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USMLE Step 1 Preparation Guide

Compiled by the Office of Medical Education

OFFICE OF MEDICAL EDUCATION


TULANE UNIVERSITY SCHOOL OF MEDICINE
1430 TULANE AVENUE, SL-6
NEW ORLEANS, LA 70112
PHONE: 504-988-6600
EMAIL: OME@TULANE.EDU

USMLE What is it?


In order to become a licensed physician in the United States, individuals must pass a series of examinations
sponsored by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards
(FSMB). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are
four separate exams that must be passed in order to become eligible for medical licensure:

Step 1, usually taken after the completion of the second year of medical school;
Step 2 Clinical Knowledge (CK), usually taken during the fourth year;
Step 2 Clinical Skills (CS), usually taken during the fourth year; and
Step 3, typically taken during the first year of post graduate training.

Step 1 assesses whether you understand and can apply important basic science concepts to the practice of
medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy.
Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of
medicine in the present, but also the scientific principles required for maintenance of competence through lifelong
learning. Step 1 is constructed according to an integrated content outline that organizes basic science material
along two dimensions: system and process.
Step 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for
the provision of patient care under supervision and includes emphasis on health promotion and disease prevention.
Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that
provide the foundation for the safe and competent practice of medicine. There are two components of Step 2:
Step 2 Clinical Knowledge (CK) is constructed according to an integrated content outline that
organizes clinical science material along two dimensions: physician task and disease category. This is the
computer-based, multiple-choice portion of Step 2.
Step 2 Clinical Skills (CS) uses standardized patients to test medical students and graduates on their
ability to gather information from patients, perform physical examinations, and communicate their findings
to patients and colleagues. Implementation of the clinical skills examination began in June 2004. USMLE
Step 2 CS is administered at five regional test centers (CSEC Centers) in the United States.
Step 3 assesses whether you can apply medical knowledge and understand biomedical and clinical science essential
for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3
provides a final assessment of physicians assuming independent responsibility for delivering general medical care to
patients.
Requirements for licensure in each state are set by the state's medical licensing boards, but there is a nationwide
six-attempt limit for each component of the exam. Each state board may determine the maximum number of times
that a person may take each Step exam and still remain eligible for licensure. In Louisiana, applicants have six
attempts to pass USMLE Step 1, four attempts to pass USMLE Step 2 and four attempts to pass
USMLE Step 3. All sections of the exam must be taken within a 10-year span.
But what we're really here for is to talk about preparing for Step 1. Step 1 is your first BIG hurdle. And make no
mistake about it, this is a VERY important test. An excellent performance on Step 1 can definitely help you when it
comes to securing a top-rate residency, and likewise a poor score can hurt you and limit your options. A failure on
Step 1 can eliminate the possibility of some residencies altogether. So it is definitely in your best interest to do all
you can to maximize your chances of doing well, regardless of what type of residency you may choose to pursue.

Step I: Basic Information


How is Step 1 scored?

When you take Step 1, the computer records your responses. After your test ends, your responses are
transmitted to the NBME for scoring. The number of test items you answer correctly is converted to a three-digit
score.
On the three-digit scale, most Step 1 scores fall between 140 and 260. The mean score for first-time examinees
from accredited medical school programs in the United States is in the range of 220 to 240, and the standard
deviation is approximately 20. Your score report will include the mean and standard deviation for recent
administrations of the examination, and you can see performance reports from past years at
http://www.usmle.org/performance-data/. In the past, applicants received both a 3-digit and a 2-digit score, but as
of April 2013 the USMLE Composite Committee (the governing body of the USMLE program) directed staff to
discontinue reporting of the 2-digit score due to confusion surrounding its interpretation and use.
The Step 1 exam contains 322 multiple-choice items administered in 7 blocks of 60 minutes each. The number of
questions per block on a given examination form may vary but will not exceed 46. Blocks of items are constructed
to meet specific content specifications. As a result, the combination of blocks of items creates a form of the
examination that is comparable in content to all other forms. The percentage of correctly answered items
required to pass varies from form to form. However, examinees typically must answer 60 to 70 percent of items
correctly to achieve a passing score.

What is the minimum passing score?

The USMLE program provides a recommended pass or fail outcome for all Step examinations. Recommended
performance standards for the USMLE are based on a specified level of proficiency. As a result, no predetermined
percentage of examinees will pass or fail the examination. The recommended minimum passing level is reviewed
periodically and may be adjusted at any time. Notice of such review and any adjustments will be posted at the
USMLE website. Effective January 1, 2014, the minimum passing score for Step 1 is 192.

What is Tulane School of Medicine policy on USMLE exams?


Step 1 Exam

USMLE Step 1 must be passed by November 1st of the third year. Students not passing Step 1 are
required to take a leave of absence until a passing score on Step 1 is achieved.

The Committee on Academic Performance and the Senior Associate Dean for Student Affairs may
recommend a delay in a student sitting for Step 1 until a study program is satisfactorily completed.

Step 2 Exam

All students are required to pass USMLE Step 2 CK and Step 2 CS prior to graduating medical school.
Students not passing both Step 2 CK and CS by April of their fourth year of medical school will be
required to take a leave of absence until passing scores on both Step 2 CK and CS are achieved.

All senior students must sit for USMLE Step 2 CS and Step 2 CK before December 31st of their senior
year in order to be allowed to participate in the Match. This motion was passed in order to assure that
every Tulane senior participating in the Match will be allowed to graduate and begin residencies on time.
You will still be required to have passing scores on both parts of Step 2 in order to graduate, but will have
until June to do so. This will allow for retakes if necessary.

A student may accumulate a maximum of 24 months of leave for the purpose of meeting the USMLE
requirement.

After 24 months of leave, if USMLE Step 1, Step 2 CK and Step 2 CS are


not passed, the student will be dismissed.
2

How do I apply for Step 1?

The initial application for Step 1 is done on the Internet. Go to http://www.nbme.org/students/licensing.html. Click
on the link that says NBME Licensing Examination Services Website. In the yellow LOG IN box, click
on "First-time user" and follow the instructions. As part of the application, you will indicate a 90-day eligibility
period during which you plan to take the exam. Payment is also required at this time (the 2014 fee is $580). Once
you submit the online form, you will receive a link to the Certification of ID/Applicant Authorization form.
Print out the application authorization form, which will require your signature and a picture. You do
not have to get a passport photo takenthe Office of Student Affairs has printed copies of your white coat
ceremony picture.
Bring the form to the Student Affairs Office (Murphy Building 15th floor) to attach your white coat
picture and request an authorized signature and school seal placement.
After that, you're ready to mail it in to the address listed on the bottom of the form.

Where do I take the test?

Thomson Prometric, a part of The Thomson Corporation, provides scheduling and test centers for the computerbased components of USMLE. Step 1 and Step 2 CK are given around the world at Prometric Test Centers
(PTCs).
Prometric test centers are located throughout the U.S. In Louisiana there are centers in:
Alexandria
Baton Rouge
Bossier City
Lake Charles
Metairie

How do I schedule my test?

Once your application has been processed, you will receive an email from NBME notifying you that your
application is complete. About a week later, you will receive a second email from them notifying you that your
scheduling permit is available; this message will include instructions for accessing the electronic scheduling permit
using the registration entity's interactive website.
PRINT OUT YOUR SCHEDULING PERMIT and keep it in a safe place. You MUST bring it with you to the
test center on the day of your test. You will not be allowed to take the exam without your scheduling permit.
Once you've gotten your permit, you may schedule your test online at www.prometric.com for any available test
date that is within your approved 90-day eligibility period. Not all Prometric centers are open on weekends, and
USMLE exams are not necessarily offered every day the centers are open. Please note that May through July
is one of the busiest periods for these testing centers because of the large USMLE demand during
that time - PLAN AHEAD!
No fee is charged for changing testing appointments 31 or more days prior to the first day of the scheduled test. If
you must reschedule outside the approved eligibility period, you will need to reapply and pay an additional fee (see
following page):

Appointment Change Fees Table for Computer Based Examinations


The date that you
change your
appointment

Prometric Testing Region

Step 1

Step 2 CK

Step 3*

31 or more days before


(but not including) the
first day of the scheduled
test date

All testing regions

No Fee

No Fee

No Fee

Fewer than 31 days and


more than 5 days before
(but not including) the
first day of the scheduled
test date

All testing regions

$50

$50

$50

US and Canada

$110

$124

$221

Africa, Asia (including Hong Kong and


Pakistan),
Australia, China, India, Indonesia, Latin
America,
Middle East (including Egypt), Thailand

$268

$302

N/A

Europe (including Israel), Korea, Taiwan

$304

$342

N/A

Japan

$491

$552

N/A

5 or fewer days before


(but not including) the
first day of the scheduled
test date

Please note that these fees are subject to change at any timealways check http://www.usmle.org for current information.

What is the format of the test?

The Step 1 test day lasts 8 hours. The 8 hours includes the test itself as well as break time. The exam consists of
322 multiple choice questions arranged in seven 60-minute blocks of 46 questions each, which means
you will have about 1.25 minutes per question. During each block you can answer questions in any order, go
back and review questions in the block, and change answers. Once you have exited a block or the time for that
block has expired, you will no longer be able to review questions or change answers in that block.

Some blocks are harder than others. Don't panic if your first block happens to be a more difficult
one.
The questions are random, so don't expect a block of pathology questions, a group of pharmacology
questions, etc.
Some questions will include pictures - histology, gross pathology, CT images, etc.
Step 1 includes only SINGLE BEST ANSWER questions. This is the traditional, most frequently
used multiple-choice format. These items consist of a statement or question followed by three to eleven
response options arranged in alphabetical or logical order. Examinees are required to select the best
answer to the question. Other options may be partially correct, but there is only ONE BEST answer.

*Most score reporting of Step 1 results occurs within 8 weeks of testing.

Can I practice taking the test?


You should acquaint yourself with the test software well before your test date(s). Practice time is not available on
test day, and test center staff is not authorized to provide instruction on use of the software. A brief tutorial on
the test day provides a review of the test software, including navigation tools and examination format, prior to
beginning the test. It does not provide an opportunity to practice.
1.

You can practice by downloading materials from the USMLE website


(http://www.usmle.org/practice-materials/index.html).
The NBME software has over 100 practice test items and a software tutorial. Some practice items may
include multimedia files, such as video or audio clips.

2.

You can schedule a practice test at a Prometric Test Center.


Once your Step 1 application has been processed and you have received your Scheduling Permit, you are
eligible to register for a Practice Session for that examination. Practice Sessions are available at
Thomson Prometric, a part of The Thomson Corporation, test centers. The Practice Sessions use
the same sample test materials that are available on the USMLE website; however, they do
not include any multimedia items. NO NEW SAMPLE TEST MATERIALS ARE
PRESENTED AT PRACTICE SESSIONS. Those who are eligible to register for a Practice Session
may take only one session per exam registration and must take it in the same testing region as your Step
1 exam. Please note that Practice Sessions are not available on major local holidays or during the first
two weeks of January. The Practice Session is a maximum of 3.5 hours and is divided into a brief
tutorial section and three 1-hour blocks of 46-50 multiple choice test items each. When you complete the
session, you will receive a printed percent correct score.

If you register for a practice session, a scheduling permit will be issued to you within seven business days. Do not
schedule a Practice Session using your permit for the actual Step examination. The $75 fee for the
practice session must be paid directly to Prometric by credit card at the time you schedule your appointment.

What's on the test?


The NBME's Comprehensive Basic Sciences Exam is the closest thing to the real thing that they will let anyone see.
In fact, since ALL of the items written by NBME are copyrighted, you should be a little leery of anyone other than
NBME who claims to have "actual USMLE questions". As of April 2014, the following is provided as a breakdown of
the content areas on Step 1:
SYSTEM**

15%-20% General principles of Foundational Science


60%-70% Individual organ systems
15%-20% Multisystem Processes & Disorders
Biostatistics & Epidemiology/Population Health
Social Sciences

PROCESS*

10%-15% Normal processes


55%-60% Abnormal processes
15%-20% Principles of therapeutics
10%-15% Other (likely general principles,
biostats/EBM, or social science
categories)

* Percentages are subject to change at any time. See the USMLE website for the most up-to date information.
** The general principles category includes test items concerning those normal and abnormal processes that are
not limited to specific organ systems. Categories for individual organ systems include test items concerning those
normal and abnormal processes that are system specific.
NBME also publishes a more detailed outline of the topics covered on the Step 1 exam. Use this as an
outline to make sure you are covering all of these topics in your study plan. You'll find the complete
outline of what's on the Step 1 exam at the end of this book in Appendix A.

Step 1: Preparation
Several things have been proven to help students prepare to do their best of Step 1.
1. LEARN the material you are currently studying in your classes.
Approximately 70% of the questions on the exam are likely to use or combine information in ways that you have
not seen before. It is the purpose of the testing agency to see how adept you are at taking partial information and,
based on that, figuring out an answer you consider to be a high probability response. You can't do that with
MEMORIZED material, but you can do it using material that you have LEARNED.
2. KNOW how to approach multiple choice questions and PRACTICE. Some people seem to
instinctively know how to answer multiple choice questions correctly, others of us not so much. There are skills
that you can learn to help you answer these kinds of test questions. Here's how Kaplan recommends approaching
vignette styled multiple choice questions:
1. Assemble key clues into a mental "snapshot" of the patient
2. Understand precisely what is being asked
3. Allow a few moments to think, recall, and to anticipate possible answers
4. Compare the given choices to your anticipated answer
5. Mark choices that match best
6. Rule out choices that don't account for all findings
7. Mark the best answer
Kaplan's experts say that people who are bad at multiple choice questions focus on the choices rather than the
stems of the questions. This is a very inefficient approach and one that tends to result in more mistakes. Those
who are good at multiple choice questions focus on the stems, not the choices. If you always feel that
your performance on multiple choice tests doesn't equate with your mastery of the material, you might think
about having your test-taking skills analyzed.
3. ALLOW enough time to prepare, but not too much.
Four to six weeks should be plenty of time to prepare for Step 1. Many students in the past who have taken longer
than 6 weeks to prepare later said they felt they took too much time and actually lost ground with their studying.
Analysis of our own students over the years shows that you get the most "bang for your buck" by studying for 6 to
9 hours per day for 4 to 6 weeks.
4. MAKE a study schedule and stick to it. This is a critical step in successful Step 1 preparation. More detailed
information about study schedules can be found in the following section.
5. STUDY smart. Spending 10 hours a day passively reading study guides or old notes is much less effective than
spending half that amount of time in active study. Explain concepts out loud to a study partner, practice answering
questions by explaining why the right answers are right and the wrong answers are wrong. If concept mapping
works for you, do it. If there are other methods that work for you, use them.

OTHER STEP 1 ADVICE


The ways in which USMLE exams are similar to medical practice:
1. you must find key information
2. the information you need may be buried
3. there are distractions
4. there is time pressure
5. you must use probabilities to make decisions
6. youll never know it all
7. situations wont exactly fit what youve learned
Mistakes most commonly made when preparing for Step 1:
1. passive studying
2. insufficient practice with questions
3. memorizing, not understanding the material
4. inappropriate test day strategies
5. misreading or misinterpreting questions

So, where do I start?


1.

Self-assessment. The first thing you need to do is take some sort of diagnostic test to see where your areas
of strength and weakness are. Diagnostic tests are available from Kaplan, NBME, and a variety of other online
sources that are listed later in this guide.

2.

Make a study schedule. Lots of sample schedules are out there and two are included later in this guide.
BUT - please remember that these schedules were made by individual students and the schedules reflect those
students' individual circumstances. When you prepare your own study schedule, you must first look at your
own diagnostic test results and prepare your schedule with more time allotted to weaker subjects, and less
time to stronger subjects. Individual study pace also needs to be factored in, as some accomplish more per
study day than others.

Heres some advice from Kaplans Judy Schwenker:


1.

Take a comprehensive test to begin as a measure of where your recall is right now. You can use your
profile report from the Comprehensive Basic Science Exam or can use the Kaplan diagnostic test if you
have taken it.

2.

Once you know your percent correct score for each subject, use the information to decide the relative
amount of review time to put into each area. For example, if Physiology is 20% lower than Microbiology,
you should be spending at least 20% MORE time reviewing Physiology than Micro.

3.

As you begin to review a subject, look over some questions on the material before you start your review.
This will help keep you focused on what is important to know and show you how you will need to use
the information on the test.

4.

As you move through the material, create your own condensed summaries of the key material so you can
review this right before test day. 20-30 pages per subject are a decent size to shoot for, because
otherwise you will end up taking overly detailed notes and they wont help at the end.

5.

As you finish a subject, use the QBank to create and take a test with maybe 50 items from each subject
that you have completed up to that point. So if you have finished Anatomy and Physiology, you would do
a 100-item test under timed, test mode assessing those 2 areas. By the end, you will be taking long
practice tests under test conditions that cover all the completed subject areas. This helps keep the earlier
material in memory, and gives you a more accurate picture of your preparedness. It also gives you good
practice for the mental stamina and pacing needed on test day.

6.

Plan time during the final 2-3 weeks to do nothing but review your own summaries and take increasing
numbers of simulated test modules of 50 items each under timed conditions (one hour per module). This
is the final get it all fresh in mind, build mental stamina, and intensive test practice phase, which should
lead right up to 2 days before your actual test date. Our experience has shown that students who are
doing 70% or better on our full length simulated exams (or comparable practice tests created with Qbank
or IV Qbank) by their test dates DO PASS, so this is a good level to aim for. You may also choose to
take one of the NBME self-assessments. If you do decide to do this, be advised that based on feedback
from message boards, Form 1 seems to be the most reliable.

Additional Advice from Kaplan


Tips for the Week Before

During the last few days before the exam, you should be tapering off your studying and getting into mental and
physical shape.
1.

This is not the time for cramming new materialbut time to organize and integrate what you already
know. Work on making what you know more accessible.

2.

Review keywords, phrases and concepts. Look over your summary notes one more time. This is the
time to drill yourself on essential information. The key is to practice recall, not simply read over the material
again. What you need to know is probably already in your head. Your task now is to train yourself to access
it when you need it. Doing practice questions is a good way to reinforce your recall skills. Use them to clarify
your understanding.

3.

No one can know everything that is asked on this exam. Be honest with yourself about what you do
and do not know. Knowing that you do not know something gives you more sense of control on the exam
and makes you less likely to panic when you encounter the material and/or waste time on questions you are
not likely to get correct.

4.

Get yourself onto the right time schedule. Wake up every day at the same time you will need to on the
day of the exam. This will get your circadian rhythms coordinated with the exam schedule. Do not nap
between 8:00am and 5:00 pm; otherwise, you will be accustomed your body to shutting down during the
critical exam hours. If you get up at the same time each day, you will find it easier to fall asleep at night. By
getting into a proper sleep-wake cycle, you will find it easier to get sleep the night of the exam as well.

5.

You should be getting a sufficient amount of sleep. For most people that means at least 6 to 7 hours a
night. Sleep is an essential time for your brain to consolidate what you have learned. You need sleep; it
makes you a more efficient learner when you are awake.

6. Take some time each day to relax. Have a good meal. Take a walk in the fresh air. Find time for
exercise. The change of pace will refresh you and the physical activity will help you relax and sleep at night.
7. If you havent done so already, visit the Prometric Test Center where you will be taking the exam. It
will be indicated on your exam entry ticket. This will ensure you know how to get there and how much time
you should allow for the commute. You can see where you should park, and see what the computer set-up is
like.
8. Review the tutorial at http://www.usmle.org/practice-materials/index.html. Become familiar with the
interface, the location of key information on the screen and how to navigate between screens. If you walk
into the exam familiar with the exam, you will not have to use any of your valuable break time to do this on
the test day.

Tips for the Day before the Exam


1. Take the day off from studying. This is your day to relax and gather your strength before the main event.
Get out of bed at the same time you will have to get up the next day. If you feel you must study, limit yourself to
reviewing your own notes and flashcards.
2. Have some fun. Go for a walk. Listen to your favorite music. Go see a good comedy or an action movie that
will allow cathartic release. Go shopping. Spend time with a significant other. Do whatever you like. You have
worked hard and deserve it.
3. Make sure that you have checked out the basics for the exam:
Have you worked through the USMLE tutorial?

Do you know where the Prometric center is, and how to get there?

Do you have alternative transportation if, for example, your car does not start?

Do you trust your alarm clock to wake you up in time? If not, make arrangements with friends as back up.
You want to be sure to wake up rested, refreshed, and on time.
Layout what you'll need for the exam before you go to sleep. This includes photo identification,
scheduling permit and confirmation number, as well as any personal items like eyeglasses. While you're at it,
don't forget to pack a lunch!
4. Call your friends and classmates and make some plans to celebrate. You'll need to blow off some
steam anyhow, and talking with colleagues will remind you that you are not in this by yourself.
5. Be sure to do some physical activity. Just taking a walk for an hour will help relax you.
6. Get a good night's sleep. To help you sleep, consider a hot bath or warm milk. Avoid taking sleeping
medication as it may leave you groggy in the morning.

Kaplans Tips for Test Day


1. Arrive at the Prometric Test Center 30 minutes early so you are not rushed and have time to get
organized. You will be given a locker to store your personal items and then assigned a computer station.
Remember that you have a total of seven hours to complete 322 questions, and a total of one hour to be used
throughout the day for breaks and lunch.
2. To cope with fatigue, you will need to schedule breaks. Our recommended schedule for the exam is:
Question Block

Break time at end of Block

Block 1
Block 2
Block 3
Block 4
Block 5
Block 6
Block 7

No break
5 minute break
5 minute break
30 minute break
No break
10 minute break
Done!

This allows you 10 minutes extra to use as needed. Remember that you will need to sign in and out when you take
breaks. You should also be aware that if you leave the exam room during a block, it will be marked as an
irregularity in your testing session. Therefore, you need to consider after each block if you want to take a

bathroom break.
3. Start with the beginning of the question block and work your way to the end. The idea here is to get
into a rhythm that will help create what one psychologist calls a "Flow" experience. The flow experience is a state
of optimal concentration and maximal performance.
4. Do not skip any questions. If you don't know it when you come to it, you are not likely to know it later.
Skipping around wastes time and can end up confusing you. Deal with each question as you come to it, answer it as
best you can, and move on to the next question.
5. Limit your use of the marking feature to no more than two or three questions per block. Of
course you should answer each question as you come to it, but you may want to double-check yourself on a few
questions. The marking feature lets you return to review and reconsider questions if you have time left over. Used
correctly, marking will help you revisit questions where you have a high probability of getting the answer correct.
Misused, marking causes you to not give a question your full attention the first time around. You simply may not
have time to go back and look at questions you have marked, especially if you mark a lot of them.
6. Be cautious about changing answers. In general, your odds of changing a correct answer to a wrong one
are so much higher than the reverse that it is simply not worth the risk. If you change an answer, you are most
likely making it wrong! Your first impulse is usually the correct one. Stay with it unless some clear insight occurs to
you.
7. If you finish a question block with time left over, go back and "check" only those answers that you
have previously marked. Checking almost always leads to changing and tends to reduce your score. If you have
a spare moment, make sure that you have entered an answer for every question in the block and then, relax. Sit,
take a break, and mentally prepare yourself for the next block of questions. Focus on the questions to come, not
the ones that have passed.
8. Monitor your time. Know how much you have left, so you do not find yourself rushed at the end. Work on
your pacing from the beginning of the question block. Check your watch every 10 questions to make sure you are
on the correct pace to finish. If you pace yourself throughout the block, you should not be squeezed for time at
the end.
9. Relax. During the breaks between question blocks, try to relax and not think back over the exam. The desire
to recall questions is strong, but not helpful. Those questions are in the past; you will never see them again. Focus
on relaxing and making the most of your break. Remember, you will always tend to remember those questions you
get wrong.
Another piece of important advice: BRING FOOD TO THE TEST. If you are used to having caffeine, bring
coffee too.

AND HERES SOME PREP ADVICE FROM SOME OF OUR STUDENTS.


"I'd recommend studying no more than about 5 weeks. Any more and you will start forgetting things you learned
earlier. I caution you to take what your classmates say about their exam with a grain of salt, because every exam
is different. Also, buzzwords are not typically used on Step 1. Rather than use the words smudge cells, for
example, theyll probably just show you a blood smear."
Have a planned study schedule that you stick to. If you fall behind, youll have a hard time getting through
everything and still being able to review material.
Get one good review book and one good question bank and really learn them. Don't try to use too many
10

sources.
Start early, stick to a schedule, try not to become overwhelmed with all available resources. Pick a couple for
each subject because in my experience you cannot absorb it all. Use First Aid as a scaffold it really is helpful
for recall association.
The last week/few days before Step are very distracting dont give yourself too much time to study, 4-6 weeks
worked for me. Be prepared mentally for the anxiety the week before the test focus on easier subjects to
review.
Do as many questions as possible, from as many resources as possible. You can remember more than 3 weeks
of information. During my actual exam, I recalled information from first year lectures.
The best advice I got was to take every course seriously; I focused on my med school courses and did very little
specific boards study other than the question bank. I wish I had started to use First Aid the first semester of
first year; I also wish I had started the question bank first year and that I would have used it during the first and
second year courses.
Confidence in your own knowledge is very important going into the exam. You know what they are trying to ask
you, the problem is that questions are worded in such a way that it is often difficult to know exactly what the
question is asking. Whatever you can do (practice tests etc.) to improve your confidence will allow you to avoid
second-guessing yourself or over stressing during the actual exam so that you can figure out exactly what the
question is trying to ask.

11

Resources
Review Courses

Some students find the structure and discipline of a review course very helpful as part of their Step 1 preparation.
Unfortunately some programs schedule their courses at times of the year that dont coincide with most first-time
test takers preparation efforts. Nevertheless, here is the information on some review courses that are available.
Costs and dates are always subject to change; check the company websites for the most up-to-date information.

DOCTORS IN TRAINING
http://www.doctorsintraining.com
Part 1: Questions and Video Answers
You will receive 34 sets of 10 short-answer questions three times a week posted to your dashboard.
Part 2: Videos
Focused high-yield videos, 70-75 hours, incorporating active learning principles. The course contains more than
800 images, illustrations, charts, graphs, and pathology slides and has a corresponding study guide.
Cost: $825 (plus tax and shipping)
*This program is fairly popular with Tulane medical students; 12/13 Class of 2012 students who utilized it
recommended it, but several noted that it requires a great deal of study time (feels drawn out) and is best used
as a review of First Aid.
A three-week live course in Galveston, TX is also available some years, but it takes place during May.

KAPLAN

http://www.kaptest.com/Medical-Licensing/

LivePrep: Structured, live lecture-style preparation.


7 week course: $3,699
14 week course: $5,999
CenterPrep: Review video lectures at your own pace at a Kaplan center.
3 month access: $3,699
6 month access: $5,499
9 month access: $6,999
Classroom Anywhere: Over 240 hours (14 weeks) of live online lectures.
Class dates: Jan. 5 April 12, 2015 (6:00-9:00 PM EST) - $3,519 with Promo Code.
LivePrep Retreat: 6-week live lecture retreat in a hotel setting. Previous retreats have taken place in Atlanta and
Chicago. 2015 will be held in Houston.
*Must call Kaplan for current pricing and more information.
Live Question-Based Integration: 28 hours of guided USMLE question-based review.
Pathophysiology (2 sessions)
Pharmacology (2 sessions)
Biochemistry (2 session)
Microbiology (1 session)
*2014 cost was $599; call Kaplan for current pricing and more information.
OnlinePrep: Web-based course with access to approximately 200 hours of online video.
3 month access: $2,399
6 month access: $3,899
High Yield: 50-hour fast-paced online review, $799
*Most programs also include access to assessment tests and simulated exams. Bundle packages (including access
to Kaplans QBank) are available. Free Live Online seminars and practice exams are also offered by Kaplan; check
their website for current details.

12

FALCON PHYSICIAN REVIEWS


http://www.falconreviews.com
Live: 7-week intensive review offered in several U.S. cities. Package includes over 300 hours of live lectures,
access to USMLE World QBank for 3 months, clinical vignettes and case students, daily Q/A sessions, and two
NBME exams.
*Prices vary by city location.
Live Online Review: Over 275 hours of live classroom instruction accessible from any device with internet
access. Includes an interactive eBook, 6-months of USMLE World Q Bank, 30 hours of integrated cases, and
two NBME exams.
Price: $4,299; check website for price reductions
Live Online Integrated Cases: 30 hours of live online case-based review over 6 days.
Price: $549
Self-Study Online Review: Over 200 hours of multimedia instruction optimized into 115 hours of
streaming video lecture material; organized into 10- to 40-minute modules. Includes interactive e-books and
the option of purchasing QBank of your choice and Becker textbooks.

NORTHWESTERN MEDICAL REVIEW


http://www.northwesternmedicalreview.com
Options include short-term live lecture review courses (3-15 days), private tutoring, question bank access,
video library access, hard copy study materials and books.
Live review courses last between 3 and 15 days and typically take place in East Lansing, MI or Chicago, IL. They
also offer cruise reviews. Prices range from $580 - $1,900. Visit their website for more information.

Question Banks

Practice questions are a key component of USMLE Step 1 preparation. Many students suggest obtaining access to
one question bank (Kaplan and USMLEWorld are the most popular choices) and using it concurrently with course
studying for the year before Step 1, then buying another to use for intensive preparation before the test
(USMLEWorld is more difficult and perhaps better suited for this use). If you have any other suggestions for
efficient ways to use question banks, please e-mail your tips to ome@tulane.edu.
QUESTION BANK
Kaplan Medical (QBank)
http://www.kaplanmedical.com

USMLE World
http://usmleworld.com/

DETAILS
Internet-based question bank providing
tailored CBT-format exams (over 2,000
questions). Test content and
performance feedback are provided by
organ system and discipline. Questions
are representative in style and at times
content to those on the actual exam.
Reading the often detailed explanations is
time well spent. There is a free online
demonstration. Requires time
commitment. iPhone and Android
accessibility
An excellent bank of well-constructed
questions that closely mirror those
found on Step 1. Questions demand
multistep reasoning and are often more
difficult than those on the actual exam.
Offers excellent, detailed explanations
with figures and tables. Features a
number of test customization and

COST
1 month: $99
12 months: $299

1 month: $125
2 months: $175
3 months: $210
6 months: $299
12 months: $399

13

analysis options. Unfortunately, the


program does not allow other
application windows to be open for
reference. Users can see cumulative
results both over time and compared to
other test takers. Mobile companion app
available for iOS and Android-based
devices.
*This is a very popular resource among
Tulane students.
USMLE Consult
http://www.usmleconsult.com

USMLE Rx
http://www.usmlerx.com

USMLE Easy
http://www.usmle-easy.com

A solid question bank that can be divided


according to discipline and subject area.
Questions are more straightforward than
those on actual exam. Offers concise
explanations with links to Student
Consult and First Consult content. Users
can see cumulative results both over
time and compared to other test takers.
Premium Review offers a Robbins
Pathology test bank featuring 500
USMLE-style questions as well as the
Scorrelator that predicts your USMLE
Step 1 score.
A well-priced question bank that offers
Step 1-style questions accompanied by
thorough explanations. Some obscure
material is omitted, making it more
straightforward than other question
banks. Each explanation includes highyield facts and references from First Aid.
However, the proportion of questions
covering a given subject area does not
always reflect the actual exams relative
emphasis. Question stems occasionally
rely on buzzwords. Most useful to help
memorize First Aid facts. Provides
detailed performance analyses.
A question bank based on the PreTest
series. Many questions are shorter and
more obscure than those on the actual
Step 1 exam. Users can track questions
completed as well as customize tests.
Useful as a supplemental review after
other resources have been exhausted.
*USMLEasy Lite (25% of questions) is
available for free through AccessMedicine
(see Online Resources).

1 month: $75
2 months: $115
3 months: $135
1 year: $395

1 month: $99
6 months: $199
3 months: $149
Till You Pass (12 months):
$249

Call for pricing:


1-888-307-5984

14

Other Study Resources


There are many more websites and books available than those that are listed here. If you find a book or website
that you find helpful, please send it to ome@tulane.edu so that it can be included in our list of resources.
Remember that you can easily get overwhelmed by using too many resources as you study, so pick out the few
that seem to work best with your style of studying and learning and go with them. What works for one person
may not work for another, so be careful about using a book just because someone else said it worked for them.
Try it for yourself - if it doesn't fit you, move on to something that does. A number of books are available for
check-out in the Office of Medical Education library.
Online Resources

ONLINE RESOURCE
AccessMedicine
http://www.accessmedicine.com

Lippincotts 350-Question
Practice Test for USMLE Step 1
http://bit.ly/1aRYORB
Database of Medical Mnemonics
http://www.medicalmnemonics.co
m
NBME Self-Assessment Services
http://www.nbme.org/students/sas
/sas.html

WebPath: The Internet Pathology


Laboratory for Medical Education
http://library.med.utah.edu/WebP
ath/

DETAILS
Innovative online resource that provides students,
residents, clinicians, researchers, and all health
professionals with access to more than 60 medical
titles from the best minds in medicine, updated
content, thousands of images and illustrations,
interactive self-assessment, case files, diagnostic
tools, a comprehensive search platform, and the
ability to view from and download content to a
mobile device.
350-question comprehensive USMLE practice test.
Review mode and test mode available. These
questions have been written and reviewed to
provide excellent diagnostic practice.
A free, non-profit, online searchable database of
medical mnemonics to help remember the
important details. PDA version available.
The material presented in these self-assessments
is provided by the NBME for educational
purposes only. Medical students and graduates
may find them to be useful tools as they prepare
for USMLE Step1, Step 2 CK, and Step 3.
Participants will receive a performance profile and
a score interpretation guide immediately after
completing a self-assessment.
Contains over 2700 images with text that
illustrate gross and microscopic pathologic
findings along with radiologic imaging associated
with human disease conditions. For selfassessment and study there are over 1300
examination items. There are more than 20
tutorials in specific subject areas.

COST
Free for Tulane
students through
Matas Library
subscription (can be
accessed from the
library website
through the
databases link).
Free; must be
registered for an
account at lww.com.
Free.
Basic exam: $50
Expanded feedback
version: $60

Free.

15

Library Resources:
ExamMaster: free for Tulane students. Register at http://www.exammaster2.com/wdsentry/tulane.htm.
Books
First Aid for the USMLE Step 1 (McGrawHill Medical)
Appleton & Lange Review for the USMLE Step 1
(McGraw-Hill/Appleton & Lange)
Blueprints Step 1 Q&A (Lippincott Williams &
Wilkins)
Board Review Series (Lippincott Williams &
Wilkins)
High-Yield Comprehensive USMLE Step 1 Review
(Lippincott Williams & Wilkins)
High-Yield Pathology (Lippincott Williams &
Wilkins)
Kaplan QBook
NMS Review for Step 1 (Lippincott Williams &
Wilkins)
Platinum Vignettes (Elsevier)

Rapid Review Series -USMLE Step 1 (Mosby)


aka Goljans
Robbins Review of Pathology (Saunders)
Step Up: A High-Yield, Systems-Based Review for
USMLE Step 1 (Lippincott Williams &
Wilkins)
Underground Clinical Vignettes (Lippincott
Williams & Wilkins)
USMLE Road Map Series (McGraw-Hill
Medical)
USMLE Step 1 Made Ridiculously Simple
(MedMaster Inc.)
USMLE Step 1 Recall: Buzzwords for the Boards
(Lippincott Williams & Wilkins)
USMLE Step 1 Secrets (Mosby)

Mobile Applications
Cram Fighter (iPhone)
Kaplan Mobile QBank (iPhone)
Skyscape USMLE Step 1 Recall (Several)

Study Schedule

One of the biggest pieces of advice that students and experts alike give surrounds the idea of developing and sticking to a
study schedule. Again, everybody has their own idea of what works for them and what doesn't, or what topics need to be
studied more, but you also need to have a starting point. Remember you must create your own study schedule based on
YOUR individual needs. Youll find a sample 28-day study schedule at the back of this book in Appendix B.

16

APPENDIX A: NBME OFFICIAL LIST OF STEP 1 TOPICS

Biochemistry and molecular biology

Biology of cells

GENERAL PRINCIPLES
gene expression: DNA structure, replication,
exchange, and epigenetics
gene expression: transcription
gene expression: translation, post-translational
processing, modifications, and disposition of
proteins(degradation),including
protein/glycoprotein synthesis,
intra/extracellular sorting, and
processes/functions related to Golgi complex
and rough endoplasmic reticulum
structure and function of proteins and enzymes
energy metabolism

Human development and genetics

Biology of tissue response to disease

adaptive cell responses and cellular homeostasis


intracellular accumulations
mechanisms of injury and necrosis
apoptosis
mechanisms of dysregulation
o cell biology of cancer, including genetics
of cancer
o general principles of invasion and
metastasis, including cancer staging
cell/tissue structure, regulation, and function,
including cytoskeleton, organelles, glycolipids,
channels, gap junctions, extracellular matrix, and
receptors
principles of pedigree analysis
o inheritance patterns
o occurrence and recurrence risk
determination
population genetics: Hardy-Weinberg law,
founder effects, mutation-selection equilibrium
principles of gene therapy
genetic testing and counseling
genetic mechanisms
acute inflammatory responses (patterns of
response)
o acute inflammation and mediator
systems
o vascular response to injury, including
mediators
o principles of cell adherence and
migration
o microbicidal mechanisms and tissue

17

injury
o clinical manifestations
chronic inflammatory responses
reparative processes
o wound healing, hemostasis, and repair;
thrombosis, granulation tissue,
angiogenesis, fibrosis, scar/keloid
formation
o regenerative processes

GENDER, ETHNIC, AND BEHAVIORAL CONSIDERATIONS AFFECTING DISEASE TREATMENT


AND PREVENTION, INCLUDING PSYCHOSOCIAL, CULTURAL, OCCUPATIONAL, AND
ENVIRONMENTAL
Progression through the life cycle, including birth
cognitive, language, motor skills, and social and
through senescence
interpersonal development
sexual development
influence of developmental stage on physicianpatient interview
Psychological and social factors influencing
patient behavior

personality traits or coping style, including


coping mechanisms
psychodynamic and behavioral factors, related
past experience
family and cultural factors, including
socioeconomic status, ethnicity, and gender
adaptive behavioral responses to stress and
illness
maladaptive behavioral responses to stress and
illness
interactions between the patient and the
physician or the health care system
patient adherence (general and adolescent)

establishing and maintaining rapport

data gathering

approaches to patient education

enticing patients to make lifestyle changes

communicating bad news

difficult interviews

multicultural ethnic characteristics

consent and informed consent to treatment


physician-patient relationships
death and dying

Patient interviewing, consultation, and


interactions with the family

Medical ethics, jurisprudence, and professional


behavior

18

Nutrition

birth-related issues
issues related to patient participation in
research
interactions with other health professionals,
including impaired physician and patient safety
sexuality and the profession; other boundary
issues
ethics of managed care
organization and cost of health care delivery

MULTISYSTEM PROCESSES
generation, expenditure, and storage of energy
at the whole-body level
assessment of nutritional status across the life
span, including calories, protein, essential
nutrients, hypoalimentation

functions of nutrients

protein-calorie malnutrition

vitamin deficiencies and/or toxicities (including


megaloblastic anemia with other findings)
mineral deficiencies and toxicities

Temperature regulation
Adaptation to environmental extremes, including
occupational exposures

physical and associated disorders (including


temperature, radiation, burns, decreased
atmospheric pressure, high-altitude sickness,
increased water pressure)
chemical (including gases, vapors, smoke
inhalation, agricultural hazards, organic solvents,
heavy metals, principles of poisoning and
therapy)

Fluid, electrolyte, and acid-base balance disorders


Inherited metabolic disorders, including disorders
related to amino acids, purines, porphyrins,
carnitine, fatty acids, and carbohydrates

PHARMACODYNAMIC AND PHARMACOKINETIC PROCESSES


pharmacokinetics: absorption, distribution,
General principles
metabolism, excretion, dosage intervals
mechanisms of drug action, structure-activity
relationships (including anticancer drugs)
concentration- and dose-effect relationships,
types of agonists and antagonists and their
actions
individual factors altering pharmacokinetics and

19

pharmacodynamics
mechanisms of drug adverse effects, overdosage,
toxicology
mechanisms of drug interactions
regulatory issues
signal transduction, including structure/function
of all components of signal transduction pathway
such as receptors, ligands
cell cycle/cell cycle regulation

MICROBIAL BIOLOGY AND INFECTION


Microbial identification and classification, including principles, microorganism identification, and
nonimmunologic lab diagnosis
Microbial identification and classification

Bacteria

Viruses

Fungi

Parasites

principles
microorganism identification

nonimmunologic lab diagnosis

structure
processes, replication, and genetics
oncogenesis
antibacterial agents

structure
processes, replication, and genetics
oncogenesis
antiviral agents

structure
processes, replication, and genetics
antifungal agents

structure
processes, replication, and genetics
antiparasitic agents

Prions
Epidemiology, outbreaks, and infection control

QUANTITATIVE METHODS
scales of measurement
Fundamental concepts of measurement
distribution, central tendency, variability,
probability
disease prevalence and incidence
disease outcomes
associations
health impact
sensitivity, specificity, predictive values
Fundamental concepts of study design
types of experimental studies

types of observational studies

20

Fundamental concepts of hypothesis testing and


statistical interference

sampling and sample size


subject selection and exposure allocation
outcome assessment
internal and external validity

confidence intervals
statistical significance and Type I error
statistical power and Type II error

For all systems:


Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including
psychosocial, cultural, occupational, and environmental
emotional and behavioral factors
influence on person, family, and society
occupational and other environmental risk factors
gender and ethnic factors

21

HEMATOPOIETIC AND LYMPHORETICULAR SYSTEMS


Normal processes
embryonic development, fetal maturation, and perinatal changes
organ structure and function
cell/tissue structure and function
o production and function of erythrocytes, hemoglobin, O2 and CO2 transport, transport proteins
o production and function of platelets
o production and function of coagulation and fibrinolytic factors
repair, regeneration, and changes associated with stage of life
Abnormal processes
infectious, inflammatory, and immunologic disorders
o infections of the blood, reticuloendothelial system, and endothelial cells
o autoimmunity and autoimmune diseases
o anemia of chronic disease
o non-immunologically mediated transfusion complications, transplant rejection
traumatic and mechanical injury
neoplastic disorders (including lymphoma, leukemia, multiple myeloma, dysproteinemias, amyloidosis)
metabolic and regulatory disorders, including acquired
o nutritional anemias
o cythemia
o hemorrhagic and hemostatic disorders
o bleeding secondary to platelet disorders and disorders of primary hemostasis
vascular and endothelial disorders
systemic disorders affecting the hematopoietic and lymphoreticular system
idiopathic disorders
degenerative disorders
drug-induced adverse effects on the hematopoietic and lymphoreticular systems
congenital and genetic disorders affecting the hematopoietic and lymphoreticular systems
Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the hematopoietic system
o blood and blood products
o treatment of anemia, drugs stimulating erythrocyte production
o drugs stimulating leukocyte production
o anticoagulants, thrombolytic drugs
o antiplatelet drugs
o antimicrobials and antiparasitics
o antineoplastic and immunosuppressive drugs in the clinical context of disease
other therapeutic modalities

22

CENTRAL AND PERIPHERAL NERVOUS SYSTEMS


Normal processes
embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives, cerebral ventricles,
neural crest derivatives
organ structure and function
o spinal cord, including gross anatomy, blood supply, and spinal reflexes
o brain stem
o brain, including gross anatomy and blood supply; cognition, language, memory; hypothalamic function; limbic system
and emotional behavior; circadian rhythms and sleep; control of eye movement
o sensory systems, including proprioception, pain, vision, hearing, balance, taste, and olfaction
o motor systems, including brain and spinal cord, basal ganglia, and cerebellum
o autonomic nervous system
o peripheral nerve
cell/tissue structure and function
o axonal transport
o excitable properties of neurons, axons and dendrites, including channels
o synthesis, storage, release, reuptake, and degradation of neurotransmitters and neuromodulators
o pre- and postsynaptic receptor interactions, trophic and growth factors
o brain metabolism
o glia, myelin
o brain homeostasis: blood-brain barrier; cerebrospinal fluid formation and flow; choroid plexus
repair, regeneration, and changes associated with stage of life, including definition of brain death
Abnormal processes
infectious, inflammatory, and immunologic disorders (including demyelinating disorders, myasthenia gravis and muscle
channelopathies, and disorders of the eye and ear)
traumatic and mechanical disorders
neoplastic disorders, including primary and metastatic
metabolic and regulatory disorders
vascular disorders
systemic disorders affecting the nervous system
idiopathic disorders affecting the nervous system
congenital and genetic disorders, including metabolic
degenerative disorders
paroxysmal disorders
disorders of special senses
psychopathologic disorders, processes, and their evaluation
o early-onset disorders
o disorders related to substance use
o schizophrenia and other psychotic disorders
o mood disorders
o anxiety disorders
o somatoform disorders
o personality disorders

23

o physical and sexual abuse of children, adults, and elders


o other disorders
drug-induced adverse effects on the central and peripheral nervous system
neurologic pain syndromes
Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the nervous system
o anesthetics
o hypnotic sedatives
o psychopharmacologic agents
o anticonvulsants
o analgesics
o stimulants, amphetamines
o antiparkinsonian drugs and drugs for dementia, Alzheimer type; multiple sclerosis; and restless legs syndrome
o skeletal muscle relaxants, botulinum toxin
o neuromuscular junction agonists and antagonists
o antiglaucoma drugs
o drugs used to decrease intracranial pressure
o antimigraine agents
o drugs affecting the autonomic nervous system, including all general autonomic pharmacology
o antimicrobials, antineoplastic drugs, and antiparasitics
o drugs used to treat cerebrovascular disorders
o treatment for substance abuse disorders
other therapeutic modalities

24

SKIN AND RELATED CONNECTIVE TISSUE


Normal processes
embryonic development, fetal maturation, and perinatal changes
organ structure and function
cell/tissue structure and function, including barrier functions, thermal regulation, eccrine function
repair, regeneration, and changes associated with stage of life or ethnicity
skin defense mechanisms and normal flora
Abnormal processes
infectious, inflammatory, and immunologic disorders
o bacterial infections
o viral infections
o fungal infections, including mycoses, dermatophytosis
o parasitic infections, ectoparasitic infestations, and mycobacterial infections
o immune and autoimmune disorders
traumatic and mechanical disorders (including thermal injury, decubitus ulcers, effects of ultraviolet light and radiation)
neoplastic disorders
o keratinocytes
o melanocytes
o vascular neoplasms
o other
metabolic, regulatory, and structural disorders
vascular disorders
systemic disorders affecting the skin
idiopathic disorders
degenerative disorders
drug-induced adverse effects on the skin and related connective tissue
congenital and genetic disorders affecting the skin and related connective tissue
Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the skin and connective tissue
o anti-inflammatory agents
o emollients
o sunscreen
o retinoids
o antimicrobial and antiparasitic agents
o cytotoxic and immunologic therapy and antineoplastic drugs
other therapeutic modalities

25

MUSCULOSKELETAL SYSTEM
Normal processes
embryonic development, fetal maturation, and perinatal changes
organ structure and function
cell/tissue structure and function
o biology of bones, joints, tendons, skeletal muscle
o exercise and physical conditioning
repair, regeneration, and changes associated with stage of life
Abnormal processes
infectious, inflammatory, and immunologic disorders
traumatic and mechanical disorders (including fractures, sprains, strains, dislocations, joint injuries, repetitive motion
injuries, and impingement syndrome)
neoplastic disorders
metabolic, regulatory, and structural disorders (including osteomalacia, osteoporosis, osteodystrophy, gout, and
pseudogout)
vascular disorders
systemic disorders affecting the musculoskeletal system
idiopathic disorders
degenerative disorders
drug-induced adverse effects on the musculoskeletal system
congenital and genetic disorders affecting the musculoskeletal system
Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the musculoskeletal system
o nonsteroidal anti-inflammatory drugs and analgesics
o muscle relaxants
o antigout therapy
o immunosuppressive and antineoplastic drugs
o drugs affecting bone mineralization
o antimicrobial and antiparasitic agents
other therapeutic modalities

26

RESPIRATORY SYSTEM
Normal processes
embryonic development, fetal maturation, and perinatal changes
organ structure and function
o airways, including mechanics and regulation of breathing
o lung parenchyma, including ventilation, perfusion, gas exchange
o pleura
o nasopharyx and sinuses
cell/tissue structure and function, including surfactant formation, alveolar structure
repair, regeneration, and changes associated with stage of life
pulmonary defense mechanisms and normal flora
Abnormal processes
infectious, inflammatory, and immunologic disorders
o infectious diseases
infectious diseases of the upper respiratory tract
pyogenic infectious diseases of the lower respiratory tract and pleura, viral infections, and associated
complications
other infectious diseases of the lower respiratory tract
o immunologic disorders
allergic and hypersensitivity disorders
autoimmune disorders
o inflammatory disorders
pneumoconioses
acute and chronic alveolar injury
chronic obstructive pulmonary disease
restrictive pulmonary disease
traumatic and mechanical disorders
neoplastic disorders (including upper airway, lower airway and lung parenchyma, pleura, and metastatic tumors)
metabolic, regulatory, and structural disorders
vascular and circulatory disorders (including thromboembolic disease, pulmonary hypertension, pulmonary edema, and
pleural effusion)
systemic disorders affecting the respiratory system
idiopathic and degenerative disorders
drug-induced adverse effects on the respiratory system
congenital and genetic disorders affecting the respiratory system
Principles of therapeutics
mechanisms of action and use of drugs for
treatment of disorders of the respiratory system
o decongestants, cough suppressants,
expectorants, mucolytics
o bronchodilator drugs
o anti-inflammatory and cytotoxic drugs

o antimicrobial agents and antiparasitic agents


o antineoplastic agents
o pulmonary vasodilators
other therapeutic modalities

27

CARDIOVASCULAR SYSTEM
Normal processes
embryonic development, fetal maturation, and perinatal changes
organ structure and function
o chambers, valves
o cardiac cycle, mechanics, heart sounds, cardiac conduction
o hemodynamics, including systemic, pulmonary, coronary, and blood volume
o circulation in specific vascular beds
cell/tissue structure and function
o heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function
o endothelium and secretory function, vascular smooth muscle, microcirculation, and lymph flow (including
mechanisms of atherosclerosis)
o neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change
in posture, exercise, and tissue metabolism
repair, regeneration, and changes associated with stage of life
Abnormal processes
infectious, inflammatory, and immunologic disorders
traumatic and mechanical disorders
neoplastic disorders
metabolic and regulatory disorders (including dysrhythmias, systolic and diastolic dysfunction, low- and highoutput heart failure, cor pulmonale, systemic hypertension, ischemic heart disease, myocardial infarction, systemic
hypotension and shock, and dyslipidemias)
vascular disorders
systemic diseases affecting the cardiovascular system
congenital and genetic disorders of the heart and central vessels
idiopathic disorders
drug-induced adverse effects on the cardiovascular system
degenerative disorders

Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the cardiovascular system
o coronary and peripheral vasodilators
o antiarrhythmic drugs
o antihypertensive drugs
o measures used to combat hypotension and shock
o drugs affecting cholesterol and lipid metabolism
o drugs affecting blood coagulation, thrombolytic agents, and antiplatelet agents
o inotropic agents and treatment of heart failure
o immunosuppressive, antimicrobial, antineoplastic, and antiparasitic drugs
o drugs to treat peripheral arterial disease
o other pharmacotherapy
other therapeutic modalities

28

GASTROINTESTINAL SYSTEM

Normal processes
embryonic development, fetal maturation, and perinatal changes
organ structure and function, including alimentary canal, liver and biliary system, salivary glands and exocrine
pancreas, motility, and digestion and absorption
cell/tissue structure and function
o endocrine and neural regulatory functions, including GI hormones
o salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins, bile salts, and
processes
o synthetic and metabolic functions of hepatocytes
repair, regeneration, and changes associated with stage of life
gastrointestinal defense mechanisms and normal flora
Abnormal processes
infectious, inflammatory, and immunologic disorders
traumatic and mechanical disorders
o malocclusion
o hiatal hernia
o obstruction
o perforation of hollow viscus and blunt trauma
o inguinal, femoral, and abdominal wall hernias
o esophageal, intestinal, and colonic diverticula
neoplastic disorders, including benign and malignant
metabolic and regulatory disorders (including motility disorders, malabsorption, hepatic failure,
cholelithiasis, nutritional disorders)
vascular disorders (including portal hypertension, esophageal varices, hemorrhoids, anal fissure, ischemia,
angiodysplasia, thromboses, vasculitis)
systemic disorders affecting the gastrointestinal system
idiopathic disorders
degenerative disorders
drug-induced adverse effects on the gastrointestinal system
congenital and genetic disorders affecting the gastrointestinal system
Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the gastrointestinal system
o treatment and prophylaxis of peptic ulcer disease and gastroesophageal reflux
o drugs to alter gastrointestinal motility
o fluid replacement
o pancreatic replacement therapy and treatment of pancreatitis
o drugs for treatment of hepatic failure and biliary disease
o anti-inflammatory, immunosuppressive, antineoplastic, antimicrobial, and antiparasitic drugs
other therapeutic modalities

29

RENAL/URINARY SYSTEM
Normal processes
embryonic development, fetal maturation, and perinatal changes
organ structure and function
o kidneys, ureters, bladder, urethra
o glomerular filtration and hemodynamics
o tubular reabsorption and secretion, including transport processes and proteins
o urinary concentration and dilution
o renal mechanisms in acid-base balance
o renal mechanisms in body fluid homeostasis
o micturition
cell/tissue structure and function, including renal metabolism and oxygen consumption, hormones produced by or
acting on the kidney
repair, regeneration, and changes associated with stage of life
Abnormal processes
infectious, inflammatory, and immunologic disorders
o infectious disorders
upper urinary tract
lower urinary tract
o inflammatory and immunologic disorders
glomerular disorders
tubular interstitial disease
traumatic and mechanical disorders
neoplastic disorders, including primary and metastases
metabolic and regulatory disorders
o renal failure, acute and chronic
o tubular and collecting duct disorders
o renal calculi
vascular disorders
systemic diseases affecting the renal system
idiopathic disorders
degenerative disorders
drug-induced adverse effects on the renal/urinary system
congenital and genetic disorders affecting the renal/urinary system
Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the renal and urinary system
o diuretics, antidiuretic drugs
o drugs and fluids used to treat volume, electrolyte, and acid-base disorders
o drugs used to enhance renal perfusion
o anti-inflammatory, antimicrobial, immunosuppressive, antineoplastic, and antiparasitic drugs
o drugs used to treat lower urinary tract system
other therapeutic modalities

30

REPRODUCTIVE SYSTEM
Normal processes
embryonic development, fetal maturation, and perinatal changes, including gametogenesis
organ structure and function
o female structure (including breast) and function
o male structure and function
o intercourse, orgasm
o pregnancy, including ovulation, fertilization, implantation, labor and delivery, the puerperium, lactation,
gestational uterus, placenta
cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational
hormones
reproductive system defense mechanisms and normal flora
Abnormal processes
infectious, inflammatory, and immunologic
disorders (female and male)
traumatic and mechanical disorders (female and
male)
neoplastic disorders (including female
reproductive, male reproductive, breast [including
fibrocystic changes], trophoblastic disease)
metabolic and regulatory processes (female and
male)
prenatal and perinatal counseling and screening
systemic disorders affecting reproductive function

Principles of therapeutics
mechanisms of action and use of drugs for
treatment of disorders of the reproductive system
and management of normal reproductive function
o female reproductive tract
fertility drugs
oral contraception, other methods of
contraception
estrogen, progesterone replacement,
treatment of menopause
stimulants and inhibitors of labor
estrogen and progesterone antagonists
stimulators and inhibitors of lactation

disorders relating to pregnancy, the puerperium,


and the postpartum period
o obstetric problems
o complications affecting other organ systems
o disorders associated with the puerperium
o antepartum, intrapartum, postpartum
disorders of the fetus
idiopathic disorders
drug-induced adverse effects on the reproductive
system
degenerative disorders
congenital and genetic disorders affecting the
reproductive system

male reproductive tract


fertility drugs
androgen replacement and antagonists
o gonadotropin-releasing hormone and
gonadotropin replacement, including all
gonadotropin-releasing hormone antagonists
o abortifacients
o antimicrobial and antiparasitic agents
o antineoplastics
o restoration of potency
other therapeutic modalities affecting the
reproductive system
o

31

ENDOCRINE SYSTEM
Normal processes
embryonic development, fetal maturation, and perinatal changes
organ structure and function
o hypothalamus, posterior and anterior pituitary gland
o thyroid gland
o parathyroid glands
o adrenal cortex, adrenal medulla
o pancreatic islets
o ovary and testis
o adipose tissue
cell/tissue structure and function, including hormone synthesis, secretion, action, and metabolism
o peptide hormones
o steroid hormones, including vitamin D
o thyroid hormones
o catecholamine hormones
o renin-angiotensin system
repair, regeneration, and changes associated with stage of life
Abnormal processes
infectious, inflammatory, and immunologic disorders
traumatic and mechanical disorders
neoplastic disorders (including pituitary, thyroid, parathyroid, adrenal cortex, pancreatic islets, neural crest,
pheochromocytoma)
metabolic and regulatory processes (including diabetes mellitus, pituitary, hypothalamus, thyroid, parathyroid, pancreatic
islet disorders, adrenal disorders)
vascular disorders
systemic disorders affecting the endocrine system
idiopathic disorders
degenerative disorders
drug-induced adverse effects on the endocrine system
congenital and genetic disorders affecting the endocrine system
Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the endocrine system
o hormones and hormone analogs
o stimulators of hormone production
o inhibitors of hormone production
o hormone antagonists
o potentiators of hormone action
o antiobesity agents
o nonhormonal therapy for endocrine disorders
o other treatment for diabetes
other treatment modalities

32

IMMUNE SYSTEM
Normal processes
development of cells of the adaptive immune response, including positive and negative selection during immune
development
structure, production, and function
o granulocytes, natural killer cells, macrophages, mast cells, dendritic cells, cell receptors
o T lymphocytes, including T-lymphocyte receptors, accessory molecules, cell activation and proliferation, cytotoxic T
lymphocytes, and memory T lymphocytes
o B lymphocytes and plasma cells, including B-lymphocyte receptors, immunoglobulins, cell activation and proliferation,
including development of antibodies and memory B lymphocytes
o structure and function of lymph nodes, host defense mechanisms, host barriers to infection, mucosal immunity
o immunogenetics
o Rh and ABO antigens, including genetics
cellular basis of the immune response and immunologic mediators
o antigen processing and presentation in the context of MHC I and MHC II molecules, including distribution of MHC I
and MHC II on different cells, mechanism of MHC I and MHC II deficiencies, and the genetics of MHC
o regulation of the adaptive immune response
o activation, function, and molecular biology of complement
o function and molecular biology of cytokines
basis of immunologic diagnosis
Abnormal processes
disorders with alterations in immunologic function
o abnormalities in adaptive immune responses
o deficiencies of phagocytic cells and natural killer cells
o complement deficiency
o HIV infection/AIDS
o Non-HIV infections of lymphocytes
o systemic diseases of immunologic function
o systemic disorders affecting the immune system and the effect of age on the function of components of the immune
system
immunologically mediated disorders
o type I, type II, type III hypersensitivity
o type IV hypersensitivity
o transplantation risks and rejection, including transfusion reactions
o isoimmunization, hemolytic disease of the newborn
drug-induced adverse effects on the immune system, including Jarisch-Herxheimer
Principles of therapeutics
mechanisms of action and use of drugs that
specifically affect immune function
o vaccines (active and passive)
o antiretrovirals

immunomodulating and antineoplastic drugs


biologics, including monoclonal and polyclonal
antibodies
other therapeutic modalities

o
o

33

APPENDIX B: 28-DAY SAMPLE STUDY SCHEDULE FROM TULANE

Day 1
Objective

General Overview & Begin


Biochemistry
Assignments

Source

Details

Complete sample test


materials for NBME
General overview of Read Through Section
material to be covered Introductory Material from
First Aid, and Skim Section II
Basic Metabolism
Chapters 5 & 6, and sample
questions at end of each
chapter. Bookmark figure 6.2
and refer to it before studying
each biochemical pathway.

Download from
www.nbme.org
First Aid

Complete 150 sample questions, and note trouble 3 hrs


areas to focus on.
Learn about the test, and how to best use First 4 hrs
Aid as a resource.

Lippincotts
Biochemistry

Understand the role of ATP. Know where the


2.5 hrs
electron transport chain and oxidative
phosphorylation occur and how they fit into the
overall metabolic scheme. Review the main
classes of cell receptors and signaling mechanisms.

Objective
Structure &
Metabolism of
Carbohydrates

Details
Review the digestion of sugars and disorders of
fructose, galactose, and lactose metabolism.
Spend more time on glycogen metabolism, its
regulation, and related disorders. Use Figure 13.7
to memorize the glycogen storage disease
Know the start and end points, hormonal
regulation. Energy yield and various fates of
pyruvate.
Study it by comparison to glycolysis. Know the
reactions & regulation unique to gluconeogenesis.
Focus on start and end points, place in overall
metabolism, and regulation.
Shim reactions an focus on G6PD deficiency

Self-Assessment

Day 2

Continue Biochemistry
Assignments
Chapters 11, 12, 13 &
questions

Source
Lippincotts
Biochemistry

Glycolysis

Chapter 7 & questions

Lippincotts
Biochemistry

Gluconeogenesis

Hexose
Monophosphate

Chapter 8 & questions, Review Lippincotts


Figure 6.2 again!
Biochemistry
Chapter 9 & questions
Lippincotts
Biochemistry
Chapter 10 & questions
Lippincotts
Biochemistry

Objective
Lipid Metabolism

Assignments
Chapter 17 & questions

Source
Lippincotts
Biochemistry

Skim Chapters 18, 19

Lippincotts
Biochemistry

Citric Acid Cycle

Day 3

Phospholipids
&Glycolipids

Continue Biochemistry

Cholesterol & Steroid Chapter 20, Sect. I VII


Metabolism

Lippincotts
Biochemistry

Steroid Hormones

Chapter 20, Sect. VII

Lippincotts
Biochemistry

Day 4

Continue Biochemistry

Objective
Protein & Enzymes

Assignments
Chapter 1-4 & questions

Digestion of Dietary Chapter 21


Proteins and Nitrogen

Source
Lippincotts
Biochemistry

Lippincotts
Biochemistry

Est. Time

Est. Time
3 hrs

1.5 hrs
1 hr
1 hr
1 hr

Details
Est. Time
Focus on roles of pancreatic lipase and bile salts. 3 hrs
Fatty acid metabolism: know where synthesis
occurs, relationship to glucose metabolism, and
role of triacylglycerols for storage of fatty acids.
Review mobilization of and oxidation of fatty
acids. Finally, carefully review eicosanoids,
focusing on figure 17.20
Gain senses of what these are, but do not
1 hr
memorize structure of pathways. Focus on related
disorders instead, using figures 18.10, 19.4
Review Cholesterol synthesis (esp. the role of
2 hrs
HMG CoA reductase) and its regulation.
Understand synthesis and role of bile salts.
Review biology of lipoproteins and their role in
atherogenesis. Key figure are 20.12, 20.14, 20.16
Know the major enzymes deficiencies in steroid 1 hr
synthesis and know where steroid receptors act
in the cell. Study figures 20.19, 20.20
Details
Est. Time
Become familiar with basic properties of amino 4 hrs
acids, levels of protein structure, hemoglobin, and
collagen. For enzymes, focus on appreciating (not
memorizing) the Michaelis-Menten equation, types
of enzyme in clinical diagnosis.
Learn the various pancreatic proteases and how 2 hrs
they are regulated. Understand transamination

Metabolism of Amino Chapter 22


Acid Carbon Skeletons

Lippincotts
Biochemistry

and oxidative deamination, but dont memorize


Pathways. Spend more time on urea cycle and
ammonia metabolism focus on figures 21.4, 21.11,
21.17
Emphasize relevant disorders. Focus on figures 1 hr
22.2, 22.16

Objective
Assignments
Heme, Porphyrins,
Chapter 23
Serotonin, Histamine
and Catholamines
Gylcosaminglycans and Skim Chapter 14, 15
Glycoproteins

Source
Lippincotts
Biochemistry

Details
Est. Time
Focus on the porphyrias and bilirubin metabolism. 1 hr
Focus on figures 23.5 and 23.7

Lippincotts
Biochemistry

Nutrition and Vitamins Chapter 27, 28

Lippincotts
Biochemistry

Nucleotide Metabolism Chapter 29

Lippincotts
Biochemistry

Know what they are and know the related


1 hr
disorders. Dont get too bogged down in details
just study figures 14.12 and 15.14, then move
on.
Know the daily energy requirements and vitamin 3 hrs
deficiencies. Focus on absorption of vitamin B12
and pernicious anemia, as well as vitamin D.
Focus on figures 28.12, and 28.18
Understand differences between de novo and
2 hrs
salvage purine synthesis. Study purine
degradation and the Pathophysiology of gout and
ADA deficiency. Study figures 29.7, 29.9,29.10

Day 5

Continue Biochemistry

Day 6

Finish Biochemistry

Day 7

General Pharmacology

Objective
Ingrative Metabolism

Source
Lippincotts
Biochemistry

Details
Est. Time
Synthesize the information youve reviewed this 5 hrs
week by studying insulin, glucagon, the fed/starved
states, and the metabolic aspects of diabetes
mellitus. Time spent on these topics will be VERY
WORTHWHILE

Assignments
Chapter 1, 2

Source
Lippincotts
Biochemistry

Autonomic Drugs

Chapters 3 7

Lippincotts
Biochemistry

Details
Est. Time
Study general principles of pharmacology. Specific 2 hrs
agents will be covered with relevant organ
systems.
Know different types of adrenergic and
5 hrs
cholinergic receptors cold. Study figures 3.3, 3.6,
4.2, 5.2, 6.15, and 7.10.

Day 8

Begin Microbiology

Objective
Bacteria

Assignments
Chapter 1 15

Day 9

Continue Microbiology

Objective
Antibiotics

Assignments
Chapter 28 33

Fungi

Chapter 20

Antifungal

Chapter 34

Day 10

Finish Microbiology

Objective
Pharmacokinetics &
Pharmacodynamics

Assignments
Chapters 24, 25, & 26

Source
Clinical
Microbiology made
Ridiculously Simple

Source
Lippincotts
Pharmacology

Details
Est. Time
Rely heavily on charts. Start building buzzword
10 hrs
associations with characteristics of each organism
and how is identified (with a special stain, culture
medium, etc.) Also, time spent with Qbank
questions here will be golden

Details
This is high yield material, read, review and
continue to do Qbank questions to keep building
buzzword associations.
Clinical
This is high yield material, read, review and
Microbiology made continue to do Qbank questions to keep building
Ridiculously Simple buzzword associations.
Lippincotts
This is high yield material, read, review and
Pharmacology
continue to do Qbank questions to keep building
buzzword associations.

Est. Time
6 hrs

1.5hr

1 hr

Objective
Viruses

Assignments
Chapter 22-29

Antiviral

Chapter 37

Parasites

Chapter 30, 31

Antiparasites

Chapter 35, 36

Clinical Vignettes

Source
Details
Est. Time
Clinical
This is high yield material, read, review and
6 hrs
Microbiology made continue to do Qbank questions to keep building
Ridiculously Simple buzzword associations
Lippincotts
Review antiviral agents, particularly mechanisms of 1 hr
Pharmacology
action.
Clinical
This is high yield material, read, review and
2 hrs
Microbiology made continue to do Qbank questions to keep building
Ridiculously Simple buzzword associations
Lippincotts
Review antiprotozoal and antihelminthic agent,
1 hr
Pharmacology
particularly multi-drug regimens
Underground
Good for group study and another way to keep 3 hrs
Clinical Vignettes sharpening buzzword recall.
Microbiology

Day 11

Immunology & General


Pathology

Objective
Review Immunology

Assignments
Part VII

Cellular injury

Chapter 1

Source
Medical
Microbiology &
Immunology:
Examination and
Board Review
BRS Pathology

Inflammation

Chapter 2

BRS Pathology

Hemostasis

Chapter 3

BRS Pathology

Genetic Disorders
Immune Dysfunction

Chapter 4
Chapter 5

BRS Pathology
BRS Pathology

Neoplasia

Chapter 6

BRS Pathology

Environmental
Chapter 7
Pathology
Nutritional Disorders Chapter 8

BRS Pathology

Day 12

BRS Pathology

Details
Excellent, concise summary of immunology

Est. Time
4 hrs

Focus on mechanisms of cellular injury and


0.5 hr
differences between necrosis & apoptosis
Distinguish mechanisms and histological
1 hr
characteristics of acute vs. chronic inflammation
Know coagulation cascade, types of embolism, and 1 hr
types of shock.
0.5 hr
Focus on immune deficiency disorders,
0.5 hr
autoimmunity, and collagen vascular disease
Distinguish between tumor suppressor genes & 1 hr
oncogenes, know mechanisms of carcinogenesis,
and the properties of malignant cells.
Quickly review
0.5 hr
Review vitamin deficiencies to refresh biochem
memory

0.5 hr

Cellular Biology

Objective
Assignments
DNA, RNA, Proteins Chapter 30 33

Source
Lippincotts
Biochemistry

Details
Est. Time
Know mechanisms of DNA repair, different
3.5 hrs
types/roles of RNA, mechanism of translation, and
molecular biology techniques. Focus on figure
30.2, 30.16, 30.19, 30.22,31.11, 32.9
BRS Cell Biology & Know properties of membranes and membrane 1 hr
Histology
proteins

Cell Membranes

Chapter 1

Nucleus

Chapter 2

BRS Cell Biology & Know contents of nuclei, and RNA import/export 0.5 hr
Histology
mechanisms.

Cytoplasm

Chapter 3

BRS Cell Biology & Review organelles and function


Histology

0.5 hr

Extracellular Matrix

Chapter 4

BRS Cell Biology & Know different types of collagen, basement


Histology
membrane composition, and other ECM
components.
BRS Cell Biology & Review types of epithelia and locations of each.
Histology
Review connective tissue focusing on bone
histology

1 hr

Objective
Cell Physiology

Cellular Physiology &


General Embryology
Assignments
Chapter 1

Source
BRS Physiology

Est. Time
1 hr

Embryology

Chapter 1-4

BRS Embryology

Birth Defects

Chapter 17, 18

BRS Embryology

Exam

Diagnostic Test

Board Simulator
Series Body
Systems Review

Good opportunity to identify weakness in organ


system areas.

2 hrs

Day 14

Thorax
Source
BRS Embryology

Details
Know the congenital cardiac abnormalities, and
fetal circulation. Also understand the stages of
fetal lung maturation.

Est. Time
3.5 hrs

Epithelia & Connective Chapter 5,6


Tissue
Day 13

Objective
Assignments
Embryology of thorax Chapter 5, 11

Thoracic Anatomy
Histology of thoracic
viscera

Details
Know mechanisms of ion transport, action
potentials.
Know stages from zygote through embryo.
Review 3 Germ cell layers and their derivative
tissues.

Cardiovascular System

Objective
Cardiovascular
Physiology

Assignments
Chapter 3

Source
BRS Physiology

Cardiac Pathology
Vascular Pathology
Cardiovascular
Pharmacology

Chapter 10
Chapter 9
Chapter 1619 , 21

BRS Pathology
BRS Pathology
Lippincotts
Pharmacology

Day 16

Respiratory System &


Begin Hematology

Objective
Assignments
Respiratory Physiology Chapter 4

Source
BRS Physiology

Respiratory Pathology Chapter 14

BRS Pathology

Respiratory
Pharmacology
Clinical Vignettes

Lippincotts
Pharmacology
Underground

Chapter 22
Volume 1: Cases 1-19,

3 hrs

1.5 hrs

Chapter 12
(Also use
High Yield Gross
Netters Atlas for reference ) Anatomy
Chapters 11, 15
BRS Cell Biology & Be able to distinguish arteries and veins in cross
Histology
section. Understand architecture of the gas
diffusion barrier in the lungs.

Day 15

1.5 hrs

3 hrs
1 hr

Details
Est. Time
Review hemodynamic, electrophysiology, cardiac 1.5 hrs
cycle, blood pressure regulation, response to
exercise, volume loss, and altitude. Understand
pre-load, after-load, Frank-Starling curve and
condition.
Study this chapter thoroughly
1.5 hrs
Study this chapter thoroughly
1 hr
Know drugs used to treat CH, HTN, arrhythmias, 5 hrs
angina, and hyperlipidemia

Details
Know varies lung volume measurements, and
understand acid base disorders.
Study this chapter thoroughly

Est. Time
1.5 hrs
1.5 hrs
0.5 hr

Good opportunity for group review

2 hrs

Volume 2: Cases 52-66

Clinical Vignettes
Patho-physiology
BRS Cell Biology & Familiarize yourself with lymph nodes architecture 3 hrs
Histology
and understand the spleen. Understand RBC,
WBC, platelet

Histology of Bone
Marrow, Spleen, &
Lymph Nodes

Chapters 10, 12 (and a


histological atlas for further
review

Day 17

Finish Hematology

Objective
Anemia

Assignments
Chapter 11

Source
BRS Pathology

Hematopoietic &
Lymph reticular
Neoplasia
Hemorrhagic
Disorders
Drugs affecting
coagulation
Anticancer Drugs

Chapter 12

BRS Pathology

Chapter 13

BRS Pathology

Chapter 20

Clinical Vignettes

Volume 1: Cases 74-102

Lippincotts
Pharmacology
Lippincotts
Pharmacology
Underground
Clinical Vignettes
Patho-physiology

Day 18

Gastrointestinal System

Chapter 38

Details
Est. Time
Know Patho physiology and lab differentiation of 2 hrs
various etiologies of anemia
Distinguish between leukemia & lymphoma.
2 hrs
Understand different types of each.
Know how to diagnose and correct each
disorder.

1 hr
1.5 hrs
1.5 hrs
2 hrs

Objective
Assignments
Embryology of Gut and Chapters 10, 16
Body Cavities

Source
BRS Embryology

Abdominal Anatomy

High Yield Gross


Anatomy
BRS Cell Biology & Know layers of gut wall. Understand liver
1.5 hrs
Histology
structure, portal blood flow, and bile flow
BRS Physiology
Understand innervations of gut and gut hormones 1 hr

Chapter 3 (Also refer to


Netters atlas)
Histology of GI Tract Chapter 6

Details
Est. Time
Understand rotation of gut and related
1.5 hrs
malformations. Know which structures are
derived of foregut, midgut, hindgut, in addition to
vascular supplies.
2 hrs

GI Physiology

Chapter 6

Day 19

Gastrointestinal System

Objective
Gastrointestinal
Pathology
Hepatobiliary and
Exocrine Pancreatic
GI Pharmacology

Assignments
Chapter 15

Source
BRS Pathology

Details
Study this chapter thoroughly

Est. Time
2 hrs

Chapter 16

BRS Pathology

Study this chapter thoroughly

2 hrs

Chapter 24

2 hrs

Clinical Vignettes

Volume 1: Cases 40-73

Lippincotts
Know GI drugs as well as antiemetic
Pharmacology
Underground
Good opportunity for group review
Clinical Vignettes
Patho-physiology

Day 20

Genitourinary System

Objective
Embryology of GU

Assignments
Chapter 6, 13, 14

Source
BRS Embryology

Est. Time
3 hrs

Anatomy of Pelvis and Chapters 4, 5


Perineum
Histology of GU

Chapter 18, 19, 20

High Yield Gross


Anatomy

Details

2 hrs

Know the maturation sequence of spermatocytes 3 hrs


and ovarian follicles. Know the anatomy of the
nephron.
BRS Cell Biology & Know the maturation sequence of spermatocytes 3 hrs

Organs

Histology

and ovarian follicles. Know the anatomy of the


nephron.
Details

Day 21

Endocrine System

Objective
Renal Physiology

Assignments
Chapter 5

Source
BRS Physiology

Diuretics

Chapter 23

Renal & Urinary Tract


Pathology
Male Reproductive
Pathology
Female Reproductive
Pathology
Clinical Vignettes

Chapter 17

Lippincotts
Pharmacology
BRS Pathology

Chapter 18

BRS Pathology

Chapter 19

BRS Pathology

Volume 2: Cases 30-51, and


83-103

Underground
Good opportunity for group review
Clinical Vignettes
Patho-physiology

Day 22

Endocrine System

Objective
Assignments
Histology of Endocrine Chapter 13
System
Physiology
Chapter 7

Source
BRS Embryology

Insulin and oral


hypoglycemic

Chapter 26

Lippincotts
Pharmacology

Steroid Hormones

Chapter 27

Clinical Vignettes

Volume 1: Cases 25-38

EXAM

Body System III Test 1

Lippincotts
Pharmacology
Underground
Clinical VignettesPatho-physiology
Board Simulator
Series-Body
Systems Review

Day 23

Nervous System

Objective
Assignments
Embryology of Head Chapter 7, 8, 9, 10
Neck, & Nervous
System
Head & Neck Anatomy Chapter 8 (also refer to
Netter)
Neuroanatomy
Chapter 1-23

BRS Physiology

Source
BRS Embryology

High Yield Gross


Anatomy
High Yield
Neuroanatomy

Day 24

Nervous System

Objective
Neurophysiology

Assignments
Chapter 2

Source
BRS Physiology

Neuropathology

Chapter 23

BRS Pathology

Clinical Vignettes

Volume 2: Cases 45-61,


Anatomy Cases 40-56.

Underground
Clinical VignettesPatho-physiology

Est. Time
1.5 hrs
1.5 hrs

Study this chapter thoroughly

1.5 hrs

Know the different types of testicular cancer, and 1 hr


the biology of BPH and prostate cancer
Understand cervical, uterine cancer
1.5 hrs
2 hrs

Details
Est. Time
Review structure of endocrine organ, and use an 1 hr
atlas for additional pictures.
Know hormonal axes
2.5 hrs
Know different types of insulin and their half-lives. 1.5 hrs
Know classes of oral hypoglycemic and side
effects.
1 hr
Good opportunity of group review

2 hrs

Tough questions, but great explanations. Well


1.5 hrs
worth the time to push yourself a bit and solidify
the material youve learned.
Details
Est. Time
Know bronchial arches/clefts and their derivatives. 3 hrs.
Understand the transition from neural plate to
mature CNS. Know fate of neural crest cells.
2 hrs
6 hrs

Details
Understand Synaptic transmission and axonal
conduction
Know types of CNS infection, tumors, and
vascular disorders.
Good opportunity of group review.

Est. Time
2 hrs
2 hrs
2 hrs

Neuropharmacology

Chapters 8,10, 11, 14, 15

Lippincotts
Pharmacology

Review drugs used to treat epilepsy, Parkinsons. 3.5 hrs


Also review anesthetics and analgesics.

Day 25

Musculoskeletal System

Objective
Embryology

Assignments
Chapter 15

Source
BRS Embryology

Details

Anatomy of Limbs and


Back
Histology
Anti-inflammatory
Agents and Autacoids

Chapters 1, 6, 7 (also use


Netter)
Chapter 7, 8, 10
Chapters 39, 40

High Yield
Anatomy

Day 26

Musculoskeletal System

Objective
Dermatologic
Pathology

Assignments
Chapter 21

Source
BRS Pathology

Musculoskeletal
Pathology
Clinical Vignettes

Chapter 22

BRS Pathology

Exam

Body Systems II Test I

Day 27

Behavioral Science &


Biostatistics

Objective
Clinical Vignettes

Assignments
All cases

Source
Details
Underground
Clinical VignettesBehavioral Science

Est. Time
3 hrs

Psychotropic Drugs

Chapter 9-12, 13

3 hrs

Biostatistics

Read entire book

Lippincotts
Pharmacology
High Yield
Biostatics

Day 28

Final Review & Exam


Logistics

Final Review
Exam Logistics

3.5 hrs
2 hrs
2 hrs

Lippincotts
Pharmacology
Details
Focus on malignancies (melanoma, SCC, BCC)
and refer to a dermatology atlas so that you can
differentiate between them.

Est. Time
1.5 hrs

1.5 hrs

Volume 3: Cases 9-18, and 96- Underground


Good opportunity of group review.
104. Also Anatomy: Cases
Clinical Vignettes62- 84
Patho-physiology
Board Simulator
Series-Body
Systems Review

Est. Time
1 hr

2.5 hrs

Touch questions, but great explanations. Well


2 hrs
worth the time to push yourself a bit and solidify
the material youve learned.

Understand sensitivity, specificity, PPV, NPV. Be 4 hrs


prepared to calculate risk, odds ratio, etc.

Review Any Remaining Topics and finish practice 4 hrs


questions
Prepare exam bag-with ID, ticket, directions to
center, lunch.

Rest & Relax

NOTE: This is a sample schedule only, and is meant to serve as a framework for you to build your own
individualized study plan. Chapter and case numbers may differ based on the edition of the books you are using. If you
need assistance preparing a study schedule, please contact the Office of Medical Education.

APPENDIX C: 5-MONTH SAMPLE STUDY SCHEDULE


(LATE APRIL TEST DATE)

Time Frame

Content Topic to Review

Pages in First Aid

November: Begin studying during Thanksgiving break


December
Week 1

Heme/Onc & Pulmonary

46 pages

Week 2

Cardio & Immunology

52 pages

Week 3

Renal

30 pages

Week 4

Biochemistry

52 pages

Week 5

Microbiology

60 pages

Week 1

Microbiology

60 pages

Week 2

GI & Embryology

54 pages

Week 3

Path, Pharm, & Musculoskeletal

60 pages

Week 4

Neuro

44 pages

Week 5

Endo & Reproductive

42 pages

January

February Psychiatry block in progress


March
Week 1

Behavior & Psych

Week 2

Practice questions

Week 3

CBSE Exam

Week 4

Custom Shelf Exams

34 pages

This sample schedule is meant to be used as a framework for you to build your own individualized
study plan; in addition to First Aid readings, challenge yourself to complete a set number of
question bank items per week (or even per day as you get closer to the exam).
Many thanks to Taimur Khan and Ryan Roach for their assistance in creating this sample schedule.

APPENDIX D: TULANE STUDENT USMLE STEP 1 OWL CLUB SURVEY


RESULTS

Score

Questions Completed Vs. Score

270
260
250
240
230
220
210
200
190
180
170

1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000
Number of Questions Completed

% of time studying Qs vs. score

Series1
Linear (Series1)

270

Score

250
230
210
190
170
150

20

40

60

% of studying doing questions

80

100

2
3

0
2
1
1

Pulmonary

14
Renal

Infectious

Genetics

Microbiology

Neurology

Cardiology

Pharmacolo

Physiology

Pharmacolo

Biostatistics

Ethics

12
1

Biochemistry

Neurology

Inflammation

Biochemistry

Heme/Onc

15

Pathology

10

Anatomy

Pathology

Number of Respondents
70
60
50
40
30
20
10
0

Endocrine

Number of Respondents

Studying which subject was most beneficial


(i.e. most represented on the test)?

59

Which subject do you wish you spent more


time on?

14

10

Tulane University School of Medicine Step 1 Performance


232

231

230

230

Mean Score

228
226
224

223

222
220
218
2011

2012
Academic Year

Tulane Step 1 Pass Rates


Year

Percent Passing

2011

88%

2012

98%

2013

98%

2013