USMLEPREPLECTURESERIES

Lecture3.3

LastUpdated:February27,2019

OrganizingastudyplanforStep2

• 3to6week schedule• FulltimestudyduringadefinedperiodAFTERmajorclinicalyear

• Fewornointerruptionsorobligations• Adequatetimetocoverallthematerialanddoquestionsdaily• Dailymixofquestions,reviewsandotheractivities

• 3month schedule• Integratedduringremainingclinicalrotations

• Weekdaysarefilledwithclinicalwork

• Questionsshiftedtoheavilytotheweekends• Reviews,readingandintegrationduringtheworkweek

Traditional Weekend Intensive

Traditional:KeyTenantsofaSTRONGStudyCalendar

GetthroughUworld andyourIncorrects TWICE!– Firstpassisdetailedandsecondpassisquick/timedblocks

TakeaMINIMUMof3practicetests(NBMEs/UWSAs)

Limityourresources– DothebestfewREALLYwell.

ReviewFlashcardsEVERYDAY

First,BlockofftimefortheFirstpassofUworld,NBMEs,andPre-examReviewtime

M T W T F S S

1 2 3 4 5 6 7

NBME

Exam

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31 1 2 3 4

NBME

Exam

5 6 7 8 9 10 11

NBME

ExamTEST DAY

Review

Review

Uworld First Pass

Uworld First Pass

UWorld First Pass

Uworld First Pass

Uworld First Pass

First Pass will be DETAILED, in TUTOR MODE

reading all explanations,

considering why all wrong answers are wrong, and how the prompt would need to change to make

wrong answers right

During Review, the Second Pass through UWorldwill be in TIMED blocks simulating the REAL exam

Next,calculateAvg #ofquestions/daytofinishUworld FirstPass

Calculate Avg # Questions /day

• 31 total non NBME UW First Pass days in

• Divide the Qbank total question number

by 31.

• Example: 2271/31 = ~73-74 questions per

day on average

• Note: Question number varies by version/year, please use most updated total.

M T W T F S S

1 2 3 4 5 6 7

NBME

Exam

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31 1 2 3 4

NBME

Exam

5 6 7 8 9 10 11

NBME

ExamTEST DAY

Review

Review

Uworld First Pass

Uworld First Pass

UWorld First Pass

Uworld First Pass

Uworld First Pass

PerTopic,Calculate#ofdaysandquestionsCalculations

• Write out the number of Uworld questions per topic

• Divide the questions per topic by the average # of questions per day you need to do (i.e 73) to find the # of days needed

• Round to the nearest day.

• Calculate Actual # of questions per day by dividing questions in the topic by rounded days

Questions/day 73

TopicTotal Questions in

Topic# of days needed

RoundActual ?s Per

DayMedicine 1345 18.4 18 75Pediatrics 368 5.0 5 74Surgery 134 1.8 2 67OB/GYN 263 3.6 4 66Psychiatry 161 2.2 2 81Total 2271 31.0 31

Populateyourcalendarwiththetopics/#of?sM T W T F S S

1 2 3 4 5 6 7

NBME Exam

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31 1 2 3 4

NBME Exam

5 6 7 8 9 10 11

NBME Exam

TEST DAY

PEDS

PEDS 75q/d Surgery 67q/d

OB/GYN 66q/d

OB/GYN

Psych 81q/d

Medicine 75q/d

Medicine 75q/d

Medicine 75q/d

Review

Review

This forms the basis

for your calendar,

next we will break up

medicine into smaller

topics that you will

review via reading or

video

BreakdownMedicineintoMTB/FATopics

Use your discretion to

divide up the

chapters/videos over the

allotted days. Give extra

time for YOUR weaker

topics and less time for

YOUR stronger ones.

TRY to coordinate the

UWorld medicine

subtopics with the

reading/videos

M T W T F S S1 2 3 4 5 6 7

ENDO H/O8 9 10 11 12 13 14

Psych15 16 17 18 19 20 21

Other22 23 24 25 26 27 28

29 30 31 1 2 3 4

NBME Exam

5 6 7 8 9 10 11

NBME Exam

TEST DAY

Psych 81q/d Review

NBME Exam

Review

CVS GI

ID NEURO Pulm

Renal Rheum/Ortho

PEDS

PEDS 75q/d

Medicine 75q/d

Medicine 75q/d

Medicine 75q/d

Surgery 67q/d OB/GYN

OB/GYN 66q/d

9

HaveaDailyRoutine

•AM:ReadChapter/WatchVideo,AnnotatefromUWQuestions

•EarlyAfternoon:Uworld Q-bankQuestions.MakeFlashcards

•LateAfternoon:ReviewQbank Questions,IncorrectQsFirst

•Evening:FlashcardsEVERYNIGHT!

RemainingClinicalRotations

Ø FamilyMed:5weekendsØ Psych/Neuro:3weekends,PassoverbreakØ Surgery:9weekends,Memorial/IndependenceDay,Shavuotbreak

• ½oftheSurgerygroupismoreintensive(6a-6p)• ½oftheSurgerygroupislessintensive(7a-4p)

Takeaway:17weekends+/- 10holidays

WeekendIntensive:WeekendbolusofQs,thenreview,theretakeQs

GetthroughUworld andyourIncorrects 1.5x– 2x!TakeaMINIMUMof3practicetests(NBMEs/UWSAs)Limityourresources– DothebestfewREALLYwell.ReviewFlashcardsEVERYDAY

1. Chooseatopicoftheweek2. Day1:Doalargesetofquestions(150-200

Qs)onthetopicatthebeginningoftheweek

3. DoQ’sinintimedmode,~1minuteperquestion.

4. Thateveninganalyzethetestfortimespentonwronganswersandhowthatrelatestotheoverallperformance

5. Day2and3:makeflashcards,reviewselectedvideos

6. Day4and5:reviewflashcardsuntiltheyareextremelyfamiliarconcepts

7. Day6:Re-takeyoursubjectteststoseeyourperformance.

Same principles apply as with the standard method.

Just a different organization

Assess:• # incorrect where >50% of UWorld users

got right• # of Qs taking more than 90 sec

1-on-1Check-ins•DiscussedwithadministrationtimingandarequirementsregardingUSMLEStep2CKatBGUMSIH•Iwillmakeavailable1-on-1advisingsessionstospeakwithme

•15-20minlongstartinginMarch•Organizedfirstcomefirstserve•Discussioncanfocusongeneralorspecificadvising•ALLDISCUSSIONSARECONFIDENTIAL.Detailswillnotbesharedwithotherstudentsoradministration

•Purpose:•Tohelpyouanswerspecificorgeneralquestions•Determinefeasibilityandinterestinotherinitiatives,possiblyofferedinJune2019

Please email me at marcel@elitemedicalprep.com

Total Cost per Student

$500 = $50/hr

for

10 hoursOnline Small Group Tutoring for Step 2

Tutoring is Supplemented by Back-End Support Provided for Tutoring Students

- 24hr email-based response to questions and comments

- Private webpage for posting lectures, calendars

- Q&A forum staffed by experienced Elite Medical Prep Tutors

Group Tutoring Pricing USMLE Step2 14

Lectures at regular intervals designed to give overview and set benchmarks

5 tutoring sessions x 2 hr each

Tutoring is Supplemented by Back-End Support Provided for Tutoring Students

- 24hr email-based response to questions and comments

- Private webpage for posting lectures, calendars

- Q&A forum staffed by experienced Elite Medical Prep Tutors

Lectures at regular intervals designed to give overview and set benchmarks

5 tutoring sessions x 2 hr each

Minimum Cost per Student for 10hr

$950 = $195/hrTotal Cost per Student

$500 = $50/hr

for

10 hoursOnline Small Group Tutoring for Step 2

VS 3:1 Tutoring 1:1 Tutoring

Group Tutoring Pricing USMLE Step2 15

A 26 year old woman is brought to the emergency department by her roommate because of vomiting for 4 hours. She also has a 2 day history of fatigue and dizziness on standing. She has had severe heartburn for 3 months; treatment with over-the-counter antacids has provided some relief. The vital signs of the patient are T 35.6C (96F), pulse 110/min, and blood pressure 80/55 mm Hg. Physical examination shows marked pallor. Laboratory studies show a hemoglobin concentration of 6 g/dL and hematocrit of 18%. A chest x-ray is obtained (shown) and a pulmonary catheter is inserted and laboratory values are measured.

The patient is most likely experiencing which of the following types of shock?

A) Anaphylactic.

B) Cardiogenic.

C) Hypovolemic.

D) Neurogenic.

E) Septic.

2

3

USMLEPracticeQuestionBreakdown

1

• Thequestionstem– tellsyouwhatthequestionisasking

• Theanswerchoices– Givenyousomecontextastowhatthequestionisabout

• Theprompt– Summarizekeyinformationasit’sgiveninyourownwords;ensurethattheanswermatchesALLoftheinformationgiven,notjustsome

• Labsandimages.EVALthelabs.IGNOREtheimages.

1

2

3

4EMP’sSUGGESTEDORDER.

Thereisnoonerightwaytodothis.

4

▪ Analyzethecase.▪ Discussthecorrectanswer▪ Practicere-wordingthequestiontoaccountforotherpossibilities.▪ Brieflyreviewsomeneuro-imagingandneuroanatomy.

17

NeuroCase

A55-year-oldwomanpresentstotheERwith2daysofincreasingconfusionandheadache.Thepatientisunabletoanswerquestions.Reviewofhermedicalrecordsrevealsnopastmedicalhistory.Thepatientisuptodateonvaccinations.HervitalsignsareBP130/78,HR105,RR16,Temp100.9F.AheadCTisobtainedandshowsill-definedhypodensity inthelefttemporallobe.FollowingtheCTthepatienthasaseizure.FollowingstabilizationsheissentforMRIshowingabnormalsignalthroughoutthelefttemporallobe(imageshown).Whatisthemostlikelydiagnosis?A. Bacterialmeningitis.B. Viralencephalitis.C. Parasiticmeningoencephalitis.D. Limbicencephalitis.E. LeftMCAterritoryembolicstroke.F. Highgradeglialneoplasm.

Case courtesy of Dr Mohammad A. ElBeialy, Radiopaedia.org, rID: 32026

A55-year-oldwomanpresentstotheERwith2daysofincreasingconfusionandheadache.Thepatientisunabletoanswerquestions.Reviewofhermedicalrecordsrevealsnopastmedicalhistory.Thepatientisuptodateonvaccinations.HervitalsignsareBP130/78,HR105,RR16,Temp100.9F.AheadCTisobtainedandshowsill-definedhypodensity inthelefttemporallobe.FollowingtheCTthepatienthasaseizure.FollowingstabilizationsheissentforMRIshowingabnormalsignalthroughoutthelefttemporallobe(imageshown).Whatisthemostlikelydiagnosis?A. Bacterialmeningitis.B. Viralencephalitis.C. Parasiticmeningoencephalitis.D. Limbicencephalitis.E. LeftMCAterritoryembolicstroke.F. Highgradeglialneoplasm.

Case courtesy of Dr Mohammad A. ElBeialy, Radiopaedia.org, rID: 32026

Continuation…

20

Thepatientissentforcerebrospinalfluidcollectionviaspinaltap.AdditionallytheyarestartedonIVmedicationforasuspectedviralencephalitis.Whatdiagnostictoolismostlikelytopositivelyidentifythecausativeorganism?A. GramstainandcultureofCSFfluid.B. Anti-bodytitersofCSFfluid.C. PCRofCSFfluid.D. Bloodcultures.E. Nasalswab.F. Brainbiopsy

Case courtesy of Dr Mohammad A. ElBeialy, Radiopaedia.org, rID: 32026

Continuation…

21

Thepatientissentforcerebrospinalfluidcollectionviaspinaltap.AdditionallytheyarestartedonIVmedicationforasuspectedviralencephalitis.Whatdiagnostictoolismostlikelytopositivelyidentifythecausativeorganism?A. GramstainandcultureofCSFfluid.B. Anti-bodytitersofCSFfluid.C. PCRofCSFfluid.D. Bloodcultures.E. Nasalswab.F. Brainbiopsy

Case courtesy of Dr Mohammad A. ElBeialy, Radiopaedia.org, rID: 32026

Continuation…

22

WhilethePCRanalysisispending,whatisthenextstepinmanagementofthepatientwithsuspectedviralmeningitis?A. TreatmentwithVancomycinandLevetiracetamB. TreatmentwithCeftriaxoneandPhenytoinC. TreatmentwithAcyclovirandLevetiracetamD. TreatmentwithFoscarnet andPhenytoinE. TreatmentwithGancyclovir andLevetiracetamF. AwaitdiagnosticconfirmationfromPCR

analysispriortostartingtreatment

Case courtesy of Dr Mohammad A. ElBeialy, Radiopaedia.org, rID: 32026

Continuation…

23

WhilethePCRanalysisispending,whatisthenextstepinmanagementofthepatientwithsuspectedviralmeningitis?A. TreatmentwithVancomycinandLevetiracetamB. TreatmentwithCeftriaxoneandPhenytoinC. TreatmentwithAcyclovirandLevetiracetamD. TreatmentwithFoscarnet andPhenytoinE. TreatmentwithGancyclovir andLevetiracetamF. AwaitdiagnosticconfirmationfromPCR

analysispriortostartingtreatment

Case courtesy of Dr Mohammad A. ElBeialy, Radiopaedia.org, rID: 32026

Continuation…

24

EmpirictreatmentisstartedwithAcyclovir.However,thereisashortageofLevetiracetam atthehospitalandtheclinicalteamwillbeusingPhenytoinforseizureprophylaxis.Whichofthefollowinglaboratoryvaluesshouldbemonitoredbeforeandduringtreatmentwiththesemedications?A. CreatinineandAST/ALTB. HemoglobinandAST/ALTC. PlateletsandAST/ALTD. CreatinineandHemoglobinE. CreatinineandPlateletsF. TSHandASL/ALT

Case courtesy of Dr Mohammad A. ElBeialy, Radiopaedia.org, rID: 32026

Continuation…

25

EmpirictreatmentisstartedwithAcyclovir.However,thereisashortageofLevetiracetam atthehospitalandtheclinicalteamwillbeusingPhenytoinforseizureprophylaxis.Whichofthefollowinglaboratoryvaluesshouldbemonitoredbeforeandduringtreatmentwiththesemedications?A. CreatinineandAST/ALTB. HemoglobinandAST/ALTC. PlateletsandAST/ALTD. CreatinineandHemoglobinE. CreatinineandPlateletsF. TSHandASL/ALT

Case courtesy of Dr Mohammad A. ElBeialy, Radiopaedia.org, rID: 32026

ThankYou.