09-20-2008, 02:59 PM
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Remembered Questions
« on: January 06, 2008 »
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Hi! Took the step 1 last Friday. Its was really really tough. These are the questions that got me pooped:
1. HIV (+) man with anemia. Slide of bone marrow shows large cells with numerous intracytoplasmic inclusions. What??????????????????s the pathogen? (I remember one of the choices was CMV. )
2. Adult female who had chemotherapy for AML. Developed fever and dry cough after one week. Cxr was clear. BAL fluid microscopic slide: it looks like darkly staining organisms with narrow based darkly staining bud, these are not inside macrophages or anything. What??????????????????s the virulence factor? (choices I remembered are: large capsule, production of alveolar exudates [but I swear it didn??????????????????t look like PCP], intracytoplasmic location [but I swear it??????????????????s not])
3. Adult male consulted for hereditary colonic CA with suggestive symptoms. Brother and father died of same diagnosis. Work-up reveals colonic CA. wife implores to you not to tell patient for fear of depression. What to do? (I can??????????????????t decide between telling patient outright or asking patient first what he wants to know about the results? I answered the latter. Of course whatever the wife says is immaterial. )
4. Cross section diagram of superior part of chest. What pointed structure is responsible for mydriasis, eye opening, sweating/what structure if lesioned will produce Horner??????????????????s? (I chose this bilateral structure very near and just lateral to the vertebral bodies, other choices were several nerve like sections albeit unilateral just posterior & lateral to esophagus, and the trachea) I know I??????????????????m supposed to look for the superior cervical ganglion but I haven??????????????????t encountered this diagram before.
5. Very long intimidating question about drug given to young versus old. Young person??????????????????s VD and CL are twice that of the old??????????????????s. T1/2 for young person is 24 hours. What??????????????????s the T1/2 for the old person? (Without computing, I just answered 24 hours; should it have been higher or lower? I mean, the VD and CL are half of the young person??????????????????s and the formula is 0. 7 Vd/Cl anyway?)
6. Glyceraldehyde 6 P ???????????????? DHAP, reaction in favor of DHAP. What??????????????????s the G of this reaction? (I didn??????????????????t cover this in my review so I forgot about choices. )
7. 4-year old boy got hit by an arrow in the sternum. (Oh yeah, they have really funny situations in store for us. ) What structure is just behind the sternum in the superior mediastinum. (I answered thymus. The other choices were trachea, heart (obviously wrong) and arch of the aorta. )
Lessons I learned &/or things that I should have done but I chose not to or didn??????????????????t have time:
1. Webpath, webpath & more webpath images!!!! I downloaded the images but didn??????????????????t have time to view them. Maybe somebody should come out with an atlas for step 1.
2. Radiographic anatomy atlas or anything of that sort is a BIG must. I never bothered thinking I??????????????????m just gonna get a few qs on them but whoa! I got like a block worth of those.
3. Don??????????????????t believe people who tell you that micro and pharma is underrepresented and that FA-1 for these areas are enough. In fact, no single subject is underrepresented. Not even histology or embryology! Study these thoroughly. And FA is not enough!!!!!
4. Memorize DNA and RNA viruses and replication. I got several questions with same choices. I regret skipping this figure in Jawetz 6th ed p 170.
5. Learn synonyms of diseases/syndromes. The obvious names are out! The occult names are in.
6. Most clinical questions that have something to do with pharma begin with a case, but the question is neither the diagnosis nor the DOC but the adverse reaction, drug interaction, or adverse affects.
7. The questions with more than five choices are actually friendly, recall questions.
Super high yield topics:
1. AIDS, and infections/complications in immunosuppressed (e. g. , s/p chemo) patients.
2. Study designs, statistical power, bias, probability. No need to compute but be prepared to think beyond what??????????????????s given.
3. Alzheimer??????????????????s, Pick??????????????????s and all those dementias including Huntington??????????????????s.
4. The classic sporotrichosis question, by the way, did come out, along with a lot of fungal and parasitic infections and their DOCs.
5. Enzyme kinetics.
6. Hemoglobin dissociation curves
7. Molecular biology & genetics in Kaplan esp transcription, translation, translocations, mutations, degeneracy, genetic diseases.
8. Down??????????????????s syndrome. This, plus AIDS are like the theme for most of my cases.
9. Pulmonary function tests.
10. Cardiac cycle, e. g. , where do you have S4? Curves for CHF and the like.
11. Autonomic drugs given to tissues in petri dishes. Yes there was a piece of a heart & a frog??????????????????s intestine amongst the others. But not so fast, two to three drugs were given and you need to know all of em!
12. The second messengers, not just for aminergic but also for rhodopsin.
13. Cyclosporine??????????????????s MOA.
14. Nerve deficits, and two q about severe combined degeneration.
So it is true. The USMLE cd underestimates the real exam. My first block was really easy, very much like what is in the USMLE cd. But my subsequent blocks look more like they??????????????????re taken from the Kaplan 150-q cd. Some qs are even more difficult. I thought somewhere along the way, I??????????????????ll get easier qs since I know the exam is not adaptive. But then again, I wasn??????????????????t that lucky. Stems got longer and longer and choices got weirder. I can definitely say I didn??????????????????t do well in the exam. (I??????????????????m not even looking forward to receiving my score report anymore. ) Of course I felt bad about it that??????????????????s why it took me 2 days to finally talk and write about it. I??????????????????m doing this so you guys will have a better chance. Sorry if I sound scary though.