STEP 3 Score VS USMLE WORLD AVERAGE

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There is a great thread for Step 2ck VS UW%. I though it might be helpful if anyone out there can give us there input with there Step 3 VS UW%...etc as well. Anyways Thanks for the contribution.

I'm do to take Step 3 in the next month. Will update this thread as well. For better or for worse. :scared:

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Hi! Please does anybody know what nbme 5=440 mean?? my exam is in 2 days and I am thinking about postponing it. Got 580 on nbme 4 1 month back and 229 on uwsa 1 3 weeks ago but took a break from studying afterwards. Help please :(
 
Hi! Please does anybody know what nbme 5=440 mean?? my exam is in 2 days and I am thinking about postponing it. Got 580 on nbme 4 1 month back and 229 on uwsa 1 3 weeks ago but took a break from studying afterwards. Help please :(
Doesn't NBME 5 give you a mean and a SD? I think that you should find your percentile in NBME and just see what score would you have if you were in that percentile in the real exam.

Unfortunately there are not many people, having taken the NBME5 in order for us to be able to safely compare our scores...
 
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Doesn't NBME 5 give you a mean and a SD? I think that you should find your percentile in NBME and just see what score would you have if you were in that percentile in the real exam.

Unfortunately there are not many people, having taken the NBME5 in order for us to be able to safely compare our scores...
It says mean 500 with 100 SD :S
 
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It says mean 500 with 100 SD :S

For USMLE step 3, I can only find info about the mean score and SD for the year 2017. It was a mean of 226 with a SD of 15 back then.
So with a score of 440 you are approximately at 28th percentile which would be a 217 in the real test.

Personally I would take it.. However I saw that you had some great scores some weeks ago which would put you at a much higher percentile.. So it may have been just a bad day or NBME 5 may underpredict our real scores (without others' experiences I dont think we can come to any safe conclusion...)

Whatever you decide, I wish you a very very good luck!!
 
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For USMLE step 3, I can only find info about the mean score and SD for the year 2017. It was a mean of 226 with a SD of 15 back then.
So with a score of 440 you are approximately at 28th percentile which would be a 217 in the real test.

Personally I would take it.. However I saw that you had some great scores some weeks ago which would put you at a much higher percentile.. So it may have been just a bad day or NBME 5 may underpredict our real scores (without others' experiences I dont think we can come to any safe conclusion...)

Whatever you decide, I wish you a very very good luck!!
you're so kind, thank you!!
 
Uworld average 68%
UWSA 1 - 210
UWSA 2 - 215
Real deal - 231

About 1mo of lazy prep and 1 week dedicated.
I went through Uworld once (multiple choice not ccs) and did about 40% of ccscases.com.

UWSA really seems to be an under predictor.
 
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Hey guys, I just took NBME 5 and got a 480!
My NBME 4, approximately 2 weeks ago was at 490.

An interesting point is that until now we have, including mine, three reported experiences with NBME 5.
All of them being either at or at a lower score compared to NBME 4.

If anyone has had an experience with NBME 5, it would be really helpful sharing!

Thanks in advance!
 
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Neurology Prelim, Took Step 3 in the middle of April.

Uworld Average: 67% (Earlier on, my block averages were ~60%, towards the end of my prep they became more consistently ~75%.)
Final Result: 236, 75th percentile (With my subcategory performance listed as same in all categories, except for MK:Applying Foundational Sciences, where I performed higher)

Exam Experience:

Day 1:

Felt like Step 1/2 as you know them. Uworld+intern year prepares you most for these questions, but there were some big throwbacks to basic science that I either remembered or didn't, and you can't really fully prepare for those throwback basic science questions while you're working full time as an intern. Lots of Biostats. Overall, I felt that this was the more challenging day.

Day 2:
The management multiple choice section was great, I felt very confident about this section. Uworld+intern year is absolutely enough to do great on this section. Focuses more on big picture, what's the next step in management type questions. No Biostats. CCS cases felt really odd, mostly because people told me that if I was doing well that my cases would all end early. This happened for about 6-8 of my 13 cases. For the others, I used all my time, especially for my 10 minute cases. That said, in terms of my actual management, I felt great about 10/13 of my cases. 2 of them I knew what was going on and managed them decently but could have been better, and 1 case I completely hail-maryed and did some bare bones management based on general principles but did not really know how to manage the patient. CCS is just a new format with a weird and laggy interface, so it felt less comfortable.

How I Prepped:
Did 50% of Uworld intermittently at a slow pace in between December and the middle of March, then the last 50% over a 4 week period (was on a Pulmonary/Cardiology inpatient floor rotation for 2 of those weeks, and an outpatient elective for the other 2 weeks).

Did not do any UWSA or NBME exams because I didn't have time and just focused on the Qbank. I highly recommend the Uworld Biostats review as I definitely was able to snag a lot of easy points by having my biostats down, especially when there seemed to be a lot of biostats questions.

Did not really focus on CCS case studying as much as I should have, but I still did well on them. I used the Uworld Interactive cases and finished all of them in the 1.5 weeks leading up to my exam date. Getting the software and timing down was key, as well as all the little things you must order for patients in certain scenarios while managing their main issues. Didn't really use the non-interactive practice cases, tried doing 1 or 2 of them but found the interactive ones so much more helpful.
 
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Spent a lot of time reading through this thread so wanted to add my experience.

Step 1: 240-245
Step 2: 245-250 (taken 1.5 years before step 3)
Step 3: 255-260 (subcategory performances the same in all).

UWorld Average: ~78% correct (untimed, did blocks by organ system. this average includes some blocks I repeated)
UWSA 1: 225 (taken the night after day 1 of my actual step 3)
UWSA 2: 227 (taken 2-3 days after I finished step 3, because I had paid for it already and wanted the score for predictive value)

How I studied:
UWorld + UWorld biostats review + 75% of MTB Step 3 + referenced my old SUTM book from my medicine clerkship for some organ systems. I did the bulk of my studying in the month prior to my exam. Had casually done 1 organ system in MTB and <100 questions before this month, but had retained very little of what I had studied. During this month, was on inpatient with not great hours the first two weeks and got about 30% of qbank done, then when I was on an elective the last 2 weeks, I did most of the rest of Uworld (finished about 95%, sped through derm questions w/o really learning, skipped ophtho/ent). I had a day off before Day 1 of my exam (and focused on biostats for most of that day), and then a couple days (including another day off) before Day 2.

CCS: I did 1 CCS case before Day 1, and then the remainder of the interactive cases the day before Day 2 over about 10 hours. Skimmed through about half of the non-interactive cases. Felt like there really wasn't much feedback as to how I was actually doing on these cases, but the explanations were decent. I actually don't think you need to spend the time doing more than about 15 or so interactive cases to get used to the format, and then if you're short on time, just reading the explanations for the rest of the cases is probably sufficient.

How residency helped prepare me:
I'm a medicine intern in an inpatient heavy year. Much of the exam is medicine-based so I felt being in medicine was a distinct advantage (even much of the surgery and ob seemed to be quite focused on medical-management of surgical patients). Didn't find that our residency conference series helped much with step 3 knowledge as our lectures were quite a bit more in-depth and niche than step 3 knowledge. Did find that referencing algorithms for common conditions throughout the year in Pocket Medicine and our resident handbook actually helped reinforce diagnostic steps/basic management quite a bit for the exam. Didn't find the uptodate-ing that I did over the year for my patients helped for the exam at all.

Exam experience:
Day 1: Felt pretty good. Lots of biostats, so glad I had studied this well (the biostats review was pretty comprehensive). The questions felt similar in style to UWorld, and I felt good about maybe 60-75% of the questions that day. There was a smattering of questions with basic science tie in that I had to completely guess on (nothing too complicated, just hadn't reviewed this at all).
Day 2: The MC felt so awful and vague. Lots of prognosis and risk factor questions where it was really hard for me to narrow down beyond 3 or so choices. I felt good about maybe 40-50% of the questions, and had to make varying degrees of "educated" guesses on the rest. CCS cases felt mostly straightforward in figuring out what was going on, but knowing what management steps I was expected to do was trickier. I felt pretty good about 9-10 cases, and then felt like I go to the right place in the end but kind of made some blunders along the way for 2-3 cases. Only about a third of my cases ended early.

Overall, the day 2 MC felt so stressful that I was somewhat worried about my score, which is why I took the second UWSA a couple days after my actual step 3. My actual step 2 fell 20+ points from UWSA (taken night before the real exam), so I was prepared to get a much more borderline score in case something similar happened with step 3, but was pleasantly surprised by my result.

I felt sub-optimally prepared going into the exam, but it was hard to find time to study during a busy internship. I actually thought about postponing the exam since I had only done 30-40% of qbank about 10 days before my actual test, but didn't really have another great time to take the exam in the next few months. I'm glad I pushed through in the end, and I think that 4 weeks of dedicated study (with the last 2 weeks being during a lighter block) is probably a good amount of time for most people to get to a comfortable passing range.
 
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Hey all.

IMG here

Prep time: 3 months, on and off
resources: UWORLD , First Aid, NBME

UWSA 1: 239
UWSA 2 :239
NBME 4: 660
NBME 5: 620

Final Score: 251
 
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Good luck!!

I'm taking Day 1 on Thursday. Any last minute tips for some topics I should focus on these two days?
First aid for step 1: pharm mechanisms of action (didn’t do this and deeply regret it! I really don’t think it takes long) and micro diagrams. Good luck!
 
Background:
IMG, MD, PhD
USMLE Step 1: 259
USMLE Step 2 CK: 264
USMLE Step 2 CS: Passed (first attempt)
Residency: From next month

I had not really planned on taking Step 3, but I was allowed one "ASAP" shot for visa purposes. I have a full time clinical job in my home country, so basically, I scheduled the exam the first Monday-Tuesday-Wednesday I had off with a preceding weekend off as well for travelling. Total study time was 3 weeks, with around 4-5 days "dedicated", i.e., the weekend right before the exam and the weekend before that as well. I was aiming for 245+ as I wanted to break the 90th percentile.

Study material: Finished 54% of UWorld Step 3 QBank (timed random mode, 78%, 94th percentile) and did Practice CCS cases (none of the interactive cases; I never looked at them so I do not know whether they are basically the same). I wanted to do Crush CCS as a friend who recently scored 255 had only used that for CCS, but I was out of time. Also, did not manage to do NBME.

UWSA 1 (7 days out): 233
UWSA 2 (6 days out): 241

After that, I only looked at my weakest subjects, i.e., ethics and OBGYN. Completed FRED the weekend before the exam (cannot remember my exact percentage, but it was around 85%). Also completed the "official" CCS practice cases.

Exam experience:
Overall, not very different from prior steps. This time, I was not really worried and I got plenty of sleep the nights before the two exam days. The exam is still very tiring, but I always take breaks between each block to just go out, get a sip of Red Bull, eat some snacks, pee, do a little exercise, and so forth which helps me stay focused. Day 1 went by really fast and was the most enjoyable since it had tons of biostatistics, abstracts, etc. There was some basic science (nothing particularly high yield that I can think of, just random stuff), but I should mention that I took Step 1 in May 2018 so a lot of that was still pretty fresh. For day 2, I agree with some of the prior posters that a fair amount of questions were vague similar to Step 2 CK. However, most of them were rather straightforward, particularly for those with clinical experience. I decided to just choose the "simple/easy option" whenever I was in doubt and not overthink. When the time came for CCS cases, I was pretty tired (and it was bedtime according to my own timezone). I messed up the treatment in one of them, but other than that, it went pretty well. About half of them ended early. None of them concerned rare diseases; it was big picture stuff, though a few of them employed a slightly atypical presentation for a common condition. You will catch the diagnosis if you just use standard diagnostic approaches.

USMLE Step 3: 259 (99th percentile). Higher performance than my average in cardiovascular and biostatistics, lower in ethics.

Take home messages:
If you have done well on prior steps, Step 3 will not contain any major surprises; however, make sure to practice using the CCS software.
UWorld appears to be enough in terms of general curriculum.
UWSA appears to underestimate one's score.
Biostatistics is extremely high yield and you can score full points with minimal effort.
 
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Hey guys, IMG here!

This was the only forum that helped me go through the step 3 examination, so now that it's over for me I think that it is imperative to share my experience and help any future cadidates!

Resources:

  1. UWorld for step 3
  2. My step 2 CK notes

Preparation- Dedicated only (Mid-March- Mid-May)

  1. 13 Mar- 22 Mar: Step 2 CK notes-review all
  2. 23 Mar: UWSA--> 204
  3. 25 Mar- 28 Mar: CCS UWorld
  4. 29 Mar- 4 Apr: UWorld (2blocks/day)
  5. 5 Apr- 7 Apr: CCS UWorld
  6. 8 Apr- 11 Apr: UWorld (2blocks/ day)
  7. 14 Apr- 20 Apr: Step 2 CK notes-review all
  8. 21 Apr: NBME--> 490
  9. 23 Apr- 24 Apr: CCS UWorld
  10. 25 Apr- 30 Apr: UWorld (2blocks/day)
  11. 1 May- 2 May: Step 2 CK notes- review
  12. 3 May: NBME--> 480
  13. 4 May- 11 May: Step 2 CK notes- review continue
  14. 13 May: DAY 1
  15. 13 May- 15 May: CCS UWorld
  16. 16 May: DAY 2--> final score: 232

Comments
  1. Hours per day
    Studied 5-7h/ day. In contrast with the other USMLE I didn’t have much energy left towards the end of the day to keep studying.
  2. Go through UW CCS!
    I found going through UW CCS 3 times really useful. I was very comfortable with almost all my cases. Here I posted some notes that I really found useful for the CCS section:
  3. Post- exam feelings:
After day 1 I didn’t feel like I did well. I felt that I could do better especially in the drug ads and research questions. In the contrary I did get right literally all the biostats questions. Many step 1 facts are also tested during the first day.​
After day 2 I felt much much better. Although I knew I lost some multiple choice questions, I felt really comfortable with all my cases (only 1 exception, in which I couldn’t figure out the diagnosis and my patient kept deteriorating despite treatment). Nearly all 20-min cases and some of my 10-min cases ended early (which can give you a great boost in your beak time.. I started my CCS section with 12 minute break time left and when I finished the exam I had almost 40 minutes of break time left, even after having taken some breaks during the CCS section). Luckily, I had no lags at all during CCS.​
So, that's it guys, finished with the USMLEs forever. Good luck to any future candidates and keep in mind that this is your last USMLE so be patient and get done with it :D
 
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Hey guys, IMG here!

This was the only forum that helped me go through the step 3 examination, so now that it's over for me I think that it is imperative to share my experience and help any future cadidates!

Resources:

  1. UWorld for step 3
  2. My step 2 CK notes

Preparation- Dedicated only (Mid-March- Mid-May)

  1. 13 Mar- 22 Mar: Step 2 CK notes-review all
  2. 23 Mar: UWSA--> 204
  3. 25 Mar- 28 Mar: CCS UWorld
  4. 29 Mar- 4 Apr: UWorld (2blocks/day)
  5. 5 Apr- 7 Apr: CCS UWorld
  6. 8 Apr- 11 Apr: UWorld (2blocks/ day)
  7. 14 Apr- 20 Apr: Step 2 CK notes-review all
  8. 21 Apr: NBME--> 490
  9. 23 Apr- 24 Apr: CCS UWorld
  10. 25 Apr- 30 Apr: UWorld (2blocks/day)
  11. 1 May- 2 May: Step 2 CK notes- review
  12. 3 May: NBME--> 480
  13. 4 May- 11 May: Step 2 CK notes- review continue
  14. 13 May: DAY 1
  15. 13 May- 15 May: CCS UWorld
  16. 16 May: DAY 2--> final score: 232

Comments
  1. Hours per day
    Studied 5-7h/ day. In contrast with the other USMLE I didn’t have much energy left towards the end of the day to keep studying.
  2. Go through UW CCS!
    I found going through UW CCS 3 times really useful. I was very comfortable with almost all my cases. Here I posted some notes that I really found useful for the CCS section:
  3. Post- exam feelings:
After day 1 I didn’t feel like I did well. I felt that I could do better especially in the drug ads and research questions. In the contrary I did get right literally all the biostats questions. Many step 1 facts are also tested during the first day.​
After day 2 I felt much much better. Although I knew I lost some multiple choice questions, I felt really comfortable with all my cases (only 1 exception, in which I couldn’t figure out the diagnosis and my patient kept deteriorating despite treatment). Nearly all 20-min cases and some of my 10-min cases ended early (which can give you a great boost in your beak time.. I started my CCS section with 12 minute break time left and when I finished the exam I had almost 40 minutes of break time left, even after having taken some breaks during the CCS section). Luckily, I had no lags at all during CCS.​
So, that's it guys, finished with the USMLEs forever. Good luck to any future candidates and keep in mind that this is your last USMLE so be patient and get done with it :D

Wow, amazing! Congrats!
How was your performance on CCS? I'm trying to see how to compensate the MCQs with CCS since I am not a great test taker.. :/
 
Wow, amazing! Congrats!
How was your performance on CCS? I'm trying to see how to compensate the MCQs with CCS since I am not a great test taker.. :/
Unfortunately in the new format I can not really understand how well I did because they compare your performance in eg. CCS section with your overall performance. What they give as a result is a lower, the same or a higher performance (always in comparison to your overall performance).
My CCS performance was "the same" as my overall performance.
 
UWorld UWSA1 practice test: 168
Real Step 3 1 week later after review of YouTube bio stats: 208
Prep: UWorld, You-Tube, First Aid for Step 3. Casual studying, nothing crazy
 
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USIMG Here, I didn't match in 2019 cycle and hoping the Step 3 score will improve my chance

Just took Step 3, had 4 days between Day 1 & 2.

S1 212, 1 attempt
S2 244,
CS

1 Week out
NBME 4 - 490
UWSA 1 -215
UW 90%, 65% average.
I also used Exam Master here and there which was absolutely useless.
Step 3 MTB Preventative med section is a helpful read a couple of days before.

Felt really unsure going out of the exam.

I read about 15 pages going back of this thread and people's experiences- seems to be the going theme that people are sure they failed and they come out with a OKAY score. I don't want to succumb to confirmation bias and assume my situation will be same thing..but it did make me feel a little bit better.

Day 1 - LONG question stems, even for the biostats question - had to really dig for the info and make the squares - ate a lot of time.
The basic science stuff wasn't too bad, reviewing the receptors and basic pharm mechs in first aid was helpful. HARD ethic questions.
I ended up going to the end of the time limit for basically every block, and for only 2 blocks I had enough time to go review some questions.

Days 2 - Some what shorter question stems, 1 or 2 blocks I went till the clock ran out. Handful of ECGs and Xrays to look at and also Head CT's for acute bleeds - but not entirely necessary to answer the questions. As someone mentioned previously, know the statins.

CCS - I felt odd about this - the 10min cases seemed a lot more complicated to me than the 20min cases - and could have easily been managed for much longer and I did as much as I could.
There are 6-7 10min and 6-7 20min cases, don't remember. Most 10min cases went to their limit, maybe 2 ended early?
Most 20mins cases with exception of 1 ended early, I had absolutely no clue on one.. Still don't. It was either leukemia or aplastic anemia. And on another the patient didn't improve but didn't get worse?

It's gonna be a long 4 weeks -
I am wondering if i should keep studying in fear that I might need to repeat? Any thoughts or guidance would be helpful
 
Something doesn't seem to make sense to me. Just took NBME 4 for practice and got a score of 60. I didn't think I had done that bad on the exam. Any suggestions on how to move forward from this?
That's indeed too low.I would suggest to closely review your assessment. You should have plenty wrong questions in order for such a score to be correct. I have not heard anything similar. Make sure to first rule out (or in) common explanations- ie: your actual performance.
 
@DocSpy332 and others, how can I get answers for NBME 4? I was curious regarding some of the biostats questions.
Hey there!
I dont know if there is any way to find explanations for NBME 4 (personally I didn't find any..) However, I suppose that you could post any question(s) you have here or in another more suitable thread.
I would bet that there are members who will give you a proper explanation.
Be careful! dont post the question itself because thats against the rules of both sdn (I suppose) and nbme. I would ask about the concept that the question targets.
I would be happy to help, if I can of course...
 
@DocSpy332 and others, how can I get answers for NBME 4? I was curious regarding some of the biostats questions.

Biostats questions are gonna be varied and of similar quality to those in Uworld - the best strategy is to gain a fundimental understanding of how to approach them.

I use this guys videos to get a good understanding - he has 2 videos they are about half hour long - after watching them a few times I understood the biostats questions as asked by usmle way better than reading first-aid and uworld explanations.



You can probably work out all of the biostats questions on form 4 after u review this video.

It was also helpful in making a cheat-sheet for day 1 of high yield biostats formulas to write down at the 5 minute tutorial screen.
 
thank you so much @AloD. a few questions which i had:

the question about the 8-year old with seizures who has been seizure free for 18 months with daily phenytoin. kids parents forget to give him phenytoin when he went to the sleep over and he had an episode. what's the most appropriate advice to give to the parents?
1. obtain blood phenytoin concentrations --> clearly wrong
2. give single dose of diazepam and continue phenytoin as usual
3. have him come home now and take two doses of phenytoin
4. should take one dose of phenytoin to him and give it to him
5. wean him off --> clearly wrong

i picked 2, but correct answer is 4. i'm guessing 2 is the better choice for status epilepticus?


78 year old f with BP of 200/110 and progressive loss of function on the left side of her body for the past 24 hours. what's the management?
1. IV nitroprusside
2. general supportive care with gradual control of BP
3. intubate and mechanival ventilaton
4. rapid anticoagulation --> need to do a CT first to see to see if it's hemorrhagic or nonhemo before starting meds.
5. right carotid thromboendarterectomy --> wrong. doesn't mention anything about % of stenosis.

i picked 1, but answer is 2. is 2 just an overall better answer, because 1 is still correct according to sources.

87 year old female in nursing home with mild dementia. spends most of her time reading novels. physical exam is normal. oriented to person, place, and time. when asked if she would consent to a cataract operation, patient agrees she would like to see better. which of the following is the most accurate statement about patient's opthalmologic condition?
a. family's wishes should override patient's wishes --> clearly wrong
b. her age is contraindication to a cataract operation
c. an operation is likely to result in improvement in her functional status
d. she's high risk for adverse outcomes from cararact operation
e. likely to be hospitalized for a cataract operation --> wrong

i chose b, but answer was c. looking back b and d are basically the same answer somewhat. i don't see how C is the right answer.


83 year old man brought in by daughter w/ c/c of suddenly becoming confused and doesnt remember things in 1 week. wife recently admitted to hospital due to hip fracture. daughter is staying with dad while mom is in rehab. blood tests are ordered. RPR is positive. what's the best way to tell if this problem is acute or chronic?
a. arrange consult with neurologist
b. check response to empiric ginkgo biloba --> clearly wrong
c. check serum antitremponemal antibody tites
d. interview family and friends more extensively
e. order an mri of the brain

picked a, but d is the right answer. doesn't that seem more tedious compared to A and more cost effective than interviewing "family and friends".

15 year old girl has asthma for past 6 years. mother says she hears her daughter coughing and wheezing, but daughter won't admit to any problems. during past 4 months, she has missed 8 days of school due to her asthma. patient has a new best friend whom she has been seeing frequently during this period of time at the other girl's home. while interviewing the pt, it's most appropriate to do which of the following?

a. ask her about her relationship with her mother
b. ask about substance abuse
c. ask if asthma gets worse when visiting her friend
d. ask if shes getting enough sleep
e. review school grade

i thought it was b, thinking peer relations and missing school, perhaps its drug use, but answer is C. makes no sense.

58 year old m with gastric CA admitted due to dehydration secondary to nausea and vomiting. underwent stomach resection 6 weeks ago. iv fluids are started which helps his nausea. weighs 118lbs today. vitals are 98.6F, pulse is 88, respirations are 16, BP is 105/60. as he's prepared for dicharge, he asks if theres any complementary or alternative treatment that might help his nausea. he should be referred to which of the following?

a. acupuncturist
b. massage therapise
c. practioniner of healing touch therapy
d. practitioner of homeopathy
e. reflexologist

chose b as it seemed the most legit from the others, but correct answer is A, smh.

are majority of the questions on step 3 the level of difficulty of the last four questions?

65 year old f POD 2 after right colectomy is on PEEP of 10cm with fio2 of 0.5. abruptly becomes hypoxic and hypotensive. pt is obese and has smoked one pack of cigs per day for past 30 years. which of the following most likely caused her episode.

a. ARDS
b. atelectasis --> POD 2, but clearly wrong.
c. bronchopneumonia
d. CHF
e. PE


i chose b since it was POD 2, but right answer is E.


Pt comes to ED due to 24 hour hx of progressive SOB. in past 2 weeks shes noticed right extremity swelling and nagging dry cough. pmhx of MVP, HTN, and type 2 DM. takes HCTz and rosiglitazone. presents to ED with edema of the face, right upper extremity, JVD, and palpabale supraclavicular nodes. what's the most appropriate diagnostic text

a. ct
b. doppler carotid
c. doppler upper extremitities
d. v/q scan
e. xray

i got this right, but what's causing this? is it mvp which potentially causing her congestive heart failure being exacerbated by the rosiglitazone?




72 year old man brought to the ED with daughter because of 1 day hx of mild confusion and agitation and increasing SOB. pt has a 7yr history of COPD and has production of green sputum, during past 3 days. vitals are 99F, pulse of 92, respirations of 24, and bp of 118/72. pulse ox is 88%. auscultation shows soft wheezes and prolonged expiratory phase. what's the most appropriate initial mgmt?
a. aminophylline therapy
b. amox-clavulanate therapy
c. endotracheal intubation
d. hepatin
e. noninvasive positive pressure ventilation

chose B because i was thinking he's getting an infection on top of his COPD due to change in sputum color. answer is E. any explanations?


another question about COPD in pt with 30 year hx of COPD. patient has low grade fever for past 4 to 5 days and recently starting producing yellowish sputum. his albuterol-ipratropium inhaler ran out 2 days ago. he's smoked cigs for past 40 years. vitals are 99.9F, pulse of 116, respirations of 26, bp of 122/66. pulse ox is 84% auscultation has decreased breather sounds and 1+ pitting edema in lower extremities. in addition to starting o2 therapy, what else should he be started on?
a. albuterol
b. ceftriaxone
c. furosemide
d. levofloxacin
e. metoprolol

chose D thinking he was getting an infection but answer is A.

Same thing for the next question, after oxygen he should get what? Bronchodialators - they work the fastest.

50 year old w/ alcoholic cirrhosis admitted due to bleeding esophageal varices. treated successfully. several days later has left upper quadrant, left shoulder, and left costal margin pain. worse with deep breathing. vitals are 102, pulse is 100, respirations are 20, bp is 140/90. abdominal exam discloses hepatosplenomegaly. whats the most appropriate next initial step?

a. iv antibiotic therapy
b. heparin therapy
c. mechanical ventilatory support
d. portacval shunt
e. repeat variceal sclerosis

chose d, but answer is A. i hope this isn't SBP.

Just as a heads up u may want to paraphrase those questions and answer choices in accordance with rules of SDN and NBME.

Kid with seizure d/o - i think he had a missed dose and was successfully seizure free on phenytoin - diazapam would be considered for 5min + for gen seizure - missed dosage should be given as soon as possible.

Stroke patient with high BP - you want permissive hypertension for cerbral perfusion - nitroprusside is indicated for hypertensive emergency or for cases requring rapid correction of BP. Its also been 24 hours - too late for a lot of interventions.

87 year old with cataracts and other health issues - yes she should get vision corrected - being able to see better would improve anyones qualify of life. reduce risk of falls/accidents, improve mobility, allow her to do more thing such as "activities of daily living".

83 yo brought in by daughter - interview other family. The daughter has only recently been with the family member and most common of sequelae dementia is chronic. And it is actually the cheapest option, you still have to pay the neurologist for a consult.

Worsening asthma - query most common reasons for flare ups - allergens, mites, dust, smoking, - could all be present at her friends house where she is spending an increased amount of time.

Gastric CA being referred to alternative therapy - I guess this is a throwback question - I guessed massage therapy as well here. I suppose that acupuncture can help in some way via nerve block for pain (would like some feedback if anyone has)

65 year old on POD 2 - One thing they wanna hammer into you is that PE/DVT can and will occur despite being on prophylaxis. Smoking is a clue, vitals points towards saddle type embolus, and POD day 1-2 atlectasis will have fever, sob, but the ddx changes when you see changes in hemodynamic statuses. There are a few of these types questions - definitly know causes of fever in the post op state, days they are likely to happen and their management, as well as settings for intubation, tidal volume, peep, resp rate, fio2, etc.

Pt with cough and SOB - This is a throwback to step 1/step 2 - you will want to make association of the anatomical structures mentioned, and look for relevant clues in the question stem. Its likely a description of superior vena cava syndrome due to a broncial mass. Other way they can test this is by describing horner syndrome, cough, right arm swelling, etc.


72 yo man with SOB - main point of the question is INITIAL management - remember your ABC's - his o2 sat is 88%, hes having acute copd exacerbation episode - so you want to hook him up to non-invasive oxygen first.


Same thing for the next question, after oxygen he should get what? Bronchodialators - they work the fastest.

50 yo cirrhotic pt. Definitely do some case studies on SBP and management in relation to cirrhosis, bleeding varices, and presences of ascites - In general - if you have bleeding varices with cirrhosis or ascites, the likelihood they will develop SBP is high - almost definite - they should be started on IV abx - 3rd gen cephalosporin and quniolones (don't quote me on that).

I apologize for the spelling errors or if something wasn't clear - I hope it was somewhat helpful.
 
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any idea what 620 on NBME 5 correlates to ?
For USMLE step 3, you can find info about the mean score and SD for the year 2017. It was a mean of 226 with a SD of 15 back then.
So with a score of 620 in your NBME you should find your percentile. Then estimate which would be your USMLE score, if you were to score at that percentile in the real exam.
 
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US IMG-applying this coming season.
PASSED STEP 3!!
Real deal: 210
UWSA 1: no time
UWSA 2 (2 weeks): 201 (56.3% correct. 90/160)
NBME 5 (4 days): 350 (66% correct)
NBME 4 (2 days): 330 (68% correct)
FRED: 80% done avg of ~65%
UW Avg 1st time: 58%
UW Ang 2nd round: only done 40% with avg of 75%

Study time: 3 1/2 months UW and UW CCS only. CK done >1yr ago.
Source: CK tables and 100 CCS CASES and UW Qbank. and UW CCS only. Used Secrets STEP 3 here and there.
Day 1:
-Hard and brutal. Worse day ever. Abstracts(biostats) every block and about 5-7qs each block so make sure to watch the 2 vids on youtube everyone talks about. They are good. UW biostats is only other thing I used
-Good amount of MOA of drugs and micro (just use first aid). There also cell biology question like STEP 1 asking for what genes were defected causing the dx.
-
Day 2:
-A bit better but long and exhausting. I ended up using all my breaks and the whole 9hrs of time. I also used a break after every 1-2 case for CCS.
-Qs were a bit better but still felt hard. no biostats/MOA of drugs for me. A lot of prognosis question which I have no idea how to study for but UW seen to be the best bet.
CCS:
-I was already exhausted from the blocks and had to take a break after almost every case. Again UW CCS and CCSCASES were all I used.
-I honestly thought I had failed the exam after going through CCS b/c only 4 cases ended early, the rest either ran out of time or it just continues.
-Also only 4 cases showed pt update with improvements, the rest didn't give updates or ended early.
-If I could go back and do it differently I would try to go through Crush CCS in addition to UW and CCSCASES. I only read through a few cases. I also practice with a friend through skype and felt that it helps b/c it motivates to go over the cases and practice them.
Overall, this exam is brutal, hard, and exhausting. I find this exam to be the hardest compared to the other STEPS so make sure to study hard and revise your weak areas. Good Luck to all!!
Lastly, make sure to go over the NBME's and FRED b/c I found a handful of similar questions.
 
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US IMG-applying this coming season.
PASSED STEP 3!!
Real deal: 210
UWSA 1: no time
UWSA 2 (2 weeks): 201 (56.3% correct. 90/160)
NBME 5 (4 days): 350 (66% correct)
NBME 4 (2 days): 330 (68% correct)
FRED: 80% done avg of ~65%
UW Avg 1st time: 58%
UW Ang 2nd round: only done 40% with avg of 75%

Study time: 3 1/2 months UW and UW CCS only. CK done >1yr ago.
Source: CK tables and 100 CCS CASES and UW Qbank. and UW CCS only. Used Secrets STEP 3 here and there.
Day 1:
-Hard and brutal. Worse day ever. Abstracts(biostats) every block and about 5-7qs each block so make sure to watch the 2 vids on youtube everyone talks about. They are good. UW biostats is only other thing I used
-Good amount of MOA of drugs and micro (just use first aid). There also cell biology question like STEP 1 asking for what genes were defected causing the dx.
-
Day 2:
-A bit better but long and exhausting. I ended up using all my breaks and the whole 9hrs of time. I also used a break after every 1-2 case for CCS.
-Qs were a bit better but still felt hard. no biostats/MOA of drugs for me. A lot of prognosis question which I have no idea how to study for but UW seen to be the best bet.
CCS:
-I was already exhausted from the blocks and had to take a break after almost every case. Again UW CCS and CCSCASES were all I used.
-I honestly thought I had failed the exam after going through CCS b/c only 4 cases ended early, the rest either ran out of time or it just continues.
-Also only 4 cases showed pt update with improvements, the rest didn't give updates or ended early.
-If I could go back and do it differently I would try to go through Crush CCS in addition to UW and CCSCASES. I only read through a few cases. I also practice with a friend through skype and felt that it helps b/c it motivates to go over the cases and practice them.
Overall, this exam is brutal, hard, and exhausting. I find this exam to be the hardest compared to the other STEPS so make sure to study hard and revise your weak areas. Good Luck to all!!
Lastly, make sure to go over the NBME's and FRED b/c I found a handful of similar questions.

Mind sharing the Biostats youtube videos that you are referencing?
 
Has anyone ever had a technical issue with a CCS case? In the middle of a case I had one that caused us to restart the computer several times, and I was not allowed (by the software) to finish that case. Tech support was called and prometric logged the issue. What happens next-will my exam score be adjusted accordingly?
 
Study time: 3 weeks
Uworld average 59% after completion on tutor mode
Went through weak areas again afterwards
Did all of uworld CCS and free practice cases on ccscases.com x1

No books used

Uwsa 1: 194 (wish I just had my done it)

Step 3: 229

Took step 2 over 4 years ago
 
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IMG here

Uworld random and timed 79%
Reviewed missed questions
Uworld CCS and CCscases.com
FA step 1 for quick biostat review


UwSA 1 245
UwSA 2 243
Fred 86%
Nbme 6: 620


Final score: 257, relative low performance on CCS and biostatistics. But like I said it’s relative
 
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Uworld avg: 70%
UWSA 1: 229
UWSA 2: 235

Step 3: 250

I took the self assessments toward the end of my studying so they seem to grossly under predict scores. Only thing I did to study was uworld, read through the CCS cases, and reviewed my anki decks from step 2 to review
 
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Hi guys,

freaking out here
NBME4, got 230 (should correspond to something like 188?)

I have day#1 in 2 days and then day#2 in 1 week.
What should I do?

Thanks to every kind soul that wrote down his experience :)
 
Congrats to those who passed. If anyone is wanting to sell their UWorld bank, feel free to message me.
 
Seems like consensus is that UWSA1 under predicts. I just completed it and scored 87th percentile which gave me a numerical score of 225? Any rough numbers on how much it under predicts? I am in a unique position where my score on this exam matters for residency application purposes and I would rather postpone than get a score lower than what I am hoping for (goal is 240+)

Thanks in advance
 
Seems like consensus is that UWSA1 under predicts. I just completed it and scored 87th percentile which gave me a numerical score of 225? Any rough numbers on how much it under predicts? I am in a unique position where my score on this exam matters for residency application purposes and I would rather postpone than get a score lower than what I am hoping for (goal is 240+)

Thanks in advance
Looking through the thread, it's a bit hit or miss, but in the 220s+ on UWSA and 70%+ UW average tends to get 235+ on the real deal (purely by the eyeball method).

That being said, similar to a Step 1 vs Step 3 score, a UWSA score is not comparable to any Step exam score. However, I would, if I were UWorld, try to calibrate the UWSA 3 digit scores to the real Step scores; I think their scaling is poorly calibrated to the real deal. For any Step exam, I've found my percentiles (Q bank and UWSA) to be closer indicators of my Step exam performance. People focus too much on the scaled scores (on non-real deal tests) but percentile ranks are probably more stable since they don't require calibration across exams where the UW user pool is probably pretty representative of the Step examinee pool
 
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Hi.
European IMG here. Peds resident in Europe. Took Step 1&2 in 2014.
Studied about ~ 6 weeks while working shifts at ICU. Just needed a pass to complete my USMLE journey.

step 1: 217
step 2ck: 237
step 2cs: pass.

UW qbank average 58%
UWSA1 (4!!! days!!! before exam!!!): 192
Real deal: 223

pleasantly surprised. Done with USMLE.

Used Uworld and MTB3. Did Uworld CCS only during the 3 days between my exams.
 
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Hi.
European IMG here. Peds resident in Europe. Took Step 1&2 in 2014.
Studied about ~ 6 weeks while working shifts at ICU. Just needed a pass to complete my USMLE journey.

step 1: 217
step 2ck: 237
step 2cs: pass.

UW qbank average 58%
UWSA1 (4!!! days!!! before exam!!!): 192
Real deal: 223

pleasantly surprised. Done with USMLE.

Used Uworld and MTB3. Did Uworld CCS only during the 3 days between my exams.
Congrats! When did you receive your result and when did you take the exam?
 
Congrats! When did you receive your result and when did you take the exam?

took the exam 9/16 and 9/19, received the results last Wednesday, 10/9.
For CCS, the time between exam days was obviously sufficient (was worried before but had no possibility to take extra study time because of travels to US).
 
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Waiting for my score. Status expired this morning, permit link gone. No yellow box. Hope this means something lol
 
Yup! My permit link disappeared too! Finding out tomorrow y'all! q minus 23 hrs and 15 minutes haha
 
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Waiting for my score. Status expired this morning, permit link gone. No yellow box. Hope this means something lol

it doesn't... i got all of this the first time I failed. so just wait till tonight and don't get any false hopes. with that said, it has a high passing rate so I would bet on it that you passed
 
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