USMLE PREP LECTURE SERIES Lecture 3 · Organizing a study plan for Step 2 •3 to 6 weekschedule...
Transcript of USMLE PREP LECTURE SERIES Lecture 3 · Organizing a study plan for Step 2 •3 to 6 weekschedule...
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USMLEPREPLECTURESERIES
Lecture3.3
LastUpdated:February27,2019
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OrganizingastudyplanforStep2
• 3to6week schedule• FulltimestudyduringadefinedperiodAFTERmajorclinicalyear
• Fewornointerruptionsorobligations• Adequatetimetocoverallthematerialanddoquestionsdaily• Dailymixofquestions,reviewsandotheractivities
• 3month schedule• Integratedduringremainingclinicalrotations
• Weekdaysarefilledwithclinicalwork
• Questionsshiftedtoheavilytotheweekends• Reviews,readingandintegrationduringtheworkweek
Traditional Weekend Intensive
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Traditional:KeyTenantsofaSTRONGStudyCalendar
GetthroughUworld andyourIncorrects TWICE!– Firstpassisdetailedandsecondpassisquick/timedblocks
TakeaMINIMUMof3practicetests(NBMEs/UWSAs)
Limityourresources– DothebestfewREALLYwell.
ReviewFlashcardsEVERYDAY
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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
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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
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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
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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
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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
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9
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HaveaDailyRoutine
•AM:ReadChapter/WatchVideo,AnnotatefromUWQuestions
•EarlyAfternoon:Uworld Q-bankQuestions.MakeFlashcards
•LateAfternoon:ReviewQbank Questions,IncorrectQsFirst
•Evening:FlashcardsEVERYNIGHT!
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RemainingClinicalRotations
Ø FamilyMed:5weekendsØ Psych/Neuro:3weekends,PassoverbreakØ Surgery:9weekends,Memorial/IndependenceDay,Shavuotbreak
• ½oftheSurgerygroupismoreintensive(6a-6p)• ½oftheSurgerygroupislessintensive(7a-4p)
Takeaway:17weekends+/- 10holidays
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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
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1-on-1Check-ins•DiscussedwithadministrationtimingandarequirementsregardingUSMLEStep2CKatBGUMSIH•Iwillmakeavailable1-on-1advisingsessionstospeakwithme
•15-20minlongstartinginMarch•Organizedfirstcomefirstserve•Discussioncanfocusongeneralorspecificadvising•ALLDISCUSSIONSARECONFIDENTIAL.Detailswillnotbesharedwithotherstudentsoradministration
•Purpose:•Tohelpyouanswerspecificorgeneralquestions•Determinefeasibilityandinterestinotherinitiatives,possiblyofferedinJune2019
Please email me at [email protected]
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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
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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
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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
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▪ Analyzethecase.▪ Discussthecorrectanswer▪ Practicere-wordingthequestiontoaccountforotherpossibilities.▪ Brieflyreviewsomeneuro-imagingandneuroanatomy.
17
NeuroCase
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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
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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
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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
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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
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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
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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
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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
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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
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ThankYou.