Official Internal Medicine Shelf Exam Thread

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Also, do I need to do the Neurology and ophthalmology sections for the IM shelf?
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I had 3-5 optho questions on my shelf. Feel like optho has showed up on almost all of my shelfs so it's a good subject to know the high yields and be able to differentiate the acute pathologies.
 
Took the medicine shelf not long ago. Got a raw score of 98. Quite surprised. I thought I got at least 7 or 8 questions wrong. I used only MKSAP5 and UW to study. But I was constantly looking up things that happened to my patients. A lot of questions were very similar to my clinical experiences. Seeing a good volume of patients and studying their problems are very helpful to prepare for the shelf exam.

IM is my last rotation in 3rd year. It is 11 wks long. I went over MKSAP5 during the first 4 weeks of the rotation and read the explanations carefully. Then spent 5~6 wks finishing up ~1000 UW IM questions. I did UW questions in random order. Initially my average UW score was about 50~60%. It improved to ~80% towards the end. Practice is really important. Spent the last few days going over marked MKSAP questions. If I had more time, I would read UW explanations more carefully. I was kind of rushing through.

Hope this helps.
 
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Well..

Like so many others, I have followed this website and countless threads for step1, all the shelf exams and now preparing for step 2. Took my Imed shelf last week and wanted to share my experience and the materials I used

1. Uworld- Duh. But not just going through all the Imed questions (I have heard of some people not doing neurology for some reason, big mistake) but rather taking detailed notes on things you missed or learned in a notebook/pdf/word doc etc so the day before the shelf you can do a high yield review and have everything fresh in your mind come exam day
2. OnlineMEDED- This website is awesome! The doc draws clear algorithms and can really cement some of the "next best step in management" questions. Highly recommend these videos for any topics you don't feel completely confident on
3. Stepup to medicine- It is a love hate relationship. It was extremely painful to get through but come test day, there were some questions that I followed my gut on and later realized my instinct came from the vague memory of what I had read in step up to medicine. If you have the time and are looking for 90+ on shelf, read it, make notes and review before the shelf
4. As always, do both practice NBME's. Without fail a couple exact or very similar questions will show up on your exam


Things I wish I had done
1. As I am preparing for STEP 2, I wish I would have used MTB2 Imed as well. It offers great high yield review
2. MKSAP 5- heard great things about it, but if it comes down to doing this or Uworld- no brainer. Stick with the holy grail
3. Reviewed surgery notes- There was tons of surgery on my shelf! Lots of trauma and acute abdomen type situations

Overall, like all shelf exams, the absolute key to rocking it is consistency- you have to start studying on day one of the clerkship, cramming two weeks before never gets you anywhere. I am no genius I promise you, I am your ordinary middle of the class student, but I always try to set up a study plan from the get go and stick to it.

Uworld: low 70's in beginning, by the end low 80's
NBME form 1 (half way through clerkship):77
NBME form 2 (night before shelf): 96
IMED SHELF: 98
 
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How are you guys doing on UWorld? I'm using it primarily as a learning tool but I still feel like I'm getting raped on it. 55-60% here. Hopefully thats good enough for me to do well on the shelf.
 
Lafakads said:
How are you guys doing on UWorld? I'm using it primarily as a learning tool but I still feel like I'm getting raped on it. 55-60% here. Hopefully thats good enough for me to do well on the shelf.
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I got rocked on Uworld IM; averaged like a 68%. Shelf was considerably less tricky and I ended up with a 90 something.
 
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notbobtrustme said:
I got rocked on Uworld IM; averaged like a 68%. Shelf was considerably less tricky and I ended up with a 90 something.
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I love you, SDN. Never change.

But seriously, change.
 
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Really don't feel like searching through the full thread that dates back to 2005 or something. Do most people buy 12 months of UW? Or is it better to just buy it for 2-3 months to last through the medicine clerkship and then reactivate it when studying for Step 2?
 
seminoma said:
Really don't feel like searching through the full thread that dates back to 2005 or something. Do most people buy 12 months of UW? Or is it better to just buy it for 2-3 months to last through the medicine clerkship and then reactivate it when studying for Step 2?
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This topic has actually been covered many many times. I'll summarize the consensus for people who don't want to do a simple search: Don't bother spending all that money. Just buy it for 2 months..... Actually, I have found Pre-Test to be an *excellent* resource that you can get for free from the library - so you don't even really need UWorld
 
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Elixir6 said:
This topic has actually been covered many many times. I'll summarize the consensus for people who don't want to do a simple search: Don't bother spending all that money. Just buy it for 2 months..... Actually, I have found Pre-Test to be an *excellent* resource that you can get for free from the library - so you don't even really need UWorld
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Thank you. Is there a huge benefit to buying the newest edition of Step Up? Or is it like most books where an older edition is exactly the same?
 
seminoma said:
Thank you. Is there a huge benefit to buying the newest edition of Step Up? Or is it like most books where an older edition is exactly the same?
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If you look, you'll find no one has reported an errata or errors in Step Up. In fact there is *no* thread that specifically goes over errors in the second edition. So go with older version like with most things.

Like I said, UWorld is way over-rated. Just use Pre-Test. The questions in there are very shelf-like and you'll ace it.
 
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Elixir6 said:
If you look, you'll find no one has reported an errata or errors in Step Up. In fact there is *no* thread that specifically goes over errors in the second edition. So go with older version like with most things.

Like I said, UWorld is way over-rated. Just use Pre-Test. The questions in there are very shelf-like and you'll ace it.
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How do you feel about pretest for neuro?
 
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seminoma said:
How do you feel about pretest for neuro?
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*palm in face* ... Pre-Test is the best for everything? The only thing I think is better than Pre-Test is BluePrints since it's well known to cover topics in-depth.
 
I don't know why people are all over pretest. Half the questions in pretest aren't even shelf material. At all.

Psych was the worst offender. I used it because there was a dearth of psych questions available and every other question was about theories of mind, or which famous psychiatrist said what, which absolutely wasn't on the shelf. pre-test is awful. You have to dig through the s*** to find the decent questions in that qbank.
 
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It amazes me how very hard it is to come across as facetious on a thread even if you underline and bold. Or for that matter, that people will believe patently incorrect statements that could be easily refuted by just scrolling up 5 posts to see 10 people give the answer to the question you just asked....
 
just did uworld questions for this
i don't think you need to do them all, there's a lot of overlaps and repeats
i didn't use a book (tried step up and hated it) so that was probably my weakness for this shelf
ended up with high 70s
 
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Took the shelf a a couple weeks ago and wanted to share. this was my last shelf of the year and I felt it was very manageable and surprisingly straightforward. I had done all of Uworld except the internal med questions by the time I reached this shelf for all the other rotations . Overall I used

Uworld internal medicine X1 repeating incorrects ( I had done GI for surgery and neuro for my clerkship so didn't focus as much in those) . As others have said this is where the money's , I did tutor mode and thought it helped to teach all the relate to points . The actual test questions in some ways felt different , more straightforward and similar in length . I was averaging in the 60-70s

Case files X1 the weekend before - nice overview of the bread and butter you'll see, pretty broad and general. Great for quick refreshing memory before the test , not sure how good it is as a primary source
UTSW high yield medicine by Emma r- this was great , really hit on the stuff they like to test on . Highly recommend going over it throughout the clerkship

NBME1 (92), NBME2 (88) - I always do the practice test , thought they were representative of the randomness of the test as well as the question length

I felt really prepared going in to the test and felt there was a lot of hype around it. What makes it difficult is the fact that really anything is fair game but if you use the sources above you can pick up what they definitely will test . I can see this being pretty hard early on since there were a smattering of surgery , OB , psych and neuro intertwined. People get in trouble because they run out of time on this test , so go fast off your gut ( I finished 30 mins early !) . If anything I think what carried me was all the previous shelfs I had done . I felt pulm, rheum and ID had a good showing. Surprised by the lack of cardio , in particular really straightforward ekgs. Some neuro that were gimmes if you knew them , no optho or stats.Learn as much about the work up and treatment of the common floor stuff like MI, COPD , UTIs, back pain, etc and pick up he esoteric random stuff from qbank , good luck it's great to finally be done w shelfs !

Finals result : 86 scaled , 87 percentile , second best shelf
 
IM consistently seems to be the toughest shelf exam because there's so much material to test on. I scored honors using my lecture notes, Qbank and FA.
 
Jeffrety said:
IM consistently seems to be the toughest shelf exam because there's so much material to test on. I scored honors using my lecture notes, Qbank and FA.
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Lecture notes? You guys still have lecture notes?
 
Does doing UW IM get quicker as the rotation goes along and you've finished a good chunk of the bank/learned on rotation? My day literally consists right now of being in the hospital, coming home, doing a block, and reviewing it, then I have about 1 hour to do something else whether it be hit the gym or study. Just wondering if I can look forward to possibly not being an idiot and getting half the questions wrong in a few weeks.
 
Bancrofti said:
Does doing UW IM get quicker as the rotation goes along and you've finished a good chunk of the bank/learned on rotation? My day literally consists right now of being in the hospital, coming home, doing a block, and reviewing it, then I have about 1 hour to do something else whether it be hit the gym or study. Just wondering if I can look forward to possibly not being an idiot and getting half the questions wrong in a few weeks.
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Man that sounds nice.. I'm at the hospital for 12-16 hours everyday. I haven't been able to sit down and do a full block, but I think it's going faster recently.
 
seminoma said:
Man that sounds nice.. I'm at the hospital for 12-16 hours everyday. I haven't been able to sit down and do a full block, but I think it's going faster recently.
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Yea that sucks. I'm averaging a fairly consistent 10 hours right now and it's worse b/c of a short commute. But... I guess I should be thankful for what I have lol

That being said, I said blocks, but I only do them in sets of 26 since it'll allow me to get through them with a week to spare before the shelf if I keep at it. I couldn't imagine doing 44 questions... or multiple blocks per day as some here have said.
 
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Bancrofti said:
Yea that sucks. I'm averaging a fairly consistent 10 hours right now and it's worse b/c of a short commute. But... I guess I should be thankful for what I have lol

That being said, I said blocks, but I only do them in sets of 26 since it'll allow me to get through them with a week to spare before the shelf if I keep at it. I couldn't imagine doing 44 questions... or multiple blocks per day as some one here have said.
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Yeah, I think I'm going to start dropping hints about leaving or something. I mean I care about my evals, but I gotta study some time.
 
IM rotation is 3 months at my school , I had a pretty demanding rotation and worked really hard (I seemed to get a lot of demanding residents and attendings whom pushed me to work hard. I luckily ended up on a renal consult service for 2 weeks and worked directly with attending (no residents or fellows). He grilled me every day so hard and had high expectations. Turned renal and electrolytes from my weakest topic to my strongest. May last month did not get to study much was on call a lot and my resident gave me a lot of stuff to read and present after I was dismissed for day.

I did UW IM (with neurology) 1 time was scoring consistently between 65-75%. I did sections of MKSAP 4 that I thought I was weak on.

I felt I was struggling with Cardio and heard it was overrepresented on exam so I did Case Files Cardio (felt it was good but overkill for exam, good for person who struggles at topic). I woke up early to read 1 case per day at end of rotation.

I would rate hospital experience > usmle world > mksap. There were so many questions I got right that I remember residents or attending asking me on wards.

I got 86 on shelf (our school requires minimum of 85 for honors).

Overall strong evaluation letters and Honors grade, could not be happier.
 
Just took the medicine shelf today. It was 110 question was kind of short on time for the last 7 questions. Did 1000 IM questions on uworld. Watched most of the kaplan high yeild videos. Listened to most of them on my drives about 3 times each sections. Read master the Boards for Infectious disease and nephrology and a little bit for neurology. Hopefully I get a good grade. Got the grade back 74. I took a practice NBME 2 weeks out got a 77 on it.
 
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vskv said:
Just took the medicine shelf today. It was 110 question was kind of short on time for the last 7 questions. Did 1000 IM questions on uworld. Watched most of the kaplan high yeild videos. Read master the Boards for Infectious disease and nephrology and a little bit for neurology. Hopefully I get a good grade. How long do the grades take to come back and do they email them to?
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My school clerkship coordinator sent them probably 3 weeks after. If you were doing alright on uworld questions, you probably did fine I think I did about the same as you, 1000 questions, and got like an 87 or something
 
Case files + UWorld is an excellent combination. I highly recommend it. You will cover more than what you need to know with these sources.
 
Question from 2nd practice test if anyone remembers:

32 year old lady, low grade fever, joint pain, 10 pound weight loss, rash with sunlight, cervical and axillary lymphadenopathy. Labs: anemia, leukopenia, high ESR, positive ANA, positive Smith. She's a vegetarian. Next best step?

HAART, multivitamin, prednisone, bone marrow biopsy, lymph node biopsy, chemotherapy
 
Bancrofti said:
Question from 2nd practice test if anyone remembers:

32 year old lady, low grade fever, joint pain, 10 pound weight loss, rash with sunlight, cervical and axillary lymphadenopathy. Labs: anemia, leukopenia, high ESR, positive ANA, positive Smith. She's a vegetarian. Next best step?

HAART, multivitamin, prednisone, bone marrow biopsy, lymph node biopsy, chemotherapy
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Did the question say "low grade fever" or did it give a number?
 
Bancrofti said:
Question from 2nd practice test if anyone remembers:

32 year old lady, low grade fever, joint pain, 10 pound weight loss, rash with sunlight, cervical and axillary lymphadenopathy. Labs: anemia, leukopenia, high ESR, positive ANA, positive Smith. She's a vegetarian. Next best step?

HAART, multivitamin, prednisone, bone marrow biopsy, lymph node biopsy, chemotherapy
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Why wouldn't the answer be prednisone? She has every symptom of lupus, it's causing serious problems, and her labs correlate perfectly. Primary treatment for lupus is 'roids. And, there is no better test for lupus than clinical symptoms + Smith.

HAART: wat... a zebra presentation of HIV?
vitamins: I know of no vitamin deficiency that causes that syndrome
marrow biopsy: hilariously invasive and unnecessary - leukemia is possible but very unlikely, at least do a blood smear first if you think it may be leukemia
LN biopsy: see above, all you're going to see is leukemoid reaction (inflammed nodes)
chemotherapy: generally a poor idea to treat a cancer if you don't know exactly what that cancer is - "maybe leukemia" is not good enough
 
stepone2015 said:
Why wouldn't the answer be prednisone? She has every symptom of lupus, it's causing serious problems, and her labs correlate perfectly. Primary treatment for lupus is 'roids. And, there is no better test for lupus than clinical symptoms + Smith.

HAART: wat... a zebra presentation of HIV?
vitamins: I know of no vitamin deficiency that causes that syndrome
marrow biopsy: hilariously invasive and unnecessary - leukemia is possible but very unlikely, at least do a blood smear first if you think it may be leukemia
LN biopsy: see above, all you're going to see is leukemoid reaction (inflammed nodes)
chemotherapy: generally a poor idea to treat a cancer if you don't know exactly what that cancer is - "maybe leukemia" is not good enough
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I wouldn't have classified her lupus as being severe. She has all the classic symptoms, she definitely has lupus, and it seems undiagnosed. The best answer IMO would have been to start her on Hydroxychloroquine to decrease flares and NSAID for joint pain, but neither of those were answer choices. There wasn't really anything in the stem to indicate that the severity of her presentation warranted steroids. I was wondering if I missed something in the stem and someone remembers this question who could explain. Maybe she does just need Prednisone, but if that's the case, I'm wondering what the actual indication is.

edit: nvm, Uptodate says a mild flare is considered a patient who has symptoms + new onset low grade fever. They may also be leukopenic. They may require no treatment. Alternatively you can give them Hydroxychloroquine or prednisone 7.5 mg/day.
 
VPericarditis said:
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98/68 isn't hypotensive unless it's a patient with normally high BP. She could have toxic megacolon from C. diff, but that doesn't mean she has a perf'd colon. She did get C. diff colitis from recent antibiotic use, but it has to get into her colon first before it can cause colitis, so she had to have ingested spores at some point.
 
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VPericarditis said:
Hey guys!
Sorry last question

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I know the answer is ingested spores but I don't understand why the answer couldn't have been toxic megacolon and hence consequent perforation of colon since she is hypotensive, appears lethargic, has a high grade fever, and has a high WBC count. Also, since she was hospitalized 2 weeks ago and treated with antibiotics couldn't she have just gotten C diff from the antibiotic effects instead of spore ingestion?
Thank you so much in advance!
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In addition to what Pd said, scoping someone with a bowel perforation would show more than just pseudomembranes. It, in and of itself, can cause a perforation, but it would likely show tons of blood, massive backup of stool (worsened by bowel prep), and the tear itself.

If the answer was digging for toxic megacolon, I imagine they would have hinted in some way about a massive amount of stool in the abdomen, ie via abdominal xray.
 
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VPericarditis said:
Hey guys!
Sorry last question

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I know the answer is ingested spores but I don't understand why the answer couldn't have been toxic megacolon and hence consequent perforation of colon since she is hypotensive, appears lethargic, has a high grade fever, and has a high WBC count. Also, since she was hospitalized 2 weeks ago and treated with antibiotics couldn't she have just gotten C diff from the antibiotic effects instead of spore ingestion?
Thank you so much in advance!
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Ultimately she had to first become colonized with c diff. Hence why spores is the correct answer.

By the way, the IM essentials text has T.M. presenting more with LLQ pain (not that this is likely helpful in the real world but might help with questions).
 
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Anyone getting about 50% on UWorld willing to say what they got on their shelf?
 
Got scores back yesterday, 89 "equated percent correct score", whatever that means (99th percentile).

Did all of UW, but only reviewed incorrects and 2/3 of the corrects. I think my average was 81% single pass, random, mix of full blocks and some 10-15 question blocks. Some were done untimed so I could work on them before rounds, during downtime, etc. Also did some MKSAP5 here and there, but didn't find it that helpful.

Referenced NMS Medicine Casebook once in a while and thought it was very helpful, but I just wasn't motivated to ever sit down and read it. Didn't use SUTM for anything.

Did ~80% of the online meded videos, but didn't think those were helpful for the shelf.

Shelf itself was pretty difficult imo. Majority of questions I could rule out all but 2 answer choices, but was stuck after that. Total of 110 questions, and maybe 5-10 were gimmes (35F AA with painful shin nodules and cough. Diagnosis? etc), but the rest were either vague or just difficult diagnostically. Also had a handful of zebras that I only knew because some intern/resident pimped me on it. Fav question was an eponymous AR exam finding that wasn't waterhammer, corrigan, quinke, or de musset. Obviously some of the "best next step" were difficult as well. Can't be bothered to look it up, but I don't know how to choose between abx and ERCP as the next step in a cholangitis patient.
 
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need some advice, if someone has a decent commute to their IM rotation, what would you guys recommend listening in the car? Like is there a pestana equivalent for medicine?
 
PL198 said:
need some advice, if someone has a decent commute to their IM rotation, what would you guys recommend listening in the car? Like is there a pestana equivalent for medicine?
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There's a MKSAP audio floating out there where pirates dock.
 
PL198 said:
need some advice, if someone has a decent commute to their IM rotation, what would you guys recommend listening in the car? Like is there a pestana equivalent for medicine?
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online Meded
 
Went through Uworld once (70%) and redid cards/gi/renal/pulm incorrects.
Form1: 45/50 - 7 days b4.
Form2: 40/50 - 2 days b4.

Actual test was hard af. Already know of 5-10 that I plain goof'd on. Two questions in particular were laughably stupid.
I predict I scored poorly.
3rd year blows
 
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