A R e so u rce for

U SMLE S t e p 1
Pr e p a r a tio n
C o m pile d b y t h e T T U H S C
Sch ool of Me dicin e
O ffice of S t u d e n t Aff airs
D r. JoAn n Larsen
Assista nt D ea n for Stu dent Affairs
USMLE W h ats it for?
I n ord e r t o b eco m e a lice ns e d p h ysicia n in t h e U nit e d S t a t es, in divid u als m ust p a ss a se ries
of e x a m in a tio ns co n d uct e d b y t h e N a tio n al B o a rd of Me dic al E x a m in e rs. T h es e e x a m in a tio ns
a r e t h e U nit e d S t a t es Me dic al Lice nsin g E x a m in a tio ns, or U SMLE . C u rr e n tly t h e r e a r e fo u r
se p a r a t e e x a m s w hich m ust b e p a sse d in ord e r t o eligible for m e dical lic e nsu r e :
Step
Step
Step
Step

1 , usu ally t a k e n aft e r t h e co m ple tio n of t h e s eco n d y e a r of m e dic al sch ool ;

2 Clinical Kno w ledge ( CK ) , usu ally t a k e n d u rin g t h e fo u rt h y e a r ;
2 Clinical Skills ( CS ) , usu ally t a k e n d u rin g t h e fo u rt h y e a r ; a n d
3 , t y pic ally t a k e n d u rin g t h e first y e a r of p ost gr a d u a t e tr ainin g .

Step 1 a ssess e s w h e t h e r y o u u n d e rst a n d a n d c a n a p ply i m p ort a n t co nce p ts of t h e scie nce s

b a sic to t h e pr a ctice of m e dicin e , wit h sp ecial e m p h a sis o n principles a n d m ech a nis m s
u n d e rlyin g h e alt h , dis e a s e , a n d m o d es of t h e r a p y . S t e p 1 e nsur e s m a st e r y of n ot o nly t h e
scie nce s t h a t pro vid e a fo u n d a tio n for t h e s a f e a n d co m p e t e n t pr a ctice of m e dicin e in t h e
pr ese n t , b u t also t h e scie n tific prin ciples r e q uir e d for m ain t e n a nce of co m p e t e nce t h ro u g h
lif elo n g le a r nin g .

Step 2 a ssesses w h e t h e r y o u ca n a p ply m e dical k n o wle d g e , skills, a n d u n d e rst a n din g of

clinical scie nce esse n tial for t h e pro visio n of p a tie n t ca r e u n d e r su p e r visio n a n d inclu d es
e m p h a sis o n h e alt h pro m otio n a n d dis e a s e pr e v e n tio n . S t e p 2 e nsu r es t h a t d u e a t t e n tio n is
d e v ot e d t o principles of clinical scie nces a n d b a sic p a tie n t -ce n t e r e d skills t h a t pro vid e t h e
fo u n d a tio n for t h e s af e a n d co m p e t e n t pr a ctice of m e dicin e .
Step 2 Clinical Skills (CS) A clinical skills e x a min a tion w as p art of th e origin al d esign of
USMLE. Th e N BME w as ch arg e d with including a test of clinical skills using st a nd ardiz e d p a tie nts
w h e n such a n e x a min a tion w as show n to b e v alid, relia ble , a nd practical. NBME rese arch a n d th e
work of oth er org a niz a tions a d ministerin g clinical skills e x a min a tions d e m onstra t e th a t clinical
skills e x a min a tions m e asure skill sets differe nt fro m those m e asure d b y tra dition al m ultiple choice qu estions. Mast ery of clinical a nd co m m unica tion skills, as w ell as cognitiv e skills, b y
in dividu als se e king m e dical lice nsure is im port a nt to th e protection of th e public.
I m ple m e n t a tio n of t h e clinic al skills e x a m in a tio n b e g a n in Ju n e 2 0 0 4 . T h e clinic al s kills
e x a m in a tio n is a se p a r a t ely a d m inist e r e d co m p o n e n t of S t e p 2 a n d is r e f e rr e d to a s S t e p 2
Clinical S kills, or S t e p 2 C S . T h e co m p u t e r - b a se d , m ultiple -ch oice co m p o n e n t of S t e p 2 is
r e f e rr e d t o a s S t e p 2 Clinic al K n o wle d g e , or S t e p 2 C K .
USMLE Step 2 CS is ad ministered at fiv e region al test centers (CSEC C enters) in the United States.
Step 3 a ssess es w h e t h e r y o u c a n a p ply m e dic al k n o wle d g e a n d u n d e rst a n din g of bio m e dic al
a n d clinic al scie nce ess e n tial for t h e u nsu p e r vis e d pr a ctice of m e dicin e , wit h e m p h a sis o n
p a tie n t m a n a g e m e n t in a m b ula t or y se t tin gs. S t e p 3 pro vid es a fin al a ssess m e n t of p h ysicia ns
a ssu m in g in d e p e n d e n t r espo nsibilit y for d eliv e rin g g e n e r al m e dic al c a r e .
R e q uir e m e n ts for lice nsu r e in e ach st a t e a r e s e t b y t h e st a t es m e dic al lice nsin g b o a rds. E a ch
st a t e b o a rd m a y d e t e r m in e t h e m a xi m u m n u m b e r of ti m e s t h a t a p e rso n m a y t a k e e a ch S t e p
e x a m a n d still r e m ain eligible for lic e nsu r e. I n Texas, individ uals are li m ited to th ree
atte m pts at each Step exa m .
B u t w h a t w er e r e ally h e r e for is t o t alk a b o u t pr e p a rin g for S t e p 1 . S t e p 1 is y o ur first B I G
h u rdle . A n d m a k e n o m ist a k e a b o u t it , t his is a V ERY i m p ort a n t t est . A v e r y g oo d
p e rfor m a nce o n S t e p 1 c a n d e finit ely h elp y o u w h e n it co m e s to s ecu rin g a to p - r a t e
r esid e ncy , a n d lik e wise a p oor scor e ca n h u rt y o u a n d li m it y o u r o p tio ns. A n d a f ailu r e o n
S t e p 1 ca n eli m in a t e t h e p ossibilit y of so m e r esid e ncies alt o g e t h e r. S o it is d efinit ely in y o u r
b e st in t e r e st to d o all y o u c a n t o m a xi m iz e y o u r ch a nce s of d oin g w ell, r e g a rdle ss of w h a t
t y p e of r e sid e ncy y o u m a y ch oos e t o p u rsu e .

Ho w is Step 1 scored?
W h e n y o u t a k e S t e p 1 , t h e co m p u t e r r ecords y o u r r e sp o nses. Aft e r y o u r t e st e n ds, y o u r
r e sp o ns e s a r e tr a ns m it t e d to t h e N BME for scorin g . T h e n u m b e r of t est it e m s y o u a nsw e r
corr ectly is co n v e rt e d to t w o e q uiv ale n t scor e s, o n e o n a t h r e e - digit scor e sc ale a n d o n e o n a
t w o - digit scor e sc ale . B ot h sc ale s a r e us e d for scor e - r e p ortin g p u rp os es.
O n t h e t h r e e - digit sc ale , m ost S t e p 1 scor e s f all b e t w e e n 1 4 0 a n d 2 6 0 . T h e m e a n scor e for
first - ti m e e x a m in e es fro m a ccr e dit e d m e dic al school pro gr a m s in t h e U nit e d S t a t es is in t h e
r a n g e of 2 0 0 t o 2 2 0 , a n d t h e st a n d a rd d e via tio n is a p pro xi m a t ely 2 0 . Yo u r scor e r e p ort will
inclu d e t h e m e a n a n d st a n d a rd d e via tio n for r ece n t a d m inistr a tio ns of t h e e x a m in a tio n . T h e
t w o - digit scor e is d e riv e d fro m t h e t h r e e - digit scor e . I t is use d in scor e r e p ortin g b ec a us e
so m e m e dic al lice nsin g a u t h orities h a v e r e q uir e m e n ts t h a t inclu d e la n g u a g e d escribin g a
" p a ssin g scor e of 7 5 . " T h e t w o - digit scor e is d eriv e d in such a w a y t h a t a scor e of 7 5 alw a y s
corr e sp o n ds to t h e m ini m u m p a ssin g scor e .

Blocks of it e m s a r e co nstr uct e d to m e e t sp ecific co n t e n t sp ecifica tio n s. As a r esult , t h e

co m bin a tio n of blocks of it e m s cr e a t es a for m of t h e e x a m in a tio n t h a t is co m p a r a ble in
co n t e n t t o all o t h e r for m s. T h e p e rce n t a g e of corr ectly a nsw e r e d it e m s r e q uir e d to p a ss
v a rie s fro m for m to for m . H o w e v e r, e x a m in e e s t y pic ally m ust a nsw e r 6 0 t o 7 0 p e rce n t of
it e m s corr ectly to a chie v e a p a ssin g scor e .

W h at is the m ini m u m passin g score?

I n D ece m b er 2 0 0 6, th e St ep 1 Co m mitt e e d ecid e d to raise th e thre e -digit score reco m m e nd e d to
p ass St e p 1 fro m 1 8 2 to 185. Th e n e w minim u m p assing score will b e a pplie d to St e p 1
e x a min a tions for w hich th e first d a y of t esting is on or aft er Ja nu ary 1, 2 0 0 7.

W h at is Texas Techs policy on USMLE exa ms?

Step 1 Exa m
All st u d e n ts will b e r e q uir e d t o t a k e t h e U nit e d S t a t es Me dical Lice nsin g
E x a m in a tio n ( U SMLE ) S t e p 1 a t t h e e n d of Ye a r T w o a n d no later t h a n Ju ne 3 0 .
E xce p t e d fro m t his r e q uir e m e n t a r e st u d e n ts w h o m ust r e m e dia t e a B a sic Scie nce
co u rse i m m e dia t ely follo win g Ye a r T w o. S uch st u d e n ts will co m ple t e a n y
r e m e dia tio n w or k / e x a m b y Ju n e 1 5 follo win g Ye a r T w o a n d t a k e U SMLE S t e p 1 b y
July 3 1 of Ye a r T h r e e .
All s t u d e n t s w h o t a k e t h e U S MLE S t e p 1 n o l a t e r t h a n Ju n e 3 0 f ollo w i n g
co m pl e t io n of Y e a r T w o w ill b e e li gib l e t o s t a r t t h e Y e a r T h r e e cl e r k s h ip
r o t a t io n s i n Ju l y of t h a t y e a r .
Pa ss a g e of U SMLE S t e p 1 is r e q uir e d for pro m otio n to Ye a r F o u r.
F or st u d e n ts w h o m ust r e p e a t U SMLE S t e p 1 , le a v e fro m t h e t hird y e a r cu rriculu m
to pr e p a r e for t h e e x a m is n ot r e q uir e d b u t is strongly reco m m ended a nd
encouraged. A n y r e q u e st for such le a v e m ust b e a p pro v e d b y t h e Associa t e
D e a n for E d uc a tio n al Pro gr a m s or t h e Assist a n t D e a n for S t u d e n t Aff airs.
S t u d e n ts w h o r e a ch t h e e n d of t h e Ye a r T h r e e cu rriculu m a n d h a v e n ot y e t p a sse d
S t e p 1 will b e place d o n a d m inistr a tiv e le a v e of a bse nce for u p t o o n e y e a r,
co nsist e n t wit h S ectio n 4 . 1 of t his p olicy w hich allo w s n o m or e t h a n six ( 6 ) y e a rs
to co m ple t e t h e cu rriculu m for t h e D octor of Me dicin e d e gr e e , inclusiv e of all
le a v e s, r e p e titio n , or d eco m pr e ssio n of a n ac a d e m ic y e a r. Pa ss a g e of t h e e x a m
d u rin g t his ti m e fr a m e will r e sult in r e t u r n t o t h e cu rriculu m .
I n a bilit y t o p a ss S t e p 1 wit hin t h e o n e - y e a r le a v e of a bse nce will r esult in
wit h dr a w al fro m t h e cu rriculu m a s st a t e d in t h e S O M S t u d e n t Aff airs S t u d e n t
H a n d b oo k u n d e r S t u d e n t Le a v e s of A bs e nce . A p p e als r e g a rdin g t his issu e will b e
h a n dle d a s o u tlin e d in S ectio ns 6 , 7 , a n d 8 of t h e G r a din g a n d Pro m otio ns p olicy .
Step 2 Exa m
F or st u d e n ts w h o b e gin t h e cu rriculu m in A u g ust of 2 0 0 5 or la t e r, passage of S t e p
2 Clinic al K n o wle d g e a n d S t e p 2 Clinic al S kills will b e r e q uir e d for gr a d u a tio n .
Pa ssin g scor e s m ust b e d ocu m e n t e d n o la t e r t h a n May 1 of t h e y e a r gr a d u a tin g .

Ho w do I apply for Step 1?

T h e initial a p plica tio n for S t e p 1 is d o n e o n t h e I n t e r n e t . G o t o w w w . n b m e . org . Click o n
NBME Licensing Exa m Ser vices, t h e n National Licensin g Exa mination Ser vices
W ebsite . I n t h e y ello w LOG I N b o x , ple a s e n ot e y o u d o n ot h a v e a U SMLE I D n u m b e r y e t .
I nst e a d , clic k o n First ti m e user a n d follo w t h e instr uctio ns. As p a rt of t h e a p plica tio n ,

y o u will in dica t e a 9 0 - d a y eligibilit y p e rio d d u rin g w hich y o u pla n t o t a k e t h e e x a m . Pa y m e n t

is also r e q uir e d a t t his ti m e ( $ 4 8 0 ) .
Prin t o u t t h e a p plic a tio n for m w hich will r e q uir e y o u r sig n a t u r e a n d a pict u r e .
B rin g t h e for m to t h e S t u d e n t Aff airs Office for sig n a t u r e D r. McMa h o n , D r.
La rs e n , T a m a r a La n e , a n d K a r e n N elso n a r e a u t h oriz e d to sig n t h e for m .
T h e n t a k e t h e for m to t h e R e gistr a rs O ffice ( 2 C 4 0 0 a cross fro m t h e S y n e rgistic
C e n t e r ) a n d h a v e t h e sch ool s e al p u t o n it .
Aft e r t h a t , y o ur e r e a d y t o m ail it in .

W here do I take the test?

T h o m so n Pro m e tric, a p a rt of T h e T h o m so n C orpor a tio n , pro vid es sch e d ulin g a n d t est ce n t e rs
for t h e co m p u t e r - b a s e d co m p o n e n ts of U SMLE . S t e p 1 a n d S t e p 2 C K a r e giv e n a ro u n d t h e
w orld a t Pro m e tric T est C e n t e rs (PT Cs) .
Pro m e tric t e st ce n t e rs a r e loc a t e d t h ro u g h o u t t h e U . S . I n T e x a s t h e r e a r e ce n t e rs in :
A bile n e
A m a rillo
A ustin ( 2 )
Beau mont
B e dford ( 2 )
C orp us C h risti
D alla s ( 2 )
El Pa so
H o ust o n ( 3 )
Lu b b ock
McAlle n
Midla n d
S a n A n t o nio ( 2 )
T yle r
W a co
Wichit a F alls

Ho w do I sched ule m y test?

O nce y o u r a p plica tio n h a s b e e n processe d , y o u will r eceiv e a n e m ail fro m N BME n otif yin g y o u
t h a t y o u r a p plica tio n is co m ple t e . A b o u t a w e e k la t e r, y o u will r eceiv e a seco n d e m ail fro m
t h e m n otif yin g y o u t h a t y o u r sch e d ulin g p e r m it is a v aila ble ; t his m ess a g e will inclu d e
instr uctio ns for a cce ssin g t h e electro nic sch e dulin g p e r m it usin g t h e r e gistr a tio n e n tit y's
in t e r activ e w e bsit e .
PR I NT OUT YOUR SCHEDUL I NG PERM I T a n d k e e p it in a s af e pla ce . Yo u MUST brin g it
wit h y o u t o t h e t e st ce n t e r o n t h e d a y of y o u r t est . Yo u will n o t b e allo w e d t o t a k e t h e e x a m
wit h o u t y o u r sch e d ulin g p e r m it .
O nce y o uv e g ot t e n y o u r p e r m it , y o u m a y sch e d ule y o u r t est o nlin e a t w w w . pro m e tric.co m
for a n y a v aila ble t est d a t e t h a t is wit hin y o u r a p pro v e d 9 0 - d a y eligibilit y p e rio d . N ot all
Pro m e tric ce n t e rs a r e op e n o n w e e k e n ds, a n d U SMLE e x a m s a r e n ot n ecess a rily off e r e d e v e r y
d a y t h e ce n t e rs a r e o p e n . Please note th at May th roug h July are one of the b usiest
periods for these testin g centers beca use of the large USMLE de m a n d d u rin g that
ti m e PLAN AHEA D!

Yo u will b e a ble t o ch a n g e y o u r t est d a t e a ft e r y o u h a v e sch e d ule d it I F y o u r n e w t est d a t e is

still wit hin t h e 9 0 - d a y eligibilit y p e rio d . If y o u m ust r esch e d ule o u tsid e t h e a p pro v e d
eligibilit y p e rio d , y o u will n e e d t o r e a p ply a n d p a y a n a d ditio n al f e e .

W h at is the for m at of the test?

T h e S t e p 1 t est d a y is a n 8 - h o u r d a y . T h e 8 h o u rs inclu d es t h e t est itself a s w ell a s br e a k
ti m e . T h e e x a m co nsists of a p pro xi m a t ely 3 5 0 m ultiple ch oice q u e stio ns a rr a n g e d in blocks
of 5 0 q u e stio ns w hich m e a ns y o u will h a v e a bo u t 1 . 2 m in u t e s p e r q u e stio n . D u rin g e a ch
block y o u ca n a nsw e r q u e stio ns in a n y ord e r, g o b a ck a n d r e vie w q u estio ns in t h e block , a n d
ch a n g e a nsw e rs. O nce y o u h a v e e xit e d a block or t h e ti m e for t h a t block h a s e x pir e d , y o u
will n o lo n g e r b e a ble t o r e vie w q u e stio ns or ch a n g e a nsw e rs in t h a t block .
So m e blocks are h arder tha n others. D o nt p a nic if y o u r first block h a p p e ns t o
b e a m or e difficult o n e .
The q uestions are ran do m , so do nt e x p ect a block of p a t h olo g y q u e stio ns, a
gro u p of p h a r m a colo g y q u e stio ns, e tc.
Some questions will include pictures histolog y, gross p a tholog y, CT im a g es, etc.
Approxi m ately 7 5 % of the q uestions are S I NGLE BEST ANS W ER. T h e r e will
b e a n y w h e r e fro m 3 to 5 a nsw e r ch oice s.
Other q uestions co nsist of exte n ded m atchin g a list of it e m s fro m w hich
y o u m ust ch oos e t h e o n e b e st a nsw e r t h a t corr e sp o n ds wit h t h e n u m b e r e d it e m s
or q u e stio ns loc a t e d b elo w t h e list .

Ca n I practice takin g the test?

Yo u sh o uld a cq u ain t y o u rs elf wit h t h e t e st soft w a r e w ell b e for e y o u r t est d a t e (s) . Pr a ctice
ti m e is n o t a v aila ble o n t h e t e st d a y , a n d t est ce n t e r st a ff a r e n ot a u t h oriz e d to pro vid e
instr uctio n o n us e of t h e soft w a r e . A brief t u t orial o n t h e t est d a y pro vid e s a r e vie w of t h e
t e st soft w a r e , inclu din g n a vig a tio n tools a n d e x a m in a tio n for m a t , prior to b e gin nin g t h e t e st .
I t d o e s n ot pro vid e a n op p ort u nit y t o pr a ctice .
1. You can practice b y do w nloadin g soft w are fro m the NBME w ebsite
( h t t p : / / w w w . us m le . org / O rie n t a tio n / 2 0 0 7 / r e a d m e . h t m # soft w a r e ) . T h e N BME soft w a r e
y o u inst all h a s o v e r 1 0 0 pr a ctice t e st it e m s a n d a soft w a r e t u torial. S o m e pr a ctice
it e m s m a y inclu d e m ulti m e dia files, such a s vid e o or a u dio clips.
2. You can sched ule a practice test at a Pro m etric Test Center.
O nce y o u r S t e p 1 a p plic a tio n h a s b e e n processe d a n d y o u h a v e r eceiv e d y o u r Sch e d ulin g
Pe r m it , y o u a r e eligible t o r e gist e r for a Practice Session for t h a t e x a m in a tio n . Pr a ctice
S essio ns a r e a v aila ble a t T h o m so n Pro m e tric, a p a rt of T h e T h o m so n C orp or a tio n , t est
ce n t e rs. The Practice Sessions use the sa m e sa m ple test m aterials that are
available on the USMLE w ebsite; ho w ever, they do not include a n y m ultim edia
ite ms. N O NE W SAMPLE TEST MATER I ALS ARE PRESENTED AT PRACT I CE
SESS I O NS. T h os e w h o a r e eligible to r e gist e r for a Pr a ctice S e ssio n m a y t a k e o nly o n e
s essio n p e r e x a m r e gistr a tio n . Ple a s e n o t e t h a t Pr a ctice S essio ns a r e n ot a v aila ble o n
m a j or local h olid a y s a nd d u rin g the first t w o w eeks of Ja n u ar y .
Note: T h e N BME soft w a r e , k n o w n a s FRE D , will r e pla ce t h e Pro m e tric soft w a r e for t h e
U SMLE Pr a ctice S essio n b e gin nin g in D ece m b e r 2 0 0 6 . I nst alla tio n of FRE D for t h e U SMLE
Pr actice S essio ns will b e p h a se d in o v e r se v e r al w e e ks. If y o u sch e d ule t o t a k e a C B T
Pr a ctice S e ssio n fro m D ece m b e r 2 0 0 6 t h rou g h Ja n u a r y 2 0 0 7 , y ou m ig h t t e st wit h

eit h e r t h e Pro m e tric or FRE D t e st d eliv e r y soft w a r e .

U n til t his tr a nsitio n is co m ple t e , e x a m in e e s w h o wish t o pr a ctice wit h t h e a ct u al FRE D
soft w a r e sh o uld us e t h e s a m ple m a t e rials a v aila ble a t t h e U SMLE w e bsit e .
T h e Pr a ctice S essio n is a m a xi m u m of 3 . 5 h o u rs a n d is divid e d in t o 3 1 - h o u r blocks of 4 6 - 5 0
m ultiple ch oice t e st it e m s e a ch . W h e n y o u co m ple t e t h e s essio n , y o u will r eceiv e a prin t e d
p e rce n t corr ect scor e .
I f y o u r e gist e r for a pr actice s essio n , a YELL O W Sch e d ulin g Pe r m it will b e m aile d t o y o u wit hin
t w o w e e k s w hich will allo w y o u t o sch e d ule t h e Pr actice S essio n . D o not sched ule a Practice
Session usin g you r per m it for the actu al Step exa m in atio n. T h e $ 4 2 f e e for t h e Pr a ctice
s essio n m ust b e p aid dir ectly t o Pro m e tric b y cr e dit c a rd a t t h e ti m e y o u sch e d ule y o u r
a p p oin t m e n t .

W h ats o n the test?

As w e h a v e talk ed about alre ady, the NBMEs Com prehensiv e Basic Sciences Ex a m is the closest
thing to th e re al thing that th e y will let a nyon e see. In fact, since ALL of the ite ms written by NBME
are copyrighted, you should be a little le ery of a nyone other th a n NBME who claims to h a v e actu al
USMLE qu estions. Th e NBME offers a bre akdown of the content are as on the test :
Syste m * *
4 0 % 5 0 % G e n e r al principles
5 0 % 6 0 % I n divid u al org a n s y st e m s
h e m a to p oie tic / ly m p h or e ticula r
n e r v o us / sp ecial s e ns e s
skin / co n n ectiv e tissu e
m usculosk ele t al
r e spir a tor y
c a rdio v a scula r
g a stroin t estin al
r e n al / u rin a r y
r e pro d uctiv e
e n d ocrin e
Process
30 % 50 %
30 % 50 %
15 % 25 %
10 % 20 %

N or m al str uct u r e a n d fu nctio n

A b n or m al proce ss e s
Principle s of t h e r a p e u tics
Ps ych osocial, cult u r al, occu p a tio n al a n d e n viro n m e n t al co nsid e r a tio ns

* Pe rce n t a g es a r e su b j ect to ch a n g e a t a n y ti m e . S e e t h e U SMLE w e bsit e for t h e m ost u p - t o d a t e infor m a tio n .

* * T h e g e n e r al principle s c a t e g or y inclu d e s t est it e m s co nce r nin g t h os e n or m al a n d a b n or m al
proce ss e s t h a t a r e n ot li m it e d to sp ecific org a n s y st e m s. C a t e g orie s for in divid u al org a n
s y st e m s inclu d e t e st it e m s co nce r nin g t h os e n or m al a n d a b n or m al proce ss e s t h a t a r e s y st e m
sp ecific.

NBME also p u blishes a m ore detailed outline of the topics covered on the Step 1
exa m. Use this as an outline to m ake sure you are coverin g all of these topics in

you r stud y plan. Youll fin d the co m plete outline of w hats on the Step 1 exa m at
the end of this book in Appendix A.

Ho w do I prepare for Step 1?

S e v e r al t hin gs h a v e b e e n pro v e n to h elp st u d e n ts pr e p a r e to d o t h eir b e st of S t e p 1 .
1. LEARN the m aterial you are cu rrently stu d yin g in your classes.
A p pro xi m a t ely 7 0 % of t h e q u e stio ns o n t h e e x a m a r e lik ely t o us e or co m bin e infor m a tio n in
w a y s t h a t y o u h a v e n o t s e e n b e for e . I t is t h e p u rp os e of t h e t estin g a g e ncy to s e e h o w a d e p t
y o u a r e a t t a kin g p a rtial infor m a tio n a n d , b a se d o n t h a t ,fig u rin g o u t a n a nsw e r y o u co nsid e r
to b e a hig h pro b a bilit y r e sp o ns e . A n d y o u c a nt d o t h a t wit h MEM O R I Z E D m a t e rial, b u t y o u
c a n d o it usin g m a t e rial t h a t y o u h a v e LE ARN E D .
2. KN O W ho w to approach m ultiple choice q uestions a nd PRACT I CE. S o m e p e o ple
se e m t o instinctiv ely k n o w h o w t o a nsw e r m ultiple ch oice q u e stio ns corr ectly , o t h e rs of us
n o t so m uch . T h e r e a r e skills t h a t y o u c a n le a r n t o h elp y o u a nsw e r t h e s e kin ds of t e st
q u e stio ns. H e r es h o w K a pla n r eco m m e n ds a p pro a chin g vig n e t t e st yle d m ultiple ch oice
q u e stio ns :
1.
2.
3.
4.
5.
6.
7.

a ss e m ble k e y clu e s in t o a m e n t al sn a psh o t of t h e p a tie n t .

u n d e rst a n d pr ecis ely w h a t is b ein g a sk e d
allo w a fe w m o m e n ts t o t hin k , r ecall, a n d to a n ticip a t e p ossible a nsw e rs
co m p a r e t h e giv e n ch oice s t o y o u r a n ticip a t e d a nsw e r
m a r k ch oice s t h a t m a tch b e st
rule o u t ch oice s t h a t d ont acco u n t for all fin din gs
m a r k t h e b est a nsw e r

Kapla ns experts sa y th at people w ho are bad at m ultiple choice q uestions focus on

the choices rather tha n the ste ms of the q uestions. T his is a v e r y in efficie n t a p pro ach
a n d o n e t h a t t e n ds t o r esult in m or e m ist a k e s. Those w ho are good at m ultiple choice
q uestions focus on the ste ms, not the choices.
I f y o u alw a y s f e el t h a t y o u r p e rfor m a nce o n m ultiple ch oice t ests do esnt e q u a t e wit h y o u r
m a st e r y of t h e m a t e rial, y o u m ig h t t hin k a b o u t h a vin g y o ur t e st t a kin g a n aly z e d . T h e
U niv e rsit y of Misso u ri a t K a ns a s Cit ys I nstit u t e for Prof essio n al Pr e p a r a tio n ( IPP) off e rs a n
o nlin e S t e p 1 diag nostic test. W h e n a n aly z e d , t h e s e t e sts n ot o nly e v alu a t e p e rfor m a nce in
e a ch of t h e s e v e n b a sic scie nce s a r e a s, b u t also loo k a t so m e 4 0 o t h e r in tr a - t e st v a ria ble s
w hich ca n h elp y o u g ain insig h t in to t h e t y p es of e rrors y o u m a y b e co m m it tin g a s y o u g o
t h ro u g h a t est , esp ecially w h e n t h es e e rrors m a y b e d e pr e ssin g y o u r o v e r all p e rfor m a nce .
V a ria ble s such a s : t h e a m o u n t of ti m e sp e n t o n diff e r e n t t y p e s of q u estio ns ; corr ela tio ns
b e t w e e n t h e le n g t h of a q u estio n a n d t h e lik elih oo d of a nsw e rin g it successfully ; p e rfor m a nce
o n q u e stio ns w hich r ely o n strict d efinitio ns or pr ecis e in t e rpr e t a tio n of t ech nic al v oc a b ula r y ;
a n d t h e e x t e n t t o w hich y o u a r e a ble t o n a rrow d o w n y o u r ch oice s t o t w o g oo d a nsw e rs a n d
t h e e x t e n t to w hich y o u r s eco n d ch oice s a r e corr ect , a r e e x a m ples of t h e in tr a - t est v a ria bles
a n aly z e d w h e n y o u t a k e a " D ia g n ostic " t e st . I n a d ditio n to a su m m a r y d a t a sh e e t sh o win g
y o u r p e rfor m a nce in t h es e a r e a s, t h e y m a y also pro vid e a co m p u t e r g e n e r a t e d six to eig h t
p a g e r e p ort w hich discuss e s t h e s e v a ria bles a n d giv e s so m e co ncr e t e su g g e stio ns for
m ini m izin g t h e i m p act of t h ese " e rror p a t t e r ns " . T his dia g n ostic t est is a v aila ble for a s m all
f e e . F or d e t ails a n d h o w t o ord e r a t est , ple a s e g o to h t t p : / / w w w . u m kc. e d u / ip p / cb t . a sp .
T h e y also off e r a full -len gth Mock Board Exa m .
H e r e is a s a m ple S t e p 1 Dia g n ostic T est r e p ort .

STEP 1 REPORT
6

All Step 1 "Diagnostics", "Mock Boards",

to the one shown below. In addition, the
generated six to eight page report which
some concrete suggestions for minimizing

and "Tests" produce a summary similar

"Diagnostic" also provides a computer
discusses these variables and gives
the impact of these "error patterns".

Student Name
PercentCorrect Overall
54
Percent Correct of 2nd Choices
37
Mean Time per Question
62
Category:
% Correct
Mean Time (sec)
Questions Involving Statistics
61
60
Diagnosis Questions
62
53
Questions Involving Judgement
53
51
Process Questions
49
51
Questions Involving Definitions
51
51
Cause Effect Reasoning Questions
51
51
Questions with Graphics
40
61
Questions Requiring Visualization
43
54
Subject:
% Correct
Mean Time (sec)
Anatomy
43
55
Behavioral Sciences
63
54
Biochemistry
37
45
Microbiology
52
45
Pathology
56
48
Pharmacology
45
55
Physiology
65
62
Question Type:
% Correct
Mean Time (sec)
Multiple Choice
49
52
Extended Foils
55
51
Confidence levels:
% Correct
Number
Mean Time (sec)
1 (low)
16
25
62
2
36
22
69
3
33
15
51
4
74
38
52
5 (high)
75
24
26
Cognitive Level:
% Correct
Mean Time (sec)
Recall
52
45
Comprehension
42
59
Application
63
59
3. ALLO W enoug h tim e to prepare, b ut not too m uch. Alt h o u g h y o u will h a v e
a p pro xi m a t ely 1 0 w e e ks fro m t h e ti m e sch ool e n ds t o t h e d e a dlin e for t a kin g S t e p 1 (Ju n e
3 0 ) , fo u r t o six w e e ks sh o uld b e ple n t y of ti m e t o pr e p a r e for S t e p 1 . Ma n y st u d e n ts in t h e
p a st w h o h a v e t a k e n lo n g e r t h a n 6 w e e ks to pr e p a r e la t e r s aid t h e y felt t h e y t oo k t oo m uch
ti m e , a n d act u ally lost gro u n d wit h t h eir st u d yin g . A n aly sis of o u r o w n st u d e n ts o v e r t h e
y e a rs sh o ws t h a t y o u g e t t h e m ost b a n g for y o u r b uck b y st u d yin g for 6 t o 9 h o u rs p e r d a y
for 4 to 6 w e e ks. B elo w y o ull s e e a gr a p h of h o u rs / d a y a n d w e e ks of st u d yin g gr a p h e d
a g ainst a ct u al S t e p 1 scor e s.

30
3-5 hours per day / 2-4 weeks
3-5 hours per day / 4-6 weeks
25

3-5 hours per day / > 6 weeks

6-9 hours per day / 2- 4 weeks
6-9 hours per day / 4-6 weeks

20

6-9 hours per day / > 6 weeks

>9 hours per day / 2-4 weeks
>9 hours per day / 4-6 weeks

15

>9 hours per day / > 6 weeks

10

0
<183

183-199

200-215

216-230

>230

4. MAKE a stu d y sched ule a nd stick to it. T his is a critical st e p in successful S t e p 1

pr e p a r a tio n . Mor e d e t aile d infor m a tio n a b o u t st u d y sch e d ules is in t h e follo win g sectio n .
5. STUDY sm art. S p e n din g 1 0 h o u rs a d a y p a ssiv ely r e a din g st u d y g uid e s or old n ot e s is
m uch le ss e ff ectiv e t h a n sp e n din g h alf t h a t a m o u n t of ti m e in a ctiv e st u d y . E x plain co nce p ts
o u t lo u d t o a st u d y p a rt n e r, pr a ctice a nsw e rin g q u e stio ns b y e x plainin g w h y t h e rig h t a nsw e rs
a r e rig h t a n d t h e w ro n g a nsw e rs a r e w ro n g . If co nce p t m a p pin g w or k s for y o u , d o it . I f
t h e r e a r e ot h e r m e t h o ds t h a t w or k for y o u , us e t h e m .

OTHER STEP 1 A DV I CE
Ju d y Sch w e n k e r, K a pla ns C u rriculu m D ir ect or, t alk e d a b o u t t h e w a y s in w hich U SMLE e x a m s
a r e si m ila r t o m e dic al p r a ctice :
1 . y o u m ust fin d k e y infor m a tio n
2 . t h e infor m a tio n y o u n e e d m a y b e b u rie d
3 . t h e r e a r e distr a ctio ns
4 . t h e r e is ti m e pr essu r e
5 . y o u m ust us e pro b a bilities to m a k e d ecisio ns
6 . y o ull n e v e r k n o w it all
7 . sit u a tio ns w o nt e x actly fit w h a t y o uv e le a r n e d
S h e also t alk e d a b o u t t h e m ist a k e s m ost co m m o nly m a d e w h e n pr e p a rin g for S t e p 1 :
1 . p a ssiv e st u d yin g
2 . insufficie n t pr a ctice wit h q u e stio ns
3 . m e m orizin g , n o t u n d e rst a n din g t h e m a t e rial
4 . in a p pro pria t e t est d a y str a t e gies
5 . m isr e a din g or m isin t e rp r e tin g q u estio ns

So w here do I start?
8

1. Self - assessm ent. I t hin k all of t h e e x p e rts a gr e e t h a t t h e first t hin g y o u n e e d to d o

is t a k e so m e sort of dia g n ostic t e st to s e e w h e r e y o u r a r e a s of str e n g t h a n d w e a k n e ss
a r e . Dia g n ostic t e sts a r e a v aila ble fro m K a pla n , N BME , a n d a v a rie t y of ot h e r o nlin e
so u rce s t h a t a r e list e d la t e r u n d e r O t h e r R e so u rce s.
2. Make a stud y sched ule. Lots of s a m ple sch e d ules a r e o u t t h e r e a n d lin ks to t h e m
a r e inclu d e d la t e r in t his n ot e b oo k . B U T ple a s e r e m e m b e r t h a t t h es e sch e d ules
w e r e m a d e b y in divid u al st u d e n ts a n d t h e sch e d ule s r e flect t h os e st u d e n ts in divid u al
circu m st a nces. W h e n y o u pr e p a r e y o u r o w n st u d y sch e d ule , y o u m ust first loo k a t
y o u r o w n dia g n ostic t e st r e sults a n d pr e p a r e y o u r sch e d ule wit h m or e ti m e allot t e d t o
w e a k e r su b j ects, a n d le ss ti m e to stro n g e r sub j ects. I n divid u al st u d y p a ce also n e e ds
to b e f a ct or e d in , a s so m e a cco m plish m or e p e r st u d y d a y t h a n o t h e rs.
H e r es so m e a d vice fro m K a pla ns Ju d y Sch w e n k e r :
( 1 ) T a k e a co m pr e h e nsiv e t e st t o b e gin a s a m e a su r e of w h e r e y o u r r ec all is rig h t n o w . Us e
t h e K a pla n dia g n ostic t est if y o u h a v e t a k e n it .
( 2 ) O nce y o u k n o w y o u r p e rce n t corr ect scor e for e a ch su b j ect , us e t his infor m a tio n t o
d ecid e t h e r ela tiv e a m o u n t of r e vie w ti m e t o p u t in t o e a ch a r e a . F or e x a m ple , if Ph ysiolo g y is
2 0 % lo w e r t h a n Micro biolo g y , y o u sh o uld b e sp e n din g a t le a st 2 0 % M O RE ti m e r e vie win g
Ph ysiolo g y t h a n y o u p u t in t o Micro.
( 3 ) As y o u b e gin t o r e vie w a su b j ect , loo k o v e r so m e q u estio ns o n t h e m a t e rial b e for e y o u
st a rt t o r e vie w . T his will h elp k e e p y o u focuse d o n w h a t is i m p ort a n t to k n o w a n d sh o w y o u
h o w y o u will n e e d t o use t h e infor m a tio n o n t h e t est .
( 4 ) As y o u m o v e t h ro u g h t h e m a t e rial, cr e a t e y o u r o w n co n d e ns e d su m m a ries of t h e k e y
m a t e rial so y o u c a n r e vie w t h e s e rig h t b e for e t e st d a y . 2 0 - 3 0 p a g e s p e r su b j ect is a d ece n t
siz e t o sh oot for, b eca use ot h e r wise y o u will e n d u p t a kin g t oo d e t aile d n ot es a n d t h e y w o n't
h elp a t t h e e n d .
( 5 ) As y o u finish a su b j ect , us e Q B a n k t o cre a t e a n d t a k e a t e st wit h m a y b e 5 0 it e m s fro m
e a ch su b j ect t h a t y o u h a v e co m ple t e d u p to t h a t p oin t . So if y o u h a v e finish e d A n a t o m y a n d
Ph y siolo g y , y o u w o uld do a 1 0 0 -it e m t e st u n d e r ti m e d , t e st m o d e a ss essin g t h os e 2 a r e a s.
B y t h e e n d , y o u will b e t a kin g lo n g pr actice t ests u n d e r t est co n ditio ns t h a t co v e r all t h e
co m ple t e d su b j ect a r e a s. T his h elps k e e p t h e e a rlie r m a t e rial in m e m or y , a n d giv es y o u a
m or e a ccu r a t e pict u r e of y o u r pr e p a r e d n e ss. I t also giv es y o u g oo d pr a ctice for t h e m e n t al
st a m in a a n d p a cin g n e e d e d o n t e st d a y .
( 6 ) Pla n ti m e d u rin g t h e fin al 2 - 3 w e e ks t o do n o t hin g b u t r e vie w y o u r o w n su m m a rie s a n d
t a k e incr e a sin g n u m b e rs of sim ula t e d t est m o d ules of 5 0 it e m s e a ch u n d e r ti m e d co n ditio ns
( o n e h o u r p e r m o d ule ) . T his is t h e fin al " g e t it all fr esh in m in d , b uild m e n t al st a m in a , a n d
in t e nsiv e t est pr actice " p h a se , w hich sh o uld le a d rig h t u p to 2 d a y s b efor e y o u r a ct u al t e st
d a t e . O u r e x p e rie nce h a s sh o w n t h a t st u d e n ts w h o a r e d oin g 7 0 % or b e t t e r o n o u r fullle n g t h si m ula t e d e x a m s ( or co m p a r a ble pr a ctic e t e sts cr e a t e d wit h Q b a n k or I V Q b a n k ) b y
t h eir t e st d a t e s D O PA S S , so t his is a g oo d le v el t o ai m for. Yo u m a y also ch oos e t o t a k e o n e
of t h e N BME t e sts t o g e t a pr e dict e d U SMLE scor e . I f y o u d o d ecid e t o d o t his, b e a d vis e d
t h a t b a s e d o n f e e d b a ck I h a v e g o t t e n o n t h e bo a rd , F or m 1 se e m s to b e t h e m ost r elia ble .
( 7 ) D o nt st u d y a n y t hin g t h e d a y b e for e . Pla n so m e t hin g fu n a n d m in dle ss, b ec a us e st u d y
wit hin 2 4 h o u rs of t h e e x a m a ct u ally h u rts y ou r a bilit y t o r ec all fro m e a rlie r r e vie win g .

Additional Advice from Kaplan

9

Tips for the W eek Before

D u rin g t h e la st f e w d a ys b e for e t h e e x a m y o u sh o uld b e t a p e rin g off y o u r st u d yin g , a n d
g e t tin g in to m e n t al a n d p h y sic al sh a p e .
1. This is not the ti m e for cra m m in g in ne w m aterial... b u t a ti m e t o or g a niz e a n d
in t e gr a t e w h a t y o u alr e a d y k n o w . W or k o n m a kin g w h a t y o u k n o w m or e a cce ssible .
2. Revie w key w ords, p h rases a n d concepts. Loo k o v e r y o u r su m m a r y n ot e s o n e m or e
ti m e . T his is t h e ti m e to drill y o u rself o n esse n tial infor m a tio n . T h e k e y is t o pr actice r ecall,
n o t si m ply r e a d o v e r t h e m a t e rial a g ain . W h a t y o u n e e d t o k n o w is pro b a bly alr e a d y in y o u r
h e a d . Yo u r t a s k n o w is t o tr ain y o u rs elf t o a cce ss it w h e n y o u n e e d it . D oin g pr a ctice
q u estio ns is a g oo d w a y t o r einforce y o u r r ecall skills. Use t h e m t o cla rif y y o u r u n d e rst a n din g
of k e y d e t ails.
3. No one ca n k no w everythin g th at is asked on this exa m . B e h o n e st wit h y o u rs elf
a b o u t w h a t y o u d o a n d d o n ot k n o w . K n o win g t h a t y o u d o n o t k n o w so m e t hin g giv e s y o u
m or e of a s e ns e of co n trol o n t h e e x a m a n d m a k e s y o u less lik ely t o p a nic w h e n y o u
e nco u n t e r t h e m a t e rial a n d / or w a st e ti m e o n q u e stio ns y o u a r e n ot lik ely t o g e t corr ect .
4. Get yourself onto the rig ht tim e sched ule. W a k e u p e v e r y d a y a t t h e s a m e ti m e y o u
will n e e d t o o n t h e d a y of t h e e x a m . T his will g e t y o u r circa dia n r h y t h m coordin a t e d wit h t h e
e x a m sch e d ule . D o n ot n a p b e t w e e n 8 : 0 0 a m a n d 5 : 0 0 p m . O t h e r wise y o u will a ccust o m
y o u r b o d y to sh u t tin g do w n d u rin g t h e critic al e x a m h o u rs. I f y o u g e t u p a t t h e rig h t ti m e
e ach d a y , y o u will also fin d it e a sie r t o f all a sle e p a t nig h t . B y g e t tin g in t o t h e pro p e r sle e p w a k e cy cle , y o u will fin d it e a sie r t o g e t t o sle e p t h e nig h t of t h e e x a m a s w ell.
5. You should be gettin g a sufficient a m ou nt of sleep. F or m ost p e o ple t h a t m e a ns a t
le a st 6 t o 7 h o u rs a nig h t . Sle e p is a n e ss e n tial ti m e for y o u r br ain t o co nsolid a t e w h a t y o u
h a v e le a r n e d . Yo u n e e d sle e p ; it m a k e s y o u a m or e e fficie n t le a r n e r w h e n y o u a r e a w a k e .
6. Take so m e tim e each day to relax. H a v e a g oo d m e al. T a k e a w alk in t h e fr e sh air.
Fin d ti m e for e x e rcise . T h e ch a n g e of p ace will r efr esh y o u a n d t h e p h y sical activit y will h elp
y o u r ela x a n d sle e p a t nig h t .
7. I f you ha ven't done so alread y, visit the Pro m etric Test Center w h e r e y o u will b e
t a kin g t h e e x a m . I t will b e in dica t e d o n y o u r e x a m e n tr y tick e t . T his will e nsu r e y o u k n o w
h o w t o g e t t h e r e a n d h o w m uch ti m e y o u sh o uld allo w for t h e co m m u t e . Yo u c a n s e e w h e r e
y o u sh o uld p a r k , a n d se e w h a t t h e co m p u t e r s e t - u p is lik e .
8. Revie w the tutorial at h t t p : / / w w w . us m le . or g / st e p 1 / d e f a ult . h t m . B eco m e f a m ilia r wit h
t h e in t e rf a ce , t h e loc a tio n of k e y infor m a tio n o n t h e scr e e n a n d h o w to n a vig a t e b e t w e e n
scr e e ns. If y o u w alk in to t h e e x a m f a m ilia r wit h t h e e x a m , y o u will n ot h a v e t o use a n y of
y o u r v alu a ble br e a k ti m e t o d o t his o n t h e t e st d a y .

Kaplans Tips For The D ay Before The Exa m

1. Take the da y off fro m stud ying. T his is y o u r d a y t o r ela x a n d g a t h e r y o u r str e n g t h
b efor e t h e m ain e v e n t . G e t o u t of b e d a t t h e s a m e ti m e y o u will h a v e t o g e t u p t h e n e x t
d a y . I f y o u f e el y o u m ust st u d y , li m it y o u rs elf t o r e vie win g y o u r o w n n o t e s a n d fla shc a rds.
2. Have so m e fu n. G o for a w alk . List e n t o y o ur f a v orit e m usic. G o s e e a g oo d co m e d y or
a n actio n m o vie t h a t will allo w ca t h a rtic r ele a se . G o sh o p pin g . S p e n d ti m e wit h a
sig nifica n t ot h e r. D o w h a t e v e r y o u lik e . Yo u h a v e w or k e d h a rd a n d d es e r v e it .

10

3. Make su re th at you ha ve checked out the basics for the exa m :

H a v e y o u w or k e d t h ro u g h t h e U SMLE t u t orial?
D o y o u k n o w w h e r e t h e Pro m e tric ce n t e r is, a n d h o w to g e t t h e r e?
D o y o u h a v e alt e r n a tiv e tr a nsp ort a tio n if, for e x a m ple , y o u r c a r d o es
n o t st a rt?
D o y o u trust y o u r ala r m clock t o w a k e y o u u p in ti m e? I f n o t , m a k e
a rr a n g e m e n ts wit h frie n ds a s b a ck u p . Yo u w a n t t o b e su r e t o w a k e u p
r e st e d , r e fr e sh e d , a n d o n ti m e .
La y o u t w h a t y o u'll n e e d for t h e e x a m b e for e y o u g o t o sle e p . T his
inclu d es p h ot o id e n tifica tio n , sch e d ulin g p e r m it a n d co nfir m a tio n
n u m b e r, a s w ell a s a n y p e rso n al it e m s lik e e y e gla sses. W hile y o u'r e a t
it , d o n't forg e t t o p a ck a lu nch!
4. Call you r frien ds a nd classm ates a nd m ake so m e pla ns to celebrate. Yo u'll n e e d t o
blo w off so m e st e a m a n y h o w , a n d t alkin g wit h colle a g u es will r e m in d y o u t h a t y o u a r e n ot
in t his b y y o u rself.
5. Be sure to do some physical activity. Just ta king a w alk for a n hour will h elp rela x you.
6. Get a good nig ht's sleep. To h elp y o u sle e p , co nsid e r a h ot b a t h or w a r m m ilk . A v oid
t a kin g sle e pin g m e dic a tio n a s it m a y le a v e y o u gro g g y in t h e m or nin g .

Kaplans Tips for test day

1. Arrive at the Pro m etric Test Center 3 0 m in utes early so you are not rushed a n d
h ave tim e to get orga nized. Yo u will b e giv e n a lock e r t o stor e y o u r p e rso n al it e m s a n d
t h e n a ssig n e d a co m p u t e r st a tio n . R e m e m b e r t h a t y o u h a v e a t o t al of s e v e n h o u rs t o
co m ple t e 3 5 0 q u e stio ns, a n d a tot al of o n e h o u r t o b e us e d t h ro u g h o u t t h e d a y for br e a ks
a n d lu nch .
2. To cope with fatigue, you will need to schedule breaks. O ur reco m m ended schedule for
the e x a m is :
Q uestio n Block

Break ti m e at end of Block

Block
Block
Block
Block
Block
Block
Block

N o br e a k
5 m in u t e br e a k
5 m in u t e br e a k
3 0 m in u t e lu nch br e a k
N o br e a k
1 0 m in u t e br e a k
D o n e!

1
2
3
4
5
6
7

T his allo w s y o u 1 0 m in u t es e x tr a to us e a s n e e d e d . R e m e m b e r t h a t y o u will n e e d t o sig n in

a n d o u t w h e n y o u t a k e br e a ks. Yo u sh o uld also b e a w a r e t h a t if y o u le a v e t h e e x a m roo m
d urin g a block , it will b e m a r k e d a s a n irr e g ula rit y in y o u r t estin g sessio n . T h e r efor e , y o u
n e e d to co nsid e r a ft e r e a ch block w h e t h er y o u w a n t t o t a k e a b a t h roo m br e a k .

11

3. Start with the beginning of the question block and work your way to the end. The ide a
h ere is to get into a rh yth m th at will h elp cre ate wh at on e psychologist calls a " Flow " e xperience.
The flow e xperience is a state of optim al concentration and m a xim al perfor m ance.
4. D o not skip a n y q uestions. If y o u d o n't k n o w it w h e n y o u co m e to it , y o u a r e n ot lik ely
t o k n o w it la t e r. S kip pin g a ro u n d w a st e s ti m e a n d c a n e n d u p co nfusin g y o u . D e al wit h e a ch
q u e stio n a s y o u co m e to it , a nsw e r it a s b e st y o u c a n , a n d m o v e o n t o t h e n e x t q u e stio n .
5. Limit your use of the marking feature to no more than two or three questions per
block. Of course you should a nsw er e ach question as you co m e to it, but you m a y w ant to
double-check yourself on a fe w questions. Th e m arking fe ature lets you return to re vie w a nd
reconsider qu estions if you h a v e tim e left ov er. Used correctly, m arking will h elp you re visit
questions where you h a v e a high probability of getting the a nsw er correct. Misused, m arking
ca uses you to not giv e a qu estion your full attention th e first tim e around. You sim ply m a y not h a v e
tim e to go back a nd look at qu estions you h a v e m ark ed, especially if you m ark a lot of th e m .
6. Be ca utio us about ch a ngin g a nsw ers. I n g e n e r al, y o u r o d ds of ch a n gin g a corr ect
a nsw e r to a w ro n g o n e a r e so m uch hig h e r t h a n t h e r e v e rs e t h a t it is si m ply n o t w ort h t h e
risk . If y o u ch a n g e a n a nsw e r, y o u a r e m ost lik ely m a kin g it w ro n g! Yo u r first i m p ulse is
usu ally t h e corr ect o n e . S t a y wit h it u nle ss so m e cle a r insig h t occu rs to y o u .
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 mo m ent, m ake sure that you have entered an answer for
every question in the block and then, relax. Sit, take a break, and m entally prepare yourself for the
next block of questions. Focus on the questions to com e, not the ones that are past.
8. Monitor your ti m e. K n o w h o w m uch y o u h a v e left , so y o u d o n o t fin d y o u rs elf r ush e d a t
t h e e n d . W or k o n y o u r p a cin g fro m t h e b e gin nin g of t h e q u e stio n block . C h eck y o u r w a tch
e v e r y 1 0 q u estio ns to m a k e su r e y o u a r e o n t h e corr ect p a ce to finish . If y o u p ace y o u rs elf
t h ro u g h o u t t h e block , y o u sh o uld n ot b e sq u e e z e d for ti m e a t t h e e n d .
9. Relax. D u rin g t h e br e a ks b e t w e e n q u e stio n blocks, tr y t o r ela x a n d n o t t hin k b a ck o v e r
t h e e x a m . T h e d esir e to r ec all q u e stio ns is stro n g , b u t n ot h elpful. T h os e q u estio ns a r e in t h e
p a st ; y o u will n e v e r s e e t h e m a g ain . F ocus o n r ela xin g a n d m a kin g t h e m ost of y o u r br e a k .
R e m e m b e r, y o u will alw a y s t e n d to r e m e m b e r t h ose q u estio ns y o u g e t w ro n g .

AN D HERES SOME PREP A D V I CE FROM SOME OF OUR STUDENTS

Id r eco m m e n d st u d yin g n o m or e t h a n a bou t 5 w e e ks. A n y m or e a n d y o u will st a rt
forg e t tin g t hin gs y o u le a r n e d e a rlie r. I ca u tion y o u to t a k e w h a t y o ur class m a t es s a y a bo u t
t h eir e x a m wit h a gr ain of salt , b eca use e v e r y e x a m is diffe r e n t . Also, b u z z w ords a r e n ot
t y pically use d o n S t e p 1 . R a t h e r t h a n use t h e w ords s m u d g e cells, for e x a m ple , t h e yll
prob a bly j ust sh o w y o u a blood s m e a r.
H a v e a pla n n e d st u d y sch e d ule t h a t y o u stick to . I f y o u f all b e hin d , y o ull h a v e a h a r d ti m e
g e t tin g t h ro u g h e v e r y t hin g a n d still b ein g a ble to r e vie w m a t e rial.

D o n ot use First Aid or t h e all-inclusiv e b oo ks as t h e sole st u d y aid . If p ossible , use t h e Hig h

Yield boo ks.
S t a rt e a rly , stick t o a sch e d ule , tr y n o t t o b eco m e o v e r w h el m e d wit h all a v aila ble r eso u rces.
Pick a co u ple for e a ch su b j ect b ec a us e in m y e x p e rie nce y o u c a n n ot a bsorb it all. Use First
Aid a s a sca ffold it r e ally is h elpful for r ecall a ssocia tio n .

12

T h e last w e e k / fe w d a ys b efor e S t e p a r e v e r y distr actin g do nt giv e y o u rself too m uch ti m e

to st u d y , 4 - 6 w e e ks w or k e d for m e . B u t b e pr e p a r e d m e n t ally for t h e a n xie t y t h e w e e k
b efor e t h e t est focus o n e asie r su b j ects to r e vie w .

W h at abo ut revie w co u rses?

S o m e st u d e n ts fin d t h e str uct u r e a n d disciplin e of a r e vie w co u rs e v e r y h elpful a s p a rt of
t h eir S t e p 1 pr e p a r a tio n . U nfort u n a t ely so m e pro gr a m s sch e d ule t h eir co u rs e s a t ti m e s of
t h e y e a r t h a t d o nt coincid e wit h m ost first - tim e t a k e rs pr e p a r a tio n e fforts. N e v e rt h ele ss,
h e r e is t h e infor m a tio n o n r e vie w co u rs es t h a t a r e a v aila ble .

Marsh all University Joa n C Ed w ards School of Medicin e

T hird A n n u al U SMLE S t e p 1 R e vie w C o u rs e
May 1 4 - Ju ne 6, 2 0 0 7
H u ntington, W V
Course I nfor m ation :
1 7 d a y co u rs e
A p pro xi m a t ely 1 2 0 lect u r e h o u rs
8 a m - 4 p m , Mo n d a y - Frid a y ( n o cla ss o n Mo n d a y , Ma y 2 8 - - Me m orial D a y )
O v e r 2 0 a w a rd - win nin g f a cult y wit h e x p e rtise in U SMLE R e vie w
Acce ss to JC E S OM U SMLE w e bsit e , inclu din g pr a ctice e x a m s wit h f e e d b a ck
Cost: $ 1 , 5 0 0 p e r p e rso n ( d o es n ot inclu d e h ot el a cco m m o d a tio ns)
Space is limited to 1 0 0 registrants & g uaranteed only after pay m ent is received

Kapla n
Visit w w w . k a pla n .co m for m or e infor m a tio n .
Liv e Pr e p co u rs e s a r e 6 - 7 w e e ks in le n g t h . Price is $ 3 , 3 9 9 d o es n ot inclu d e foo d or
a cco m m o d a tio ns.
S t e p 1 Liv e R e tr e a t price is $ 5 , 5 9 9 inclu d e s foo d a n d acco m m o d a tio ns.
O t h e r pro gr a m s a r e a v aila ble .
Location
Atla nta Area
Chicago

Chicago Area
D allas Area
D.C.
Housto n
Mia m i

Step 1
Ja n . 8 - F e b . 1 7 , 2 0 0 7 * * *
Ma r. 1 2 - A pr. 2 9 , 2 0 0 7
Ju n . 1 1 - S e p . 3 0 , 2 0 0 7 * *
Ju n . 1 8 - S e p . 2 3 , 2 0 0 7 *
A pr. 3 0 - Ju n . 1 0 , 2 0 0 7 * * *
A u g . 2 7 - O ct . 6 , 2 0 0 7 * * *
Aug. 6 - Sep. 16, 2007***
Ja n . 2 2 - Ma r. 1 1 , 2 0 0 7
Aug. 13 - Sep. 30, 2007
A pr. 2 3 - Ju n . 1 0 , 2 0 0 7
O ct . 1 - N o v . 1 8 , 2 0 0 7
A pr. 1 6 - Ju n . 1 7 , 2 0 0 7
O ct . 1 5 - D ec. 1 6 , 2 0 0 7

13

Ne w ark ( NJM I )

Ne w York

Pasadena

Ja n . 8 - F e b . 2 5 , 2 0 0 7
Ma r. 5 - Jul. 8 , 2 0 0 7 * *
A u g . 2 7 - D ec. 1 6 , 2 0 0 7 * *
S e p . 3 - D ec. 9 , 2 0 0 7 *
O ct . 1 - N o v . 1 8 , 2 0 0 7
F e b . 2 6 - A pr. 1 5 , 2 0 0 7
Ju n . 1 8 - A u g . 5 , 2 0 0 7
S e p . 1 0 - O ct . 2 8 , 2 0 0 7
Ja n . 8 - F e b . 2 5 , 2 0 0 7
Ma y 2 1 - Jul. 1 , 2 0 0 7
Ma y 2 9 - Jul. 9 , 2 0 0 7 * * *

Philadelp hia
Area
* E x t e n d e dPr e p * * KMI * * * S t e p 1 Pr e p R e tr e a t
E v e nin gs a n d W e e k e n ds W e e k e n ds o nly S t e p 2 Pr e p R e tr e a t
N ot e : A n y of t h e a b o v e Liv ePr e p co u rs e s c a n b e p u rch a s e d a s p a rt of a D elu x ePr e p Pa ck a g e .

University of Missou ri at Ka nsas City I nstitute for Profession al

Preparation
F or m or e infor m a tio n visit h t t p : / / w w w . u m kc. e d u / ip p / pro gr a m s. a sp
Jan uary 8 to March 1 6, 2 0 0 7
This 10 - week, highly interactive program is for students who have a history of difficulty
with standardized tests; including multiple unsuccessful attempts at Step 1. I t focus e s
o n clinical corr ela tio ns in Bioch e m istr y , Ph y siolo g y , a n d Pa t h olo g y , Micro biolo g y a n d
m icro biolo g y r ela t e d bioch e m istr y . T h es e a r e t h e fields t h a t t y pic ally c a us e e x a m in e e s t h e
gr e a t est difficult y . O t h e r a re a s inclu d e d a r e A n a to m y , Ph a r m a colo g y , E m br y olo g y , G e n e tics,
Biost a tistics a n d B e h a vior al Scie nce .
A t y pic al sch e d ule for Mo n d a y t h ro u g h F rid a y in v olv e s a n eig h t h o u r d a y . S o m e w e e k e n d
s essio ns a r e also sch e d ule d . T his sch e d ule inclu d es a v a rie t y of s m all gro u p in t e r activ e
instr uctio n le d b y tr ain e d s m all gro u p f a cilit a tors a n d for m al lect u r e s pr e s e n t e d b y
e x p e rie nce d b a sic scie nce lect u r e rs. T h e instructio n al pro gr a m str e n g t h e ns t h e b a sic
scie nces b ack gro u n d of all p a rticip a n ts. C o m p u t e riz e d e x a m in a tio ns p e r m it st a ff, m e e tin g
in divid u ally wit h st u d e n ts, t o a n aly z e a n d m o nitor st u d e n ts pro gr e ss a s t h e y a p pro a ch t h eir
e x a m in a tio n .
T h e pro gr a m inclu d e s : ( a ) p e rso n aliz e d dia g n ostics, ( b ) scr e e nin g t e stin g , (c) m ock b o a rds,
( d ) p a t h olo g y ca se st u dies, ( e ) clinical a n d fu n d a m e n t al p h a r m acolo g y , (f) co m p u t e r b a se d
t e stin g a n d ( g ) t h e h all m a r k of o u r pro gr a m s, q u e stio n gro u p . Tuitio n is $ 6,4 0 0, ho using
costs are additional.

May 7 to Ju ne 1, 2 0 0 7
First tim e test takers a n d repeaters with scores at 1 6 8 or above. T his pro gr a m is
m ost b e n e ficial for a st u d e n t w a n tin g a focus e d r e vie w of t h e hig h i m p a ct to pics in a
str uct u r e d , q u e stio n b as e d for m a t .
T h e S u m m e r Pro gr a m off e rs a n in t e nsiv e fo u r w e e k r e vie w of t h e G e n e r al Principle s of
Pa t h olo g y , pr e s e n t e d b y a n a tio n ally r e sp ect e d p a t h olo gist ; critic al clinic al corr ela tio ns
e x plain e d in Bioch e m ist r y , Ph a r m acolo g y , a n d Ph ysiolo g y a n d a B e h a vior al Scie nces / E t hics
r e vie w . S t u d e n ts in t e r act wit h o n e a n o t h e r a n d t h e instr uctors a s t h e y sort o u t co nce p ts t h a t
t h e y u n d e rst a n d inco m ple t ely .
Q u e stio n - b as e d t u t orials h elp p a rticip a n ts t o d e v elo p t h e kin d a n d q u alit y of t hin kin g r e q uir e d

14

for success o n S t e p 1 . D aily s m all gro u p lect u r e r e vie w sessio ns will aid in org a niz a tio n a n d
r e t e n tio n . E m p h a sis is pla ce d o n u n d e rst a n din g of t h e co m m o n dis e a s e s a n d r ela t e d
tr e a t m e n t r e gi m e ns. I n a d ditio n , t h e pro gr a m will pro vid e a dia g n ostic, select e d su b j ect
e x a m s, a n d a m ock b o a rd . Tuition is $ 3 0 0 0.

August 28 to October 20, 2006 (dates not yet announced for 2007)

This 8 - w eek, live lectu re progra m is desig ned both for first tim e test takers w ho
desire a revie w of basic science concepts a n d for the stu dent w ho has scored at 1 6 7
or above on Step 1 a n d w ho is pla n nin g on sittin g for the USMLE Step 1 in early
Nove m ber. S t u d e n ts wit h a hist or y of difficult y o n st a n d a rdiz e d e x a m s a r e m or e lik ely t o b e
succe ssful wit h o u r lo n g e r pr e p a r a tio n pro gr a m b e gin nin g in Ja n u a r y .
As wit h all of o u r co u rs es, focus o n u n d e rst a n din g t h e m a t e rial co v e r e d , pr a cticin g
a p pro pria t e t e st t a kin g str a t e gies, a n d a p plyin g all skills a cq uir e d a n d co n t e n t r e vie w e d in a
co m p u t e r b a se d t estin g e n viro n m e n t . T his liv e lect u r e pro gr a m will inclu d e a r e vie w of
B act e riolo g y , Pa t h olo g y , Ph y siolo g y , I m m u n olo g y , Virolo g y , a n d Bioch e m istr y. Tuition is
$ 4,6 0 0. Housing costs are additional.

F ALCO N P HYS I C I AN R EV I E W S
F or m or e co m ple t e infor m a tio n visit h t t p : / / w w w .f alco n r e vie ws.co m / in d e x . h t m .
Co m plete revie w package includes:
B oo ks
Lu x u r y H ot el Acco m m o d a tio ns
D aily C o n tin e n t al Br e a k f a st a n d Lu nch
O v e r 3 2 5 co n t a ct h o u rs ( S t e p 1 )
O v e r 1 5 , 0 0 0 U SMLE T y p e E x a m Q u e stio ns
G ro u n d tr a nsp ort a tio n to a n d fro m t h e airp ort .
S h u ttle S e r vice t o sh o p pin g , m o vies, a n d ot h e r a r e a s of in t e r est
Step 1 Progra ms inclu d e infor m a tio n fro m : A n a t o m y , Histolo g y , Bioch e m istr y , Micro biolo g y ,
E m br y olo g y , Ph y siolo g y , N e u rolo g y , Ph a r m acolo g y , a n d B e h a vior al Scie nce , plus Clinical
Vig n e t t e s, C a s e Historie s, Gloss y Slid e s, a n d S a m ple T e sts.
REV I E W COURSE DATES for 2 0 0 7 :
Ja n u a r y 8 to F e br u a r y 2 3 - Co urse Full
Ma y 7 t o Ju n e 2 2
Ma y 1 4 t o Ju n e 2 9 (Mia m i)
M a y 1 4 t o Ju n e 2 9 (Phila d elp hia , PA a r e a )

July 1 6 t o A u g ust 3 1
A u g ust 2 0 t o O ct o b e r 5
O ct o b e r 1 t o N o v e m b e r 1 6

Unless other wise noted, all courses are held in D allas.

Cost of cou rse:
double occu pa ncy - $ 4,5 5 0 ; single occu pa ncy - $ 5, 5 5 0.

Nort h w ester n Medical Revie w

F or m or e infor m a tio n visit h t t p : / / w w w . n ort h w est e r n m e dic alr e vie w .co m / in d e x . p h p

(fro m t h e w e bsit e ) : N ort h w est e r n Me dical R e vie w off e rs liv e -lect u r e co u rses in pr e p a r a tio n for
t h e U SMLE a n d C O MLE X S t e p / Le v el 1 , 2 a n d 3 e x a m in a tio ns. T h es e co u rs es a r e d esig n e d to
allo w cu rr e n t m e dical st u d e n ts or gr a d u a tin g in t e r n a tio n al p h ysicia ns t o p a ss t h eir
e x a m in a tio ns in t h eir first a t t e m p t or t o r ais e t h eir pr e vio us scor e s t o a s a tisf a ct or y le v el.
R e vie w pla ns r a n gin g fro m a 3 - d a y q uick r e vie w co u rs e t o a 1 5 - d a y co m pr e h e nsiv e

15

p r e p a r a tio n a r e a v aila ble .

C o u rs e s a r e t a u g h t b y distin g uish e d a n d e x p e rie nce d m e dic al b o a rds lect u r e rs, m a n y of
w h o m h a v e a u t h or e d b est -s ellin g N ort h w e st e r n R e vie w b oo ks or h a v e m a st e r e d m ulti m e dia
T ALLP m e t h o d olo g y .
Progra m s are offere d at v arious m e dical schools or con v e ntion sit es within th e USA, C aribb e a n
Isla nds, a n d select sit es in Asia a n d E urop e . All courses includ e co m plet e sets of stud y m at erials,
r e vie w books, pret ests, a udio C Ds a n d USMLE w e b-b ased qu estion b a n k access.
N B I 3 0 0 ( S T EP I ) 1 0 , 1 5 , a n d 2 1 - D AY U SMLE
RE V I E W
LO CATI O N

DATE

E a st La nsin g , MI

Ja n u a r y 1 2 - 2 1 ,
2007

E a st La nsin g , MI

F e br u a r y 1 3 - 2 2 ,
2007

Phila d elp hia , PA

Extended Weekend
Pla n

sta n dard TU I T I O N RATES

NB I 3 0 0 ( 2 1 - day )

$1780

NB I 3 0 0 ( 1 5 - day )

$1380

NB I 3 0 0 ( 1 0 - day )

$1080

F e b 2 4 - 2 5 , Ma rch 3
- 4 , Ma rch 1 0 - 1 1 ,
A pril 1 4 - 1 5 , A pril 2 1
- 2 2 , a n d Ma y 5 - 6 ,
2007
S a t u rd a y s a n d
S u n d a y m ornin gs

E a st La nsin g , MI

Ma y 2 1 - 3 0 , 2 0 0 7

E a st La nsin g , MI

Ju n e 2 - 1 1 , 2 0 0 7

F OR S TUDENTS W I TH D OCUMENTED L EARN I NG D I SAB I L I T I ES

Marsh all University Medical H.E.L.P Progra m

OR

ADHD

F or m or e infor m a tio n visit h t t p : / / w w w . m a rsh all. e d u / m e dic alh elp /

(fro m t h e w e bsit e ) T h e Ma rsh all U niv e rsit y Me dical H . E .L.P. Pro gr a m b e g a n in 1 9 8 6 wit h a
visio n of h elpin g m e dical st u d e n ts a n d p h y sicia ns wit h le a r nin g dis a bilities a n d / or A D H D
succe e d aca d e m ically . Since t h a t ti m e , Ma rsh all Me dical H . E .L.P. h a s w or k e d wit h
a p pro xi m a t ely 6 0 0 st u d e n ts fro m a cross t h e U nit e d S t a t e s a n d s e v e r al for eig n co u n trie s. A
fiv e w e e k in t e nsiv e co u rse is h eld fo u r ti m e s e a ch y e a r in Ja n u a r y , Ma rch , Ju n e , a n d
S e p t e m b e r, wit h in divid u al o n e o n o n e s essio ns a v aila ble t h e r est of t h e y e a r. T h ro u g h o u t
t h e in t e nsiv e pro gr a m to pics such a s r e a din g a n d co m pr e h e nsio n , r e a din g r a t e , le a r nin g
str a t e gies, m e m oriz a tio n t ech niq u es, t est - t a kin g skills, e rror a n aly sis, a n d self- est e e m a r e
t a rg e t e d for i m pro v e m e n t .
This 5 - w eek course is held fou r ti m es a year : Ja n u ary, March, Ju ne, a n d Septe m ber.
The cost is $ 4,5 0 0 a nd does not inclu de acco m m odations.

16

O THER S TUDY R ESOURCES

T h e r e a r e pro b a bly a s m a n y m or e w e bsit es a n d b oo ks a v aila ble t h a n t h os e t h a t a r e list e d
h e r e . I f y o u fin d a b oo k or w e bsit e t h a t y o u fin d h elpful, ple a s e s e n d it o n t o m e so I c a n
inclu d e it in o u r list of r eso u rces. R e m e m b e r t h a t y o u ca n e a sily g e t o v e r w h el m e d b y usin g
t oo m a n y r e so u rce s a s y o u st u d y , so pick o u t t h e f e w t h a t s e e m t o w or k b e st wit h y o u r st yle
of st u d yin g a n d le a r nin g a n d g o wit h it . W h a t w or ks for o n e p e rso n m a y n o t w or k for
a n ot h e r, so b e c a r e ful a b o u t usin g a b oo k j ust b ec a us e so m e o n e els e s aid it w or k e d for t h e m .
Tr y it for y o u rself if it d o esnt fit y o u , m o v e o n t o so m e t hin g t h a t d o es. A n u m b e r of b oo ks
a r e a v aila ble for ch eck - o u t in t h e S t u d e n t Aff airs O ffice libr a r y .
For o nline q uestio n ba n ks, revie w books, etc.
w w w . us m le st e ps1 2 3 .co m
w w w . us m le r x .co m
h t t p : / / w w w . e x a m m a st e r 2 .co m / w ds e n tr y / t t u hsc- 1 . h t m
w w w .scor e 9 5 .co m
w w w . b o a rd pr e p . n e t / st e p o n e . h t m l
w w w . a p e x t e stin g .co m
BO OKS
NMS R e vie w for S t e p 1
Hig h -Yield Pa t h olo g y
S t e p U p : A Hig h -Yield , S y st e m s- B a s e d R e vie w for U SMLE S t e p 1
U SMLE S t e p 1 R ec all : B u z z w ords for t h e B o a rds
Hig h -Yield C o m pr e h e nsiv e U SMLE S t e p 1 R e vie w
K a pla n Q B oo k
First Aid C as e s for U SMLE S t e p 1
U SMLE S t e p 1 S ecr e ts
First Aid Q &A for U SMLE S t e p 1
G olj a ns R a pid R e vie w of Pa t h olo g y
Ro b bins R e vie w of Pa t h olo g y
Prince t o n Re vie w U SMLE R e vie w
Blu e prin ts S t e p 1 Q &A
A p ple to n & La n g e U SMLE S t e p 1
Pla tin u m Vig n e t t es ( Else vie r)
R a pid R e vie w S e rie s - U SMLE S t e p 1

Stu d y Sched ules

O n e of t h e big g e st piece s of a d vice t h a t st u d e n ts a n d e x p e rts alik e giv e su rro u n ds t h e id e a of
d e v elo pin g a n d stickin g t o a st u d y sch e d ule . A g ain , e v e r y b o d y h a s t h eir o w n id e a of w h a t
w or ks for t h e m a n d w h a t d o e snt , or w h a t t o pics n e e d to b e st u die d m or e , b u t y o u also n e e d
t o h a v e a st a rtin g p oin t . R e m e m b e r y o u m ust cr e a t e y o u r o w n st u d y sch e d ule b a se d o n
Y O UR in divid u al n e e ds. B u t h e r e is a w e bsit e wit h PD F files of a d o z e n or so s a m ple st u d y

17

sch e d ule s so y o u c a n g e t a n id e a of w h e r e to st a rt m ost of t h e m a r e a b o u t 4 w e e ks or so .

h t t p : / / w w w . b u m c. b u . e d u / D e p t / C o n t e n t. a sp x?D e p a rt m e n t I D = 4 2&Pa g e I D = 7 5 5 4

Youll find a sample 28-day study schedule at the back of this book in Appendix B.

APPEN D I X A USMLE D etailed O utline of Topics Covered on Step 1

G ENERAL P R I NC I PLES
Bioche m istr y a n d m olecular biolog y
g e n e e x pr e ssio n : D N A str uct u r e , r e plic a tio n , a n d e xch a n g e
o D N A str uct u r e : sin gle - a n d d o u ble -str a n d e d D N A , st a bilizin g forces,
su p e rcoilin g
o a n aly sis of D N A : se q u e ncin g , r estrictio n a n aly sis, PC R a m plifica tio n ,
h y bridiz a tio n
o D N A r e plica tio n , m u t a tio n , r e p air, d e gr a d a tio n , a n d in activ a tio n
o g e n e str uct u r e a n d org a niz a tio n ; ch ro m oso m es ; ce n tro m e r e , t elo m e r e
o r eco m bin a tio n , ins e rtio n s e q u e nces, tr a nsp oso ns
o m ech a nis m s of g e n e tic e xch a n g e , inclu din g tr a nsfor m a tio n , tr a nsd uctio n ,
co n j u g a tio n , crosso v e r, r eco m bin a tio n , lin k a g e
o pla s m ids a n d b a ct e rio p h a g e s
g e n e e x pr e ssio n : tr a nscrip tio n , inclu din g d ef ects
o tr a nscrip tio n of D N A in t o RN A , e n z y m a tic r e a ctio ns, RN A , RN A d e gr a d a tio n
o r e g ula tio n : cis- r e g ula tor y ele m e n ts, tr a nscrip tio n f a ctors, e n h a nce rs,
pro m ot e rs, sile nce rs, r e pr ess a n ts, splicin g
g e n e e x pr e ssio n : tr a nsla tio n , inclu din g d ef ects
o t h e g e n e tic co d e
o str uct u r e a n d fu nctio n of tRN A
o str uct u r e a n d fu nctio n of rib oso m e s
o prot ein s y n t h esis
o r e g ula tio n of tr a nsla tio n

18

p o s t - t r a n sl a tio n a l m o dific a t io n s , i n cl u di n g p h os p h o r y l a t io n , a d d it io n of C H O
u n it s
o prot ein d e gr a d a tio n
str uct u r e a n d fu nctio n of pro t eins
o principle s of prot ein struct u r e a n d foldin g
o e n z y m e s : kin e tics, r e a ctio n m ech a nis m s
o str uct u r al a n d r e g ula tor y prot eins : lig a n d bin din g , self- a sse m bly
o r e g ula tor y pro p e rtie s
e n e rg y m e t a b olis m , inclu din g m e t a b olic s e q u e nce s a n d r e g ula tio n
o g e n e r a tio n of e n e rg y fro m ca rb o h y dr a t es, f a t t y acids, a n d esse n tial a m in o
a cids ; glycoly sis, p e n tos e p h osp h a t e p a t h w a y , trica rb o x ylic acid cy cle ,
k e t o g e n e sis, electro n tr a nsp ort a n d o xid a tiv e p h osp h or yla tio n , glyco g e n oly sis
o stora g e of e n erg y : glucon eog e n esis, glycog e n esis, fatt y acid a n d triglycerid e
sy nth esis
o t h e r m o d y n a m ics : fr e e e n e rg y , ch e m ic al e q uilibria a n d gro u p tr a nsf e r p o t e n tial,
e n e rg e tics of A TP a n d ot h e r hig h - e n e rg y co m po u n ds
m e t a b olic p a t h w a y s of s m all m olecules a n d a ssocia t e d dis e a s es
o bios y n t h e sis a n d d e gr a d a tio n of a m in o a cids ( e g , h o m ocy stin u ria , m a ple s y r u p
u rin e dis e a s e )
o bios y n t h e sis a n d d e gr a d a tio n of p urin e a n d p y ri m idin e n ucle o tid e s
o biosy n t h esis a n d d e gr a d a tio n of lipids ( e g , d y slipid e m ia s, ca r nitin e d eficie ncy ,
a dr e n o g e nit al s y n dro m e s)
o bios y n t h e sis a n d d e gr a d a tio n of p orp h y rins
o g ala ctos e m ia a n d ot h e r s m all su g a r disord e rs
bios y n t h e sis a n d d e gr a d a tio n of ot h e r m a cro m olecule s a n d a ssocia t e d a b n or m alitie s,
co m ple x c a rb o h y dr a t e s ( e g , ly soso m al st or a g e dis e a s e ) , glyco pro t eins, a n d
prot e o glyc a ns ( e g , t y p e I I glyco g e n stor a g e dis e a s e )
o

Biolog y of cells
str uct u r e a n d fu nctio n of cell co m p o n e n ts ( e g , n ucle us, cy tos k ele to n , e n d o pla s m ic
r e ticulu m , pla s m a m e m br a n e )
sig n al tr a nsd uctio n (inclu din g b a sic principle s, r ece p tors a n d ch a n n els, s eco n d
m e ss e n g e rs, sig n al tr a nsd uctio n p a t h w a y s)
cell-cell a n d cell- m a trix a d h esio n
cell m otilit y
in tr acellula r sortin g ( e g , tr a ffickin g , e n d ocy tosis)
cellular ho m eost asis ( e g, turnov er, pH m aint e n a nce, prot e aso m e , ions, solu ble prot eins)
cell cycle ( e g , m itosis, m eiosis, str uct u r e of spin dle a p p a r a t us, cell cycle r e g ula tio n )
str uct u r e a n d fu nctio n of b a sic tissu e co m p o n e n ts (inclu din g e pit h elial cells, co n n ectiv e
tissu e cells, m uscle cells, n e r v e cells, a n d e x tr acellula r m a trix )
a d a p tiv e cell r e sp o ns e to in j u r y
in tr a cellula r a ccu m ula tio ns ( e g , pig m e n ts, f a ts, pro t eins, ca rb o h y dr a t es, m in e r als,
inclusio ns, v a cu ole s)
m ech a nis m s of in j u r y a n d n ecrosis
a p o p tosis
H u m a n develop m ent a n d genetics
e m br y o g e n e sis : pro gr a m m e d g e n e e x pressio n , tissu e diff e r e n tia tio n a n d
m orp h o g e n esis, h o m e otic g e n es, a n d d e v elop m e n t al r e g ula tio n of g e n e e x pr e ssio n
co n g e nit al a b n or m alitie s : principles, p a t t e r ns of a n o m alies, d y s m orp h o g e n esis
principle s of p e digr e e a n aly sis, inclu din g in h e rit a nce p a t t e r ns, occu rr e nce a n d
r ecu rr e nce risk d e t e r m in a tio n
popula tion g e n etics : H ard y - W ein b erg la w, found er effects, m ut a tion-selection e quilibriu m

19

g e n e tic m ech a nis m s : ch ro m oso m al a b n or m alitie s, m e n d elia n in h e rit a nce ,

m ultif a ctorial dis e a s es
clinical g e n e tics, inclu din g g e n e tic t estin g , pr e n a t al dia g n osis, n e w b or n scr e e nin g ,
g e n e tic co u ns elin g / e t hics, g e n e t h e r a p y
Biolog y of tissue response to disease
infla m m a tio n , inclu din g cells a n d m e dia t ors
o a cu t e infla m m a tio n a n d m e dia tor s y st e m s
o v a scula r r e sp o ns e to in j ur y , inclu din g m e dia tors
o infla m m a t or y cell r ecr uit m e n t , inclu din g a d h e r e nce a n d cell m igr a tio n , a n d
p h a g ocy t osis
o b act e ricid al m ech a nis m s a n d tissu e in j u r y
o clinical m anifestations (eg, pain, fe v er, leu kocytosis, leu k e m oid re action, and chills)
o ch ro nic infla m m a tio n
r e p a r a tiv e proce ss e s
o w o u n d h e alin g , h e m ost a sis, a n d r e p air : t h ro m b osis, gr a n ula tio n tissu e ,
a n gio g e n esis, fibrosis, sca r / k eloid for m a tio n
o r e g e n e r a tiv e proce ss e s
n e o pla sia
o cla ssific a tio n , histolo gic dia g n osis
o gr a din g a n d st a gin g of n e o pla s m s
o cell biolo g y , bioch e m istr y , a n d m olecula r biolo g y of n e o pla stic cells :
tr a nsfor m a tio n , o nco g e n e s, alt e r e d cell diff e r e n tia tio n , a n d prolif e r a tio n
o h e r e dit a r y n e o pla stic disord e rs
o in v a sio n a n d m e t a st a sis
o t u m or i m m u n olo g y
o p a r a n e o pla stic m a nif e st a tio ns of c a nce r
o c a nce r e pid e m iolo g y a n d pr e v e n tio n
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
pro gr essio n t h ro u g h t h e lif e cycle , inclu din g birt h t h ro u g h s e n e sce nce
o co g nitiv e , la n g u a g e , m ot or skills, a n d social a n d in t e rp e rso n al d e v elo p m e n t
o s e x u al d e v elo p m e n t ( e g , p u b e rt y , m e n o p a us e )
o influ e nce of d e v elo p m e n t al st a g e o n p h y sicia n - p a tie n t in t e r vie w
ps ych olo gic a n d social f a ctors influ e ncin g p a tie n t b e h a vior
o p e rso n alit y tr aits or co pin g st yle , inclu din g co pin g m ech a nis m s
o ps ych o d y n a m ic a n d b e h a vior al f a ctors, r ela t e d p a st e x p e rie nce
o fa mily a nd cultural factors, including socioecono mic status, ethnicity, a nd gender
o a d a p tiv e a n d m ala d a p tiv e b e h a vior al r esp o ns es t o str ess a n d illn ess ( e g , dr u g s e e kin g b e h a vior, sle e p d e priv a tio n )
o in t e r a ctio ns b e t w e e n t h e p a tie n t a n d t h e p h y sicia n or t h e h e alt h c a r e s y st e m
( e g , tr a nsf e r e nce )
o p a tie n t a d h e r e nce , inclu din g g e n e r al a n d a d ole sce n t
p a tie n t in t e r vie win g , co nsult a tio n , a n d in t e r a ctio ns wit h t h e f a m ily
o est a blishin g a n d m ain t ainin g r a p p ort
o d a t a g a t h e rin g
o a p pro a ch e s t o p a tie n t e d uc a tio n
o e n ticin g p a tie n ts t o m a k e lif e st yle ch a n g e s
o co m m u nic a tin g b a d n e ws
o difficult in t e r vie ws ( e g , a n xio us or a n gr y p a tie n ts)
o m ulticult u r al e t h nic ch a r a ct e ristics
m e dic al e t hics, j u rispr u d e nce , a n d prof e ssio n al b e h a vior

20

o
o
o
o
o
o
o
o
o

co nse n t a n d infor m e d co ns e n t t o tr e a t m e n t
p h y sicia n - p a tie n t r ela tio nships ( e g , e t hical co n d uct , co nfid e n tialit y )
d e a t h a n d d yin g
birt h - r ela t e d issu e s
issu es r ela t e d t o p a tie n t p a rticip a tio n in r ese a rch
in t e r a ctio ns wit h o t h e r h e alt h prof essio n als ( e g , r e f e rr al)
s e x u alit y a n d t h e prof e ssio n ; ot h e r b o u n d a r y issu e s
e t hics of m a n a g e d c a r e
org a niz a tio n a n d cost of h e alt h c a r e d eliv e r y

Multisyste m processes
n u tritio n
o g e n e r a tio n , e x p e n dit u r e , a n d stor a g e of e n e rg y a t t h e w h ole - b o d y le v el
o a ss ess m e n t of n u tritio n al st a t us across t h e lif e sp a n , inclu din g c alorie s, prot ein ,
e ss e n tial n u trie n ts, h y po ali m e n t a tio n
o fu nctio ns of n u trie n ts, inclu din g esse n tial, tr a ns-f a t t y acids, ch olest e rol
o pro t ein -c alorie m aln u tritio n
o vit a m in d e ficie ncie s a n d / or to xicitie s
o m in e r al d eficie ncies a n d t o xicitie s
o e a tin g disord e rs ( e g , o b esit y , a n or e xia , b uli m ia )
t e m p e r a t u r e r e g ula tio n
a d a p t a tio n to e n viro n m e n t al e x tr e m es, inclu din g occu p a tio n al e x p osu r e s
o physical a nd associated disorders (eg, te m perature, radiation, burns, decre ased
at m ospheric pressure, high- altitude sickness, incre ased w ater pressure)
o ch e m ical ( e g , g a ses, v a p ors, s m o k e in h ala tio n , a gricult u r al h a z a rds, v ola tile
org a nic solv e n ts, h e a v y m e t als, principles of p oiso nin g a n d t h e r a p y )
fluid, electrolyte, a nd acid-base bala nce a nd disorders (eg, dehydration, acidosis, alk alosis)
Ph ar m acod y na m ic an d p h ar m acokinetic processes
g e n e r al prin ciples
o ph ar m acokinetics : absorption, distribution, m etabolism , e xcretion, dosage interv als
o m ech a nis m s of dr u g a ctio n , str uct u r e - a ctivit y r ela tio nships
o co nce n tr a tio n - a n d d ose - e ff ect r ela tio nships ( e g , e ffic a cy , p o t e ncy ) , t y p e s of
a g o nists a n d a n t a g o nists a n d t h eir a ctio ns
o in divid u al f a ctors alt e rin g p h a r m a co kin e tics a n d p h a r m a co d y n a m ics ( e g , a g e ,
g e n d e r, dise a se , t ole r a nce , co m plia nce , b o d y w eig h t , m e t a b olic proficie ncy ,
p h a r m a co g e n e tics)
o dr u g sid e e ff ects, o v e rdos a g e , to xicolo g y
o dr u g in t e r actio ns
o r e g ula tor y issu e s ( e g , dr u g d e v elo p m e n t , a p pro v al, sch e d ulin g )
g e n e r al pro p e rties of a u t acoids, inclu din g p e p tid e s a n d a n alo gs, bio g e nic a m in e s,
prost a n oids a n d t h eir in hibitors, a n d s m oot h m uscle / e n d ot h elial a u t a coids
g e n e r al principles of a u to n o m ic p h a r m a colo g y
g e n e r al pro p e rties of a n ti m icro bials, inclu din g m ech a nis m s of actio n a n d r e sist a nce
g e n e r al pro p e rties of a n tin e o pla stic a g e n ts a n d i m m u n osu p pr e ss a n ts, inclu din g dr u g
e ff ects o n r a pidly dividin g m a m m alia n cells
Microbial biolog y a nd infection
m icro bial cla ssific a tio n a n d its b a sis
b a ct e ria a n d b a ct e rial dis e a s es
o str uct u r e a n d co m p ositio n

21

o m e t a b olis m , p h y siolo g y , a n d r e g ula tio n

o g e n e tics
o n a t u r e a n d m ech a nis m s of a ctio n of vir ule nce f a ctors
o p a t h o p h y siolo g y of inf ectio n
o e pid e m iolo g y a n d ecolo g y
o principles of cultiv a tio n , a ss a y , a n d la b or a tor y dia g n osis
vir us es a n d vir al dis e a s es
o p h y sic al a n d ch e m ic al pro p e rties
o r e plica tio n
o g e n e tics
o principles of cultiv a tio n , a ss a y , a n d la b or a tor y dia g n osis
o m olecula r b a sis of p a t h o g e n esis
o p a t h o p h y siolo g y of inf ectio n
o la t e n t a n d p e rsist e n t infectio ns
o e pid e m iolo g y
o o nco g e nic vir us e s
fu n gi a n d fu n g al inf e ctio ns
o str uct u r e , p h y siolo g y , cultiv a tio n , a n d la b or a t or y dia g n osis
o p a t h o g e n esis a n d e pid e m iolo g y
p a r a sit e s a n d p a r asitic dis e a s es
o str uct u r e , p h y siolo g y , a n d la b or a tor y dia g n osis
o p a t h o g e n esis a n d e pid e m iolo g y
principles of st e riliz a tio n a n d p u r e cult u r e t ech niq u e
I m m u ne responses
pro d uctio n a n d fu nctio n of gr a n ulocy t e s, n a t u r al kille r cells, a n d m a cro p h a g e s
pro d uctio n a n d fu nctio n of T ly m p h ocy t e s, T -ly m p h ocy t e r ece p tors
pro d uctio n a n d fu nctio n of B ly m p h ocy t es a n d pla s m a cells ; i m m u n o glo b ulin a n d
a n tib o die s : str uct u r e a n d biolo gic pro p e rties
a n tig e nicit y a n d i m m u n o g e nicit y ; a n tig e n pr e se n t a tio n ; cell a ctiv a tio n a n d r e g ula tio n ;
tole r a nce a n d clo n al d ele tio n
i m m u n olo gic m e dia tors : ch e m istr y , fu nctio n , m olecula r biolo g y , cla ssic a n d alt e r n a tiv e
co m ple m e n t p a t h w a y s, cy to kin e s, ch e m o kin e s
im m unogenetics ; MHC structure a nd function, class I, I I m olecules ; erythrocyte a ntigens
i m m u niz a tio ns : v a ccin e s, pro t ectiv e i m m u nit y
alt e r a tio ns in i m m u n olo gic fu nctio n
o T - or B -ly m p h ocy t e d e ficie ncies ( e g , DiG e org e s y n dro m e )
o d e ficie ncie s of p h a g ocy tic cells
o co m bin e d i m m u n o d e ficie ncy dis e a s e
o H I V inf ectio n / A I D S a n d o t h e r a cq uir e d disord e rs of i m m u n e r e sp o nsiv e n e ss
o dr u g -in d uce d alt e r a tio ns in i m m u n e r e sp o ns e s, i m m u n o p h a r m a colo g y
i m m u n olo gic ally m e dia t e d disord e rs
o h y p e rs e nsitivit y ( t y p e s I I V )
o tr a nspla n t a n d tr a nspla n t r e j ectio n
o a u toi m m u n e disord e rs
o risks of tr a nspla n t a tio n , tr a nsfusio n ( e g , gr a ft - v e rsus- h ost dis e a s e )
o isoi m m u niz a tio n , h e m oly tic dis e a s e of t h e n e w b or n
o i m m u n o p a t h o g e n e sis
i m m u n olo gic principles u n d e rlyin g dia g n ostic la b or a tor y t e sts ( e g , ELI S A , co m ple m e n t
fix a tio n , R I A , a g glu tin a tio n )
in n a t e i m m u nit y
Q u a ntitative m ethods

22

fu n d a m e n t al co nce p ts of m e a su r e m e n t
o sc ale s of m e a su r e m e n t
o distrib u tio n , ce n tr al t e n d e ncy , v a ria bilit y , pro b a bilit y
o dis e a s e pr e v ale nce a n d incid e nce
o dis e a s e o u tco m e s ( e g , f a t alit y r a t e s)
o a ssocia tio ns ( e g , corr ela tio n a n d co v a ria nce )
o h e alt h i m p a ct ( e g , risk diff e r e nce s a n d r a tios)
o se nsitivit y , sp ecificit y , pr e dictiv e v alu es
fu n d a m e n t al co nce p ts of st u d y d e sig n
o t y p es of e x p e ri m e n t al st u dies ( e g , clinical trials, co m m u nit y in t e r v e n tio n trials)
o t y p e s of o bse r v a tio n al st u die s ( e g , co h ort , c a se -co n trol, cross-s ectio n al, c a s e
s e rie s, co m m u nit y su r v e y s)
o s a m plin g a n d s a m ple siz e
o su b j ect s electio n a n d e x p osu r e alloc a tio n ( e g , r a n d o m iz a tio n , str a tific a tio n ,
s elf-s electio n , sy st e m a tic a ssig n m e n t )
o o u tco m e a ss e ss m e n t
o in t e r n al a n d e x t e r n al v alidit y
fu n d a m e n t al co nce p ts of h y p ot h esis t estin g a n d st a tistical inf e r e nce
o co nfid e nce in t e r v als
o st a tistic al sig nific a nce a n d T y p e I e rror
o st a tistic al p o w e r a n d T y p e I I e rror

__________________________________________________________
H EMATOPO I ET I C

AN D

L YMPHORET I CULAR S YSTEMS

Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s
org a n struct u r e a n d fu nctio n
cell / tissu e str uct u r e a n d fu nctio n
o pro d uctio n a n d fu nctio n of e r y t h rocy t e s, h e m o glo bin , O 2 a n d C O 2 tr a nsp ort ,
tr a nsp ort pro t eins
o pro d uctio n a n d fu nctio n of le u k ocy t es a n d t h e ly m p h or e ticula r syst e m
o pro d uctio n a n d fu nctio n of pla t ele ts
o pro d uctio n a n d fu nctio n of co a g ula tio n a n d fibrin oly tic f a ct ors
r e p air, r e g e n e r a tio n , a n d ch a n g e s a ssocia t e d wit h st a g e of lif e
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs
o inf ectio ns of t h e bloo d , r e ticulo e n d ot h elial sy st e m , a n d ly m p h a tics
o alle rgic a n d a n a p h yla ctic r e a ctio ns a n d o t h e r i m m u n op a t h olo gic m ech a nis m s
o a cq uir e d disord e rs of i m m u n e d e ficie ncy
o a u t oi m m u nit y a n d a u t oi m m u n e dise a s e s ( e g , C oo m bs p ositiv e h e m oly tic
a n e m ia , cr y o glo b ulin e m ia s, I TP)
o a n e m ia of ch ro nic dis e a s e
o tr a nsfusio n co m plic a tio ns, tr a nspla n t r e j ectio n
tra u m atic a nd m ech a nical injury (eg, m ech a nical injury to erythrocytes, splenic rupture)
n e o pla stic disord e rs ( e g , ly m p h o m a , le u k e m ia , m ultiple m y elo m a )
m e t a b olic a n d r e g ula tor y disord e rs, inclu din g acq uir e d a n d co n g e nit al
o a n e m ia s a n d cy to p e nia s ( e g , iro n d eficie ncy a n e m ia , h e m o glo bin o p a t hies,
h e r e dit a r y sp h e rocy tosis)
o cy t h e m ia
o h e m orr h a gic a n d h e m ost a tic disord e rs ( e g , co a g ulo p a t hie s, D I C )

23

o ble e din g seco n d a r y t o pla t ele t disord e rs ( e g , v o n Wille br a n d )

v a scula r a n d e n d ot h elial disord e rs ( e g , eff ects a n d co m plic a tio ns of sple n ecto m y ,
h y p e rsple nis m , T TP, h e m oly tic- u r e m ic s y n dro m e )
s y st e m ic disord e rs a ff ectin g t h e h e m a to p oie tic a n d ly m p h or e ticula r s y st e m ( e g ,
n u tritio n al d e ficie ncie s, s y st e m ic lu p us e r y t h e m a tosus)
idio p a t hic disord e rs

Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e h e m a to p oie tic s y st e m
o bloo d a n d bloo d pro d ucts
o tre at m ent of a ne mia, drugs stim ulating erythrocyte production (eg, erythropoietin)
o dr u gs sti m ula tin g le u k ocy t e pro d uctio n ( e g , G - C S F , G M- C S F )
o a n tico a g ula n ts, t h ro m b oly tic dr u gs
o a n tipla t ele t dr u gs
o a n ti m icro bials ( e g , a n ti m ala rials, a n ti- H I V )
o a n tin e o pla stic a n d i m m u n osu p pr e ssiv e dr u gs
o dr u gs us e d t o tr e a t a cq uir e d disord e rs of i m m u n e r e sp o nsiv e n e ss
ot h e r t h e r a p e u tic m o d alities ( e g , sple n ecto m y , ch ela tin g a g e n ts, r a dia tio n t h e r a p y for
ly m p h o m a s, pla s m a p h e r esis)
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otio n al a n d b e h a vior al f a ctors ( e g , die t , d e pr e ssio n a n d i m m u n e r e sp o ns e s, bloo d
d o pin g a m o n g a t hle t e s)
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , child h oo d le u k e m ia )
occupation al a nd other en viron m ental risk factors (eg, he a v y m etals, hydrocarbons, le ad)
g e n d e r a n d e t h nic f a ct ors ( e g , h e rb al tre a t m e n ts wit h b o n e m a rro w d e pr e ssio n )

C ENTRAL

AN D

P ER I PHERAL N ERVOUS S YSTEMS

Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s, inclu din g n e u r al
t u b e d e riv a tiv e s, ce r e br al v e n tricle s, n e u r al cr e st d e riv a tiv e s
org a n struct u r e a n d fu nctio n
o spin al cord , inclu din g gross a n a to m y , bloo d su p ply , a n d spin al r e fle x e s
o br ain st e m , inclu din g cr a nial n e r v es a n d n uclei, r e ticula r for m a tio n , gross
a n a to m y , a n d bloo d su p ply
o br ain , inclu din g gross a n a to m y a n d bloo d su p ply ; co g nitio n , la n g u a g e ,
m e m or y ; h y p ot h ala m ic fu nctio n ; li m bic sy st e m a n d e m otio n al b e h a vior ;
circ a dia n r h y t h m s a n d sle e p ; co n trol of e y e m o v e m e n t
o s e nsor y sy st e m s, inclu din g pro prioce p tio n , p ain , visio n , h e a rin g , b ala nce , t a st e ,
a n d olf a ctio n
o m otor s y st e m s, inclu din g br ain a n d spin al cord , b a s al g a n glia a n d ce r e b ellu m
o a u to n o m ic n e r v o us s y st e m
o p e rip h e r al n e r v e
cell / tissu e str uct u r e a n d fu nctio n

24

a x o n al tr a nsp ort
e xcit a ble pro p e rties of n e u ro ns, a x o ns a n d d e n drit e s, inclu din g ch a n n els
s y n t h e sis, st or a g e , r ele a s e , r e u p t a k e , a n d d e gr a d a tio n of n e u ro tr a ns m it t e rs
a n d n e u ro m o d ula t ors
o pr e - a n d p osts y n a p tic r ece p tor in t e r actio ns, trop hic a n d gro w t h f a ct ors
o br ain m e t a b olis m
o glia , m y elin
o br ain h o m e ost a sis : bloo d - br ain b a rrie r ; ce r e b rospin al fluid for m a tio n a n d flo w ;
ch oroid ple x us
r e p air, r e g e n e r a tio n , a n d ch a n g e s a ssocia t e d wit h st a g e of lif e
o
o
o

Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs ( e g , m e nin gitis, m ultiple
scle rosis, m y a st h e nia gr a vis)
tr a u m a tic a n d m ech a nic al disord e rs ( e g , su b d u r al a n d e pid u r al h e m a to m a s, cord
co m pr essio n , p e rip h e r al n e r v e in j u r y )
n e o pla stic disord e rs, inclu din g pri m a r y a n d m e t a st a tic
a cq uir e d m e t a b olic a n d r e g ula tor y disord e rs ( e g , d eliriu m , R e y e s y n dro m e )
v a scula r disord e rs ( e g , ce r e bro v a scula r occlusio n , v e n o us sin us t h ro m b osis, a rt e rial
a n e u r y s m s, h e m orr h a g e )
s y st e m ic disord e rs a ff ectin g t h e n e r v o us syst e m ( e g , lu p us, dia b e tic n e u ro p a t h y )
idio p a t hic disord e rs a ff ectin g t h e n e r v o us sy st e m
co n g e nit al disord e rs, inclu din g m e t a b olic ( e g , n e u r al t u b e d ef ects, ce r e br al p als y ,
m e n t al r e t a rd a tio n , D o w n s y n dro m e )
d e g e n e r a tiv e disord e rs ( e g , p e rip h e r al n e u ro p a t h y , Alz h ei m e r d e m e n tia , Pa r kinso n
dise a se , H u n tin g t o n dise a se , a m y otro p hic la t e r al scle rosis)
p a ro x y s m al disord e rs ( e g , e pile ps y , h e a d a ch e , p ain s y n dro m e s, a n d sle e p disord e rs
inclu din g n a rcole ps y , r e stle ss le gs s y n dro m e / p e rio dic li m b m o v e m e n t , circ a dia n
r h y t h m disord e rs, p a r a so m nia s)
disord e rs of sp ecial s e ns es ( e g , blin d n e ss, d e afn e ss)
ps ych o p a t h olo gic disord e rs, process es a n d t h eir e v alu a tio n
o e a rly - o ns e t disord e rs ( e g , le a r nin g disord e rs)
o disord e rs r ela t e d to su bst a nce us e
o schiz o p h r e nia a n d ot h e r ps ych otic disord e rs
o m oo d disord e rs
o a n xie t y disord e rs
o so m a tofor m disord e rs
o p e rso n alit y disord e rs
o p h y sic al a n d s e x u al a b us e of childr e n , a d ults, a n d eld e rs
o other disorders (eg, dissociativ e, im pulse control, post-tra u m atic stress disorder)
Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e n e r v o us s y st e m
o a n e st h e tics
o h y p n o tics
o ps ych o p h a r m a colo gic a g e n ts ( e g , a n xioly tics, a n tid e pr e ss a n ts, a n tips ych o tic
a g e n ts, m oo d -st a bilizin g a g e n ts)
o a n tico n v ulsa n ts
o a n alg esics
o sti m ula n ts, a m p h e t a m in e s
o a n tip a r kinso nia n dr u gs
o sk ele t al m uscle r ela x a n ts, b ot ulin u m t o xin

25

n e u ro m uscula r j u nctio n blockin g a g e n ts ( p osts y n a p tic)

a n tigla uco m a dr u gs
dr u gs us e d to d ecr e a s e in tr a cr a nial pr e ssu r e ( e g , m a n nitol, hig h - d os e
glucocorticoids)
o a n ti m igr ain e a g e n ts
o dr u gs aff ectin g a u to n o m ic n e r v o us s yst e m ( e g , a n tich olin est e r a s es)
o t h e r t h e r a p e u tic m o d alitie s ( e g , r a dia tio n , C F S sh u n tin g , su rg e r y )
o
o
o

Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otio n al a n d b e h a vior al f a ctors ( e g , dru g a b us e , d e m e n tia , sle e p d e priv a tio n ,
a ccid e n t pr e v e n tio n , p e ts)
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , d e v elo p m e n t al dis a bilities, d e m e n tia ,
g e n e r a tio n r e v e rs al, n u tritio n , s eiz u r e s, sle e p disord e rs)
occu p a tio n al a n d ot h e r e n viro n m e n t al risk f a ctors ( e g , b o xin g , c a rb o n m o n o xid e
e x p osu r e )
g e n d e r a n d e t h nic f a ct ors

___________________________________________________
SK I N

AN D

R ELATED C O N NECT I VE T I SSUE

Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s
org a n struct u r e a n d fu nctio n
cell / tissu e str uct u r e a n d fu nctio n , inclu din g b a rrie r fu nctio ns, t h e r m al r e g ula tio n ,
eccrin e fu nctio n
r e p air, r e g e n e r a tio n , a n d ch a n g es associa t e d wit h st a g e of life or e t h nicit y ( e g , s e nile
p u rp u r a , m ale p a t t e r n b ald n e ss, post m e n o p a us al h air ch a n g e s)
skin d e f e nse m ech a nis m s a n d n or m al flor a
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs
o bacterial infections (eg, acn e, cellulitis, carbuncle, abscess, n ecrotizing fasciitis,
ga ngrene)
o vir al inf ectio ns ( e g , h e rp es inf ectio ns, chick e n p o x , r u b ella , m e a sles, rose ola ,
v e rr uc a e )
o fu n g al inf ectio ns, inclu din g m y coses, d e r m a to p h y tosis ( e g , tin e a )
o p a r a sitic inf ectio ns ( e g , sc a bies, lic e )
o im m une a nd a utoim m une disorders (eg, discoid lupus erythe m atosus, scleroder m a,
der m ato m yositis, alopecia, psoriasis, urticaria, allergic der m atosis)
tr a u m a tic a n d m ech a nic al disord e rs ( e g , t h e r m al in j u r y , d ecu bit us ulce rs, e ff ects of
ultr a viole t lig h t a n d r a dia tio n )
n e o pla stic disord e rs
o k e r a tin ocy t e s ( e g , s e borr h eic k e r a tosis, a ctinic k e r a tosis, b a s al cell c a rcin o m a ,
sq u a m o us cell c a rcin o m a , a n d ich t h y osis)
o m ela n ocy t e s ( e g , n e vi, m ela n o m a )
o v a scula r n e o pla s m s ( e g , h e m a n gio m a s, K a p osi s a rco m a )
o ot h e r ( e g , T -cell ly m p h o m a , skin a p p e n d a g e t u m ors)
m e t a b olic, r e g ula tor y , a n d str uct u r al disord e rs ( e g , vit a m in d e ficie ncie s,
h y p e r vit a m in osis, h y p e r hidrosis)
v a scula r disord e rs ( e g , v a sculitis, R a y n a u d dis e a s e )

26

s y st e m ic disord e rs a ff ectin g t h e skin ( e g , E hle rs- D a nlos s y n dro m e , Ma rf a n s y n dro m e )

Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e skin a n d co n n ectiv e tissu e , inclu din g a n ti-infla m m a t or y a g e n ts ( e g ,
corticost e roids, a n tihist a m in es) , e m ollie n ts, su nscr e e n , r e tin oids, a n ti m icro bial a g e n ts,
cy toto xic a n d i m m u n olo gic t h e r a p y ( e g , m e t h otr e x a t e , PU V A , k e r a tin oly tics)
ot h e r t h e r a p e u tic m o d alities ( e g , las e r, t a t too r e m o v al, cr y o t h e r a p y )
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otio n al a n d b e h a vior al f a ctors ( e g , su n e x p osu r e , a cn e )
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , psoria sis)
occu p a tio n al a n d o t h e r e n viro n m e n t al risk f a ctors
g e n d e r a n d e t h nic f a ct ors ( e g , k eloid )

________________________________________________
M USCULOSKELETAL S YSTEM
Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s
org a n struct u r e a n d fu nctio n
cell / tissu e str uct u r e a n d fu nctio n
o biolo g y of b o n e s, j oin ts, t e n d o ns, sk ele t al m uscle
o e x e rcis e a n d p h y sic al co n ditio nin g
r e p air, r e g e n e r a tio n , a n d ch a n g e s a ssocia t e d wit h st a g e of lif e
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs
o inf ectio us disord e rs ( e g , s e p tic a rt h ritis, Ly m e dis e a s e , ost e o m y elitis)
o infla m m a t or y disord e rs ( e g , fibrositis, sy n o vitis, t e n os y n o vitis)
o im m u nologic disord ers ( e g, rh e u m atoid arthritis, a n k ylosin g spond ylitis,
poly m yositis, syst e mic lupus ery th e m a tosus, d er m a to m yositis, poly m y algia
rh e u m atica )
tr a u m a tic a n d m ech a nic al disord e rs ( e g , fr a ct u r e s, spr ains, str ains, disloc a tio ns,
r e p e titiv e m o tio n in j u rie s)
n e o pla stic disord e rs ( e g , ost e osa rco m a , m e t a st a tic dis e a s e )
m e t a b olic, r e g ula tor y , a n d str uct u r al disord e rs ( e g , d w a rfis m , ost e o g e n e sis
i m p e rf ect a , ost e o m ala cia , ost e o p orosis, ost e o d y stro p h y , go u t , m uscula r d y stro p h y )
v a scula r disord e rs ( e g , p oly a rt e ritis n o d os a , b o n e inf a rcts)
s y st e m ic disord e rs a ff ectin g t h e m usculosk ele t al s y st e m ( e g , dia b e t e s m ellit us)
idio p a t hic disord e rs ( e g , D u p u y tr e n con tr a ct u r e , scoliosis, Pa g e t dis e a s e )
d e g e n e r a tiv e disord e rs ( e g , disc dise a s e , ost e o a rt h ritis)
Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e m usculosk ele t al s y st e m
o n o nst e roid al a n ti-infla m m a tor y dr u gs a n d a n alg e sics

27

m uscle r ela x a n ts
a n tig o u t t h e r a p y ( e g , allo p u rin ol, colchicin e , u ricosu ric dr u gs)
i m m u n osu p pr e ssiv e dr u gs ( e g , glucocorticoids, g old , cy toto xic a g e n ts)
dr u gs aff ectin g b o n e m in e r aliz a tio n ( e g , bisp h osp h o n a t e s, c alcito nin , e stro g e n
a n alo gs)
ot h e r t h e r a p e u tic m o d alities ( e g , r a dia tio n , su rg e r y , ca sts, r e h a bilit a tio n )
o
o
o
o

Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otio n al a n d b e h a vior al f a ctors ( e g , die t , e x e rcis e , s e a t b elts, bicycle h el m e ts)
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , ost e o p orosis, fr a ct u r e s in eld e rly , alco h ol
a b us e , a n d fr a ct u r e s)
occu p a tio n al a n d ot h e r e n viro n m e n t al risk f a ctors ( e g , a t hle t e s, m usicia ns)
g e n d e r a n d e t h nic f a ct ors ( e g , b o n e m a ss)

__________________________________________
R ESP I RATORY S YSTEM
Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s
org a n struct u r e a n d fu nctio n
o air w a y s, inclu din g m ech a nics a n d r e g ula tio n of br e a t hin g
o lu n g p a r e nch y m a , inclu din g v e n tila tio n , p e rfusio n , g a s e xch a n g e
o ple u r a
o n a so p h a r y x a n d sin us es
cell / tissu e str uct u r e a n d fu nctio n , inclu din g su rf a ct a n t for m a tio n , alv e ola r str uct u r e
r e p air, r e g e n e r a tio n , a n d ch a n g e s a ssocia t e d wit h st a g e of lif e
p ul m o n a r y d e f e ns e m ech a nis m s a n d n or m al flor a
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs
o inf ectio us dis e a s e s
infectious dise ases of the upper respiratory tract (eg, sinusitis, ph aryngitis)
a cu t e inf ectio us dis e a s e s of t h e lo w e r r espir a tor y tr a ct a n d ple u r a a n d
t h eir co m plic a tio ns ( e g , p n e u m o nia , bro nchiect a sis, a bsce ss, e m p y e m a )
ch ro nic inf ectio us dis e a s e s of t h e lo w e r r espir a t or y tr act ( e g ,
Myco b a ct e riu m , e n d e m ic fu n g al inf ectio ns, N oca rdia / Actin o m y ces)
o i m m u n olo gic disord e rs
alle rgic a n d h y p e rse nsitivit y disord e rs ( e g , a st h m a )
a utoim m une disorders (eg, W egener gra nulo m atosis, Goodpasture
syndro m e)
o infla m m a tor y disord e rs
p n e u m oco nios e s
a cu t e a n d ch ro nic alv e ola r in j u r y ( e g , a cu t e r e spir a tor y distr e ss
s y n dro m e , chlorin e g a s / s m o k e in h ala tio n )
o bstr uctiv e p ul m o n a r y dis e a s e
r estrictiv e p ul m o n a r y dis e a s e ( e g , sa rcoid osis, idio p a t hic fibrosis)
tr a u m a tic a n d m ech a nic al disord e rs ( e g , for eig n b o d y a spir a tio n , p n e u m ot h or a x ,
a t elect a sis, sle e p a p n e a )
n eoplastic disorders (eg, polyps, bronchogenic carcino m a, m esoth elio m a, m etastatic
tu m ors)

28

m e t a b olic, r e g ula tor y , a n d str uct u r al disord e rs ( e g , h y p o v e n tila tio n , disord e rs of g a s

e xch a n g e , v e n tila tio n - p e rfusio n i m b ala nce , n e o n a t al r e spir a tor y distr e ss s y n dro m e )
v a scula r a n d circula tor y disord e rs ( e g , t h ro m b o e m b olic dis e a s e , p ul m o n a r y
h y p e rt e nsio n , p ul m o n a r y e d e m a , ple u r al e ffusio n )
s y st e m ic disord e rs a ff ectin g t h e r e spir a tor y s y st e m
Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e r e spir a tor y s y st e m ( e g , d eco n g e st a n ts, co u g h su p pr ess a n ts, e x p ect or a n ts,
m ucoly tics ; bro nch o dila t or dr u gs ; a n ti-infla m m a t or y a n d cy t o t o xic dru gs ;
a n ti m icro bial a g e n ts ; a n tin e o pla stic a g e n ts)
o t h e r t h e r a p e u tic m o d alitie s ( e g , o x y g e n t h e r a p y , n a s al CPAP, m ech a nic al v e n tila tio n ,
p h y sic al t h e r a p y , su rgic al proce d u r es, inclu din g tr a nspla n t a tio n )
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otio n al a n d b e h a vior al f a ctors ( e g , s m o kin g , su bst a nce a b us e , p e ts, a n d alle rgies)
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , t u b e rculosis, a st h m a , chro nic o bstr uctiv e
p ul m o n a r y dis e a s e , sch ool issu e s, prot ectiv e p a r e n ts, f a m ily s m o kin g )
occu p a tio n al a n d o t h e r e n viro n m e n t al risk f a ctors
g e n d e r a n d e t h nic f a ct ors ( e g , s a rcoid osis, lu n g c a nce r )

_________________________________________
C ARD I OVASCULAR S YSTEM
Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s
org a n struct u r e a n d fu nctio n
o ch a m b e rs, v alv e s
o c a rdia c cycle , m ech a nics, h e a rt so u n ds, c a rdia c co n d uctio n
o h e m o d y n a m ics, inclu din g s y st e m ic, p ul m o n a r y , coro n a r y , a n d bloo d v olu m e
o circula tio n in sp ecific v a scula r b e ds
cell / tissu e str uct u r e a n d fu nctio n
o h e a rt m uscle , m e t a b olis m , o x y g e n co nsu m p tio n , bioch e m istr y , a n d s ecr e t or y
fu nctio n ( e g , a trial n a triu r e tic p e p tid e )
o e n d ot h eliu m a n d s ecr e tor y fu nctio n , v a scula r s m oo t h m uscle , m icrocircula tio n ,
a n d ly m p h flo w
o m ech a nis m s of a t h e roscle rosis
o n e u r al a n d h or m o n al r e g ula tio n of t h e h e a rt , bloo d v ess els, a n d bloo d v olu m e ,
inclu din g r e sp o ns e s to ch a n g e in post u r e , e x e rcis e , a n d tissu e m e t a b olis m
r e p air, r e g e n e r a tio n , a n d ch a n g e s a ssocia t e d wit h st a g e of lif e
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs
o inf ectio us disord e rs ( e g , e n d oc a rditis, m y oca rditis, p e rica rditis)
o infla m m a tor y a n d i m m u n olo gic disord e rs ( e g , acu t e rh e u m a tic f e v e r, sy st e m ic
lu p us e r y t h e m a tosus, v a sculitis, t e m p or al a rt e ritis)
tr a u m a tic a n d m ech a nic al disord e rs ( e g , t a m po n a d e , v alv ula r dise a se , o bstr uctiv e
ca rdio m y o p a t h y )
n e o pla stic disord e rs

29

m e t a b olic a n d r e g ula tor y disord e rs ( e g , d y srh y t h m ia s, s y stolic a n d dia stolic

d y sfu nctio n , lo w - a n d hig h - o u t p u t h e a rt f ailu r e , cor p ul m o n ale , s y st e m ic h y p e rt e nsio n ,
isch e m ic h e a rt dis e a s e , m y oc a rdial inf a rctio n , s y st e m ic h y p o t e nsio n , a n d sh ock )
v a scula r disord e rs ( e g , a n e u r y s m s, occlusio ns, v a ricositie s, a t h e roscle rosis)
s y st e m ic dis e a s e s a ff ectin g t h e c a rdio v ascula r s y st e m ( e g , a m yloid osis, a ortic
diss ectio n wit h Ma rf a n sy n dro m e , scle ro d e r m a )
co n g e nit al disord e rs of t h e h e a rt a n d ce n tr al v ess els

Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e c a rdio v a scula r s y st e m
o coro n a r y a n d p e rip h e r al v a so dila tors
o a n tia rr h y t h m ic dr u gs
o a n tih y p e rt e nsiv e dr u gs
o m e a su r es use d t o co m b a t h y p ot e nsio n a n d sh ock
o dr u gs a ff ectin g ch olest e rol a n d lipid m e t a b olis m
o dr u gs aff ectin g bloo d co a g ula tio n , t h ro m b oly tic a g e n ts
o in o tro pic a g e n ts a n d tr e a t m e n t of h e a rt f ailu r e
o i m m u n osu p pr e ssiv e a n d a n ti m icro bial dr u gs
o dr u gs to tr e a t p e rip h e r al a rt e rial dis e a s e
ot h e r t h e r a p e u tic m o d alities ( e g , p a ce m a k e rs, a n gio pla st y , v alv e s, gr a fts, ot h e r
su rgic al proce d u r e s)
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otio n al a n d b e h a vior al f a ctors ( e g , s m o kin g , alco h ol, isch e m ic h e a rt dis e a s e ,
o b e sit y , e x e rcis e , die t )
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , alt e r e d lif e st yle )
occu p a tio n al a n d ot h e r e n viro n m e n t al risk f a ctors ( e g , str ess)
g e n d e r a n d e t h nic f a ct ors ( e g , h y p e rt e nsio n )

G ASTRO I NTEST I NAL S YSTEM

Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s
org a n str uct u r e a n d fu nctio n , inclu din g ali m e n t a r y ca n al, liv e r a n d bilia r y sy st e m ,
s aliv a r y gla n ds a n d e x ocrin e p a ncr e a s, m otilit y , a n d dig e stio n a n d a bsorp tio n
cell / tissu e str uct u r e a n d fu nctio n
o e n d ocrin e a n d n e u r al r e g ula t or y fu nctio ns, inclu din g G I h or m o n e s
o s aliv a r y , g a stroin t estin al, p a ncr e a tic, h e p a tic secr e t or y pro d ucts, inclu din g
e n z y m e s, prot eins, bile s alts, a n d proce ss e s
o s y n t h e tic a n d m e t a b olic fu nctio ns of h e p a t ocy t e s
r e p air, r e g e n e r a tio n , a n d ch a n g e s a ssocia t e d wit h st a g e of lif e
g a stroin t estin al d e f e ns e m ech a nis m s a n d n or m al flor a
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs

30

inf ectio us disord e rs ( e g , p erit o nitis, h e p a titis, gin giv ost o m a titis, p e p tic ulce r,
g a stritis, e so p h a gitis, tr a v ele rs dia rr h e a , foo d p oiso nin g )
o infla m m a tor y disord e rs ( e g , ch olecy stitis, p a ncr e a titis)
o i m m u n olo gic disord e rs ( e g , C ro h n dis e a s e , ulce r a tiv e colitis)
tr a u m a tic a n d m ech a nic al disord e rs
o m alocclusio n
o hia t us h e r nia
o o bstr uctio n ( e g , v olv ulus, in t ussusce p tio n , e so p h a g e al a tr e sia , a n n ula r
p a ncr e a s, postsu rgic al o bstr uctio n )
o p e rfor a tio n of h ollo w viscus a n d blu n t tr a u m a
o in g uin al, f e m or al, a n d a b d o m in al w all h e r nia s
o eso p h a g e al a n d in t estin al div e rticula ( e g , Meck el div e rticulu m )
n e o pla stic disord e rs, inclu din g b e nig n a n d m alig n a n t
m e t a b olic a n d r e g ula t or y disord e rs ( e g , m otilit y disord e rs, m ala bsorp tio n , h e p a tic
f ailu r e , ch olelit hia sis)
v a scula r disord e rs ( e g , p ort al h y p e rt e nsio n , h e m orr h oids, isch e m ia , a n gio d y spla sia )
s y st e m ic disord e rs a ff ectin g t h e g astroin t e stin al s y st e m
o

Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e g a stroin t e stin al s y st e m
o tre at m ent and prophyla xis of peptic ulcer dise ase a nd gastroesoph age al reflux (eg,
antacids, antisecretory drugs, m otility drugs, m ucosal protectiv e agents, antibiotics)
o dr u gs to alt e r g a stroin t e stin al m o tilit y ( e g , c a t h a rtics, a n tidia rr h e al dr u gs,
a n tie m e tic dr u gs, pro kin e tic dr u gs)
o fluid r e pla c e m e n t ( e g , or al r e h y dr a tio n )
o p a ncr e a tic r e pla ce m e n t t h e r a p y a n d tr e a t m e n t of p a ncr e a titis
o dr u gs for tr e a t m e n t of h e p a tic f ailu r e ( e g , la ct ulos e ) a n d bilia r y dis e a s e ( e g ,
dr u gs to dissolv e g allsto n e s)
o a n ti-infla m m a t or y , i m m u n osu p pr essiv e , a n tin e o pla stic, a n d a n ti m icro bial dr u gs
ot h e r t h e r a p e u tic m o d alities ( e g , su rgical proce d u r e s, st e n ts, f e e din g t u b e s)
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otion al a nd beh a vioral factors (eg, peptic ulcer, encopresis, Monda y m orning stom ach)
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , infla m m a tor y b o w el dis e a s e , irrit a ble
b o w el dise a s e , p a ncr e a titis a n d alco h ol, ch ro nic la x a tiv e a b us e )
occu p a tio n al a n d o t h e r e n viro n m e n t al risk f a ctors
g e n d e r a n d e t h nic f a ct ors ( e g , die ts)

________________________________________
R ENAL / U R I NARY S YSTEM
Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s
org a n struct u r e a n d fu nctio n
o kid n e y s, u r e t e rs, bla d d e r, u r e t h r a
o glo m e r ula r filtr a tio n a n d h e m o d y n a m ics
o t u b ula r r e a bsorp tio n a n d s ecr e tio n , inclu din g tr a nsp ort proce ss e s a n d prot eins
o u rin a r y co nce n tr a tio n a n d dilu tio n
o r e n al m ech a nis m s in acid - b a se b ala nce

31

o r e n al m ech a nis m s in bo d y fluid h o m e ost a sis

o m ict u ritio n
cell / tissu e str uct u r e a n d fu nctio n , inclu din g r e n al m e t a b olis m a n d o x y g e n
co nsu m p tio n , h or m o n es pro d uce d b y or a ctin g o n t h e kid n e y
r e p air, r e g e n e r a tio n , a n d ch a n g e s a ssocia t e d wit h st a g e of lif e
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs
o inf ectio us disord e rs
u p p e r u rin a r y tr a ct ( e g , p y elo n e p h ritis, p a pilla r y n ecrosis)
lo w e r u rin a r y tr act ( e g , cy stitis, u r e t h ritis)
o infla m m a tor y a n d i m m u n olo gic disord e rs
glo m e r ula r disord e rs ( e g , glo m e r ulo n e p h ritis, n e p h ro tic sy n dro m e , a n d
I g A n e p h rop a t h y )
t u b ula r in t e rstitial dis e a s e ( e g , in t e rstitial n e p h ritis, tr a nspla n t r e j ectio n )
tr a u m a tic a n d m ech a nic al disord e rs ( e g , o bstructiv e u ro p a t h y )
n e o pla stic disord e rs, inclu din g pri m a r y ( e g , r e n al, u rin a r y bla d d e r a n d collectin g
s y st e m ) a n d m e t a st a se s
m e t a b olic a n d r e g ula tor y disord e rs
o r e n al f ailu r e , acu t e a n d ch ro nic ( e g , acu t e t u b ula r n ecrosis)
o t u b ula r a n d collectin g d uct disord e rs ( e g , F a nco ni sy n dro m e , r e n al t u b ula r
a cid osis, n e p h ro g e nic dia b e t es insipid us, p olycy stic kid n e y dis e a s e )
o r e n al calculi
v a scula r disord e rs ( e g , r e n al a rt e r y st e n osis)
s y st e m ic dis e a s es a ff ectin g t h e r e n al s y st e m ( e g , dia b e t es m ellit us, h e p a titis,
a m yloid osis, sy st e m ic lu p us e r y t h e m a tosus, W e g e n e r gr a n ulo m a tosis)
Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e r e n al a n d u rin a r y s y st e m
o diu r e tics, a n tidiu r e tic dr u gs
o dr u gs a n d fluids us e d t o tr e a t v olu m e , electroly t e , a n d a cid - b a s e disord e rs
o dr u gs us e d t o e n h a nce r e n al p e rfusio n ( e g , d o p a m in e )
o a n ti-infla m m a t or y , a n ti m icro bial, i m m u n osu p pr essiv e , a n d a n tin e o pla stic dr u gs
o dr u gs us e d t o tr e a t lo w e r u rin a r y tr a ct s y st e m ( e g , inco n tin e nce , bla d d e r
fu nctio n , b e nig n prost a tic h y p e rpla sia )
ot h e r t h e r a p e u tic m o d alities ( e g , dialy sis, r e n al tr a nspla n t a tio n )
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m o tio n al a n d b e h a vior al f a ct ors ( e g , dru g -in d uce d in t e rstitial n e p h ritis, die t )
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , h e m o dialy sis, livin g r ela t e d kid n e y
d o n a tio n , tr a nspla n ts)
occu p a tio n al a n d ot h e r e n viro n m e n t al risk f a ctors ( e g , h e a v y m e t als)
g e n d e r a n d e t h nic f a ct ors ( e g , dis e a s e pro gr essio n , u rin a r y tr act inf ectio ns)

____________________________________________
R EPRO DUCT I VE S YSTEM
Nor m al processes

32

e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s

org a n struct u r e a n d fu nctio n
o f e m ale str uct u r e , inclu din g br e a st
o f e m ale fu nctio n ( e g , m e nstr u al cycle , p u b e rt y , m e n o p a us e )
o m ale str uct u r e
o m ale fu nctio n ( e g , sp e r m a to g e n esis, p u b e rt y )
o in t e rco u rs e , org a s m
o pr e g n a ncy , inclu din g la b or a n d d eliv e r y , t h e p u e rp e riu m , lact a tio n , g est a tio n al
u t e r us, pla ce n t a
cell / tissu e str uct u r e a n d fu nctio n , inclu din g h y p o t h ala m ic- pit uit a r y - g o n a d al a xis, s e x
st e roids, a n d g est a tio n al h or m o n es
r e pro d uctiv e s y st e m d ef e ns e m ech a nis m s a n d n or m al flor a
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs ( e g , to xic sh ock s y n dro m e ,
br e a st a bsce ss, orchitis, s e x u ally tr a ns mit t e d dis e a s es, a u toi m m u n e h y p o g o n a dis m ,
cy stic m a stitis)
tra u m atic a nd m ech a nical disorders (eg, fe m ale incontinence, torsion of testis, v aricocele)
n e o pla stic disord e rs ( e g , f e m ale r e pro d uctiv e , m ale r e pro d uctiv e , br e ast [inclu din g
fibrocy stic ch a n g e s] , tro p h o bla stic dis e a s e )
m e t a b olic a n d r e g ula tor y proce ss e s
o f e m ale ( e g , a n o v ula tio n , inf e rtilit y , p oly cy stic o v a ries, e n d o m e triosis, org a s m ic
d y sfu nctio n , d ela y e d a n d pr e m a t u r e p u b e rt y )
m e n o p a us al s y n dro m e
o m ale (eg, infertility, im potence, gy n eco m astia, dela y ed a nd pre m ature puberty)
b e nig n prost a tic h y p e rpla sia
s y st e m ic disord e rs a ff ectin g r e pro d uctiv e fu nctio n ( e g , o b esit y , m y oto nic d y stro p h y ,
cirr h osis, r e n al f ailu r e )
disord e rs r ela tin g t o pr e g n a ncy , t h e p u e rp e riu m , a n d t h e p ost p a rt u m p e rio d
o o bst e tric pro ble m s ( e g , ecto pic pr e g n a ncy , t hird - tri m e st e r ble e din g )
o co m plica tio ns a ff ectin g ot h e r org a n syst e m s ( e g , ecla m psia , g est a tio n al
dia b e t e s, t h y roid disord e rs)
o disorders associated with the pu erperiu m (eg, postpartu m he m orrh age, sepsis,
depression)
o a n t e p a rt u m , in tr a p a rt u m , p ost p a rt u m disord e rs of t h e f e t us ( e g , pr e m a t u rit y ,
p ost m a t u rit y , cord co m pr e ssio n , m a croso m ia )
Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e r e pro d uctiv e s y st e m a n d m a n a g e m e n t of n or m al r e pro d uctiv e fu nctio n
o f e m ale r e pro d uctiv e tr act
f e rtilit y dr u gs
or al co n tr a ce p tio n , o t h e r m e t h o ds of co n tr a ce p tio n ( e g , co n d o m s)
estro g e n , pro g esto g e n r e pla ce m e n t , tr e a t m e n t of m e n o p a us e
sti m ula n ts a n d in hibitors of la b or
e stro g e n a n d pro g e st e ro n e a n t a g o nists
sti m ula t ors a n d in hibit ors of la ct a tio n
o m ale r e pro d uctiv e tr a ct
f e rtilit y dr u gs
a n dro g e n r e pla ce m e n t a n d a n t a g o nists
o g o n a d otro pin - r ele a sin g h or m o n e a n d g o n a d otropin r e pla ce m e n t
o a b ortif a cie n ts
o a n ti m icro bials

33

o a n tin e o pla stics

o r e stor a tio n of p ot e ncy
ot h e r t h e r a p e u tic m o d alitie s a ff ectin g t h e r e pro d uctiv e s y st e m ( e g , t a m p o ns)
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otio n al a n d b e h a vior al f a ctors ( e g , s e x u ally tr a ns m it t e d dis e a s e s)
influ e nce o n p e rso n , f a m ily , a n d socie t y ( e g , inf e rtilit y )
occu p a tio n al a n d ot h e r e n viro n m e n t al risk f a ctors ( e g , r a dia tio n )
f a m ily pla n nin g a n d pr e g n a ncy ( e g , u n w a n t e d )
g e n d e r id e n tit y , se x u al orie n t a tio n , se x u alit y , libid o
e ff ects of tr a u m a tic str ess s y n dro m e , viole nce , r a p e , child a b us e

______________________________________________
E N D OCR I NE S YSTEM
Nor m al processes
e m br y o nic d e v elo p m e n t , f e t al m a t u r a tio n , a n d p e rin a t al ch a n g e s
org a n struct u r e a n d fu nctio n
o h y p ot h ala m us, p ost e rior a n d a n t e rior pit uit a r y gla n d
o t h y roid gla n d
o p a r a t h y roid gla n ds
o a dr e n al cort e x , a dr e n al m e d ulla
o p a ncr e a tic isle ts
o o v a r y a n d t estis
o a dip os e tissu e
cell/ tissue structure and function, including hor m on e synth esis, secretion, action, a nd
m etabolism
o p e p tid e h or m o n e s
o st e roid h or m o n e s, inclu din g vit a m in D
o t h y roid h or m o n e s
o c a t ech ola m in e h or m o n es
o r e nin - a n gio t e nsin sy st e m
r e p air, r e g e n e r a tio n , a n d ch a n g e s a ssocia t e d wit h st a g e of lif e
Ab nor m al processes
inf ectio us, infla m m a t or y , a n d i m m u n olo gic disord e rs ( e g , su b a cu t e t h y roiditis, G r a v es
dis e a s e , s a rcoid osis)
tr a u m a tic a n d m ech a nic al disord e rs
n e o pla stic disord e rs ( e g , pit uit a r y , t h y roid , p a r a t h y roid , a dr e n al cort e x , p a ncr e a tic
isle ts, n e u r al cr e st , p h e och ro m ocy to m a )
m e t a b olic a n d r e g ula tor y proce ss e s ( e g , dia b e t e s m ellit us, pit uit a r y , h y p ot h ala m us,
t h y roid , p a r a t h y roid , p a ncr e a tic isle t disord e rs, a dr e n al disord e rs)
v a scula r disord e rs ( e g , pit uit a r y a po ple x y )
s y st e m ic disord e rs a ff ectin g t h e e n d ocrin e s y st e m
idio p a t hic disord e rs ( e g , hirsu tis m )
Principles of therapeutics
m ech a nis m s of a ctio n , us e , a n d a d v e rs e e ff ects of dru gs for tr e a t m e n t of disord e rs of
t h e e n d ocrin e s y st e m

34

o h or m o n e s a n d h or m o n e a n alo gs
o sti m ula tors of h or m o n e pro d uctio n ( e g , sulfo n ylu r e a s)
o in hibit ors of h or m o n e pro d uctio n ( e g , t hio u r a cils)
o h or m o n e a n t a g o nists
o p ot e n tia t ors of h or m o n e actio n ( e g , t hia z olidin e dio n es)
o a n tio b e sit y a g e n ts
ot h e r t h e r a p e u tic m o d alities ( e g , su rg e r y , r a dia tio n )
Gen der, eth nic, a nd beha vioral considerations affectin g disease treat m ent a nd
prevention, inclu ding psychosocial, cultu ral, occu pational, a nd en viro n m ental
e m otio n al a n d b e h a vior al f a ct ors ( e g , co m plia nce in dia b e t es m ellit us, f a ctitio us use of
insulin , psych o g e nic p oly dipsia )
influ e nce o n p e rso n , f a m ily , a n d socie t y
occupation al a nd other en viron m ental risk factors (eg, radiation e xposure, iodine deficiency)
g e n d e r a n d e t h nic f a ct ors

APPEN D I X B
2 8 - day Step 1 Stu d y Sched ule fro m Georgeto w n School of Medicine

35

36

Day 1

General Overview & Begin Biochemistry

Objective
Self Assessment

Assignments
Complete sample test materials
from NBME

General overview of
material to be covered

Read Through Section Introductory First Aid

Material from First Aid , and Skim
Section II

Learn about the test, and how to best use First Aid as a
resource.

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.

Lippincott's Biochemistry

Understand the role of ATP. Know where the 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.

2.5 hrs

Day 2

Continue Biochemistry

Objective
Structure & Metabolism
of Carbohydrates

Assignments
Chapters 11, 12, 13 & questions

Source
Lippincott's Biochemistry

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 diseases.

Est. Time
3 hrs

Glycolysis

Chapter 7 & questions

Lippincott's Biochemistry

Know the start and end points, hormonal regulation, energy

yield, and various fates of pyruvate.

1.5 hrs

Gluconeogenesis

Chapter 8 & questions, Review

Figure 6.2 again!

Lippincott's Biochemistry

Study it by comparison to glycolysis. Know the reactions &

regulation unique to gluconeogenesis.

1 hr

Citric Acid Cycle

Chapter 9 & questions

Lippincott's Biochemistry

Focus on start and end points, place in overall metabolism,

and regulation.

1 hr

Lippincott's Biochemistry

Skim reactions and focus on G6PD deficiency

1 hr

Hexose Monophosphate Chapter 10 & questions

Shunt

Source
Details
NBME CD-ROM or download Complete 150 sample questions, and note trouble areas to
from www.nbme.org
focus on.

Est. Time
3 hrs

4 hrs

Day 3

Continue Biochemistry

Objective
Lipid Metabolism

Assignments
Chapter 17 & questions

Source
Lippincott's Biochemistry

Details
Focus on roles of pancreatic lipase and bile salts. 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

Phospholipids &
Glycolipids

Skim Chapters 18, 19

Lippincott's Biochemistry

Gain a sense of what these are, but do not memorize

structures or pathways. Focus on related disorders instead,
using figures 18.10, 19.4.

1 hr

Cholesterol & Steroid

Metabolism

Chapter 20, Sect. I-VII

Lippincott's Biochemistry

Review cholesterol synthesis (esp. the role of HMG CoA

reductase) and its regulation. Understand synthesis and role
of bile salts. Review biology of lipoproteins and their role in
atherogenesis. Key figures are 20.12, 20.14, 20.16.

2 hrs

Steroid Hormones

Chapter 20, Sect. VII

Lippincott's Biochemistry

Know the major enzyme deficiencies in steroid synthesis and

know where steroid receptors act in the cell. Study figures
20.19, 20.20.

1 hr

Day 4

Continue Biochemistry

Objective
Protein & Enzymes

Assignments
Chapters 1-4 & questions

Source
Lippincott's Biochemistry

Details
Become familiar with basic properties of amino acids, levels of
protein structure, hemoglobin, and collagen. For enzymes,
focus on appreciating ( not memorizing) the Michaelis-Menten
equation, types of enzyme inhibition, modes of enzyme
regulation, and the use of enzymes in clinical diagnosis.

Est. Time
4 hrs

Digestion of Dietary
Proteins and Nitrogen
Metabolism

Chapter 21 & questions

Lippincott's Biochemistry

Learn the various pancreatic proteases and how they are

regulated. Understand transamination and oxidative
deamination, but don't memorize pathways. Spend more time
on urea cycle and ammonia metabolism focusing on figures
21.4, 21.11, 21.17.

2 hrs

Est. Time
3 hrs

Metabolism of Amino
Acid Carbon Skeletons

Chapter 22

Lippincott's Biochemistry

Emphasize relevant disorders. Focus on figures 22.2, 22.16.

1 hr

Day 5

Continue Biochemistry

Objective
Assignments
Heme, Porphyrins,
Chapter 23
Serotonin, Histamine and
Catecholamines

Source
Lippincott's Biochemistry

Details
Focus on the porphyrias and bilirubin metabolism. Focus on
figures 23.5 and 23.7.

Est. Time
1 hr

Glycosaminoglycans and Skim Chapters 14, 15

Glycoproteins

Lippincott's Biochemistry

Know what they are and know the related disorders. Don't get
too bogged down in details - just study figures 14.12 and 15.4,
then move on.

1 hr

Nutrition and Vitamins

Chapters 27, 28

Lippincott's Biochemistry

Know the daily energy requirements and vitamin deficiences.

Focus on absorption of vitamin B12 and pernicious anemia, as
well as vitamin D. Focus on figures 28.12, and 28.18.

3 hrs

Nucleotide Metabolism

Chapter 29

Lippincott's Biochemistry

Understand differences between de novo and salvage purine

synthesis. Study purine degradation and the pathophysiology
of gout and ADA deficiency. Study figures 29.7, 29.9, 29.10.

2 hrs

Day 6

Finish Biochemistry

Objective
Integrative Metabolism

Assignments
Chapters 24, 25, 26

Source
Lippincott's Biochemistry

Details
Synthesize the information you've reviewed this 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.

Est. Time
5 hrs

Day 7

General Pharmacology

Objective
Pharmacokinetics &
Pharmacodynamics

Assignments
Chapters 1,2

Source
Lippincott's Pharmacology

Details
Study general principles of pharmacology. Specific agents will
be covered with relevant organ systems.

Est. Time
2 hrs

Autonomic Drugs

Chapters 3-7

Lippincott's Pharmacology

Know different types of adrenergic and cholinergic receptors

cold. Study figures 3.3, 3.6, 4.2, 5.2, 6.15, 7.10.

5 hrs

Day 8

Begin Microbiology

Objective
Bacteria

Assignments
Chapters 1-15

Source
Clinical Microbiology made
Ridiculously Simple

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

Est. Time
10 hrs

Day 9

Continue Microbiology

Objective
Antibiotics

Assignments
Chapters 28-33

Source
Lippincott's Pharmacology

Details
This is high yield material, read, review and continue to do
Qbank questions to keep building buzzword associations.

Est. Time
6 hrs

Fungi

Chapter 20

Clinical Microbiology made

Ridiculously Simple

This is high yield material, read, review and continue to do

Qbank questions to keep building buzzword associations.

1.5 hrs

Antifungals

Chapter 34

Lippincott's Pharmacology

This is high yield material, read, review and continue to do

Qbank questions to keep building buzzword associations.

1 hr

Day 10

Finish Microbiology

Objective
Viruses

Assignments
Chapters 22-29

Source
Clinical Microbiology made
Ridiculously Simple

Details
This is high yield material, read, review and continue to do
Qbank questions to keep building buzzword associations.

Est. Time
6 hrs

Antivirals

Chapter 37

Lippincott's Pharmacology

Review antiviral agents, particularly mechanisms of action.

1 hr

Parasites

Chapters 30, 31

Clinical Microbiology made

Ridiculously Simple

This is high yield material, read, review and continue to do

Qbank questions to keep building buzzword associations.

2 hrs

Antiparasitics

Chapters 35, 36

Lippincott's Pharmacology

Review antiprotozoal and antihelminthic agents, particularly

multi-drug regimens

1 hr

Underground Clinical
Vignettes - Microbiology

Good for group study, and another way to keep sharpening

buzzword recall.

3 hrs

Clinical Vignettes

Day 11

Immunology & General Pathology

Objective
Review Immunology

Assignments
Part VII

Source
Medical Microbiology &
Immunology: Examination
and Board Review

Details
Excellent, concise summary of immunology.

Cellular Injury

Chapter 1

BRS Pathology

Focus on mechanisms of cellular injury and differences

between necrosis & apoptosis

Inflammation

Chapter 2

BRS Pathology

Distinguish mechanisms and histologic characteristics of acute

vs. chronic inflammation.

1 hr

Hemostasis

Chapter 3

BRS Pathology

Know coagulation cascade, types of embolism, and types of

shock.

1 hr

Genetic Disorders

Chapter 4

BRS Pathology

Immune Dysfunction

Chapter 5

BRS Pathology

Focus on immune deficiency disorders, autoimmunity, and

collagen vascular disease

Neoplasia

Chapter 6

BRS Pathology

Distinguish between tumor suppressor genes & oncogenes,

know mechanisms of carcinogenesis, and the properties of
malignant cells.

Environmental Pathology Chapter 7

BRS Pathology

Quickly review

0.5 hr

Nutritional Disorders

BRS Pathology

Review vitamin deficiencies to refresh biochem memory.

0.5 hr

Details
Know mechanisms of DNA repair, different types/roles of
RNA, mechanism of translation, and molecular biology
techniques. Focus on figures 30.2, 30.16, 30.19, 30.22,
31.11, 32.9.

Est. Time
3.5 hrs

Chapter 8

Est. Time
4 hrs

0.5 hr

0.5 hr

Day 12

Cellular Biology

Objective
DNA, RNA, Proteins

Assignments
Chapters 30 - 33

Source
Lippincott's Biochemistry

Cell Membranes

Chapter 1

BRS Cell Biology & Histology Know properties of membranes and membrane proteins.

Nucleus

Chapter 2

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

0.5 hr
1 hr

1 hr
0.5 hr

Cytoplasm

Chapter 3

BRS Cell Biology & Histology Review organelles and function

Extracellular Matrix

Chapter 4

BRS Cell Biology & Histology Know different types of collagen, basement membrane
composition, and other ECM components.

Epithelia & Connective

Tissue

Chapters 5,6

BRS Cell Biology & Histology Review types of epithelia and locations of each. Review
connective tissue focusing on bone histology.

0.5 hr
1 hr

1.5 hrs

Day 13

Cellular Physiology & General Embryology

Objective
Cell Physiology

Assignments
Chapter 1

Source
BRS Physiology

Details
Know mechanisms of ion transport, action potentials.

Embryology

Chapters 1-4

BRS Embryology

Know stages from zygote through embryo. Review 3 Germ

cell layers and their derivative tissues.

Birth Defects

Chapters 17, 18

BRS Embryology

Exam

Diagnostic Test

Board Simulator Series Body Systems Review

Good opportunity to identify weaknesses in organ system

areas.

Day 14

Thorax

Objective
Embryology of thorax

Assignments
Chapters 5, 11

Source
BRS Embryology

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

Thoracic Anatomy

Chapter 2
(Also use
Netter's Atlas for reference)

High Yield Gross Anatomy

3 hrs

Histology of thoracic
viscera

Chapters 11, 15

BRS Cell Biology & Histology Be able to distinguish arteries and veins in cross section.
Understand architecture of the gas diffusion barrier in the
lungs.

1 hr

Est. Time
1 hr
3 hrs
1.5 hrs
2 hrs

Est. Time
3.5 hrs

Day 15

Cardiovascular System

Objective
Cardiovascular
Physiology

Assignments
Chapter 3

Source
BRS Physiology

Details
Review hemodynamics, electrophysiology, cardiac cycle,
blood pressure regulation, responses to exercise, volume loss,
altitude. Understand pre-load, after-load, Frank-Starling curve,
and conduction.

Cardiac Pathology

Chapter 10

BRS Pathology

Study this chapter thoroughly.

1.5 hrs

Vascular Pathology

Chapter 9

BRS Pathology

Study this chapter thoroughly.

1 hr

Cardiovascular
Pharmacology

Chapters 16-19, 21

Lippincott's Pharmacology

Know drugs used to treat CHF, HTN, arrhythmias, angina, and

hyperlipidemia.

5 hrs

Day 16

Respiratory System & Begin Hematology

Objective
Respiratory Physiology

Assignments
Chapter 4

Source
BRS Physiology

Details
Know the various lung volume measurements, and
understand acid - base disorders.

Respiratory Pathology

Chapter 14

BRS Pathology

Study this chapter thoroughly.

Respiratory
Pharmacology

Chapter 22

Lippincott's Pharmacology

Clinical Vignettes

Volume 1: Cases 1-19, Volume 2:

Cases 52-66

Underground Clinical
Vignettes - Patho-physiology

Histology of Bone
Marrow, Spleen, &
Lymph Nodes

Chapters 10, 12 (and a histologic

atlas for further review)

BRS Cell Biology & Histology Familiarize yourself with lymph node architecture, and
understand the spleen. Understand RBC, WBC, platelet
lineages.

Est. Time
1.5 hrs

Est. Time
1.5 hrs
1.5 hrs
0.5 hrs

Good opportunity for group review.

2 hrs
3 hrs

Day 17

Finish Hematology

Objective
Anemia

Assignments
Chapter 11

Source
BRS Pathology

Details
Know pathophysiology and lab differentiation of various
etiologies of anemias.

Hempatopoietic &
Lymphoreticular
Neoplasia

Chapter 12

BRS Pathology

Distinguish between leukemia & lymphoma. Understand

different types of each.

2 hrs

Hemorrhagic Disorders

Chapter 13

BRS Pathology

Know how to diagnose and correct each disorder.

1 hr

Est. Time
2 hrs

Drugs affecting
coagulation

Chapter 20

Lippincott's Pharmacology

1.5 hrs

Anticancer Drugs

Chapter 38

Lippincott's Pharmacology

1.5 hrs

Clinical Vignettes

Volume 1: Cases 74-102

Underground Clinical
Vignettes - Patho-physiology

2 hrs

Day 18

Gastrointestinal System

Objective
Embryology of Gut and
Body Cavities

Assignments
Chapters 10, 16

Source
BRS Embryology

Abdominal Anatomy

Chapter 3 (Also refer to Netter's

atlas)

High Yield Gross Anatomy

Histology of GI Tract

Chapter 6

BRS Cell Biology & Histology Know layers of gut wall. Understand liver structure, portal
blood flow, and bile flow.

GI Physiology

Chapter 6

BRS Physiology

Understand innervation of gut and gut hormones

Day 19

Gastrointestinal System

Objective
Gastrointestinal
Pathology

Assignments
Chapter 15

Source
BRS Pathology

Details
Study this chapter thoroughly.

Est. Time
2 hrs

Hepatobiliary and
Exocrine Pancreatic
Pathology

Chapter 16

BRS Pathology

Study this chapter thoroughly.

2 hrs

GI Pharmacology

Chapter 24

Lippincott's Pharmacology

Know GI drugs as well as antiemetics.

2 hrs

Clinical Vignettes

Volume 1: Cases 40-73

Underground Clinical
Vignettes - Patho-physiology

Good opportunity for group review.

2 hrs

Source

Details

Day 20

GenitoUrinary System

Objective

Assignments

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

Est. Time
1.5 hrs

2 hrs
1.5 hrs
1 hr

Est. Time

Embryology of GU
Organs

Chapters 6, 13, 14

BRS Embryology

3 hrs

Anatomy of Pelvis and

Perineum

Chapters 4, 5

High Yield Gross Anatomy

3 hrs

Histology of GU Organs

Chapters 18, 19, 20

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

3 hrs

Day 21

GenitoUrinary System

Objective
Renal Physiology

Assignments
Chapter 5

Source
BRS Physiology

Diuretics

Chapter 23

Lippincott's Pharmacology

Renal & Urinary Tract

Pathology

Chapter 17

BRS Pathology

Study this chapter thoroughly.

Male Reproductive
Pathology

Chapter 18

BRS Pathology

Know the different types of testicular cancer, and the biology

of BPH and prostate cancer

Female Reproductive
Pathology

Chapter 19

BRS Pathology

Understand cervical, uterine cancer.

Clinical Vignettes

Volume 2: Cases 30-51, and 83-103 Underground Clinical

Vignettes - Patho-physiology

Day 22

Endocrine System

Objective
Histology of Endocrine
System

Assignments
Chapter 13

Source
BRS Embryology

Details
Review structure of endocrine organs, and use an atlas for
additional pictures.

Physiology

Chapter 7

BRS Physiology

Know hormonal axes

2.5 hrs

Insulin and oral

hypoglycemics

Chapter 26

Lippincott's Pharmacology

Know different types of insulin and their half lives. Know

classes of oral hypoglycemics and side effects.

1.5 hrs

Steroid Hormones

Chapter 27

Lippincott's Pharmacology

Details

Est. Time
1.5 hrs
1.5 hrs

Good opportunity for group review.

1.5 hrs
1 hr
1.5 hrs
2 hrs

Est. Time
1 hr

1 hr

Clinical Vignettes

Volume 1: Cases 25-38

Underground Clinical
Vignettes - Patho-physiology

Good opportunity for group review.

EXAM

Body Systems III -

Board Simulator Series Body Systems Review

Tough questions, but great explanations. Well worth the time

to push yourself a bit and solidify the material you've learned.

Day 23

Nervous System

Objective
Assignments
Embryology of Head,
Chapters 7, 8, 9, 10
Neck, & Nervous System

Source
BRS Embryology

Details
Know branchial arches/clefts and their derivatives.
Understand the transition from neural plate to mature CNS.
Know fate of neural crest cells.

Head & Neck Anatomy

Chapter 8 (also refer to Netter)

High Yield Gross Anatomy

2 hrs

Neuroanatomy

Chapters 1-23

High Yield Neuroanatomy

6hrs

Test 1

2 hrs

1.5 hrs

Est. Time
3 hrs

Day 24

Nervous System

Objective
Neurophysiology

Assignments
Chapter 2

Source
BRS Physiology

Details
Understand Synaptic transmission and axonal conduction

Neuropathology

Chapter 23

BRS Pathology

Know types of CNS infections, tumors, and vascular disorders.

2 hrs

Clinical Vignettes

Volume 2: Cases 45-61, Anatomy

Cases 40-56.

Underground Clinical
Vignettes - Patho-physiology

Good opportunity for group review.

2 hrs

Neuropharmacology

Chapters 8, 10, 11, 14, 15

Lippincott's Pharmacology

Review drugs used to treat epilepsy, Parkinson's. Also review

anesthetics and analgesics.

Day 25

Musculoskeletal System

Objective
Embryology

Assignments
Chapter 15

Source
BRS Embryology

Details

Anatomy of Limbs and

Back

Chapters 1, 6, 7 (also use Netter)

High Yield Gross Anatomy

Histology

Chapters 7, 8, 10

BRS Cell Biology & Histology Review histology of skin, muscle, bone, and cartilage

Est. Time
2 hrs

3.5 hrs

Est. Time
1 hr
3.5 hours
2 hrs

Anti-Inflammatory Agents Chapters 39, 40

and Autocoids

Lippincott's Pharmacology

2 hrs

Day 26

Musculoskeletal System

Objective
Dermatologic Pathology

Assignments
Chapter 21

Source
BRS Pathology

Musculoskeletal
Pathology

Chapter 22

BRS Pathology

Clinical Vignettes

Volume 3: Cases 9-18, and 96-104. Underground Clinical

Vignettes - Patho-physiology
Also Anatomy: Cases 62-84

Good opportunity for group review.

2 hrs

Exam

Body Systems II - Test 1

Tough questions, but great explanations. Well worth the time

to push yourself a bit and solidify the material you've learned.

2 hrs

Board Simulator Series Body Systems Review

Day 27

Behavioral Sciences & Biostatistics

Objective
Clinical Vignettes

Assignments
All cases

Source
Underground Clinical
Vignettes - Behavioral Sci.

Psychotropic Drugs

Chapters 9-12, 13

Lippincott's Pharmacology

Biostatistics

Read entire book

High Yield Biostatistics

Day 28

Final Review & Exam Logistics

Objective
Final Review

Assignments

Exam Logistics

Rest & Relax

Source

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

Details

Est. Time
3 hrs
3 hrs

Understand sensitivity, specificity, PPV, NPV. Be prepared to

calculate risk, odds ratios, etc.

4 hrs

Details
Review Any Remaining Topics and finish practice questions.

Est. Time
4 hrs

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