the COMLEX thread

[Su4n2]

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hey guys for those of you who have taken the COMLEX, congrats!
when you sober up and relax, can u give us some guidance about what you studied and what you found helpfull, did you take a class or study on your own and anything that you wish u did/didn't do. i am so happy for you guys!
thanx in advance for your help.

 

[Plinko]

There are many rumors about what the pass rate is. A person in my class, due mostly to the fact that nearly everybody in my class felt they had failed, emailed NBOME to find out what percentage of the population they failed. Here's what they wrote back:

"The failure percentage is not predetermined. There is no automatic 10% failing. Last year, the failing was 8% and year before was a little over 10%.

Conversion of raw score to standard score is not something easy to describe.
The bottom line is: do your best and do not take a chance."

Testing
NBOME

Personally, I did not think the COMLEX was a well written exam. Grammatically it was fine. My problems were more as to the exam's content. There were too many atypical presentations. As second year medical students, I don't think it is reasonable for them to try and put us on a bell curve by asking questions no one knows the answer to. This only separates us by our ability to guess. People have already written about the San Joaquin Valley fiasco. I could be wrong, but I seem to remember a grain stain from a patient with pneumonia that had cocci and some smudged RBCs on it, and strep pneumoniae was not an answer choice. Staph aureus was, so you had to go with that. The chances of getting pneumonia with staph as the causative agent is very rare. The same goes for the patient with pneumonia from Nocardia. I don't see why they would ask us about this kind of stuff so many times and then only have one strep pneumoniae question. There were also some questions that even if I had my books out in front of me I could not answer correctly. Like the guy that was a long time smoker, was febrile, and had a productive cough. You then got a murky xray to look at. You then had to decide if he had Leigonella, PCP, bronchogenic carcinoma, strep pneumoniae, and one other choice that I forget. This was particularly nasty because the next two answer choices depended on how you answered that one. There also seemed to be way too many questions where the answer was based on radiology or histology. I don't know about the rest of you, but in two years at TCOM I saw about ten x-rays, MRIs, CT scans, etc, and absolutely no gram stains. I don't know who's fault that is, NBOME's or my school's, but there was absolutley no way me or my classmates could have answered some of those questions based on what we were taught. My personal favorite though had to be the question that asked which "initial confirmatory test" would you order to determine if this patient has HIV? Well, the initial test would be ELISA, and the confirmatory test would be Western Blot. Wouldn't ya know both were answer choices. Go figure.


In the end, I didn't study as hard as the rest of my classmates, and I'm kind of glad that I didn't. I don't see what difference it would have made.

 

[Idiopathic]

The same goes for the patient with pneumonia from Nocardia.

Sorry, I just wanted to provide counterpoint...the depiction was classic for Nocardia pneumonia, which you get after treatment with immunosuppressant drugs after heart/kidney transplant. As far as the rest, morphology told you everything, some people just didnt want to go with it.

Partially acid fast, filamentous branching rods? Nocardia
'Budding' specimen from a vaginal sample? It doesnt matter what the Gram stain looks like, its Candida.
Acid-fast bacilli, cavitary lesion in the apex? TB, no matter where the patient is from.

I felt the bugs were certainly not most common (except for thre Staph osteomyelitis, which I missed), but they certainly weren't challenging. No third-order questions, very few second-order questions. 1 toxin question, I believe, and one question about the pathogenicity of Salmonella.

About the Staph pneumonia, I want to say that this patient had pre-existing influenza, but I cant recall. Certainly not most common, but common enough. Again, if we just looked at the morphology and forgot the clinical picture, the answers would have been much clearer, I think.

I am not slamming anyone for missing these, I missed my share. Mainly I am just kicking myself for wasting so much time preparing for culture plates, toxins, growth factors and what not...only to have those not show up.

 

[Plinko]

I don't disagree. Maybe I didn't make myself clear. I'm not saying that the presentation for Nocardia was atypical. Yes, partially acid-fast, etc was classic for Nocardia. What I was saying was that Nocardia is not classic, and is therefore atypical for pneumonia. If they had had more strep, h. influenzae, PCP for AIDS patients, etc. in their pneumonia presentations, then I could see why Nocardia, or Legionella in the produce worker, could have found themselves on the test. But that was not the case. Which had me asking the question: what is the function of a test that has zebra afte zebra with so few horses.

 

[Idiopathic]

I don't disagree. Maybe I didn't make myself clear. I'm not saying that the presentation for Nocardia was atypical. Yes, partially acid-fast, etc was classic for Nocardia. What I was saying was that Nocardia is not classic, and is therefore atypical for pneumonia. If they had had more strep, h. influenzae, PCP for AIDS patients, etc. in their pneumonia presentations, then I could see why Nocardia, or Legionella in the produce worker, could have found themselves on the test. But that was not the case. Which had me asking the question: what is the function of a test that has zebra afte zebra with so few horses.

On this, I would agree with you...we were warned that the test was written poorly, and was not about most commons, but we were also told there would be heavier use of 'buzzwords' on the COMLEX. It was this aspect that I felt was sorely lacking.

 

[BamaAlum]

Sorry, I just wanted to provide counterpoint...the depiction was classic for Nocardia pneumonia, which you get after treatment with immunosuppressant drugs after heart/kidney transplant. As far as the rest, morphology told you everything, some people just didnt want to go with it.

Partially acid fast, filamentous branching rods? Nocardia
'Budding' specimen from a vaginal sample? It doesnt matter what the Gram stain looks like, its Candida.
Acid-fast bacilli, cavitary lesion in the apex? TB, no matter where the patient is from.

I felt the bugs were certainly not most common (except for thre Staph osteomyelitis, which I missed), but they certainly weren't challenging. No third-order questions, very few second-order questions. 1 toxin question, I believe, and one question about the pathogenicity of Salmonella.

About the Staph pneumonia, I want to say that this patient had pre-existing influenza, but I cant recall. Certainly not most common, but common enough. Again, if we just looked at the morphology and forgot the clinical picture, the answers would have been much clearer, I think.

I am not slamming anyone for missing these, I missed my share. Mainly I am just kicking myself for wasting so much time preparing for culture plates, toxins, growth factors and what not...only to have those not show up.

You're right. The patient with staph. pheumonia had pre-existing influenza. You had to know the little pearl that staph. pneumonia's common presentation is with pre-existing viral pneumonias. Luckily I remembered that from BRS Path. I agree though, it was a little picky and if you had never seen that little pearl it would be easy to go with something else. It seemed like the micro questions were either obvious or total zebras. I mean how many UTI's caused by E. coli were there? I lost count. I think they threw in an UTI caused by Enterobacter too.

 

[Dr Alo]

On this, I would agree with you...we were warned that the test was written poorly, and was not about most commons, but we were also told there would be heavier use of 'buzzwords' on the COMLEX. It was this aspect that I felt was sorely lacking.

Well, in comparison to the USMLE, we had far fewer zebras. The USMLE is all about the zebras. Frankly, I'd rather be tested on stuff that we will see.

I do not think the test was poorly written. Neither did most of my friends or classmates. I think that, "the test is poorly written" is a bad excuse for feeling bad after taking a tough exam. All tests are tough. Why should the COMLEX be easy? It's supposed to separate the men from the boys. If everything was a typical presentation, then it would be too easy and the "buzzwords" would give it away.

I know the professor that writes some of the comlex micro questions, and she is a brilliant professor. Very intelligent and knowledgaeble in micro. While reading comlex questions, I could figure out which ones were her questions. I think that saying that the comlex is not well written is a huge insult to our profession. We are basically saying that the entire DO commuinity in America can't even come up with 750 good questions. That's not saying much and is a poor reflection of our collective self-esteem. It also points to a underlying inferiority comlpex. We should be proud that our test is difficult and that most MDs taking it will feel like they failed. Maybe it's just too well written and we are too dumb to figure it out.

The San Jaqoin valley question was brilliant! How else to fool students, other than use a 'buzzword' to send their mind in one direction, then present lots of evidence to the contrary. That is a pretty cool excercise in common sense and logic.

I think that DOs are different in that we are not like the MDs.... we do not just memorize tons of useless miniscule facts and spit them out. We really are different. We use common sense, reason, logic, play sports and know how the world works.

As for the radiology, MRIs, gram stains, x-rays, etc etc.... we lucked out in that our school taught us these photos, how to read them, and what they mean. In micro lab, we must have done over 100 gram stains and I am glad that we did (I hated it at the time). The last 2 cohorts of students at our school complained about the X-rays, MRIs, and radiology and the clinical slant of the Comlex, so our school responded by adding more and more clinical information to the curriculum.

I think students should offer advice and complain to their school curriculum committees to help produce change.

I am sure we all did well. It's a standardized test. That means, you are compared to everyone else that took your version. You will do fine.

 

[Idiopathic]

To address some things you mention:

The photographs were awful quality. While I did not have any problem with them, except for the 'obvious' lumbar spine lesion, I feel that the quality was so poor, that it would have been better to not have them, or to have them circulate on a monitor somewhere.

I personally feel that the test was poorly written, across the board. There were several that I believe had no logical answer or had two correct answers and I also was expecting the cases that were designed to trick you (i.e. the infamous TB). I also respect the need to put in extremely difficult questions as these are the ones that separate the top students from the pack.

What I mean by 'poorly written' is this: The exam had so much endocrinology on it, for instance, but few questions about cardiac physiology. Or we had the exact same lower limb question repeated no fewer than 6 times..That is poor quality control, in my opinion. Or the >10 typographical errors I noticed. Or the fact that a T3 tenderpoint was found at the rib and then the examiner 'palpated T3' without telling you they were now palpating the spine...of course we shouldnt have to be given that information, but I think a true test of our knowledge wouldnt have to be shady in the way they present information.

I appreciate your dedication to your Microbiology professor, I know that we have the same respect for Dr. Goljan, and his questions seem so natural to me (when I see them on BSS or QBank), so I understand that things that might not be second-nature to some are rote to others. Please understand that I also believe that there is very little standardization and quality control with this exam. Maybe this question will illustrate my problem:

Please assign one of the choices to the following condition: hypoparathyroidism

a) hypocalcemia
b) hypercalcemia

I can think of 15 cases where hypothyroidism could present in the setting of either hypo or hyper-calcemia. Are the test writers being so cute that they are trying to make me doubt my knowledge? Do they really want to test what I know about hypoparathyroidism?

BTW, I assumed it was pathological hypo-PTH and put hypocalcemia.

 

[NebelDO]

Yes the San Juaquin thing was a brilliant stroke of genius.And it illustrates the problem that its easy to see that buzzword and go off.. I had a but load of my classmates telling me that they were happy when they saw..the SJVF and then just put C. immitis without reading the rest of the question! 😱

I agree idio- that the xrays were not the best quality..but ive also heard that images on the usmle are not much better.I ve heard people complain about the "fuzzyness" of the MRI.That picture of the gram stain, you and I both know that you could see G+ cooci in clusters from ten feet away.(i think it was clusters...cant remember 🙂

We at NSU recieved a radiology course in the first year and were tested on x rays,CT,MRI during anatomy. I think that this shold be done at all the schools so that everyones on the same page.
I too have also heard that the usmle asks more zebras rather than comlex, i tell ya for sure tuesday night after my test.

 

[Claymore]

Anyone know what percentage of the exam is "experimental" questions? Just wondering if some of the ones we're unhappy about even counted.

Also, did anyone else get any (nearly exact) repeats in different books? I got 2 almost identical matching sections in book 1 and 4...the one on the bug vectors/diseases. Needless to say I got them all right the second time I saw the same exact set of questions.

And just to add in my vote on the USMLE vs. COMLEX debate...I thought overall the COMLEX was tougher, mostly because of the tougher pharmacology, the sheer endurance involved in a 2 day exam, and the often difficult-to-interpret radioimaging. But, we'll see what happens when the scores come back.

 

[Plinko]

"Why should the COMLEX be easy? It's supposed to separate the men from the boys. If everything was a typical presentation, then it would be too easy and the "buzzwords" would give it away."

No one is saying that ALL of it should be typical/easy.

You have to have typical presentations to separate those people that know the basics from the people that know nothing. You then separate the people who know just about everything with those people that know the basics with the questions involving the incredibly obscure minutia. What myself and others are saying is that NBOME did not adequately reward those people that studied the basics and had them down well-e.g. there were not enough typical presentations. Thus there was little in the test to separate people in the 50th percentile range from those in the 10th percentile range. That is simply not good test making. The people that were going to score in the 90th precentile range were going to do that anyway. But the way it seems to have gone down, all that is going to separate someone from the 10th precentile range from a person in the 60th percentile range is a large degree of luck. That, in my opinion, demonstrates that it was a poorly conceived exam.

PS Three friends/classmates of mine that have been bothering me about a question on Dupuytren's contracture from day one of testing. I vaguely remember the question, but not the answer. Anybody remember what answer they wanted?

 

[Idiopathic]

I didnt have the dupuytrens question, but I imagine it was either: fibroblast, fascia, or alcohol 😀

edit: or it could have been RA or amyloidosis.

 

[DRealDrZ]

I don't think I had the dupuytrens either...

 

[DireWolf]

The evidence to support my belief that the test was poorly written is the presentations of the various disease processes.

I got several questions wrong (Meckel's as an example) because of the atypical presentations. I know Meckel's backwards and forwards. But the atypical presentation and the blurry X-ray caused me to miss two what-should-have-been-easy questions. I learned it in the context of its classic presentation like most other 2nd-year medical students.

And why were all the Duchenne's patients women? (I had like 4 or 5 questions on this)

USMLE says that it purposely makes its vignette presentations as classic as possible, since this is the way medical students learn the first two years. Why can't COMLEX do the same?

I don't think pointing out the glaring faults of the COMLEX is an insult to our profession.

Rather, I think the COMLEX exam itself is an insult to our profession.

And yes, I do feel that they couldn't even come up with 750 good questions. Maybe 250.

You must be used to taking exams with crappy questions at your school. That is usually not the case where I come from.

 

[hermione]

Right now I agree with everyone who has said that COMLEX sucked. (Although most have put it more eloquently!) However I am reserving the right to change my opinion once I get my scores. I mean, if by some miracle I did very well, then COMLEX will become the most well-written exam in the world! However if I failed, then damn those COMLEX people! Damn them to hell!! 😀

 

[Idiopathic]

You must be used to taking exams with crappy questions at your school. That is usually not the case where I come from.

How quickly we forget

 

[DireWolf]

How quickly we forget

I thought most of our professors wrote good questions.

There were some obvious exceptions.

 

[Idiopathic]

I thought most of our professors wrote good questions.

There were some obvious exceptions.

Thats all I wanted to hear. 😉

 

[Ice-1]

Maybe I'm not spohisticated in the ways of test making, but it seems to me that the purpose of COMLEX should be to determine if second year students have a basic understanding of fundamental stuff, not esoteric minutiae that would be more suited to a person at a resident's level of knowledge. For that purpose typical presentations and buzz words should be included. If I have to take this test again because I didn't know a bunch of atypicals I'm going to be really pissed off!