questions by subject area.

 

[cnewber4]

Where can the practice NBME internal medicine shelf exams be found? I can only find information regarding whats on the test and not actual practice questions. Also, which IM test is it? Clincal science disciplines or advanced clinical examinations?

 

[Apoplexy__]

Anyone know if there is any biostatistics on the IM shelf?

Based on this, it looks like IM does not. The site confirms that FM does, which others have posted about.

Where can the practice NBME internal medicine shelf exams be found? I can only find information regarding whats on the test and not actual practice questions. Also, which IM test is it? Clincal science disciplines or advanced clinical examinations?

https://nsas.nbme.org/home
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"Clinical Science Mastery Series"

 

[moath roubi]

Master the wards survive IM clerkship and ace the shelf : conrad fischer

This is the top , fantastic and the best book for internal medicine in my opinion ...

 

[Cytarabine]

Shelf tomorrow. Read SUTM at start of block, finished UW, went through onlinemeded, took the two practice tests and was in the 2.5-3 SD above mean range, so hoping those correlate well. Reviewing UW motes today. Will report back

 

[Cytarabine]

Shelf tomorrow. Read SUTM at start of block, finished UW, went through onlinemeded, took the two practice tests and was in the 2.5-3 SD above mean range, so hoping those correlate well. Reviewing UW motes today. Will report back

Test was fair, varied content distribution including a few MSK q's. There weren't any biostatics questions that required calculations, but there were 2-3 that required conceptual knowledge (biases, study design, etc). Only a couple q's were off the wall. I think onlinemeded + UW would be sufficient to do well. We'll see pending outcome though.

 

[medstudent7860]

Test was fair, varied content distribution including a few MSK q's. There weren't any biostatics questions that required calculations, but there were 2-3 that required conceptual knowledge (biases, study design, etc). Only a couple q's were off the wall. I think onlinemeded + UW would be sufficient to do well. We'll see pending outcome though.

How many questions is it total?

 

[Cytarabine]

How many questions is it total?

110. Dont remember if we were given 2:45 or 2:15 to take it, but I think it was one or the other. Finished w/about 25 min left, but am generally a fast test taker / don't review my answers. Question stems were pretty consistently shorter than UW

 

[medstudent7860]

Does anyone have the answers to the NBME self-assessment forms?

 

[Soilworkgmbh]

Took the shelf last Friday and I made it through about 1000 of the UWORLD medicine questions and I really felt like I was taking UWORLD questions the entire exam. I thought it prepared me pretty well. Of course you will run into the issue that two answers will be totally reasonable, and you will have to go with your best gut answer. Everything is fair game, including ophthalmology and biostatistics! So don't omit that from your studying

 

[Apoplexy__]

There weren't any biostatics questions that required calculations, but there were 2-3 that required conceptual knowledge (biases, study design, etc).

Everything is fair game, including ophthalmology and biostatistics! So don't omit that from your studying

Thanks for addressing the biostats question guys.

 

[4thQTHailMary]

Did a brief scanning of the thread but wanted a general consensus: how predictive are the NBMEs of the real deal? I'm anticipating a much tougher test on the real deal, but hopefully a similar outcome.

 

[Soilworkgmbh]

Did a brief scanning of the thread but wanted a general consensus: how predictive are the NBMEs of the real deal? I'm anticipating a much tougher test on the real deal, but hopefully a similar outcome.

I did UWORLD and I felt as though I was taking all UWORLD questions when I took my shelf, except generally there are two reasonable answers for most questions you just have to pick the best fit. UWORLD generally didn't have it.

This doesn't really answer your question but I guess I'm getting at if you have UWORLD it's pretty close to the real deal in my experience.

 

[4thQTHailMary]

Well, exam didn't quite go as I hoped. 86 scaled score. Not bad considering I didn't bust it like I usually do, but considering I made 96+ on both NBMEs, I was a little surprised. My best advice for future test takers would be to just do UWORLD and read up on their patients. Mean of shelf is now 78 with SD of 8.

 

[Gooby]

I took it today. Was either an incredibly easy question or an incredibly vague question that felt like it had 2 right answers. Many distractions in question stems. Time wasn't an issue for me, finished with 15 minutes remaining. 110 Qs, 2.5 hrs (something like that).

NBME 1 (3 weeks out): 86
NBME 2 (2 days out): 72

Yeah..... I'm pretty inconsistent.

I did all the IM Uworld Qs, read SUTM once. Watched some of the onlinemeded videos (which are actually really good).Qs were either way easier than UWorld or much more vague. Overall it's obviously the best resource.

 

[Enzymes]

Question about Pulmonary Embolism management....So there are all these fancy flow charts about what to do with PE. Is there EVER a case where you would not give heparin before doing a diagnostic workup? All the flow charts and even Pestana surgery says to a helical CT and if positive, treat. However, it seems like the correct answer to questions is usually treat (with high clinical suspicion, as it says in Step up to Medicine) before doing diagnostic workup. Any thoughts on this? Really bugging me.

 

[Cytarabine]

Question about Pulmonary Embolism management....So there are all these fancy flow charts about what to do with PE. Is there EVER a case where you would not give heparin before doing a diagnostic workup? All the flow charts and even Pestana surgery says to a helical CT and if positive, treat. However, it seems like the correct answer to questions is usually treat (with high clinical suspicion, as it says in Step up to Medicine) before doing diagnostic workup. Any thoughts on this? Really bugging me.

Uptodate says CT-PA before anticoagulation so far as I can tell. I sure wouldn't anticoagulate if I was just going to draw a D-dimer. Before looking at uptodate, my intuition would have said anticoagulation before CT-PA if pretest probability was high

 

[Vexare]

High clinical suspicion = heparin. PE is too dangerous to wait around for diagnostic tests. In reality you'd probably send for the test and then anticoagulate while you wait for the results, but all of the questions I've seen about this want you to answer Heparin before choosing a diagnostic modality.

MTB2 spells it out pretty clearly, and I believe ACCP guidelines (Chest, 2012) support the above but don't have the reference on hand.

 

[Cytarabine]

High clinical suspicion = heparin. PE is too dangerous to wait around for diagnostic tests. In reality you'd probably send for the test and then anticoagulate while you wait for the results, but all of the questions I've seen about this want you to answer Heparin before choosing a diagnostic modality.

MTB2 spells it out pretty clearly, and I believe ACCP guidelines (Chest, 2012) support the above but don't have the reference on hand.

I looked it. For high pretest probability (not intermediate or low), chest recommends anticoagulation prior to diagnostic results, but that recommendation is grade 2c

 

[Cytarabine]

Shelf tomorrow. Read SUTM at start of block, finished UW, went through onlinemeded, took the two practice tests and was in the 2.5-3 SD above mean range, so hoping those correlate well. Reviewing UW motes today. Will report back

Test was fair, varied content distribution including a few MSK q's. There weren't any biostatics questions that required calculations, but there were 2-3 that required conceptual knowledge (biases, study design, etc). Only a couple q's were off the wall. I think onlinemeded + UW would be sufficient to do well. We'll see pending outcome though.

94 raw, works out to around 98th percentile I think, just above 2 SDs. Stand by my advice

 

[Apoplexy__]

UWorld: 60%'s --> 70%'s
NBME 1: 85
NBME 2: 96
Real deal: 80

Not the trend I was looking for. My studying (tl;dr = UWorld only):
-UWorld: ~1000 Q's completed, none re-done
-SUTM: Basically didn't use, except to annotate UWorld stuff into
-MKSAP: Didn't touch
-No other resources used, except for modest amount of "reading up on patients".

I definitely let my MS1-2 knowledge carry me on this one. If you have a strong foundation from Step 1, you're in a good position. I was fortunate enough to get a 261 on Step 1, and it was responsible for what felt like half my knowledge or more on test day.

Advice: You can do fine sticking with UWorld only. SUTM is way too dense and unnecessarily thorough to be able to get through, and I personally really disliked the style. SUTM misses key points too -- for example, pseudotumor cerebri is not covered at all. In the end, probably 5/110 Q's on the exam aren't in UWorld or SUTM so you might as well stick with the highest-yield stuff. Though the NBME's and the test blend together in my mind, I definitely remember some UWorld Q's being extremely similar to NBME Q's and probably the real deal too. If I could have changed anything, it would be starting UWorld earlier and using SUTM less. If I could have, I absolutely would have wanted to complete UWorld, then I would have re-done flagged Q's. I think the reason I choked on this shelf was because of personal issues that were really distracting on test day...no advice for that haha.

If you guys have any questions about the NBME's, post them in the thread I made here. I saved info necessary to answer many of the Q's (don't want to PM it, due to SDN TOS) so I can help you in that thread. Also, feel free to PM me about the shelf.

 

[chicagostudent]

For those who basically relied on UW to prep for this shelf... Did you do the ~140 Neuro Q's as well (ones that fall under the "Internal Medicine" division)? Or is that more suited for the Neuro rotation/shelf?

Does this mean there could be some psych on the medicine shelf as well?

 

[jdudemed]

For those who have taken the medicine SHELF, would you recommend using master the boards step 2 CK + USMLE World Q bank? I just want to annotate on the MTB2 book so that I can use it to study for both the medicine SHELF and future USMLE step 2 CK. Thanks

 

[Soilworkgmbh]

For those who have taken the medicine SHELF, would you recommend using master the boards step 2 CK + USMLE World Q bank? I just want to annotate on the MTB2 book so that I can use it to study for both the medicine SHELF and future USMLE step 2 CK. Thanks

Really up to you if you think you want that resource for later then mark it up.

Doing UWORLD on tutor mode, 1 block per day, 5 days per week for the last 4 weeks of my rotation was enough to get me an 84 on the shelf. There was no way I had time for anything else on that rotation. I had other resources like step up, but never used it, just didn't have the time

 

[sjonies88]

I'm curious as to how the practice IM shelf exams (from the NBME website) correlate to the real deal? Specifically score-wise...were they good estimators? I know for step 1, the practice NBMEs taken towards the end of dedicated studying tended to be good estimators for most people - I am just trying to gauge how my studying is going based on how the NBME practice shelf exam went (scored 72 on my first practice test last weekend, need 66 to pass at my school) and am not sure if using the NBME practice scores is representative or not!

 

[Nexus5]

Hi guys, I recently took my Medicine NBME and it had 120 questions on it. I was given a raw score, anyone know of how to convert that to percentile?

 

[Nexus5]

It was actually 110 questions.

 

[medstudent7860]

What raw score is considered honors at your schools?

 

[Cinclus]

I took the medicine shelf in late March.
Score: 99

Though it's been a few months, I remember my rules for success for this shelf, as I've repeated them to many people since.

Rule # 1: Throw Step Up to Medicine in the trash (or put it on the bookshelf as a decoration, if you prefer). It's extremely detailed and low-yield.
Rule #2: Know the heck out of the MKSAP question book. Go through this several times.
Rule #3: Case Files is awesome (for Medicine, and just in general). Read it several times, if you can.
As for questions: Do some of the medicine questions from UWorld. I did just under 700. Going nuts and doing all 1200 or whatever obviously would not have helped me, and I actually did not find the questions that similar to those on the shelf. They were more important for concepts. I made a word document with all of the answers/concepts I did not know and studied from that, as well. This was my first shelf, and it was hard, probably the hardest of the four I've taken (Medicine, Pediatrics, Psychiatry, Surgery). It had a ton of really weird, out-of-left-field questions. I felt like crap walking out of it. But BOOOM. Surprise 99. You can never really tell when you walk out of these exams.

 

[Fatalis]

started IM today.
What is a better source to read the entire rotation: MTB2 or SUTM?
My roomate who just took the shelf said MTB2 is better as SUTM is more detailed. Thoughts?

 

[Apoplexy__]

started IM today.
What is a better source to read the entire rotation: MTB2 or SUTM?
My roomate who just took the shelf said MTB2 is better as SUTM is more detailed. Thoughts?

UWorld, man. Way better than SUTM (and I would assume MTB2 too) and enough material to get you through for the months.

Between the two: Didn't look at MTB2, but SUTM is definitely way too detailed.

 

[Cytarabine]

UWorld, man. Way better than SUTM (and I would assume MTB2 too) and enough material to get you through for the months.

Between the two: Didn't look at MTB2, but SUTM is definitely way too detailed.

Yea. I still say onlinemeded for baseline knowledge base. Easy to get through, good fundamental knowledge on which to build on

 

[Fatalis]

UWorld, man. Way better than SUTM (and I would assume MTB2 too) and enough material to get you through for the months.

Between the two: Didn't look at MTB2, but SUTM is definitely way too detailed.

Obviously I know uworld, I was talking about a book to have with me.

 

[Apoplexy__]

Obviously I know uworld, I was talking about a book to have with me.

Oh yeah I know...I'm advocating ditching both altogether in favor of UWorld. Maybe pick up some of the books cinclus advocates above instead.

 

[grt398]

To add another data point in the hopes it'll help someone:

UWorld Medicine q's x1 + redo incorrects (~70% correct on first run through)
MKSAP - did about 1/2 of it
NBME 1 (2 days before actual test): 98
Actual shelf score: 82

So...very disappointed to say the least. Not really sure what happened though it appears I somehow tanked 2 organ systems.

 

[DryHopped]

Took the test about a month ago received a scaled score of 90. Here is what I used to prepare:

Uworld internal medicine - all q's(except neurology) x1, best resource for the shelf by far
Mskap - did about 3/4 of it, it was a good resource for extra q's
Nbme 1 85
Nbme 2 77

Felt horrible after the test, definitely the hardest exam I've taken to date, but I am very happy with the result.

 

[Pedantic]

What do people think of Medical Essentials, the companion book to MKSAP?

 

[wonderbread12]

can anyone who has taken the shelf comment on how heavy (if at all) it was on neuro and ophthalmology?

 

[Cytarabine]

can anyone who has taken the shelf comment on how heavy (if at all) it was on neuro and ophthalmology?

You don't need to venture into neuro or ophtho specific resources, onlinemeded / Uworld were enough

 

[Delacroix22]

Just a few questions from NBME form 2 practice exam:

39. "A 62yo woman has 3mo hx of mildly increased SOB. Smoked for 40 years but quit 3 years ago when she was diagnosed. Has not required pharmacotherapy. Pulmonary exam shows mildly decreased air movement, an occasional wheeze is heard. ABG on room air shows:
pH 7.41
PCO2 40mmHg
PO2 74 mmHg

What is next step in management?
A. Pulmonary rehab (what I picked, wrong)
B. Home O2 therapy
C. Ipratropium therapy
D. Prednisone therapy
E. Theophylline therapy"

40. 37yo woman comes to ED 45 minutes after onset of nonradiating substernal CP that woke her up. HAd 3 episodes over the past year lasting about 20 minutes, resolved spontaneously. No N/V/Diaphoresis/palpitations/heartburn/abd pain. On the way to the ED EKG showed sinus brady with normal axis, PR, and QRS interval of 0.16ms. 2mm ST segment elevations in leads II, III, AVF, no Q waves. 1 year history of migranes, have decreased in freq with atenolol. No smoking, no drinking, no drugs. Appears anxious and uncomfortable. Pulse 55, RR 14, BP 130/80. EKG and rest of exam show no abnormalities. What is the most likely cause?

A. Atherosclerotic CAD
B. Cholecystiits
C. Esophageal spasm (what I picked, wrong)
D. Panic disorder
E. Pericarditis
F. Sick sinus syndrome
G. Variant angina pectoris

Looking back on this the transtent ST elevation seems ominous for cardiac cause, no?

 

[Apoplexy__]

Just a few questions from NBME form 2 practice exam:

39. "A 62yo woman has 3mo hx of mildly increased SOB. Smoked for 40 years but quit 3 years ago when she was diagnosed. Has not required pharmacotherapy. Pulmonary exam shows mildly decreased air movement, an occasional wheeze is heard. ABG on room air shows:
pH 7.41
PCO2 40mmHg
PO2 74 mmHg

What is next step in management?
A. Pulmonary rehab (what I picked, wrong)
B. Home O2 therapy
C. Ipratropium therapy
D. Prednisone therapy
E. Theophylline therapy"

40. 37yo woman comes to ED 45 minutes after onset of nonradiating substernal CP that woke her up. HAd 3 episodes over the past year lasting about 20 minutes, resolved spontaneously. No N/V/Diaphoresis/palpitations/heartburn/abd pain. On the way to the ED EKG showed sinus brady with normal axis, PR, and QRS interval of 0.16ms. 2mm ST segment elevations in leads II, III, AVF, no Q waves. 1 year history of migranes, have decreased in freq with atenolol. No smoking, no drinking, no drugs. Appears anxious and uncomfortable. Pulse 55, RR 14, BP 130/80. EKG and rest of exam show no abnormalities. What is the most likely cause?

A. Atherosclerotic CAD
B. Cholecystiits
C. Esophageal spasm (what I picked, wrong)
D. Panic disorder
E. Pericarditis
F. Sick sinus syndrome
G. Variant angina pectoris

Looking back on this the transtent ST elevation seems ominous for cardiac cause, no?

The second one is variant angina pectoris (Prinzmetal angina). Like you said, the ST elevation in a relatively young woman with a history of episodic chest pain is indicative. Esophageal spasm is certainly a good idea if you missed the ECG, while pericarditis would be a good idea if you ignored everything else but the ECG (same ECG findings as Prinzmetal).

The first question about the smoker I got wrong too; I put home O2 therapy because of what SUTM says on managing patients like that. I guess ipratropium might be a good choice if A and B are wrong?

By the way, there's a thread dedicated to the IM NBME's if you want to check it out for any other Q's:
http://forums.studentdoctor.net/threads/internal-medicine-nbme-1-and-2-thread.1102208/

 

[Delacroix22]

The second one is variant angina pectoris (Prinzmetal angina). Like you said, the ST elevation in a relatively young woman with a history of episodic chest pain is indicative. Esophageal spasm is certainly a good idea if you missed the ECG, while pericarditis would be a good idea if you ignored everything else but the ECG (same ECG findings as Prinzmetal).

The first question about the smoker I got wrong too; I put home O2 therapy because of what SUTM says on managing patients like that. I guess ipratropium might be a good choice if A and B are wrong?

By the way, there's a thread dedicated to the IM NBME's if you want to check it out for any other Q's:
http://forums.studentdoctor.net/threads/internal-medicine-nbme-1-and-2-thread.1102208/

Oh wow! thanks for the link. Couldn't find that anywhere.

I'm guessing the answer should be ipratropium? There is a similar UWorld question about managing symtpoms with ipratropium for first choice. It's just the NBME vignette kind of implies that the "occasional wheeze" is something you shouldn't be bothered with.

Thanks.

 

[Vexare]

Oh wow! thanks for the link. Couldn't find that anywhere.

I'm guessing the answer should be ipratropium? There is a similar UWorld question about managing symtpoms with ipratropium for first choice. It's just the NBME vignette kind of implies that the "occasional wheeze" is something you shouldn't be bothered with.

Thanks.

Seems like they're going for mild COPD here, in which case Ipratropium therapy (short-acting anticholinergic to manage mild symptoms) would be the next best step. The other choices are either for treating greater levels of severity than the pt. presents with, or are second-line/alternative agents.

 

[Psai]

Had one ophtho question and a few neuro questions that were covered by uworld. Uworld is necessary but not sufficient for the shelf

 

[Fatalis]

Oh wow! thanks for the link. Couldn't find that anywhere.

I'm guessing the answer should be ipratropium? There is a similar UWorld question about managing symtpoms with ipratropium for first choice. It's just the NBME vignette kind of implies that the "occasional wheeze" is something you shouldn't be bothered with.

Thanks.

Home o2 therapy is generally given with people having a pa02< 55 and a sao2<88% or sa02<60 + other co-morb/ hct>55

 

[breakdancerj]

I will finish all UWorld questions 1x through probably tomorrow, and have the exam next Friday morning. Other than UWorld, I have mostly read about my patients, read some of Master the Wards, and SIMPLE cases. Anyone have advice of a good source to use in the last week while I go over marked UWorld questions?
My understanding is that SUTM is not feasible, MKSAP might not add much to UWorld, and Case Files might be helpful to focus on fundamentals, but I'm not really sure I like Case Files as much as some people. More specific questions - anyone have success with focused reading from USMLE Secrets?
Online MedEd seems like it might be a good resource - any experience or advice for optimal use would be helpful?
Also, how helpful is going over an annotated copy of First Aid for Step 1?
Any advice or answers to any of these questions would be appreciated.

 

[Cytarabine]

Pick your weak areas in onlinemeded

 

[J ROD]

anybody else endorse this onlinemeded? It looks decent.

 

[Ismet]

anybody else endorse this onlinemeded? It looks decent.

It's been great! Not taking the shelf for another month, but the videos are super helpful, especially if you're a visual learner. I'm working my way through the "intern content" this weekend.