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Official Internal Medicine Shelf Exam Thread

Discussion in 'Clinical Rotations' started by Kluver_Bucy, Nov 4, 2005.

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  1. recycledpaper

    recycledpaper 7+ Year Member

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    Jul 20, 2010
    I hate how my DO school has 4 weeks ward-based IM and 4 weeks outpatient, yet we are expected to study for our NBME shelf in only 4 weeks.

    That being said, does anyone know how percentiles are calculated based on raw %? Thanks.
     
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  3. Amygdarya

    Amygdarya 7+ Year Member

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    What do you mean you're expected to study for only 4 weeks? What's stopping you from studying longer, considering that you'll be studying on your own anyway?
     
  4. recycledpaper

    recycledpaper 7+ Year Member

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    I only had 4 weeks for surgery too so I was studying for that, and IM was my next rotation. So yeah, only 4 weeks.
     
  5. Amygdarya

    Amygdarya 7+ Year Member

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    But you said you had 4 weeks inpatient, 4 weeks outpatient - why can't you study during all 8 of these weeks? Or are these 2 blocks separated in time?
     
  6. recycledpaper

    recycledpaper 7+ Year Member

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    Oh yes separated in time. I suppose I'll do better on the outpatient exam :p
     
  7. Amygdarya

    Amygdarya 7+ Year Member

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    Yeah this sucks. But it's doable. Good luck!
     
  8. plasmodium

    plasmodium 5+ Year Member

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  9. Carpe-Noctem

    Carpe-Noctem Seize the Night 2+ Year Member

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    Hey everyone, quick question.

    Is step up to medicine and a video series like online med ed enough to pass/high pass shelf? Don't have time to do uworld.
     
  10. Amygdarya

    Amygdarya 7+ Year Member

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    When pressed for time, I would do it the other way around: do UWorld questions (aside from the fact that they're a great learning tool, they're also easier to fit into a hectic schedule) and skip Step Up and OnlineMedEd videos (both of which are great resources, but ONlineMedEd is an overview and not enough detail, and Step Up is dense and who has the time and patience to go through it on a busy medicine rotation?). You should have no problem passing the shelf if you actually retain most of the info from Step Up, I just don't understand why you wouldn't go with a less painful way of studying medicine such as UWorld questions.
     
  11. Carpe-Noctem

    Carpe-Noctem Seize the Night 2+ Year Member

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    So the problem is that I have about 13 days to due all of internal med uworld...is it still worth doing uworld instead?
     
  12. Amygdarya

    Amygdarya 7+ Year Member

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    I dunno - mostly because I don't know what your baseline knowledge is/how much you've learned on the floors/your didactics. Have you actually tried reading Step Up? If you're comfortable reading it and feel like you retain a lot, go for it. But I would still try to fit in some UWorld questions - do a couple of questions on your phone etc whenever you have free 10-15 mins. Watch OnlineMedEd as last ditch effort before shelf for topics you didn't cover otherwise. Watch the 2-hour Emma Holiday Internal Medicine review video for super high yield facts (which are by no means sufficient!) to make sure you didn't miss anything super high yield in your preparation.

    It also depends what kind of standardized test taker you are. If your basic science knowledge is solid, you did well on Step 1 and paid attention during the rotation, you should have no difficulty passing medicine shelf even with little book studying.
     
  13. Carpe-Noctem

    Carpe-Noctem Seize the Night 2+ Year Member

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    So for my school, we have to score at least in the 10th percentile to get a passing score. Does anyone know about what percentage correct that is or how well you have to do to do that?
     
  14. apr27

    apr27 OMS-IV 7+ Year Member

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    how long do you guys spend on UW questions? I have four 4 week left, but 1000+ questions to get through. It takes me like an hour to do 10 questions.
     
  15. dfib slim

    dfib slim 5+ Year Member

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    I usually went through a block in 2 to 3 hours. Just keep chugging away.
     
  16. Unknown 303

    Unknown 303 2+ Year Member

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    Hey guys, I needed help with the following questions if anyone could chime in that would be great: (PLEASEEEEE give one line explanation, that will help a LOT. THANK YOU)

    1. 27 year old man comes because of 3 hr hx of muscle swelling and tenderness of left thigh following minimal trauma. He has severe hemoph A and has received factor VIII replacement therapy for bleeding episodes since childhood but recently his bleeding has been poorly controlled; increasing doses of VIII have been required to stop his bleeding; platelet count is 125K; APTT is higher than 120. Next step in diagnosis of his recent bleeding?

    A. Measurement of bleeding time (I choose idk why)
    B. Measurement of factor IX conc.
    C. Measurement of thrombin time to detect heparin
    D. Platelet function studies
    E. Test for factor VIII inhibitor

    2. 82 year old man ventilated in hosp for 48 hrs because of exacerbation of COPD. he passed no urine since removal of urinary catheter 12 hrs ago. Current meds include IV methylprednisolone and albuterol, ipratropium, fluticasone by inhalation. Dx?

    A. AIN (I put)
    B. Acute urethral obstruction
    C. Contrast induced nephropathy
    D. ESRD
    E. Hepatorenal syn
    F. Ischemic ATN (Is it this one?? I feel like an idiot)
    G. Rhabdo
    H. Prerenal azotemia

    3. 27 yo with mental retardation has increasing intermittent vomiting (within hour of eating; contains partially digested food and no blood) over 3 weeks. Appetite unaffected but he stops eating before completing meal. Had 8 lb weight loss since last visit. Takes phenytoin for seizure disorder. 3x4 cm area of alopecia in right occipitoparietal area of scalp. Abdominal musculature voluntarily contracts with palpation; no organomgaly or masses palpated. Minimal contractures in both upper and lower extremities and increased muscle tone. Dx?

    Choices were achalasia, brain tumor, bulimia nervosa, cholecystitis, diabetic gastroparesis, food poisoning, gastric bezoar, gastric carcinoma, pyloric channnel ulcer, small bowel obstruction, drug toxicity, uremia

    4. 67 yo with increasing nocturnal incontinence. PMH of HTN for 20 yrs treated with verapamil. Taking amitryptyline for MDD. Bp 158/78. Lower abd distention with diffuse tenderness to palpation. Enlarged, smooth prostate on DRE with no stool in vault. Creat 1.6 and urine shows Protein 1+, WBC 1-2/hpf, RBC 2-4/hpf. Dx?

    A. BPH
    B. Cauda equina syn
    C. Alzheimer
    D. NPH
    E. UTI (I choose)

    5. 74 yo has MI; admitted to hospital to ICU. BP decreased from 148/74 to 80/62. Confused and has cool clammy skin. ABG will show what?

    A. Hypoxemia with normal PH
    B. Met acidosis
    C. met alk
    D. Resp Acidosis
    E. Resp alkalosis

    6. 32 yo woman has spontaneous discharge from nipples for 3 months. Prolactin 40, serum TSH within normal range. Recommendation?

    A. Application of ice packs to breasts
    B. Wearing tight bras
    C. Bromocriptine therapy (I didnt choose this bc it was too obvious....?)
    D. Tamoxifen therapy
    E. Vitamin E therapy

    7. 23 yo african american male with 2 months hx of pain and swelling above right knee. No hx of trauma or recent fever. Had retinoblastoma in infancy and was treated with enucleation. T 98.6. Exam shows swelling of distal femur. ALP 1350. Xray of right femur shows lytic lesion with perosteal new bone at margins. Dx?

    Choices: HyperPTH, Metastatic malig, MM, Osteotis deformans (Paget), Osteoid osteoma, osteomyelitis, osteoporosis, osteosarcoma, sickle cell

    8. 22 yo woman with fever, chills, left flank pain. +Nausea/vom, T 102, Pulse 110, abd soft with tenderness to percussion over left flank. Hematocrit 39, leukocyte 22k, rbc 10-20/hpf, WBC 20-50/hpf

    Most appropriate pharmacotherapy?

    A. oral amoxicillin
    B. oral azithromycin (I chose)
    C. IV amox
    D. IV ceftriaxone
    E. IV metronidazole

    9. 21 yo with mild cough and runny nose. Cough so bad he has vomitted. Cough is productive of thick green sputum. No fever, chest pain, SOB, He si college student. Vitals normal, sat 98%. dx?

    A. Influenza
    B. Legionnaires
    C. Pertussis
    D. Psittacosis
    E. Q fever

    10. 64 yo woman with DM2 controlled with insulin comes with exertional chest pressure for 3 weeks. Happened when she was walking up and relieved by 5 mins of rest. Second episode occured 1 week ago when she was mowing lawn and relived with 10 min rest. Few more episodes like this have been happening. Examination and ECG show no abnormalities. Next step?

    A. Self monitoring of blood glucose conc during next episode of chest pain
    B. Dipyridamole-thallium-201 scintigraphy
    C. Exercise stress test within 24 hrs (I chose)
    D. Antianginal drug therapy now and an exercise stress test in 5 days
    E. Admit patient to hospital

    11. 57 yo male with 5 year hx of HTn comes for routine exam. He has 10 year hx of throbbing frontal headaches that occur 1-2 times a month and associated sometimes with nausea and vomiting. Occassionally sees halos around objects during episode. Attributes headaches to stress at work. Only med is enalapril. BMI 32. BP 130/85; Everything elsen ormal except glucose is 265; no ketones.

    What is explanation for his high glucose?

    A. Cushing
    B. Glucagonoma (I chose)
    C. Pheo
    D. Somatostatinoma
    E. DM 2
     
  17. greatsurg

    greatsurg 2+ Year Member

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    Got my result back

    Raw score 89

    Materials used over 12 weeks of rotation

    Step up 2x
    Uworld all of internal medicine 1.5x
    NBME CMS 1-4
    Kaplan Qbook
     
    Dr. USMLE likes this.
  18. recycledpaper

    recycledpaper 7+ Year Member

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    Answers in quote and are bolded.
     
  19. sudo

    sudo Señor Member 5+ Year Member

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    How were the NBMEs? Would you recommend one NBME over another?

    I'm 500 questions away from finishing Uworld once (~60% correct :/) but want to get a baseline and think NBME would be a good idea. About 3 weeks out from my exam date. Thanks!
     
  20. greatsurg

    greatsurg 2+ Year Member

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    I was scoring about an average of 44/50, i think the latest 2 should be better
     
  21. sudo

    sudo Señor Member 5+ Year Member

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    Damn. How did you do on your first pass of uworld?
     
  22. greatsurg

    greatsurg 2+ Year Member

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    79%
     
  23. sudo

    sudo Señor Member 5+ Year Member

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    I found this kind of information useful as I prepared for my shelf, so if it's useful for any of you guys:
    • Uworld % correct: 60%
    • NBME 3: 69%
    • Real Deal: 82%
     
    Uafl112, mymembernames, W19 and 2 others like this.
  24. doyouhaveaflag

    doyouhaveaflag No flag, no country 2+ Year Member

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    For anyone who, like me, feels like stabbing their eyes out while reading Step Up, I thought I'd put it out there that it's possible to do well without reading it. I literally couldn't get through more than two chapters throughout my IM rotation and was having a lot of panic about it based on what's been said on this thread and by M4s at my school about its importance as a resource.

    I used a combination of U world (1 pass plus redoing incorrects), NBME CMS 1-4, Online MedEd, and Firecracker, and ended up doing really well on the shelf.

    I think it helped a lot that I took it only a few months after step 1. I had super random questions on the shelf in which I knew the answer from studying for step 1 rather than the shelf.

    For what it's worth, CMS 1 was most predictive of my score. 2-4 actually underpredicted by a few raw points (n=1).
     
    drklouds and Dr. USMLE like this.
  25. metview

    metview 2+ Year Member

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    Help with a Q please

    27 yo female with 2 days of fever and right knee pain. No cough, no abd pain, or dysuria. No IVDU. She has fever (102), pulse 110, resp 12, bp 110/70. Raised, red papules on her both of her palms. R knee is warm, swollen, and painful. Synovial fluid shows 45,000 wbcs (80% neutrophils). Gram stain is negative and no crystals

    contiguous soft tissue infection from s. aureus
    immunologic arthritis due to borellia b
    immunologic arthritis due to group A strep (wrong)
    infection of joint due to borellia b
    infection of join due to n. gono
     
  26. doyouhaveaflag

    doyouhaveaflag No flag, no country 2+ Year Member

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    The papular rash along with the patient age screams gonococcus. Gram stain of synovial fluid is only positive in 25% of cases or something like that. It's common to see just PMNs.
     
  27. jpwsurf21

    jpwsurf21 MS4 2+ Year Member

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    Had IM a while back but ended up scoring at the (82 raw) 86th percentile. Was definitely hoping to do better but still ended up honoring - guess the extra time and effort I spent at the hospital in place of studying ended up boosting my clinical eval grad which is worth a lot more than the shelf (50% clinical eval vs 20% for the shelf)

    Only thing I did was UWorld 1x+ flagged questions 1x (average score was ~75% on first pass), did not touch Step Up to Medicine (how does anyone have time to read that thing during IM + do uworld??). Didn't write down any info like I did for step I and I definitely regret that - the most important thing is to make sure you know why you got something wrong on UWorld and writing that info certainly helps me to solidify that information. Would also put in a plug for taking an NBME - I didn't and so the shelf felt pretty distinct from UWorld.
     
  28. Qester

    Qester 10+ Year Member

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    Hello everyone!

    As I prepare to head into my IM rotation, what is the current "Gold Standard" resources to both rock the rotation, and the shelf?
     
    okokok likes this.
  29. wtr24

    wtr24 5+ Year Member

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    Just took the shelf last friday. I did Uworld x1 and did about ½ of my incorrects. I averaged about 65-70% on my IM questions. Took one of the NBME practice tests and got a 45/50. Scored a 90 equated percent correct, I'm not sure what percentile that would be because our school doesn't include that on our score reports.

    I really think that Uworld + reading about your patients (Uptodate was my go to resource) was what helped the most.
     
    Dr. USMLE and greatsurg like this.
  30. Anicetus

    Anicetus 2+ Year Member

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    Did uworld 2x and went through online meded notes 4x while referring back to uworld graphs and tables.

    80 percentile.

    Would recommend uworld if you can remember everything.
     
  31. soop

    soop 5+ Year Member

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    The NBME's routinely underpredicted my grades both in IM and all my other rotations.

    IM (first rotation) highest NBME 85 - actual grade was 93 (raw).

    I used Kaplan Step 2 videos from 2014, UWorld (1 pass only, didn't redo wrong ones, takes me about 4hrs per block), all 4 NBMEs, and read a lot from Uptodate to take care of patients. Reading Uptodate didn't help with the Shelf.
     
  32. HungryHydrogen

    HungryHydrogen

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    Canadian student here. Not very familiar with NBMEs. Was wondering - how do I interpret an "equated percent score" of 89 percent wise? School just gave me this report and I have no idea how I did overall.

    Thanks
     
    Last edited: Mar 11, 2017
  33. wegh

    wegh

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    that's really not that bad. You could eat and shower once you're home and study from 8 to 11. That's still ~6 hours of sleep, which is fine
     
  34. wegh

    wegh

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    Depends on your school. 80th percentile or greater is honors at mine.
     
  35. wegh

    wegh

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    A good step 1 score helped the most for me lol!
     
  36. HungryHydrogen

    HungryHydrogen

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    They didn't give me a percentile sorry. Like the actual NBME score report says "equated percent correct" is 89. Are there national curves I can look at to see how that score converts to a percentile?
     
  37. wegh

    wegh

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    Sorry, I misread. Around 3am into my night shift is when my body goes on auto pilot

    The percentile depends on the course and quarter. Chances are very high that if you got 89 raw score, you are above the 80th percentile (likely above 90th percentile). Let me see if I can find the nbme breakdown
     
  38. HungryHydrogen

    HungryHydrogen

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    Ok no worries. If it's above 90th percentile i'm fine knowing roughly that's how I did.

    Thanks for your help! :)
     
  39. apr27

    apr27 OMS-IV 7+ Year Member

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    In retrospect, yes. I'm also probs not as motivated as you and would rather sleep more lol. Hope all is well.
     
    orthogenes likes this.
  40. Bbroush

    Bbroush 2+ Year Member

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    Kalamazoo, MI
    Has anyone been using the brosencephalon step 2 deck (specifically the IM deck) to study for this shelf? (or any other for that matter). I start IM in may and I'm thinking about implementing a combination of UWorld and that Anki deck every day.
     
  41. Jesus1

    Jesus1 2+ Year Member

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    Almost certain some answers need correction;
    2-answer is B-no urine after removing the catheter is most likely an acute urethral obstruction. Everything was just fine when the cath was in place.
    7-Answer is definitely osteosarcoma. Retinoblastoma early in life has a very strong association with osteosarcoma down the line.
    10-E-The most immediate next step is to admit the patient to the hospital. The episodes are becoming too frequent to comfortably send the patient home.
    11-E-The answer is DM2. This person is obese. DM2 is the more reasonable answer compared to the rarer Pheochromocytoma.
     
  42. Jesus1

    Jesus1 2+ Year Member

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    Almost certain some answers need correction but I will say the remaining bolded ones are correct;
    2-answer is B-no urine after removing the catheter is most likely an acute urethral obstruction. Everything was just fine when the cath was in place.
    7-Answer is definitely osteosarcoma. Retinoblastoma early in life has a very strong association with osteosarcoma down the line.
    10-E-The most immediate next step is to admit the patient to the hospital. The episodes are becoming too frequent to comfortably send the patient home.
    11-E-The answer is DM2. This person is obese. DM2 is the more reasonable answer compared to the rarer Pheochromocytoma.
     
  43. W19

    W19 SDN Gold Donor Gold Donor Classifieds Approved 2+ Year Member

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    Can someone post the conversion score (from % to percentile)?

    That shelf seems to have a huge curve... Our school give us both the percentage and the 'adjusted' score, but they don't give us a percentile score...
     
    Tri723 likes this.
  44. Jesus1

    Jesus1 2+ Year Member

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    >90 raw.
    Helpful resources-UWorld, NMS Medicine Casebook (highly underated but very effective, much better than SUTM IMO), Firecracker (very detailed but one of the few resources hitting HY facts you find everywhere and LY facts you don't find in many places that end up making a difference with bizarre questions on the shelf/practice NBMEs), Kaplan Step 2 CK comprehensive videos (very good, may have some outdated recs but they are quite useful). Emma Ramahi videos. Did not have time to use Onlinemeded

    NBME 1-85
    NBME 2-87
    NBME 3-90
    NBME 4-81

    Don't blow off the "minor specialty information" like Optho, ID, Derm, etc. It will hunt you down. Also, read up on the bizarre stuff on the NBME practice tests. You may see related shelf questions.
     
    Dr. USMLE likes this.
  45. Hrdrock

    Hrdrock 2+ Year Member

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    Input needed: Is there any utility in completing the NBMEs? I have 2 weeks left until I take the IM COMAT (on a 6-week inpatient medicine rotation). I've only done ~400 UW questions, averaging 62% at this point. 1.5 months out from step 1. Would you recommend that I focus entirely on UW questions or is it useful to do at least one NBME?
     
  46. FindMeOnTheLinks

    FindMeOnTheLinks 2+ Year Member

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    1 week till shelf. Have read about 1/2 of SUTM, watched/listened to all of OME, done about 500 questions in UW average ~75%. Just took NBME 3, got 85 raw. The scoring on these NBMEs are not very informative. What percentile would 85 raw correspond to? Need 80th for honors. Also, would y'all recommend finishing the rest of SUTM before the shelf (haven't read rheum, nephro, derm, neuro, or ambulatory chapters). I plan to do as much UW as I can but honestly I get really sick of it and I don't think I can do more than 400 more questions probably. Also is it beneficial to do all the NBME's, or should I be alright if I just do 3 and 4? Thanks.
     
    Last edited: Jul 29, 2017
  47. t5Nitro

    t5Nitro 5+ Year Member

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    My IM rotation is only 4 weeks long. What's the best way to approach studying for this shelf? Probably won't be able to finish all of UW questions, right? Watch OME and do UW is it?
     
  48. ClandestineStar

    ClandestineStar 7+ Year Member

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    Why does an aortic dissection cause pulmonary edema but not pulmonary HTN??
     
  49. BlackLips

    BlackLips

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    It is my understanding that vascular remodeling due to a chronic process is what causes pulmonary HTN, not simply a backup of fluid.
     
    ClandestineStar likes this.
  50. FindMeOnTheLinks

    FindMeOnTheLinks 2+ Year Member

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    Took the IM shelf today. Felt brutally difficult, much more so than the practice exams. Hoping for a generous scale. Gonna have a few beers tonight. On to OB/gyn..
     

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