Simulated USMLE Step 1 Exam Experience

AI just finished my simulated usmle exam. I tried to pace myself closely, making sure I don't run out of time on blocks. I took a total of 1 hour break time and divided it as follows:

1st block
1 minute breather
2nd block
5 minutes
3rd block
10 minutes
4th block
30 minutes for lunch
5th block
5 minutes
6th block
10 minutes
7th block

My lowest point was the 6th block, I felt so exhausted during that block. I'm probably going to experiment some more with how I divide my break time. I still have enough questions for another full simulated exam.

I consistently scored in the low to mid 80's in all the blocks. I'm pretty pleased with my performance. I'd be ecstatic to do this well on the real deal.

A couple of points I learned from this experience:

• Eat a light lunch. I probably ate more than I should have for lunch and ended up feeling too laid back during the next block of questions.
• Look at the timer every 10 questions or so to make sure you're on your track.
• Don't get bogged down if you're not doing well. Like I said before, I felt so tired during the 6th block; surprisingly, it was my 2nd highest score.
• Focus on doing one block at a time. Before I started the simulated exam, I was like, "Ugh, this is going to take forever." I decided to just focus on getting through one block at a time.

Simulating the Exam Experience

I want to make sure I'm mentally prepared for the experience of taking an 8-hour long exam. I'm going to set up a simulation for myself today and make it as close to the real deal as possible. Seven one-hour long blocks of questions with 1 hour of break time. I even have some snacks prepared for my breaks. While I'm not looking forward to spending 8 hours on my laptop, I need to find out how this is going to feel so I can be prepared for doomsday. Wish me luck! I'll report back in 8 hours.

Recombinant cytokines

Filgrastim: gra = granulocyte; stim = stimulating factor

Sargramostim: gra = granulocyte; mo = monocyte; stim = stimulating factor

10 Days to go

With 10 days left, I still have so much to do. I've done 2/3 of USMLE World and 1/2 of First Aid, so I still have a lot to cover in the next few days.

This is definitely the time when you fell the stress, a word of advice to those of you at this point is to just focus on what you want to get done and NOT worry.

Branchial Arches

A lot of people, myself included, have trouble memorizing the development of the branchial apparatus. Hopefully with these mnemonics, this process will be much easier for you. It definitely helped me. Along with congenital heart disease, this seems to be the highest yield topic in Embryology for the USMLE Step 1.

1st Arch: a Massive list of M’s

Nerve: Maxillary and Mandibular nerves

Artery: Maxillary artery

Cartilage: Meckel’s Cartilage
- Mandible + sphenoMandibular ligament
- Malleus + Incus

Muscles: MAT x 2
- Muscles of Mastication
- Mylohyoid
- Anterior belly of digastric
- Anterior 2/3 of tongue
- Tensor veli palatini
- Tensor tympani

PS: for every one you get right reward yourself with an M&M  :D



2nd arch: Second

Nerve: Seventh nerve (facial nerve)

Artery: Stapedial artery and hyoid artery

Cartilage:
- Stapes
- Styloid
- Stylohyoid ligament
- leSSer horn of hyoid

Muscles:
- Muscles of facial expression (Smiling)
- Stapedius
- Stylohyoid
- poSSSterior belly of digastric



3rd arch: think Glossopharyngeal nerve

Nerve:
- Glossopharyngeal nerve

Cartilage:
- Greater horn of hyoid

Muscle:
- Stylopharyngeus



4th Arch: Swallowing + The exceptions to the 6th arch below

Nerve: Superior Laryngeal (branch of vagus)

Cartilage:
- Thyroid cartilage

Muscles:
- Pharyngeal constrictors
- Levator veli palatini
- Cricothyroid


6th Arch: Speaking (Laryngeal)

Nerve: Recurrent laryngeal (branch of vagus)

Cartilage: All laryngeal cartilages except thyroid cartilage

Muscles:  All instrinsic laryngeal muscles except cricothyroid

First Aid Rapid Review

I've been doing the Rapid Review Section of First Aid these past few days. I do 3 pages per day after I'm done with everything else.

There are 3 sections to it:
1. Classic Findings
2. Most common associations
3. Equation Review

I personally found these VERY helpful because they are the highest yield facts in First Aid. "The biggest bang per buck" as some would say.

Each page is divided into 2 columns, questions on the left, answers on the right. I covered the right column with a cue card and tried to answer them all without uncovering the answers. If I didn't know something, I highlighted it. I'm going to go over the highlighted ones again next week. This is definitely something you should plan on doing during towards the end of your USMLE Step 1 preparation.

Progress

I'm a third of the way through USMLE World. I'm learning a lot! It's definitely something I would recommend to anyone taking the USMLE Step 1. So far my percantage is in the high 70's. I hope I can break 80 by the end.

Drug Induced Sexual Dysfunction

Statistical Tests

On the USMLE, you will most likely be presented with a research design and according to the variables, you will be asked which statistical test to use.

 

2 interval variables: Pearson's correlation

2 ordinal variables: Spearman correlation
2 nominal variables: Chi-square
Both nominal and interval variables:

• 2 groups: t-test
• more than 2 groups: ANOVA

A mnemonic for interval vs. nominal is PINK:
Pearson = Interval
Nominal = Khi square (Chi square)

USMLE World

I've been doing USMLE World questions for 3 days now, and I must say I love it! The questions are well thought up, the explanations are amazing, and the feedback you get on your performance is very useful. I'm actually having fun! Who know studying for the USMLE Step 1 could be fun? I try to do 3-4 blocks of 48 questions each per day. I then go over the explanations which takes 30 minutes to an hour for each block. So in total, each block takes 1.5-2 hours.
My plan was to finish USMLE World and read through First Aid again and Rapid Review Pathology in 14 days, but it looks like I may have to rethink it. I also do 3 pages of First Aid's Rapid Review Section per day. Today I was supposed to do the Behavioral Science and Psychiatry sections in First Aid, but I ended up doing only half of the BS section. I really need to rethink my schedule.

USMLE World Self Assessment Exam 1

I just did UWSA1. I thought the first block was just brutal! The rest of it was ok. I got 247, which I'm happy with. If you look back to my first post, you'll see that my goal is 240+, so if I do this well on the actual exam, I'll be happy. Now I'm off to review the questions I got wrong! I'm going to do UWSA2 a week before my exam, and I hope there'll be more improvement by that time.

Feeling the stress

It just hit me today that I have less than a month left until my exam! I have so much I want to do in these 4 weeks. I want to do the USMLE World Qbank, read First Aid twice, read Rapid Review Pathology once more, and go over images and radiographs among other things. I've created a hardcore schedule for the time I have left. I'm probably going to be studying 10-12 hours per day. I really hope that I can pushmyself to the limit. The USMLE Step 1 exam is infamous for being one of the toughest professional licensing examinations out there. I'm going to start with UWSA tomorrow, so we'll see how that turns out. It'll either give me a confidence boost, or will knock my confidence down like a wrecking ball. I'm hoping it'll be the former rather than the latter...Nervous!

Microbiology and Immunology

I'm finally done with Microbiology. I think overall, virology was the hardest for me. Having to learn which viruses are +ssRNA, which are -ssRNA, which are linear/circular, which are helical/icosahedral was a pain. I spent a lot of time working on the virology cheat sheet that I posted earlier. It helped me so much in that regard. Overall I found First Aid 2010 adequate for Microbiology and Immunology. I had the Kaplan lecture notes at one side and went through each section I finished in first aid. I honestly only made a few annotations here. The Kaplan lecture notes for Micro are disorganized and I didn't like their format at all. The Immunology part was okay.

I'm going to spend the day going over a few pages from First Aid that I marked to go over again. I'm also going to do the sections in the Robbins Review (Question) book for infectious diseases and Immunopathology.Tomorrow I'm going to start USMLE World, and I'm very excited about that!

Monoclonal Antibodies

The monoclonal antibodies have very hard to remember names. These probably aren't very high yield for the USMLE Step 1, but it may be useful to be able to identify them. Hopefully these mnemonics will help. There are so many monoclonal bodies that have clinical uses, however I'm only going to list the ones that are in the Kaplan Pharmacology Lecture Notes.

• ABciximab: antagonist of IIb/IIIa receptors (antiplatelet)
• INFliximab: binds TNF (Rheumatoid arthritis and Crohn disease)
• TASTtuzumab: ERB-B2 antagonist (breAST cancer)
• PaliVIzumab: blocks respiratory syntycial VIrus

 The 2 Mabs used in immunosuppression are: (no mnemonic for these)

• Dacliximab: transplants (IL-2 receptor antagonist)
• Muromonab: transplants (CD3 antagonist)

Interleukin-6

IL-6 increases the production of:

• acute phase reactants
• immunoglobulins

 Note that each has 6 syllables.