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  #1  
Old 10-03-2014
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Default nov-dec takers

hey guys whoever is taking their exam during nov dec 2014 lets gather here and keep each other updated so that we are always on our toes .Also lets help each other to bring out the best of this time

so i'll start with my update..i m presently doing uw. plan to give it few more days and then start fa with annotated stuff (big task ahead )

so what about you guys !

do update n share ur ideas
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  #2  
Old 10-03-2014
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Dominican Republic

I previously did Kaplan, DIT (not completly), pathoma and FA like 70-80% Im not sure.. 2-10 hours per day but sometimes 0 (yeah I wasted too much time, but now I'm a rehabilitated procastinator :P). I fixed the exam for the last week of novermber

I'm currently doing:

FA (Cover to Cover) + Pathoma (2nd time, only videos at 1.5x-2.0x ) + Goljan transcript with RR pictures and blue margin notes + 50 UW qs

My day looks like this:

A review of the week's material
FA Endocrine (Anat, Phys...)
25 UW qs
Endocrine Pathoma Videos
Goljan Transcript
FA Endocrine (Pharm)
25 UW qs
A review (Including a quick review of FA Endorine pathology) + 2-4 micro bugs

Total time: up to 12.5 hours , but is working for me. The reviewing stuff is boosting my retention capacity for micro and pharm.

Last edited by Mvp12; 10-03-2014 at 06:15 AM.
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  #3  
Old 10-03-2014
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that is great mvp

my schedule as of now is doing solely uw whole day so that i can finish max before picking up fa. once i pick up fa(cover to cover) i will be reviewing goljan RR along with it. total time devoted 6-8 hrs / day counting out distractions

done fa once before , did kaplan lec notes with videos , goljan ( read long time back), along with pathoma videos.

i too have fixed date for nov last week

is this ur second time of uw ?
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  #4  
Old 10-03-2014
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Thumbs Up

Participate ppl
I m sure there are many of us taking exams in this slot.
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  #5  
Old 10-04-2014
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hey guys...am planning to give the exam in Nov 2nd week...am a 3rd year med student...during my 2nd year,I did Kaplan,goljan,pathoma,Levinson,costanzo,Lippincott biochem n hy neuro...wasted so much time this year...now doing FA 2014 with DIT and uworld online...around 5-10hrs per day..uworld scores-97th percentile till now,free 150 ques-88%..
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  #6  
Old 10-04-2014
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Thumbs Up kevin

Kevin u r doing great. 97% percentile is just fabulous now all u need to do is fa fa fa n uw and most imp have confidence ull nail it for sure

How many times hv u done uw
Taken any nbmes
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  #7  
Old 10-04-2014
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thanks dude...I din complete uworld even once...am still doing it...no nbme's yet...I'll finish uworld n Fa dis month n take 2 nbmes...
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  #8  
Old 10-04-2014
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Hey guys my exam on Nov , I am doing FA for the third time and u world for the second time
I did online NBME 16 before month and I scored 217 , does anyone have nbme 16 offline , cause I think I need to revise it ,any help will be appreciated .if u have it please please P.M
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  #9  
Old 10-05-2014
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Help

hi everyone , i'm also planning for the last of nov or start of dec .not sure "(
can anyone advice me about nbme 13 and 16 , which one is more predictable .
m doinng anatomy( kaplan )right now is that enough for anatomy ? any advie ? i heard they are testing more and more on basic anatomy things
anyone on twitter ? we can follow each other and can share instant important points and informations , may be
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  #10  
Old 10-05-2014
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Quote:
Originally Posted by israaoday View Post
Hey guys my exam on Nov , I am doing FA for the third time and u world for the second time
I did online NBME 16 before month and I scored 217 , does anyone have nbme 16 offline , cause I think I need to revise it ,any help will be appreciated .if u have it please please P.M
you are just scaring me , i mean nbme 16 is that tough ? i guess your preparation ll be good , fa third time is a big achievement , at least for me
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  #11  
Old 10-05-2014
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Quote:
Originally Posted by dr mumble View Post
you are just scaring me , i mean nbme 16 is that tough ? i guess your preparation ll be good , fa third time is a big achievement , at least for me
no dont be scared ..It was tough but I did too many stupid mistakes so I think U could score better ..I heard that form 16 is by far the most predictable of ur usmle score and closer to the real exam questions ..I am planning to give nbme 15 next Friday ..Good luck in ur preparation I think it is good to use kaplan lecture note to prepare for it cause it is not covered well in f.a.. iam doing the same
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  #12  
Old 10-05-2014
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Quote:
Originally Posted by israaoday View Post
no dont be scared ..It was tough but I did too many stupid mistakes so I think U could score better ..I heard that form 16 is by far the most predictable of ur usmle score and closer to the real exam questions ..I am planning to give nbme 15 next Friday ..Good luck in ur preparation I think it is good to use kaplan lecture note to prepare for it cause it is not covered well in f.a.. iam doing the same
good luck and thanks
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  #13  
Old 10-05-2014
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Thumbs Up lacking in fa /uw

Guys what topics/subjects do u think are lacking in fa and uw and should be covered from other sources
Plz add to the list

Lacking in UW

Histology
genetics,( I would suggest to cover from kap q bank if time permits )

Lacking in fa
Genetics
Anat

Guys plz start adding so that we can help each other out. Plz add other sources in brackets where the respective topics should be covered from

Keep working hard
Let's do this
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  #14  
Old 10-05-2014
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Quote:
Originally Posted by usmlefateh View Post
that is great mvp

my schedule as of now is doing solely uw whole day so that i can finish max before picking up fa. once i pick up fa(cover to cover) i will be reviewing goljan RR along with it. total time devoted 6-8 hrs / day counting out distractions

done fa once before , did kaplan lec notes with videos , goljan ( read long time back), along with pathoma videos.

i too have fixed date for nov last week

is this ur second time of uw ?
It is my first run. I'm annotating in FA and making flashcards about the educational objective for pharm, micro and some hard concepts.
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  #15  
Old 10-05-2014
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Quote:
Originally Posted by usmlefateh View Post
Guys what topics/subjects do u think are lacking in fa and uw and should be covered from other sources
Plz add to the list

Lacking in UW

Histology
genetics,( I would suggest to cover from kap q bank if time permits )

Lacking in fa
Genetics
Anat

Guys plz start adding so that we can help each other out. Plz add other sources in brackets where the respective topics should be covered from

Keep working hard
Let's do this
I would add to FA Biochemestry.
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  #16  
Old 10-05-2014
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Quote:
Originally Posted by usmlefateh View Post
Guys what topics/subjects do u think are lacking in fa and uw and should be covered from other sources
Plz add to the list

Lacking in UW

Histology
genetics,( I would suggest to cover from kap q bank if time permits )

Lacking in fa
Genetics
Anat

Guys plz start adding so that we can help each other out. Plz add other sources in brackets where the respective topics should be covered from

Keep working hard
Let's do this
Also guys CVS physiology graphs in fa
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  #17  
Old 10-06-2014
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Thumbs Up schedules/strategy

guys share ur strategies for the coming 2 months . lets help each other out

whats your plan which all nbmes do u plan to take offline and online and when do ya all plan to take them as in timings before the exam
what are the subjects u r gonna review right before the exam
what acc to u is the mosssst hy ( which basically seems everythng at the moment )
basically whats ur plan for the coming weeks
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  #18  
Old 10-06-2014
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Surgery Kaplan HY 55 hour lectures

Hi, Everybody

Morally and spiritually I'm with every each of you - November Test Takers!!!

People passed before us, we will pass, and people will come after us to pass.

Not pass kick the ass.

Hey, people - can somebody Have Kaplan HY lectures fro Step 1 55 hours? Can somebody share Organ system part? Thanks.
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  #19  
Old 10-07-2014
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I wil take in Jan !1st read done by september (from July)
Doing the second read of kaplan with Uworld offline.
Not been able to include FA yet in the schedule !
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  #20  
Old 10-07-2014
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Hey everyone ! Good to see ppl in the same boat as me I'm planning to take step 1 in the third week of nov. Currently doing uworld second time with fa. Will be taking an nbme soon. Kind of feeling lost as to what to do this last one month. I feel my pace should be increasing but it has actually slowed down. Any suggestions guys?
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  #21  
Old 10-07-2014
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thats happening to me as well, i been pretty slow for the past couple of weeks for some unknown reason
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  #22  
Old 10-08-2014
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Hey

Count me in ppl

done with kaplan qbank ...will start UsmleRx next ..then will switch to UW

exam in Jan

GL everybody
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  #23  
Old 10-08-2014
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Correct Answer MAKE A skype group

i just started second revision
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  #24  
Old 10-08-2014
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Quote:
Originally Posted by usmlefateh View Post
Guys what topics/subjects do u think are lacking in fa and uw and should be covered from other sources
Plz add to the list

Lacking in UW

Histology
genetics,( I would suggest to cover from kap q bank if time permits )

Lacking in fa
Genetics
Anat

Guys plz start adding so that we can help each other out. Plz add other sources in brackets where the respective topics should be covered from

Keep working hard
Let's do this
I think respiratory physiology should be done from kaplan too instead of fa, for better understanding. Especially the last 2 chapters in that section.
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  #25  
Old 10-09-2014
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Thumbs Up

howz it going people
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  #26  
Old 10-09-2014
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Hi
I'm doing uworld and will be done this week ,Iwas wondering if ishld go ahead and take a nbme or give first aid a read and then take a nbme. I read first aid earlier but don't remember everything. I'm planning on taking my exam in last week of November.. can anyone suggest what is better to do
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  #27  
Old 10-09-2014
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I'm still with the same plan but can't remerber anything from micro . I have read CMMRS, made a resume in a notebook and read read read FA but the qs are still killing me. I decided to use USMLE Secrets but only for that subject coz is a super dense book and only emphasizes in a question based format what is important for the boards. It's only a cram book.
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  #28  
Old 10-10-2014
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hey guys.. i have done my uworld and FA.. And plan on giving the step later in november. Is uworld +FA enough for a 240+ or is anybody doing other stuff as well. If yes, please share .>
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  #29  
Old 10-16-2014
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Quote:
Originally Posted by druvsingh View Post
hey guys.. i have done my uworld and FA.. And plan on giving the step later in november. Is uworld +FA enough for a 240+ or is anybody doing other stuff as well. If yes, please share .>
I would add pathoma but that depends on your pathology base. Any NBME?
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  #30  
Old 10-16-2014
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Guys any update?
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  #31  
Old 10-16-2014
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I'm Done with uworld..doing a revision of fa...planning to do it in 10 days... and then take an nbme...FA is so monotonous....getting weared up easily...hope I can do it
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  #32  
Old 10-17-2014
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Quote:
Originally Posted by Mvp12 View Post
I previously did Kaplan, DIT (not completly), pathoma and FA like 70-80% Im not sure.. 2-10 hours per day but sometimes 0 (yeah I wasted too much time, but now I'm a rehabilitated procastinator :P). I fixed the exam for the last week of novermber

I'm currently doing:

FA (Cover to Cover) + Pathoma (2nd time, only videos at 1.5x-2.0x ) + Goljan transcript with RR pictures and blue margin notes + 50 UW qs

My day looks like this:

A review of the week's material
FA Endocrine (Anat, Phys...)
25 UW qs
Endocrine Pathoma Videos
Goljan Transcript
FA Endocrine (Pharm)
25 UW qs
A review (Including a quick review of FA Endorine pathology) + 2-4 micro bugs

Total time: up to 12.5 hours , but is working for me. The reviewing stuff is boosting my retention capacity for micro and pharm.



Hey MVP12. I am on the same boat as u....i have not completed my first read of FA yet (might have barely done 50%) and I am not even done with DIT. I want to take Step by december but this makes me nervous because I feel like I am so behind and that I would not be able to finish on time. How do you keep yourself motivated?
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  #33  
Old 10-17-2014
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I m pretty much in the same situation.right now i m doing fa along with uworld.planning to take exam at the end of december.i m so much behind the schedule.Also need some motivation
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  #34  
Old 10-17-2014
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Thumbs Up keep going guys!!!!

lets update everyday so that we keep on our toes

todays target : finish 1 uw block . it takes me time to finish one block per day but shall try to do 1.5 blocks today

will update at the end of day how much i finished

hoping to finish uw within 10 days then shift to uw

any one tried DIT plz share ur view on it
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  #35  
Old 10-20-2014
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Fire Thread SP -

Hi, Everybody!

I was looking for advanced SP for FA - Organ Systems, who is done with all UW, Q-bank, NBME's and holding the Exam date on November - so we can feel the same Urgency and Adrenalin Rush. About me - my last NBME's about 3 weeks ago NBME 15 - 228. Did UW, and Kaplan - twice, reading FA is getting a boring - I thought if there is two people in same boat - we could add some emotional factors to our FA - LAST READING ! - Please if you're in same needs, contact me on Skype: citadel08, we quickly talk on Skype and start tomorrow morning. Don't worry, if we feel if it is useless and not beneficial - for us then we will just walk in our own path. Thanks much for interesting. I'm in Seattle. Time frame - PST.
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  #36  
Old 10-20-2014
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Hii I am looking for an SP for NBME discussion,anyone ready to join me,we can discuss through skype.
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  #37  
Old 10-20-2014
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Which is the best book to study anat from?considering they are asking quiet a lot of ant questions now a days?Is kaplan,FA and Uworld enuff?

And where are u guys reffering for neuro MRI scans and diagrams?
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  #38  
Old 10-21-2014
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hi guys.... recently my studies have kind of slowed down.... now i feel like i am burning out... plz any suggestion on how to get motivated....
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  #39  
Old 10-21-2014
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Hey everyone! Who are all taking the exam by November ending ? my exams in the last week. I just gave nbme 7 yesterday. Has anyone else given it here? Hoping we can discuss doubts?
Doc_ind - Do kaplan gross anat and neuroanat well. Read about urinary incontinence from any source. Pelvic anatomy I heard is being tested, so read up on that. I don't think we need to do any extra book for anat apart from our kaplan, fa, uworld.
As for the mri scans I don't have a specific resource. Just reviewing uworld images.
Seriousdoc - I think it's time you give an nbme maybe? I was slowing down too, but after giving an nbme I feel it's time to speed up and study hard. Also maybe you could write down what all you need to learn more and do them and tick them off? It could be topics that are heavily tested and we always tend to make mistakes in, for example cystic fibrosis, Tb drugs mechanisms, lymph node drainage etc. That helps for me

Last edited by zh3298; 10-21-2014 at 11:53 PM.
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  #40  
Old 10-22-2014
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Fire Thread Nbme 7 doubts

A 76yr old man, comes with shorttness of breath for 3 weeks. 20 yr history of htn. temp normal, pulse 118/min, rr 22/min, BP 108/52. B/L crackles +. S1 S2 normal. S3 heard. point of maximal impulse is located at 6th intercostal space at anterior axillary line. which of the options is correct?

LV strokevolume /LA pressure /Peripheral vasc resistance
A. dec/ dec /dec
B. dec /dec /inc
C. dec /inc /inc
D. inc /dec /dec
E. inc /dec /inc
F. inc /inc /dec

The answer is given as C. can someone pls explain..
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  #41  
Old 10-22-2014
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Quote:
Originally Posted by zh3298 View Post
A 76yr old man, comes with shorttness of breath for 3 weeks. 20 yr history of htn. temp normal, pulse 118/min, rr 22/min, BP 108/52. B/L crackles +. S1 S2 normal. S3 heard. point of maximal impulse is located at 6th intercostal space at anterior axillary line. which of the options is correct?

LV strokevolume /LA pressure /Peripheral vasc resistance
A. dec/ dec /dec
B. dec /dec /inc
C. dec /inc /inc
D. inc /dec /dec
E. inc /dec /inc
F. inc /inc /dec

The answer is given as C. can someone pls explain..
In my opinion the clue here is "S3 sound" (which can be CHF, mitral regurgitation and dilated ventricles). If you look at the BP values, they are close to shock values (90/50) + dyspnea means a left heart failure (CHF). How do you discard mitral regurgitation? well, the question says "S1, S2 normal" and no murmur heard.

So, now we know this is a CHF which means heart is not contracting properly -> blood is not ejecting properly (decreased SV) -> blood accumulates in left ventricle -> accumulating blood makes pressure to increase retrogradly (increases LA pressure)

What about the peripheral vascular resistances? Well SV is decreased -> kidneys are hypoperfused -> Renin-Angiotensin-Aldosteron system increases trying to maintain GFR (compensatory mechanism in CHF) -> Angiotensin produces also a generalized vasoconstriction -> increased peripheral vascular resistances.

I hope this can help you
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  #42  
Old 10-22-2014
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Thanks a lot Chessmaster!
It is a case of Lvh, owing to the long history of htn and presence of S3. My doubts were actually 1) why the Lv SV was decreased when Lvh causes a diastolic failure and not a systolic. But I guess Lv filling is decreased because of failure of diastole. 2) why the Tpr is increased when the current BP is 108/52.. Your explanation of it does explain it.. Thank u
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Fire Thread Nbme 7 doubts

In UNcompensated respiratory acidosis, is the HCO3 normal or decreased?
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Originally Posted by zh3298 View Post
Thanks a lot Chessmaster!
It is a case of Lvh, owing to the long history of htn and presence of S3. My doubts were actually 1) why the Lv SV was decreased when Lvh causes a diastolic failure and not a systolic. But I guess Lv filling is decreased because of failure of diastole. 2) why the Tpr is increased when the current BP is 108/52.. Your explanation of it does explain it.. Thank u
Yes, at the beginning was a Lvh which has progressed to the actual CHF. The ventricular muscle hypertrophy becomes unsustainable at certain point when coronary blood flow mismatchs number of myocardyocytes (not enough blood supply for too much muscle) -> CHF

The current BP is low because of the CHF (a not efficient-heart beating is not aporting pressure to the circulatory system). TPR are increased thanks to RAA system which achieves at least a bit pressure on the system. Without RAA compensatory system the patient would be completely shocked (hypotensive shock)

As long as BP depends on both TPR and SV. If one's decreased the other will go up trying to compensate. I mean, having increased TPR does not mean necessarily a high BP if the SV is reduced (as in this case with CHF)

P.S: In hypertrophic cardiomyopathy you will hear a S4 or "atrial kick". The S3 here's reflecting a CHF after a prolongued and wasting lvh.

Your welcome!
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In UNcompensated respiratory acidosis, is the HCO3 normal or decreased?
Well, as long as no compensation has not yet occured; HCO3 would be normal. When compensation occurs, HCO3 increases (>30) in respiratory acidosis. But remember that the HCO3 compensation takes time (like a day or so) to take place!

Example:

- pH 7.25, pCO2 70 mmHg, HCO3 25 mEq/L -> This is an acute respiratory acidosis (e.g. heroin) where kidney (HCO3) has not had time enough to compensate.

- pH 7.35, pCO2 70 mmHg, HCO3 32 mEq/L -> This is a chronic respiratory acidosis where HCO3 compensation has already taken place.
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Up Trend Kaplan Self Assessment 8 hour

Just took 2nd Kaplan Self Assessment = 8 hour, 7 blocks = 322 questions, overall correct 74 % = 237 questions are correct, 85 - wrong.

Has somebody took it recently too? How much it is in USMLE score?
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Originally Posted by Chessmaster View Post
Yes, at the beginning was a Lvh which has progressed to the actual CHF. The ventricular muscle hypertrophy becomes unsustainable at certain point when coronary blood flow mismatchs number of myocardyocytes (not enough blood supply for too much muscle) -> CHF

The current BP is low because of the CHF (a not efficient-heart beating is not aporting pressure to the circulatory system). TPR are increased thanks to RAA system which achieves at least a bit pressure on the system. Without RAA compensatory system the patient would be completely shocked (hypotensive shock)

As long as BP depends on both TPR and SV. If one's decreased the other will go up trying to compensate. I mean, having increased TPR does not mean necessarily a high BP if the SV is reduced (as in this case with CHF)

P.S: In hypertrophic cardiomyopathy you will hear a S4 or "atrial kick". The S3 here's reflecting a CHF after a prolongued and wasting lvh.

Your welcome!
Yes, you are right about S3 and S4. I tend to mix them up always.
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Default Nbme 7

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Well, as long as no compensation has not yet occured; HCO3 would be normal. When compensation occurs, HCO3 increases (>30) in respiratory acidosis. But remember that the HCO3 compensation takes time (like a day or so) to take place!

Example:

- pH 7.25, pCO2 70 mmHg, HCO3 25 mEq/L -> This is an acute respiratory acidosis (e.g. heroin) where kidney (HCO3) has not had time enough to compensate.

- pH 7.35, pCO2 70 mmHg, HCO3 32 mEq/L -> This is a chronic respiratory acidosis where HCO3 compensation has already taken place.
A previously healthy 32 yr old male is unconscious after an overdose of a sedative drug. His pulse is 90/min, respirations are 6/min, BP 80/40. Arterial blood gas analysis on room air shows : pH 6.8, Pco2 80mm hg, Po2 40, HCO3 12mEq/L.
Which of the following best describes the patient's acid-base status?
A) Metabolic acidosis with reps compensation
B) Resp acidosis and metabolic acidosis
C) Resp acidosis with metabolic compensation
D) Uncompensated metabolic acidosis
E) Uncompensated respiratory acidosis
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A previously healthy 32 yr old male is unconscious after an overdose of a sedative drug. His pulse is 90/min, respirations are 6/min, BP 80/40. Arterial blood gas analysis on room air shows : pH 6.8, Pco2 80mm hg, Po2 40, HCO3 12mEq/L.
Which of the following best describes the patient's acid-base status?
A) Metabolic acidosis with reps compensation
B) Resp acidosis and metabolic acidosis
C) Resp acidosis with metabolic compensation
D) Uncompensated metabolic acidosis
E) Uncompensated respiratory acidosis
I would say E. This is a respiratory acidosis where HCO3 compensation has not yet happened.
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I would say E. This is a respiratory acidosis where HCO3 compensation has not yet happened.
Yes, you are right according to the key. Why can't it be a mixed respiratory and metabolic acidosis? Because the HCO3 is decreased..
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Yes, you are right according to the key. Why can't it be a mixed respiratory and metabolic acidosis? Because the HCO3 is decreased..
I think option B is telling you that the origin of the acidosis is both respiratory and metabolic at the same time. But the 1º disturbance is respiratory (sedatives decreases respiration parameters) and this is more option E

Nevertheless, there's as well a 2º metabolic acidosis as long as severe hypoxya -> increases lactic acid -> decreases HCO3 (as you suggested). By the way is a tricky question
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Fire Thread Nbme 7 doubts

Tricky question indeed

Another one :

A 52 yr old woman dies 9 months after being diagnosed with well differentiated ductal carcinoma of right breast metastatic to brain, lung and liver. Her mother and one of her sisters also have died of breast cancer. Which of the foll molecular abnormalities is most likely to be found in this patient?
A) Amplification of HER2 gene in somatic cells
B) Amplification of Nmyc gene in neoplasticism cells
C) Deletion of Rb locus in healthy somatic cells
D) Germline inactivation of the BRCA 1 gene

When are you giving step 1 Chessmaster? Have you given any nbmes yet?
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Tricky question indeed

Another one :

A 52 yr old woman dies 9 months after being diagnosed with well differentiated ductal carcinoma of right breast metastatic to brain, lung and liver. Her mother and one of her sisters also have died of breast cancer. Which of the foll molecular abnormalities is most likely to be found in this patient?
A) Amplification of HER2 gene in somatic cells
B) Amplification of Nmyc gene in neoplasticism cells
C) Deletion of Rb locus in healthy somatic cells
D) Germline inactivation of the BRCA 1 gene

When are you giving step 1 Chessmaster? Have you given any nbmes yet?
I would say D as long as the hereditary component in this case seems to be very strong. HER2 could be also related but somatic mutations cannot be transferred to the offspring. N-myc is about Neuroblastoma and Rb has nothing to do with breast cancer.

I will give exam on 23 Dec. Read FA, did UW and 60% Kaplan Qbank (but the Kaplan Qbank guys deleted my progress and ruined my study plan. Now I cannot do unused questions and I'm planning to switch to USMLE rx in order to make the most of time). What should I do?

On the other hand, I didn't do any NMBE. I was planning to finish the Qbank (now this plan is ****ed up thanks to the Kaplan "professionality"), read FA once again and then, do NMBE to check where I am. Should I do NMBE as soon as possible or let them to the end?
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I would say D as long as the hereditary component in this case seems to be very strong. HER2 could be also related but somatic mutations cannot be transferred to the offspring. N-myc is about Neuroblastoma and Rb has nothing to do with breast cancer.

I will give exam on 23 Dec. Read FA, did UW and 60% Kaplan Qbank (but the Kaplan Qbank guys deleted my progress and ruined my study plan. Now I cannot do unused questions and I'm planning to switch to USMLE rx in order to make the most of time). What should I do?

On the other hand, I didn't do any NMBE. I was planning to finish the Qbank (now this plan is ****ed up thanks to the Kaplan "professionality"), read FA once again and then, do NMBE to check where I am. Should I do NMBE as soon as possible or let them to the end?
I marked D too. But the key says A Maybe he means to say with germline mutations only one copy of the gene is deleted and another somatic mutation is needed to knock off the other gene and cause cancer?? I'm not sure..someone pls clarify..

With regards to giving nbme..I gave mine after I completed uworld the second time and FA once. I did like 20% of Rx and I dint find it too useful. I wanted to focus on being thorough with uworld first. Maybe you could 1) go through uworld again instead of Rx and give your first nbme, or, 2) give an nbme now and know where you stand ( since you've done uworld already once and more than half of kaplan qbank) and plan forwards based on that. You still have 2 months. That's plenty of time.
Personally, I think it's better you give an nbme now. Giving an exam and knowing your score keeps you focused and prevents slacking.
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I marked D too. But the key says A Maybe he means to say with germline mutations only one copy of the gene is deleted and another somatic mutation is needed to knock off the other gene and cause cancer?? I'm not sure..someone pls clarify..

With regards to giving nbme..I gave mine after I completed uworld the second time and FA once. I did like 20% of Rx and I dint find it too useful. I wanted to focus on being thorough with uworld first. Maybe you could 1) go through uworld again instead of Rx and give your first nbme, or, 2) give an nbme now and know where you stand ( since you've done uworld already once and more than half of kaplan qbank) and plan forwards based on that. You still have 2 months. That's plenty of time.
Personally, I think it's better you give an nbme now. Giving an exam and knowing your score keeps you focused and prevents slacking.
Thanks you for your advice!

About the question... I have no idea
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Fire Thread DIT

Guys. Anyone doing the DIT videos? I've got 30 days left. Should I do them? How useful are they?
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Hoping to take the exam in Nov.

Doing UW + FA now.
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Yes, you are right according to the key. Why can't it be a mixed respiratory and metabolic acidosis? Because the HCO3 is decreased..

Hey it's not tricky!
HCO3 is not decreased. It's normal. You read it wrongly that was why.
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Tricky question indeed

Another one :

A 52 yr old woman dies 9 months after being diagnosed with well differentiated ductal carcinoma of right breast metastatic to brain, lung and liver. Her mother and one of her sisters also have died of breast cancer. Which of the foll molecular abnormalities is most likely to be found in this patient?
A) Amplification of HER2 gene in somatic cells
B) Amplification of Nmyc gene in neoplasticism cells
C) Deletion of Rb locus in healthy somatic cells
D) Germline inactivation of the BRCA 1 gene

When are you giving step 1 Chessmaster? Have you given any nbmes yet?

Well HER2 positivity is associated with prognosis right?
Ok why will they mention that the woman died 9 months after being diagnosed?
It means the prognosis was bad. About the somatic cell thing I don't think it matters! Correct me if am wrong!
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Hey it's not tricky!
HCO3 is not decreased. It's normal. You read it wrongly that was why.
Isn't normal HCO3 21-24mEq/L?
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Well HER2 positivity is associated with prognosis right?
Ok why will they mention that the woman died 9 months after being diagnosed?
It means the prognosis was bad. About the somatic cell thing I don't think it matters! Correct me if am wrong!
Not only prognostic. Over expression of HER2 can cause Breast and Ovarian cancers. According to uworld.. But yes, they are mostly prognostic indicators and what you're saying makes sense. If you take the poor prognosis of the case into consideration. But he also says that the mother and sister had breast cancer. And that points to BRCA1..
Both options could be right, but he wouldn't give such a question..

Last edited by zh3298; 10-25-2014 at 05:36 AM.
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Sorry, a correction. Uworld doesn't say HER2 over expression causes. It says increases the risk of breast, ovarian, gastric and endometrial cancers.
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Isn't normal HCO3 21-24mEq/L?
Oh what was I thinking?
Thanks!
I confused it with anion gap value?
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Correct Answer

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Originally Posted by zh3298 View Post
Tricky question indeed

Another one :

A 52 yr old woman dies 9 months after being diagnosed with well differentiated ductal carcinoma of right breast metastatic to brain, lung and liver. Her mother and one of her sisters also have died of breast cancer. Which of the foll molecular abnormalities is most likely to be found in this patient?
A) Amplification of HER2 gene in somatic cells
B) Amplification of Nmyc gene in neoplasticism cells
C) Deletion of Rb locus in healthy somatic cells
D) Germline inactivation of the BRCA 1 gene

When are you giving step 1 Chessmaster? Have you given any nbmes yet?
answer is D=germline inactivation of BRCA 1
i marked A and got it wrong!
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answer is D=germline inactivation of BRCA 1
i marked A and got it wrong!

Really? You did it online? When? How much did you score?
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answer is D=germline inactivation of BRCA 1
i marked A and got it wrong!
Oh thank you! You must have done the nbme online? And could you help out with the HCO3 question pls..
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Oh what was I thinking?
Thanks!
I confused it with anion gap value?
Tell me about getting confused! Let's hope by the time we give the exam all the information in our brains settles down instead of moving around.
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Correct Answer

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Originally Posted by zh3298 View Post
A previously healthy 32 yr old male is unconscious after an overdose of a sedative drug. His pulse is 90/min, respirations are 6/min, BP 80/40. Arterial blood gas analysis on room air shows : pH 6.8, Pco2 80mm hg, Po2 40, HCO3 12mEq/L.
Which of the following best describes the patient's acid-base status?
A) Metabolic acidosis with reps compensation
B) Resp acidosis and metabolic acidosis
C) Resp acidosis with metabolic compensation
D) Uncompensated metabolic acidosis
E) Uncompensated respiratory acidosis

answer is B=Respiratory Acidosis + Metabolic Acidosis
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Really? You did it online? When? How much did you score?
yes, i did, one month ago, not bad but not what i wanted
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answer is B=Respiratory Acidosis + Metabolic Acidosis
Thanks a ton!
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Fire Thread Nbme 7 doubts

A male newborn born at 30 weeks gestation is admitted to the NICU. His grandmother insists that the child be given chamomile tea to treat his complications of prematurity. She gets agitated when the nursing staff tries to assure her that he is being cared for appropriately. She requests that her grandson be transferred under another physician in another hospital. At the grandmothers insistence, she and the child's mother meet with the physician to discuss the grandmothers requests. After the physician listens to the grandmothers reason for wanting to use the tea, which of the following approaches is most appropriate?
A) Explain that the tea will increase the risk of sloughing of GI mucosa
B) Gain the grandmothers support by acknowledging that she probably knows best and tell that the tea will be administered, but fail to do so.
C) Inform the mother and grandmother of the physicians credentials to assure them that the baby is getting the best care possible.
D) Negotiate to give the tea when the child's GI tract will allow administration of liquids.
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Fire Thread Nbme 7 doubts

A 50 yr old man comes to the physician for a follow up. One yr ago he was admitted to the hospital to be treated for ARDS associated with acute pancreatitis. Which of the following is most likely to be found in this patient with resolved ARDS?

A) Decreased alveolar dead space: tidal volume
B) Decreased concentration of surfactant protein D
C) Decreased diffusion capacity for CO
D) increased neutrophils in bronchoalveolar lavage fluid
E) Increased concentration of surfactant protein D
F) Increased pulmonary capillary blood flow
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Default Anki cards??

Hey guys I am planning for january last week !!

Anybody here using anki flashcards??

Are they worth doing??
I have already done for biochem and micro from anki cards...I am planning for immunology and pharmacology?

What do you suggest?
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A 50 yr old man comes to the physician for a follow up. One yr ago he was admitted to the hospital to be treated for ARDS associated with acute pancreatitis. Which of the following is most likely to be found in this patient with resolved ARDS?

A) Decreased alveolar dead space: tidal volume
B) Decreased concentration of surfactant protein D
C) Decreased diffusion capacity for CO
D) increased neutrophils in bronchoalveolar lavage fluid
E) Increased concentration of surfactant protein D
F) Increased pulmonary capillary blood flow
C= Decreased diffusion capacity for CO
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A male newborn born at 30 weeks gestation is admitted to the NICU. His grandmother insists that the child be given chamomile tea to treat his complications of prematurity. She gets agitated when the nursing staff tries to assure her that he is being cared for appropriately. She requests that her grandson be transferred under another physician in another hospital. At the grandmothers insistence, she and the child's mother meet with the physician to discuss the grandmothers requests. After the physician listens to the grandmothers reason for wanting to use the tea, which of the following approaches is most appropriate?
A) Explain that the tea will increase the risk of sloughing of GI mucosa
B) Gain the grandmothers support by acknowledging that she probably knows best and tell that the tea will be administered, but fail to do so.
C) Inform the mother and grandmother of the physicians credentials to assure them that the baby is getting the best care possible.
D) Negotiate to give the tea when the child's GI tract will allow administration of liquids.
i put A and was wrong!
Now i think its D= Negotiate ...
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i put A and was wrong!
Now i think its D= Negotiate ...
I put D but my key said C?? So wanted to clarify..
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Quote:
Originally Posted by Fereshteh View Post
C= Decreased diffusion capacity for CO
Can you please explain this answer? I always seem to get all the ARDS questions wrong!
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Old 10-26-2014
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Can you please explain this answer? I always seem to get all the ARDS questions wrong!
in ARDS we have intra-alveolar hyaline membrane which lead to decreased gas exchange and decreased diffusion capacity.
survivors of ARDS usually have diminished diffusion capacity even 1 year after.
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Old 10-27-2014
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Quote:
Originally Posted by Fereshteh View Post
in ARDS we have intra-alveolar hyaline membrane which lead to decreased gas exchange and decreased diffusion capacity.
survivors of ARDS usually have diminished diffusion capacity even 1 year after.
Okay. Thank you.
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Old 10-27-2014
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Originally Posted by zh3298 View Post
I put D but my key said C?? So wanted to clarify..

According to Goljan audios ARdS leads to diffision limited condition!
So any gas that diffuses across the alveoli will be decreased in diffusion. Membranes damaged.
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  #81  
Old 10-27-2014
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Originally Posted by Fereshteh View Post
i put A and was wrong!
Now i think its D= Negotiate ...
Never discard the religious believes of ur patients! Find a way to add them ones it would not harm them.
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  #82  
Old 10-27-2014
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Originally Posted by nsesereso View Post
According to Goljan audios ARdS leads to diffision limited condition!
So any gas that diffuses across the alveoli will be decreased in diffusion. Membranes damaged.
Thanks nsesereso. I thought since its a resolved case it won't be there anymore..
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Old 10-27-2014
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Thanks nsesereso. I thought since its a resolved case it won't be there anymore..
Yea but the destruction has happened already and can't be reversed
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Old 10-27-2014
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I am also taking step 1 in december... I have done Kaplan lecture notes and now I am doing FA and UW alongside


How often do you check ur progress? can u pls share ur NBME and UWSA scores??


I took NBME11 on september 5 and got 215, after this I moved to FA and UW

I took UWSA 2 yesterday after finishing 1400 UW questions and got 254, I don't know how realistic is this...


can you please share ur experience


thanks so much


Good luck everybody
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  #85  
Old 10-27-2014
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Originally Posted by xako7777 View Post
I am also taking step 1 in december... I have done Kaplan lecture notes and now I am doing FA and UW alongside


How often do you check ur progress? can u pls share ur NBME and UWSA scores??


I took NBME11 on september 5 and got 215, after this I moved to FA and UW

I took UWSA 2 yesterday after finishing 1400 UW questions and got 254, I don't know how realistic is this...


can you please share ur experience


thanks so much


Good luck everybody
I would say that UWSA2 tends to overpredict by 20 points, and not really predictive of the real exam. Just treat it as an extra source of q's and you'll be fine.

The exam will more likely pattern NBME 16 from what I've heard, no idea on that though. The scores should be an average of all of your NBMEs +/- 7-10 points.
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  #86  
Old 10-28-2014
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I am planning on taking the exam in nov dec too! I just need advice if someone has done the uworld biostats review. And how good it is? Is there any way of getting it offline?
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Old 10-30-2014
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A 67 yr old male is brought to the emergency department complaining of confusion, irritability and shock-like sensation that radiates to his feet on neck flexion. He has a long history of alcohol abuse and has been hospitalised for alcohol intoxication and acute pancreatitis. At presentation his blood glucose level is 52mg/dl. Two days later the patient feels better. His only complaint is some numbness of his feet.Physical examination reveals decreased bilateral vibratory sensation over the feet and ankles.Muscle strength is preserved. Which of the following is the most likely cause of this patient's current complaints?

A. Multiple Sclerosis
B. Guillain Barre syndrome
C. Cobalamin deficiency
D. Diabetes Mellitus Type 2
E. Sensory stroke
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Default C

Quote:
Originally Posted by Pikachu View Post
A 67 yr old male is brought to the emergency department complaining of confusion, irritability and shock-like sensation that radiates to his feet on neck flexion. He has a long history of alcohol abuse and has been hospitalised for alcohol intoxication and acute pancreatitis. At presentation his blood glucose level is 52mg/dl. Two days later the patient feels better. His only complaint is some numbness of his feet.Physical examination reveals decreased bilateral vibratory sensation over the feet and ankles.Muscle strength is preserved. Which of the following is the most likely cause of this patient's current complaints?

A. Multiple Sclerosis
B. Guillain Barre syndrome
C. Cobalamin deficiency
D. Diabetes Mellitus Type 2
E. Sensory stroke
C. Cobalamin deficiency.
Coalamin (Vitamin B12) is needed to make DNA and to maintain healthy nerve cells. Moderate and heavy alcohol consumption will affect vitamin B12 levels with resultant impact of a network of cytokines and growth factors, i.e, brain, spinal cord, and CSF TNF-alpha; nerve growth factor (NGF), IL-6 and epidermal growth factor (EGF), some of which are neurotrophic, others neurotoxic, giving the subacute combined degeneration-like lesions.
Excess buildup of NADH from alcohol metabolism (Alcohol & Acetaldehyde dehydrogenase activity) inhibits Gluconeogenesis -> hypoglycemia (52mg/dl).
Acetaldehyde Dehydrogenase consumes Thiamine from chronic alcohol abuse -> confusion, irritability.....
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Old 10-31-2014
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Quote:
Originally Posted by sedoley View Post
C. Cobalamin deficiency.
Coalamin (Vitamin B12) is needed to make DNA and to maintain healthy nerve cells. Moderate and heavy alcohol consumption will affect vitamin B12 levels with resultant impact of a network of cytokines and growth factors, i.e, brain, spinal cord, and CSF TNF-alpha; nerve growth factor (NGF), IL-6 and epidermal growth factor (EGF), some of which are neurotrophic, others neurotoxic, giving the subacute combined degeneration-like lesions.
Excess buildup of NADH from alcohol metabolism (Alcohol & Acetaldehyde dehydrogenase activity) inhibits Gluconeogenesis -> hypoglycemia (52mg/dl).
Acetaldehyde Dehydrogenase consumes Thiamine from chronic alcohol abuse -> confusion, irritability.....
Thank you
Yeah, Option C is correct
But in Subacute combined degeneration, cortocospinal tract involvement is seen. In the question above, i dint find any motor involvement. got a bit confused with that
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Old 11-01-2014
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Default Yes....

Yes.... SCD onset is gradual and progressive, affecting both the lat corticospinal tract and dorsal columns too. The patient was brought in at the early onset of demyelination which progresses to involve weakness of muscles.....
Quote:
Originally Posted by Pikachu View Post
Thank you
Yeah, Option C is correct
But in Subacute combined degeneration, cortocospinal tract involvement is seen. In the question above, i dint find any motor involvement. got a bit confused with that
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Old 11-05-2014
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Hey guys was away for a while ! How's it going friends. I m doing my fa with annotations and I thought it would be faster after doing uw but its the other way round . its actually taking me a while to finish topics in fa along with annotations...bt I feel satisfied after doing bthe respective topic completely. Just sticking to fa n left out Kaplan n goljan

There's alot of stuff which is in goljan n not in fa but I can't read goljan now or else I wud be stuck on it. What are u guys doing regarding goljan

How about u guys
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Old 11-05-2014
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Quote:
Originally Posted by usmlefateh View Post
Hey guys was away for a while ! How's it going friends. I m doing my fa with annotations and I thought it would be faster after doing uw but its the other way round . its actually taking me a while to finish topics in fa along with annotations...bt I feel satisfied after doing bthe respective topic completely. Just sticking to fa n left out Kaplan n goljan

There's alot of stuff which is in goljan n not in fa but I can't read goljan now or else I wud be stuck on it. What are u guys doing regarding goljan

How about u guys
Hey I haven't done Goljan either (except for the 1st 8 chapters, cardio, renal, resp but that was a long time ago) but I'll do the Goljan audios. For some reason, contrary to the popular opinion, I find those audios very boring and dragging. I think they would more be useful if you're doing some other activity (going for a walk, gym, chores, etc.) but just sitting idle and listening to them is painful.

At this point, I'm focusing on FA as well along with FA Q&As (only because I don't have many other q's to practice.) I wanted to do Kaplan qbank but I think it's pretty late now. If I get them offline, I'll just do q's from my problematic areas (physio, cardio etc.)

I'm also reviewing HY Anatomy after which, I'll do some problematic pharm topics from Kaplan and then move on to HY NA.

I just don't have anymore NBMEs left except for form 15, UWSA2, and FRED 150 so that worries be quite a bit (since my exam will be sometime in the 1st week of December.)
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  #93  
Old 11-06-2014
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Fire Thread Step 1 Practice Exam

Today, took Practice session in Prometric - in general picture questions were relatively OK - close to UW with a bigger proportion of question when people get 65-70% correct - total of 3 blocks - 87%, 85%, 93% = summary score 88% Keep it up guys - nothing much left......
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  #94  
Old 11-07-2014
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Thumbs Up citadel

Citadel wish u the best ...u have worked hard and u will ace it for sure.
Stay calm n confident and u will perform at ur best.
Goood luck !!!
We all will keep u in our prayers
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  #95  
Old 11-08-2014
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Default hypersensitivity

What type of hypersensitivity is seen in Celiac disease/ Dermatitis herpetiformis ?
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What type of hypersensitivity is seen in Celiac disease/ Dermatitis herpetiformis ?
Type 3 HSR?
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Old 11-08-2014
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What type of hypersensitivity is seen in Celiac disease/ Dermatitis herpetiformis ?
type 2 hypersensitivity
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Default hypersensitivity

Celiac disease is due to Type 4 hypersensitivity , according to kaplan
Dermatitis Herpetiformis is due to gliadin IgG and IgA antibodies which react with reticulin - according to an explanation in UWSA

am confused.
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Old 11-08-2014
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hello guys.

I took a stupid decision and moved the exam to Dec 11th instead of Nov 25th. That only decreased my rhythm and I didn't study for about 5 days for personal reasons. It took me a month to complete the schedule that I posted earlier with some chapters of USMLE Secrets (not a indispensable book really).

Well I'm now 4 weeks away from the carnage , so for the next 2 weeks my schedule will be:

FA + Goljan RR blue margin notes for 6 hours
UW qs 2 blocks
Review (including a bit of Micro and biochem) - The most important part .

For the next 2 weeks or 10 days I think the schedule will be the same but with 3 qs blocks.
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Old 11-08-2014
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Quote:
Originally Posted by Layla937 View Post
Hey MVP12. I am on the same boat as u....i have not completed my first read of FA yet (might have barely done 50%) and I am not even done with DIT. I want to take Step by december but this makes me nervous because I feel like I am so behind and that I would not be able to finish on time. How do you keep yourself motivated?
I watch in youtube these videos: "Best Motivation Video - Never Give Up! [HD]"
and "Glengarry Glen Ross speech"
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