A Resource for USMLE Step 1 Preparation

Compiled by the TTUHSC School of Medicine Office of Student Affairs
Dr. JoAnn Larsen Assistant Dean for Student Affairs USMLE – What’s it for?
In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners. These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams which must be passed in order to eligible for medical licensure: • • • • Step Step Step Step 1, usually taken after the completion of the second year of medical school; 2 Clinical Knowledge (CK), usually taken during the fourth year; 2 Clinical Skills (CS), usually taken during the fourth year; and 3, typically taken during the first year of post graduate training.

Step 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning.

Step 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine. Step 2 Clinical Skills (CS) A clinical skills examination was part of the original design of USMLE. The NBME was charged with including a test of clinical skills using standardized patients when such an examination was shown to be valid, reliable, and practical. NBME research and the work of other organizations administering clinical skills examinations demonstrate that clinical skills examinations measure skill sets different from those measured by traditional multiplechoice questions. Mastery of clinical and communication skills, as well as cognitive skills, by individuals seeking medical licensure is important to the protection of the public. Implementation of the clinical skills examination began in June 2004. The clinical skills examination is a separately administered component of Step 2 and is referred to as Step 2 Clinical Skills, or Step 2 CS. The computer-based, multiple-choice component of Step 2 is referred to as Step 2 Clinical Knowledge, or Step 2 CK. USMLE Step 2 CS is administered at five regional test centers (CSEC Centers) in the United States. Step 3 assesses whether you can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care. Requirements for licensure in each state are set by the state’s medical licensing boards. Each state board may determine the maximum number of times that a person may take each Step exam and still remain eligible for licensure. In Texas, individuals are limited to three attempts at each Step exam. But what we’re really here for is to talk about preparing for Step 1. Step 1 is your first BIG hurdle. And make no mistake about it, this is a VERY important test. A very good performance on Step 1 can definitely help you when it comes to securing a top-rate residency, and likewise a poor score can hurt you and limit your options. And a failure on Step 1 can eliminate the possibility of some residencies altogether. So it is definitely in your best interest to do all you can to maximize your chances of doing well, regardless of what type of residency you may choose to pursue.

How is Step 1 scored?

When you take Step 1, the computer records your responses. After your test ends, your responses are transmitted to the NBME for scoring. The number of test items you answer correctly is converted to two equivalent scores, one on a three-digit score scale and one on a two-digit score scale. Both scales are used for score-reporting purposes. On the three-digit scale, most Step 1 scores fall between 140 and 260. The mean score for first-time examinees from accredited medical school programs in the United States is in the range of 200 to 220, and the standard deviation is approximately 20. Your score report will include the mean and standard deviation for recent administrations of the examination. The two-digit score is derived from the three-digit score. It is used in score reporting because some medical licensing authorities have requirements that include language describing a "passing score of 75." The two-digit score is derived in such a way that a score of 75 always corresponds to the minimum passing score.


Blocks of items are constructed to meet specific content specifications. As a result, the combination of blocks of items creates a form of the examination that is comparable in content to all other forms. The percentage of correctly answered items required to pass varies from form to form. However, examinees typically must answer 60 to 70 percent of items correctly to achieve a passing score.

What is the minimum passing score?

In December 2006, the Step 1 Committee decided to raise the three-digit score recommended to pass Step 1 from 182 to 185. The new minimum passing score will be applied to Step 1 examinations for which the first day of testing is on or after January 1, 2007.

What is Texas Tech’s policy on USMLE exams?

Step 1 Exam • All students will be required to take the United States Medical Licensing Examination (USMLE) Step 1 at the end of Year Two and no later than June 30. Excepted from this requirement are students who must remediate a Basic Science course immediately following Year Two. Such students will complete any remediation work /exam by June 15 following Year Two and take USMLE Step 1 by July 31 of Year Three. • All students who take the USMLE Step 1 no later than June 30 following completion of Year Two will be eligible to start the Year Three clerkship rotations in July of that year. Passage of USMLE Step 1 is required for promotion to Year Four. For students who must repeat USMLE Step 1, leave from the third year curriculum to prepare for the exam is not required but is strongly recommended and encouraged. Any request for such leave must be approved by the Associate Dean for Educational Programs or the Assistant Dean for Student Affairs. Students who reach the end of the Year Three curriculum and have not yet passed Step 1 will be placed on administrative leave of absence for up to one year, consistent with Section 4.1 of this policy which allows no more than six (6) years to complete the curriculum for the Doctor of Medicine degree, inclusive of all leaves, repetition, or decompression of an academic year. Passage of the exam during this time frame will result in return to the curriculum. Inability to pass Step 1 within the one-year leave of absence will result in withdrawal from the curriculum as stated in the SOM Student Affairs Student Handbook under Student Leaves of Absence. Appeals regarding this issue will be handled as outlined in Sections 6, 7, and 8 of the Grading and Promotions policy.

• •

Step 2 Exam • For students who begin the curriculum in August of 2005 or later, passage of Step 2 Clinical Knowledge and Step 2 Clinical Skills will be required for graduation. Passing scores must be documented no later than May 1 of the year graduating.

How do I apply for Step 1?

The initial application for Step 1 is done on the Internet. Go to www.nbme.org. Click on “NBME Licensing Exam Services”, then “National Licensing Examination Services Website”. In the yellow LOG IN box, please note you do not have a USMLE ID number yet. Instead, click on “First time user” and follow the instructions. As part of the application,


you will indicate a 90-day eligibility period during which you plan to take the exam. Payment is also required at this time ($480). • • • Print out the application form which will require your signature and a picture. Bring the form to the Student Affairs Office for signature – Dr. McMahon, Dr. Larsen, Tamara Lane, and Karen Nelson are authorized to sign the form. Then take the form to the Registrar’s Office (2C400 – across from the Synergistic Center) and have the school seal put on it. After that, you’re ready to mail it in.

Where do I take the test?

Thomson Prometric, a part of The Thomson Corporation, provides scheduling and test centers for the computer-based components of USMLE. Step 1 and Step 2 CK are given around the world at Prometric Test Centers (PTCs). Prometric test centers are located throughout the U.S. In Texas there are centers in: • • • • • • • • • • • • • • • • Abilene Amarillo Austin (2) Beaumont Bedford (2) Corpus Christi Dallas (2) El Paso Houston (3) Lubbock McAllen Midland San Antonio (2) Tyler Waco Wichita Falls

How do I schedule my test?

Once your application has been processed, you will receive an email from NBME notifying you that your application is complete. About a week later, you will receive a second email from them notifying you that your scheduling permit is available; this message will include instructions for accessing the electronic scheduling permit using the registration entity's interactive website. PRINT OUT YOUR SCHEDULING PERMIT and keep it in a safe place. You MUST bring it with you to the test center on the day of your test. You will not be allowed to take the exam without your scheduling permit. Once you’ve gotten your permit, you may schedule your test online at www.prometric.com for any available test date that is within your approved 90-day eligibility period. Not all Prometric centers are open on weekends, and USMLE exams are not necessarily offered every day the centers are open. Please note that May through July are one of the busiest periods for these testing centers because of the large USMLE demand during that time – PLAN AHEAD!


2 minutes per question. Don’t panic if your first block happens to be a more difficult one. go back and review questions in the block. NO NEW SAMPLE TEST MATERIALS ARE PRESENTED AT PRACTICE SESSIONS. The Practice Sessions use the same sample test materials that are available on the USMLE website. Once your Step 1 application has been processed and you have received your Scheduling Permit. prior to beginning the test. Practice Sessions are available at Thomson Prometric. The 8 hours includes the test itself as well as break time. If you schedule to take a CBT Practice Session from December 2006 through January 2007. Once you have exited a block or the time for that block has expired. however. so don’t expect a block of pathology questions.usmle. you will need to reapply and pay an additional fee. The exam consists of approximately 350 multiple choice questions arranged in blocks of 50 questions which means you will have about 1. Other questions consist of extended matching – a list of items from which you must choose the one best answer that corresponds with the numbered items or questions located below the list. 1. You can practice by downloading software from the NBME website (http://www. • • • • • Some blocks are harder than others. What is the format of the test? The Step 1 test day is an 8-hour day. Some practice items may include multimedia files. Those who are eligible to register for a Practice Session may take only one session per exam registration. Practice time is not available on the test day. 2. A brief tutorial on the test day provides a review of the test software. including navigation tools and examination format. There will be anywhere from 3 to 5 answer choices. etc. and test center staff are not authorized to provide instruction on use of the software. If you must reschedule outside the approved eligibility period. and change answers. Some questions will include pictures – histology. test centers.htm#software). you will no longer be able to review questions or change answers in that block. will replace the Prometric software for the USMLE Practice Session beginning in December 2006.You will be able to change your test date after you have scheduled it IF your new test date is still within the 90-day eligibility period. Approximately 75% of the questions are SINGLE BEST ANSWER. such as video or audio clips.org/Orientation/2007/readme. It does not provide an opportunity to practice. known as FRED™. Installation of FRED for the USMLE Practice Sessions will be phased in over several weeks. The questions are random. Please note that Practice Sessions are not available on major local holidays and during the first two weeks of January. a part of The Thomson Corporation. Can I practice taking the test? You should acquaint yourself with the test software well before your test date(s). CT images. gross pathology. you are eligible to register for a Practice Session for that examination. During each block you can answer questions in any order. etc. You can schedule a practice test at a Prometric Test Center. The NBME software you install has over 100 practice test items and a software tutorial. they do not include any multimedia items. Note: The NBME software. you might test with 4 . a group of pharmacology questions.

See the USMLE website for the most up-todate information. you should be a little leery of anyone other than NBME who claims to have “actual USMLE questions”. In fact. NBME also publishes a more detailed outline of the topics covered on the Step 1 exam.5 hours and is divided into 3 1-hour blocks of 46-50 multiple choice test items each. the NBME’s Comprehensive Basic Sciences Exam is the closest thing to the real thing that they will let anyone see. The Practice Session is a maximum of 3. Until this transition is complete. The NBME offers a breakdown of the content areas on the test: System** 40%–50% General principles 50%–60% Individual organ systems • • • • • • • • • • hematopoietic/lymphoreticular nervous/special senses skin/connective tissue musculoskeletal respiratory cardiovascular gastrointestinal renal/urinary reproductive endocrine Process 30%–50% 30%–50% 15%–25% 10%–20% Normal structure and function Abnormal processes Principles of therapeutics Psychosocial. you will receive a printed percent correct score. The $42 fee for the Practice session must be paid directly to Prometric by credit card at the time you schedule your appointment. If you register for a practice session. What’s on the test? As we have talked about already. examinees who wish to practice with the actual FRED software should use the sample materials available at the USMLE website. a YELLOW Scheduling Permit will be mailed to you within two weeks which will allow you to schedule the Practice Session. Do not schedule a Practice Session using your permit for the actual Step examination. Use this as an outline to make sure you are covering all of these topics in 5 . cultural. since ALL of the items written by NBME are copyrighted. ** The general principles category includes test items concerning those normal and abnormal processes that are not limited to specific organ systems.either the Prometric or FRED test delivery software. When you complete the session. occupational and environmental considerations * Percentages are subject to change at any time. Categories for individual organ systems include test items concerning those normal and abnormal processes that are system specific.

7. assemble key clues into a mental “snapshot” of the patient. In addition to a summary data sheet showing your performance in these areas.umkc. It is the purpose of the testing agency to see how adept you are at taking partial information and. KNOW how to approach multiple choice questions and PRACTICE. Some people seem to instinctively know how to answer multiple choice questions correctly. especially when these errors may be depressing your overall performance. and to anticipate possible answers compare the given choices to your anticipated answer mark choices that match best rule out choices that don’t account for all findings mark the best answer Kaplan’s experts say that people who are bad at multiple choice questions focus on the choices rather than the stems of the questions. LEARN the material you are currently studying in your classes. For details and how to order a test. 4. recall. If you always feel that your performance on multiple choice tests doesn’t equate with your mastery of the material. please go to http://www. Approximately 70% of the questions on the exam are likely to use or combine information in ways that you have not seen before. How do I prepare for Step 1? Several things have been proven to help students prepare to do their best of Step 1. You’ll find the complete outline of what’s on the Step 1 exam at the end of this book in Appendix A. you might think about having your test taking analyzed. 6. Here’s how Kaplan recommends approaching vignette styled multiple choice questions: 1. and the extent to which you are able to narrow down your choices to two good answers and the extent to which your second choices are correct. The University of Missouri at Kansas City’s Institute for Professional Preparation (IPP) offers an online Step 1 diagnostic test. 1. 2. these tests not only evaluate performance in each of the seven basic sciences areas. This diagnostic test is available for a small fee. but you can do it using material that you have LEARNED. understand precisely what is being asked allow a few moments to think.your study plan. others of us not so much.edu/ipp/cbt. Variables such as: the amount of time spent on different types of questions. 3. They also offer a full-length Mock Board Exam. There are skills that you can learn to help you answer these kinds of test questions. based on that. Here is a sample Step 1 Diagnostic Test report. This is a very inefficient approach and one that tends to result in more mistakes. STEP 1 REPORT 6 . they may also provide a computer generated six to eight page report which discusses these variables and gives some concrete suggestions for minimizing the impact of these "error patterns". When analyzed. And you can’t do that with MEMORIZED material. 2. Those who are good at multiple choice questions focus on the stems.figuring out an answer you consider to be a high probability response. not the choices. performance on questions which rely on strict definitions or precise interpretation of technical vocabulary.asp. are examples of the intra-test variables analyzed when you take a "Diagnostic" test. 5. but also look at some 40 other intra-test variables which can help you gain insight into the types of errors you may be committing as you go through a test. correlations between the length of a question and the likelihood of answering it successfully.

Below you’ll see a graph of hours/day and weeks of studying graphed against actual Step 1 scores. In addition. Many students in the past who have taken longer than 6 weeks to prepare later said they felt they took too much time. Analysis of our own students over the years shows that you get the most “bang for your buck” by studying for 6 to 9 hours per day for 4 to 6 weeks. 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". and actually lost ground with their studying. ALLOW enough time to prepare.All Step 1 "Diagnostics". Although you will have approximately 10 weeks from the time school ends to the deadline for taking Step 1 (June 30). "Mock Boards". 7 . but not too much. four to six weeks should be plenty of time to prepare for Step 1. to the one shown below. 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.

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. MAKE a study schedule and stick to it. you must use probabilities to make decisions 6. misreading or misinterpreting questions So where do I start? 8 .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 5 0 <183 183-199 200-215 216-230 >230 4. More detailed information about study schedules is in the following section. OTHER STEP 1 ADVICE Judy Schwenker. do it. you’ll never know it all 7. use them. If there are other methods that work for you. STUDY smart. practice answering questions by explaining why the right answers are right and the wrong answers are wrong. situations won’t exactly fit what you’ve learned She also talked about the mistakes most commonly made when preparing for Step 1: 1. passive studying 2. insufficient practice with questions 3. Explain concepts out loud to a study partner. This is a critical step in successful Step 1 preparation. you must find key information 2. there are distractions 4. Spending 10 hours a day passively reading study guides or old notes is much less effective than spending half that amount of time in active study. 5. inappropriate test day strategies 5. Kaplan’s Curriculum Director. If concept mapping works for you. memorizing. talked about the ways in which USMLE exams are similar to medical practice: 1. the information you need may be buried 3. not understanding the material 4. there is time pressure 5.

NBME. Plan something fun and mindless. Lots of sample schedules are out there and links to them are included later in this notebook. be advised that based on feedback I have gotten on the board. So if you have finished Anatomy and Physiology. Self-assessment. you should be spending at least 20% MORE time reviewing Physiology than you put into Micro. and less time to stronger subjects.1. (2) Once you know your percent correct score for each subject. you will be taking long practice tests under test conditions that cover all the completed subject areas. (5) As you finish a subject. I think all of the experts agree that the first thing you need to do is take some sort of diagnostic test to see where your areas of strength and weakness are. because study within 24 hours of the exam actually hurts your ability to recall from earlier reviewing. use QBank to create and take a test with maybe 50 items from each subject that you have completed up to that point. Diagnostic tests are available from Kaplan. Individual study pace also needs to be factored in. and intensive test practice" phase.” 2. create your own condensed summaries of the key material so you can review these right before test day. Additional Advice from Kaplan… 9 . look over some questions on the material before you start to review. If you do decide to do this. you must first look at your own diagnostic test results and prepare your schedule with more time allotted to weaker subjects. Form 1 seems to be the most reliable. Here’s some advice from Kaplan’s Judy Schwenker: (1) Take a comprehensive test to begin as a measure of where your recall is right now. which should lead right up to 2 days before your actual test date. Use the Kaplan diagnostic test if you have taken it. because otherwise you will end up taking too detailed notes and they won't help at the end. By the end. if Physiology is 20% lower than Microbiology. When you prepare your own study schedule. Make a study schedule. build mental stamina. You may also choose to take one of the NBME tests to get a predicted USMLE score. as some accomplish more per study day than others. so this is a good level to aim for. and gives you a more accurate picture of your preparedness. (4) As you move through the material. This helps keep the earlier material in memory. BUT – please remember that these schedules were made by individual students and the schedules reflect those students’ individual circumstances. (6) Plan time during the final 2-3 weeks to do nothing but review your own summaries and take increasing numbers of simulated test modules of 50 items each under timed conditions (one hour per module). Our experience has shown that students who are doing 70% or better on our fulllength simulated exams (or comparable practice tests created with Qbank or IV Qbank) by their test dates DO PASS. use this information to decide the relative amount of review time to put into each area. you would do a 100-item test under timed. and a variety of other online sources that are listed later under “Other Resources. test mode assessing those 2 areas. This is the final "get it all fresh in mind. (3) As you begin to review a subject. This will help keep you focused on what is important to know and show you how you will need to use the information on the test. For example. It also gives you good practice for the mental stamina and pacing needed on test day. (7) Don’t study anything the day before. 20-30 pages per subject is a decent size to shoot for.

visit the Prometric Test Center where you will be taking the exam. No one can know everything that is asked on this exam. 4. you will also find it easier to fall asleep at night. If you feel you must study. What you need to know is probably already in your head. Take a walk in the fresh air. It will be indicated on your exam entry ticket. not simply read over the material again. This will ensure you know how to get there and how much time you should allow for the commute. Become familiar with the interface. Wake up every day at the same time you will need to on the day of the exam. Go shopping.. Find time for exercise. Get out of bed at the same time you will have to get up the next day. 3.htm. you will find it easier to get to sleep the night of the exam as well. You have worked hard and deserve it. 5.usmle. Review keywords. the location of key information on the screen and how to navigate between screens. Look over your summary notes one more time. Doing practice questions is a good way to reinforce your recall skills. 10 . Do not nap between 8:00 am and 5:00 pm. 1. Have some fun. If you haven't done so already. Knowing that you do not know something gives you more of a sense of control on the exam and makes you less likely to panic when you encounter the material and/or waste time on questions you are not likely to get correct. If you walk into the exam familiar with the exam. limit yourself to reviewing your own notes and flashcards.Tips for the Week Before During the last few days before the exam you should be tapering off your studying. You can see where you should park. The change of pace will refresh you and the physical activity will help you relax and sleep at night. Do what ever you like. Take some time each day to relax. phrases and concepts. If you get up at the right time each day. By getting into the proper sleepwake cycle. Work on making what you know more accessible. You need sleep. Listen to your favorite music. 2. Be honest with yourself about what you do and do not know. and see what the computer set-up is like. For most people that means at least 6 to 7 hours a night. 7. Your task now is to train yourself to access it when you need it. This is the time to drill yourself on essential information. This is not the time for cramming in new material. Go for a walk. 6. Spend time with a significant other. it makes you a more efficient learner when you are awake. This is your day to relax and gather your strength before the main event.org/step1/default. Have a good meal. You should be getting a sufficient amount of sleep. Review the tutorial at http://www. 8. 2. Sleep is an essential time for your brain to consolidate what you have learned. Otherwise you will accustom your body to shutting down during the critical exam hours. but a time to organize and integrate what you already know. Get yourself onto the right time schedule. Kaplan’s Tips For The Day Before The Exam 1. Use them to clarify your understanding of key details. This will get your circadian rhythm coordinated with the exam schedule. Take the day off from studying. Go see a good comedy or an action movie that will allow cathartic release. and getting into mental and physical shape. The key is to practice recall.. you will not have to use any of your valuable break time to do this on the test day.

you need to consider after each block whether you want to take a bathroom break. refreshed. Just taking a walk for an hour will help relax you. and on time. Our recommended schedule for the exam is: Question Block Block Block Block Block Block Block Block 1 2 3 4 5 6 7 Break time at end of Block No break 5 minute break 5 minute break 30 minute lunch break No break 10 minute break Done! This allows you 10 minutes extra to use as needed. it will be marked as an irregularity in your testing session. you will need to schedule breaks. Arrive at the Prometric Test Center 30 minutes early so you are not rushed and have time to get organized. scheduling permit and confirmation number. and talking with colleagues will remind you that you are not in this by yourself. Make sure that you have checked out the basics for the exam: • • • • Have you worked through the USMLE tutorial? Do you know where the Prometric center is. as well as any personal items like eyeglasses. 6. Call your friends and classmates and make some plans to celebrate. 11 . Lay out what you'll need for the exam before you go to sleep. 2. While you're at it. Therefore. Remember that you will need to sign in and out when you take breaks. You should also be aware that if you leave the exam room during a block. and how to get there? Do you have alternative transportation if. You want to be sure to wake up rested. for example. Remember that you have a total of seven hours to complete 350 questions. don't forget to pack a lunch! • 4. Avoid taking sleeping medication as it may leave you groggy in the morning. 5. This includes photo identification.3. To cope with fatigue. make arrangements with friends as back up. Kaplan’s Tips for test day… 1. You will be given a locker to store your personal items and then assigned a computer station. your car does not start? Do you trust your alarm clock to wake you up in time? If not. consider a hot bath or warm milk. To help you sleep. Be sure to do some physical activity. and a total of one hour to be used throughout the day for breaks and lunch. Get a good night's sleep. You'll need to blow off some steam anyhow.

If you finish a question block with time left over. relax. Monitor your time. Start with the beginning of the question block and work your way to the end. not the ones that are past. your odds of changing a correct answer to a wrong one are so much higher than the reverse that it is simply not worth the risk. so you do not find yourself rushed at the end. but you may want to double-check yourself on a few questions. Work on your pacing from the beginning of the question block. Use First Aid as a scaffold – it really is helpful for recall association. Focus on the questions to come. and move on to the next question. Know how much you have left. Sit. you will never see them again. stick to a schedule. for example. Checking almost always leads to changing and tends to reduce your score. try not to become overwhelmed with all available resources. they’ll probably just show you a blood smear. AND HERE’S SOME PREP ADVICE FROM SOME OF OUR STUDENTS… “I’d recommend studying no more than about 5 weeks. Those questions are in the past. Do not skip any questions. you will always tend to remember those questions you get wrong. 6. During the breaks between question blocks. The marking feature lets you return to review and reconsider questions if you have time left over.” “Have a planned study schedule that you stick to. The idea here is to get into a rhythm that will help create what one psychologist calls a "Flow" experience. Deal with each question as you come to it. Also. If you pace yourself throughout the block. especially if you mark a lot of them. Misused. use the High Yield books. Any more and you will start forgetting things you learned earlier. because every exam is different.” “Do not use First Aid or the all-inclusive books as the sole study aid. answer it as best you can. Be cautious about changing answers. If you don't know it when you come to it. Skipping around wastes time and can end up confusing you. Of course you should answer each question as you come to it. The flow experience is a state of optimal concentration and maximal performance. make sure that you have entered an answer for every question in the block and then. You simply may not have time to go back and look at questions you have marked. Focus on relaxing and making the most of your break.” 12 . “buzzwords” are not typically used on Step 1. and mentally prepare yourself for the next block of questions. Relax. marking causes you to not give a question your full attention the first time around. take a break. try to relax and not think back over the exam. you’ll have a hard time getting through everything and still being able to review material.” “Start early. 5. Rather than use the words “smudge cells”. Limit your use of the marking feature to no more than two or three questions per block. I caution you to take what your classmates say about their exam with a grain of salt. If possible. Used correctly. 9. 4. you are not likely to know it later. you are most likely making it wrong! Your first impulse is usually the correct one.3. If you change an answer. Remember. If you fall behind. 8. Pick a couple for each subject because in my experience you cannot absorb it all. but not helpful. Check your watch every 10 questions to make sure you are on the correct pace to finish. go back and "check" only those answers that you have previously marked. you should not be squeezed for time at the end. If you have a spare moment. Stay with it unless some clear insight occurs to you. 7. The desire to recall questions is strong. In general. marking will help you revisit questions where you have a high probability of getting the answer correct.

Jun. 6. 16 .Jun. Unfortunately some programs schedule their courses at times of the year that don’t coincide with most first-time takers’ preparation efforts.599 – includes food and accommodations.Apr.Oct.Memorial Day) Over 20 award-winning faculty with expertise in USMLE Review Access to JCESOM USMLE website. 16. 17. here is the information on review courses that are available. Live Prep courses are 6-7 weeks in length. What about review courses? Marshall University Joan C Edwards School of Medicine Third Annual USMLE Step 1 Review Course May 14 .Friday (no class on Monday. 2007* Apr. 29.Nov. 17. Step 1 Live Retreat – price is $5. 18 . 10. 2007† Oct. Monday . 2007 Huntington. 2007† 13 .Mar. 23 . 11 . 30. 15 . 30 .“The last week/few days before Step are very distracting – don’t give yourself too much time to study. 13 . 2007*** Mar. 8 . 23.Sep. 2007 Jun. 6 . 2007 Apr. 2007*** Aug.500 per person (does not include hotel accommodations) Space is limited to 100 registrants & guaranteed only after payment is received Kaplan Visit www.Sep. Price is $3. 2007 Apr. including practice exams with feedback Cost: $1.Sep.Feb. Other programs are available. 4-6 weeks worked for me.kaplan. May 28 -. 2007*** Jan.399 – does not include food or accommodations. 22 . 18. WV Course Information: • • • • • 17 day course Approximately 120 lecture hours 8am . 12 .C.” Some students find the structure and discipline of a review course very helpful as part of their Step 1 preparation. 2007 Oct.4pm. 16.Dec. 2007 Aug.Sep.Jun.June 6. 2007** Jun. Location Atlanta Area Chicago Chicago Area Dallas Area D.com for more information. Nevertheless. 10. 1 . 11. 2007*** Aug. Houston Miami Step 1 Jan. 30. 27 . But be prepared mentally for the anxiety the week before the test – focus on easier subjects to review.

9. presented by a nationally respected pathologist. 25. Jan. and Physiology and a Behavioral Sciences/Ethics review. 3 . Other areas included are Anatomy. 25. (d) pathology case studies. The Summer Program offers an intensive four week review of the General Principles of Pathology. Embryology. 2007 This 10 -week. 2007 Sep. 8 . 2007** Sep.Newark (NJMI) New York Pasadena Philadelphia Area *ExtendedPrep **KMI ***Step 1 Prep Retreat †Evenings and Weekends ††Weekends only †††Step 2 Prep Retreat Note: Any of the above LivePrep courses can be purchased as part of a DeluxePrep Package. This program is most beneficial for a student wanting a focused review of the high impact topics in a structured. housing costs are additional. including multiple unsuccessful attempts at Step 1. This schedule includes a variety of small group interactive instruction led by trained small group facilitators and formal lectures presented by experienced basic science lecturers.Apr. question based format.Feb. and Pathology. meeting individually with students. question group. (f) computer based testing and (g) the hallmark of our programs. 2007** Aug. Students interact with one another and the instructors as they sort out concepts that they understand incompletely.Dec. Biostatistics and Behavioral Science. 2007 Mar. 16.Jul. Physiology. 26 .Oct.edu/ipp/programs. 5. 1. (b) screening testing. These are the fields that typically cause examinees the greatest difficulty.Aug. Pharmacology. (e) clinical and fundamental pharmacology. 8 .Feb. 2007 Jan. 2007 May 21 . A typical schedule for Monday through Friday involves an eight hour day. The program includes: (a) personalized diagnostics. critical clinical correlations explained in Biochemistry.Dec. 2007 Jun.Jul.umkc.400.asp January 8 to March 16. 2007* Oct. Genetics. The instructional program strengthens the basic sciences background of all participants. 2007 May 29 . 9. 18 . May 7 to June 1.Jul. 10 . 2007*** For more information visit http://www. 5 . 18. It focuses on clinical correlations in Biochemistry. Computerized examinations permit staff. Question-based tutorials help participants to develop the kind and quality of thinking required University of Missouri at Kansas City – Institute for Professional Preparation 14 . Pharmacology. 28. highly interactive program is for students who have a history of difficulty with standardized tests. 8. 27 . Microbiology and microbiology related biochemistry. to analyze and monitor students’ progress as they approach their examination. 15.Nov. Tuition is $6. 2007 Feb. 2007 First time test takers and repeaters with scores at 168 or above. Some weekend sessions are also scheduled. (c) mock boards. 1 .

Virology. and Biochemistry. Northwestern Medical Review For more information visit http://www. Students with a history of difficulty on standardized exams are more likely to be successful with our longer preparation program beginning in January. Housing costs are additional. live lecture program is designed both for first time test takers who desire a review of basic science concepts and for the student who has scored at 167 or above on Step 1 and who is planning on sitting for the USMLE Step 1 in early November. 2 and 3 examinations. • Shuttle Service to shopping. Embryology. Emphasis is placed on understanding of the common diseases and related treatment regimens. Tuition is $3000. Physiology. Physiology.falconreviews. 550.550.for success on Step 1. practicing appropriate test taking strategies. Complete review package includes: • Books • Luxury Hotel Accommodations • Daily Continental Breakfast and Lunch • Over 325 contact hours (Step 1) • Over 15. FALCON PHYSICIAN REVIEWS For more complete information visit http://www.$4. plus Clinical Vignettes.$5. focus on understanding the material covered. This live lecture program will include a review of Bacteriology. Microbiology.php (from the website):Northwestern Medical Review offers live-lecture courses in preparation for the USMLE and COMLEX Step/Level 1. selected subject exams. Biochemistry. August 28 to October 20.Course Full May 7 to June 22 May 14 to June 29 (Miami) May 14 to June 29 (Philadelphia. movies. Pharmacology. and Behavioral Science. and a mock board. Neurology. Pathology. Daily small group lecture review sessions will aid in organization and retention. PA area) July 16 to August 31 August 20 to October 5 October 1 to November 16 Unless otherwise noted. Review plans ranging from a 3-day quick review course to a 15-day comprehensive 15 . Histology. These courses are designed to allow current medical students or graduating international physicians to pass their examinations in their first attempt or to raise their previous scores to a satisfactory level. Cost of course: double occupancy . In addition.600.000 USMLE Type Exam Questions • Ground transportation to and from the airport. Immunology.htm . single occupancy .com/index. As with all of our courses. and applying all skills acquired and content reviewed in a computer based testing environment. Tuition is $4. the program will provide a diagnostic.com/index.northwesternmedicalreview. REVIEW COURSE DATES for 2007: January 8 to February 23 . and Sample Tests. Glossy Slides. 2006 (dates not yet announced for 2007) This 8-week. all courses are held in Dallas. Case Histories. and other areas of interest Step 1 Programs include information from: Anatomy.

2007 standard TUITION RATES NBI 300 (21-day) NBI 300 (15-day) NBI 300 (10-day) $1780 $1380 $1080 Philadelphia. 16 . MI East Lansing. has worked with approximately 600 students from across the United States and several foreign countries. error analysis. March.11. pretests.E. NBI 300 (STEP I) 10. Since that time. 15.21. Caribbean Islands. memorization techniques.P Program For more information visit http://www.P. Throughout the intensive program topics such as reading and comprehension. Courses are taught by distinguished and experienced medical boards lecturers. audio CDs and USMLE web-based question bank access. 2007 Feb 24 .L. review books. MI East Lansing.25. Marshall Medical H. and self-esteem are targeted for improvement. All courses include complete sets of study materials. 2007 February 13 .edu/medicalhelp/ (from the website) The Marshall University Medical H. March.11. April 21 .500 and does not include accommodations. and September. with individual one on one sessions available the rest of the year.preparation are available. MI DATE January 12 . This 5-week course is held four times a year: January. March 3 .L. many of whom have authored best-selling Northwestern Review books or have mastered multimedia TALLP methodology. April 14 .L.6.15.P. June. PA Extended Weekend Plan FOR STUDENTS WITH DOCUMENTED LEARNING DISABILITIES OR ADHD Marshall University Medical H. reading rate. and 21-DAY USMLE REVIEW LOCATION East Lansing. test-taking skills. and September. and May 5 . June.4.E. Program began in 1986 with a vision of helping medical students and physicians with learning disabilities and/or ADHD succeed academically. 2007 June 2 .marshall. MI May 21. learning strategies. March 10 .22. The cost is $4. A five week intensive course is held four times each year in January. and select sites in Asia and Europe.E. 2007 Saturdays and Sunday mornings East Lansing. Programs are offered at various medical schools or convention sites within the USA.30.22.

move on to something that does.boardprep. But here is a website with PDF files of a dozen or so sample study 17 .com www.usmlesteps123.com BOOKS • • • • • • • • • • • • • • • • NMS Review for Step 1 High-Yield Pathology Step Up: A High-Yield.html www. www. etc.com www. please send it on to me so I can include it in our list of resources. Try it for yourself – if it doesn’t fit you.net/stepone.apextesting. Remember that you can easily get overwhelmed by using too many resources as you study. everybody has their own idea of what works for them and what doesn’t. so pick out the few that seem to work best with your style of studying and learning and go with it.OTHER STUDY RESOURCES… There are probably as many more websites and books available than those that are listed here. What works for one person may not work for another. Systems-Based Review for USMLE Step 1 USMLE Step 1 Recall: Buzzwords for the Boards High-Yield Comprehensive USMLE Step 1 Review Kaplan QBook First Aid Cases for USMLE Step 1 USMLE Step 1 Secrets First Aid Q&A for USMLE Step 1 Goljan’s Rapid Review of Pathology Robbins Review of Pathology Princeton Review USMLE Review Blueprints – Step 1 Q&A Appleton & Lange USMLE Step 1 Platinum Vignettes (Elsevier) Rapid Review Series .htm www.com http://www. Remember you must create your own study schedule based on YOUR individual needs.exammaster2. For online question banks.com/wdsentry/ttuhsc-1. Again. so be careful about using a book just because someone else said it worked for them. or what topics need to be studied more. but you also need to have a starting point. A number of books are available for check-out in the Student Affairs Office library.USMLE Step 1 Study Schedules One of the biggest pieces of advice that students and experts alike give surrounds the idea of developing and sticking to a study schedule. If you find a book or website that you find helpful. review books.score95.usmlerx.

aspx?DepartmentID=42&PageID=7554 You’ll find a sample 28-day study schedule at the back of this book in Appendix B. recombination. and exchange o DNA structure: single. restriction analysis. linkage o plasmids and bacteriophages gene expression: transcription. silencers. replication.bumc. promoters. transduction. degradation. chromosomes. PCR amplification. transposons o mechanisms of genetic exchange. stabilizing forces. telomere o recombination. including defects o the genetic code o structure and function of tRNA o structure and function of ribosomes o protein synthesis o regulation of translation • • 18 . including transformation. enzymatic reactions.edu/Dept/Content. http://www. hybridization o DNA replication. including defects o transcription of DNA into RNA. supercoiling o analysis of DNA: sequencing. repair.schedules so you can get an idea of where to start – most of them are about 4 weeks or so. repressants. conjugation. RNA degradation o regulation: cis-regulatory elements.and double-stranded DNA. insertion sequences. splicing gene expression: translation. crossover. enhancers. RNA. mutation. APPENDIX A – USMLE Detailed Outline of Topics Covered on Step 1 GENERAL PRINCIPLES Biochemistry and molecular biology • gene expression: DNA structure. centromere. transcription factors. and inactivation o gene structure and organization.bu.

addition of CHO units o protein degradation structure and function of proteins o principles of protein structure and folding o enzymes: kinetics. cell cycle regulation) structure and function of basic tissue components (including epithelial cells. nerve cells. pH maintenance. including inheritance patterns. glycogenolysis o storage of energy: gluconeogenesis. signal transduction pathways) cell-cell and cell-matrix adhesion cell motility intracellular sorting (eg. lysosomal storage disease). carnitine deficiency. mutation-selection equilibrium 19 . structure of spindle apparatus. glycogenesis. chemical equilibria and group transfer potential. maple syrup urine disease) o biosynthesis and degradation of purine and pyrimidine nucleotides o biosynthesis and degradation of lipids (eg. meiosis. trafficking. endocytosis) cellular homeostasis (eg. and proteoglycans (eg. fats. complex carbohydrates (eg. proteins. endoplasmic reticulum. second messengers. adrenogenital syndromes) o biosynthesis and degradation of porphyrins o galactosemia and other small sugar disorders biosynthesis and degradation of other macromolecules and associated abnormalities. pigments. and essential amino acids. self-assembly o regulatory properties energy metabolism. founder effects. ketogenesis. fatty acids. receptors and channels. inclusions. tissue differentiation and morphogenesis. mitosis. homeotic genes. glycolysis. including metabolic sequences and regulation o generation of energy from carbohydrates. muscle cells. fatty acid and triglyceride synthesis o thermodynamics: free energy. including phosphorylation. and extracellular matrix) adaptive cell response to injury intracellular accumulations (eg. electron transport and oxidative phosphorylation. cytoskeleton.• • • • post-translational modifications. minerals. soluble proteins) cell cycle (eg. pentose phosphate pathway. connective tissue cells. and developmental regulation of gene expression congenital abnormalities: principles. dyslipidemias. dysmorphogenesis principles of pedigree analysis. proteasome. type II glycogen storage disease) o Biology of cells • • • • • • • • • • • • structure and function of cell components (eg. glycoproteins. carbohydrates. patterns of anomalies. vacuoles) mechanisms of injury and necrosis apoptosis Human development and genetics • • • • embryogenesis: programmed gene expression. occurrence and recurrence risk determination population genetics: Hardy-Weinberg law. turnover. plasma membrane) signal transduction (including basic principles. ions. reaction mechanisms o structural and regulatory proteins: ligand binding. nucleus. homocystinuria. energetics of ATP and other high-energy compounds metabolic pathways of small molecules and associated diseases o biosynthesis and degradation of amino acids (eg. tricarboxylic acid cycle.

and interactions with the family o establishing and maintaining rapport o data gathering o approaches to patient education o enticing patients to make lifestyle changes o communicating bad news o “difficult” interviews (eg. including mediators o inflammatory cell recruitment. ethnicity. including genetic testing. including cells and mediators o acute inflammation and mediator systems o vascular response to injury. leukocytosis. and phagocytosis o bactericidal mechanisms and tissue injury o clinical manifestations (eg. fever. scar/keloid formation o regenerative processes neoplasia o classification. drugseeking behavior. consultation. gene therapy Biology of tissue response to disease • inflammation. granulation tissue. including coping mechanisms o psychodynamic and behavioral factors. hemostasis. puberty. prenatal diagnosis. pain. ethnic. biochemistry. altered cell differentiation. language. oncogenes. angiogenesis. motor skills. genetic counseling/ethics. including adherence and cell migration. and social and interpersonal development o sexual development (eg. and gender o adaptive and maladaptive behavioral responses to stress and illness (eg. including psychosocial. and environmental • progression through the life cycle. menopause) o influence of developmental stage on physician-patient interview psychologic and social factors influencing patient behavior o personality traits or coping style. occupational. jurisprudence. including socioeconomic status. and professional behavior • • • 20 . newborn screening. and molecular biology of neoplastic cells: transformation. cultural.• • genetic mechanisms: chromosomal abnormalities. multifactorial diseases clinical genetics. including birth through senescence o cognitive. sleep deprivation) o interactions between the patient and the physician or the health care system (eg. leukemoid reaction. mendelian inheritance. and chills) o chronic inflammation reparative processes o wound healing. and proliferation o hereditary neoplastic disorders o invasion and metastasis o tumor immunology o paraneoplastic manifestations of cancer o cancer epidemiology and prevention • • Gender. including general and adolescent patient interviewing. fibrosis. and behavioral considerations affecting disease treatment and prevention. transference) o patient adherence. related past experience o family and cultural factors. and repair: thrombosis. anxious or angry patients) o multicultural ethnic characteristics medical ethics. histologic diagnosis o grading and staging of neoplasms o cell biology.

tolerance. dosage intervals o mechanisms of drug action. referral) sexuality and the profession. increased water pressure) o chemical (eg. agricultural hazards. acidosis. gases. drug development. including peptides and analogs. anorexia.and dose-effect relationships (eg. essential nutrients. approval. smoke inhalation. temperature.o o o o o o o o o consent and informed consent to treatment physician-patient relationships (eg. metabolism. toxicology o drug interactions o regulatory issues (eg. structure-activity relationships o concentration. other “boundary” issues ethics of managed care organization and cost of health care delivery Multisystem processes • nutrition o generation. including calories. cholesterol o protein-calorie malnutrition o vitamin deficiencies and/or toxicities o mineral deficiencies and toxicities o eating disorders (eg. distribution. and acid-base balance and disorders (eg. hypoalimentation o functions of nutrients. dehydration. heavy metals. pharmacogenetics) o drug side effects. disease. burns. scheduling) general properties of autacoids. decreased atmospheric pressure. body weight. types of agonists and antagonists and their actions o individual factors altering pharmacokinetics and pharmacodynamics (eg. confidentiality) death and dying birth-related issues issues related to patient participation in research interactions with other health professionals (eg. prostanoids and their inhibitors. potency). including essential. expenditure. biogenic amines. ethical conduct. gender. overdosage. principles of poisoning and therapy) fluid. vapors. bulimia) temperature regulation adaptation to environmental extremes. obesity. excretion. including drug effects on rapidly dividing mammalian cells • • • • Microbial biology and infection • • microbial classification and its basis bacteria and bacterial diseases o structure and composition 21 . including mechanisms of action and resistance general properties of antineoplastic agents and immunosuppressants. trans-fatty acids. alkalosis) • • • Pharmacodynamic and pharmacokinetic processes • general principles o pharmacokinetics: absorption. efficacy. electrolyte. volatile organic solvents. protein. and storage of energy at the whole-body level o assessment of nutritional status across the life span. compliance. including occupational exposures o physical and associated disorders (eg. high-altitude sickness. and smooth muscle/endothelial autacoids general principles of autonomic pharmacology general properties of antimicrobials. age. metabolic proficiency. radiation.

protective immunity alterations in immunologic function o T.• • • • o metabolism. DiGeorge syndrome) o deficiencies of phagocytic cells o combined immunodeficiency disease o HIV infection/AIDS and other acquired disorders of immune responsiveness o drug-induced alterations in immune responses. II molecules. MHC structure and function. cytokines. tolerance and clonal deletion immunologic mediators: chemistry. assay. graft-versus-host disease) o isoimmunization.or B-lymphocyte deficiencies (eg. and laboratory diagnosis viruses and viral diseases o physical and chemical properties o replication o genetics o principles of cultivation. and laboratory diagnosis o pathogenesis and epidemiology principles of sterilization and pure culture technique Immune responses • • • • • • • • production and function of granulocytes. and laboratory diagnosis o molecular basis of pathogenesis o pathophysiology of infection o latent and persistent infections o epidemiology o oncogenic viruses fungi and fungal infections o structure. cell activation and regulation. hemolytic disease of the newborn o immunopathogenesis immunologic principles underlying diagnostic laboratory tests (eg. complement fixation. physiology. classic and alternative complement pathways. transfusion (eg. class I. physiology. function. physiology. ELISA. and macrophages production and function of T lymphocytes. assay. agglutination) innate immunity • • • Quantitative methods 22 . and regulation o genetics o nature and mechanisms of action of virulence factors o pathophysiology of infection o epidemiology and ecology o principles of cultivation. chemokines immunogenetics. erythrocyte antigens immunizations: vaccines. immunopharmacology immunologically mediated disorders o hypersensitivity (types I–IV) o transplant and transplant rejection o autoimmune disorders o risks of transplantation. T-lymphocyte receptors production and function of B lymphocytes and plasma cells. and laboratory diagnosis o pathogenesis and epidemiology parasites and parasitic diseases o structure. immunoglobulin and antibodies: structure and biologic properties antigenicity and immunogenicity. natural killer cells. molecular biology. antigen presentation. RIA. cultivation.

randomization. cryoglobulinemias. transport proteins o production and function of leukocytes and the lymphoreticular system o production and function of platelets o production and function of coagulation and fibrinolytic factors repair. and changes associated with stage of life • Abnormal processes • infectious. Coombs positive hemolytic anemia. inflammatory. hemoglobinopathies. case series. leukemia. DIC) • • • 23 . probability o disease prevalence and incidence o disease outcomes (eg. self-selection. and immunologic disorders o infections of the blood. specificity. community surveys) o sampling and sample size o subject selection and exposure allocation (eg. fatality rates) o associations (eg. cross-sectional. fetal maturation. ITP) o anemia of chronic disease o transfusion complications. cohort.• • • fundamental concepts of measurement o scales of measurement o distribution. correlation and covariance) o health impact (eg. coagulopathies. clinical trials. case-control. regeneration. and perinatal changes organ structure and function cell/tissue structure and function o production and function of erythrocytes. lymphoma. community intervention trials) o types of observational studies (eg. mechanical injury to erythrocytes. hereditary spherocytosis) o cythemia o hemorrhagic and hemostatic disorders (eg. reticuloendothelial system. O2 and CO2 transport. iron deficiency anemia. hemoglobin. stratification. predictive values fundamental concepts of study design o types of experimental studies (eg. systematic assignment) o outcome assessment o internal and external validity fundamental concepts of hypothesis testing and statistical inference o confidence intervals o statistical significance and Type I error o statistical power and Type II error __________________________________________________________ HEMATOPOIETIC AND LYMPHORETICULAR SYSTEMS Normal processes • • • embryonic development. and lymphatics o allergic and anaphylactic reactions and other immunopathologic mechanisms o acquired disorders of immune deficiency o autoimmunity and autoimmune diseases (eg. including acquired and congenital o anemias and cytopenias (eg. risk differences and ratios) o sensitivity. variability. transplant rejection traumatic and mechanical injury (eg. splenic rupture) neoplastic disorders (eg. central tendency. multiple myeloma) metabolic and regulatory disorders.

erythropoietin) o drugs stimulating leukocyte production (eg. herbal treatments with bone marrow depression) CENTRAL AND PERIPHERAL NERVOUS SYSTEMS Normal processes • • embryonic development. effects and complications of splenectomy. vision.• • • o bleeding secondary to platelet disorders (eg. von Willebrand) vascular and endothelial disorders (eg. G-CSF. hemolytic-uremic syndrome) systemic disorders affecting the hematopoietic and lymphoreticular system (eg. heavy metals. and spinal reflexes o brain stem. and society (eg. neural crest derivatives organ structure and function o spinal cord. radiation therapy for lymphomas. childhood leukemia) occupational and other environmental risk factors (eg. pain. memory. taste. diet. including brain and spinal cord. anti-HIV) o antineoplastic and immunosuppressive drugs o drugs used to treat acquired disorders of immune responsiveness other therapeutic modalities (eg. hypothalamic function. blood supply. gross anatomy. and blood supply o brain. GM-CSF) o anticoagulants. and behavioral considerations affecting disease treatment and prevention. lead) gender and ethnic factors (eg. ethnic. including gross anatomy and blood supply. nutritional deficiencies. including proprioception. depression and immune responses. including neural tube derivatives. language. fetal maturation. cognition. hypersplenism. antimalarials. family. and olfaction o motor systems. control of eye movement o sensory systems. use. including cranial nerves and nuclei. limbic system and emotional behavior. and environmental • • • • emotional and behavioral factors (eg. occupational. drugs stimulating erythrocyte production (eg. plasmapheresis) • Gender. hydrocarbons. circadian rhythms and sleep. cultural. basal ganglia and cerebellum o autonomic nervous system o peripheral nerve cell/tissue structure and function • 24 . splenectomy. chelating agents. and perinatal changes. and adverse effects of drugs for treatment of disorders of the hematopoietic system o blood and blood products o treatment of anemia. thrombolytic drugs o antiplatelet drugs o antimicrobials (eg. TTP. balance. systemic lupus erythematosus) idiopathic disorders Principles of therapeutics • mechanisms of action. “blood doping” among athletes) influence on person. hearing. cerebral ventricles. reticular formation. including gross anatomy. including psychosocial.

and sleep disorders including narcolepsy. Down syndrome) degenerative disorders (eg. cord compression. antidepressants. cerebrovascular occlusion. neural tube defects. release. impulse control. meningitis. Parkinson disease. cerebral palsy. diabetic neuropathy) idiopathic disorders affecting the nervous system congenital disorders. and adverse effects of drugs for treatment of disorders of the nervous system o anesthetics o hypnotics o psychopharmacologic agents (eg. amphetamines o antiparkinsonian drugs o skeletal muscle relaxants. parasomnias) disorders of special senses (eg. delirium. myasthenia gravis) traumatic and mechanical disorders (eg. dissociative. lupus. epilepsy. amyotrophic lateral sclerosis) paroxysmal disorders (eg. including primary and metastatic acquired metabolic and regulatory disorders (eg. and changes associated with stage of life o o o Abnormal processes • • • • • • • • • • • • infectious. peripheral neuropathy. pain syndromes. use. and elders o other disorders (eg. reuptake. headache. venous sinus thrombosis. Huntington disease. trophic and growth factors o brain metabolism o glia. post-traumatic stress disorder) Principles of therapeutics • mechanisms of action. axons and dendrites. anxiolytics. including metabolic (eg.• axonal transport excitable properties of neurons. botulinum toxin 25 . myelin o brain homeostasis: blood-brain barrier. circadian rhythm disorders. blindness. inflammatory. Alzheimer dementia. regeneration. mood-stabilizing agents) o anticonvulsants o analgesics o stimulants. processes and their evaluation o early-onset disorders (eg. mental retardation. peripheral nerve injury) neoplastic disorders. subdural and epidural hematomas. hemorrhage) systemic disorders affecting the nervous system (eg. learning disorders) o disorders related to substance use o schizophrenia and other psychotic disorders o mood disorders o anxiety disorders o somatoform disorders o personality disorders o physical and sexual abuse of children. including channels synthesis. cerebrospinal fluid formation and flow. Reye syndrome) vascular disorders (eg. choroid plexus repair. and immunologic disorders (eg. storage. deafness) psychopathologic disorders. adults. antipsychotic agents. and degradation of neurotransmitters and neuromodulators o pre. multiple sclerosis. arterial aneurysms. restless legs syndrome/periodic limb movement.and postsynaptic receptor interactions.

sleep disorders) occupational and other environmental risk factors (eg. cultural. including barrier functions. drug abuse. and changes associated with stage of life or ethnicity (eg. tinea) o parasitic infections (eg. developmental disabilities. surgery) o o o Gender. Kaposi sarcoma) o other (eg. acne. abscess. nutrition. radiation. cellulitis. effects of ultraviolet light and radiation) neoplastic disorders o keratinocytes (eg. dermatomyositis. lice) o immune and autoimmune disorders (eg. dementia. T-cell lymphoma. skin appendage tumors) metabolic. thermal regulation. occupational. verrucae) o fungal infections. and ichthyosis) o melanocytes (eg. measles. chickenpox. and perinatal changes organ structure and function cell/tissue structure and function. alopecia. and immunologic disorders o bacterial infections (eg. squamous cell carcinoma. postmenopausal hair changes) skin defense mechanisms and normal flora Abnormal processes • infectious. carbon monoxide exposure) gender and ethnic factors ___________________________________________________ SKIN AND RELATED CONNECTIVE TISSUE Normal processes • • • • • embryonic development. dementia. hypervitaminosis. dermatophytosis (eg. ethnic. inflammatory. and structural disorders (eg. male pattern baldness. necrotizing fasciitis. rubella. accident prevention. pets) influence on person. senile purpura. thermal injury. regeneration. scabies. basal cell carcinoma.• neuromuscular junction blocking agents (postsynaptic) antiglaucoma drugs drugs used to decrease intracranial pressure (eg. seizures. scleroderma. psoriasis. sleep deprivation. eccrine function repair. anticholinesterases) other therapeutic modalities (eg. decubitus ulcers. hemangiomas. regulatory. vasculitis. generation reversal. roseola. hyperhidrosis) vascular disorders (eg. family. discoid lupus erythematosus. seborrheic keratosis. high-dose glucocorticoids) o antimigraine agents o drugs affecting autonomic nervous system (eg. CFS shunting. and behavioral considerations affecting disease treatment and prevention. fetal maturation. gangrene) o viral infections (eg. actinic keratosis. allergic dermatosis) traumatic and mechanical disorders (eg. and society (eg. melanoma) o vascular neoplasms (eg. vitamin deficiencies. mannitol. Raynaud disease) • • • • 26 . including psychosocial. herpes infections. including mycoses. urticaria. carbuncle. nevi. boxing. and environmental • • • • emotional and behavioral factors (eg.

laser. disc disease. regulatory. sprains. emollients. acne) influence on person. dislocations. and perinatal changes organ structure and function cell/tissue structure and function o biology of bones. fibrositis. gout. sunscreen. polymyositis. joints. occupational. septic arthritis. rheumatoid arthritis. inflammatory. and environmental • • • • emotional and behavioral factors (eg. osteosarcoma. PUVA. osteoporosis. including psychosocial. diabetes mellitus) idiopathic disorders (eg. and behavioral considerations affecting disease treatment and prevention. Marfan syndrome) Principles of therapeutics • mechanisms of action. methotrexate. use. muscular dystrophy) vascular disorders (eg. Dupuytren contracture. osteomyelitis) o inflammatory disorders (eg. repetitive motion injuries) neoplastic disorders (eg. osteodystrophy.• systemic disorders affecting the skin (eg. use. Lyme disease. antihistamines). family. and adverse effects of drugs for treatment of disorders of the musculoskeletal system o nonsteroidal anti-inflammatory drugs and analgesics 27 . fetal maturation. fractures. polyarteritis nodosa. keratinolytics) other therapeutic modalities (eg. including anti-inflammatory agents (eg. Paget disease) degenerative disorders (eg. ethnic. scoliosis. cytotoxic and immunologic therapy (eg. and society (eg. bone infarcts) systemic disorders affecting the musculoskeletal system (eg. strains. tenosynovitis) o immunologic disorders (eg. systemic lupus erythematosus. metastatic disease) metabolic. and structural disorders (eg. and immunologic disorders o infectious disorders (eg. and adverse effects of drugs for treatment of disorders of the skin and connective tissue. psoriasis) occupational and other environmental risk factors gender and ethnic factors (eg. cryotherapy) • Gender. osteoarthritis) • • • • • • • Principles of therapeutics • mechanisms of action. antimicrobial agents. osteomalacia. synovitis. retinoids. skeletal muscle o exercise and physical conditioning repair. Ehlers-Danlos syndrome. corticosteroids. ankylosing spondylitis. sun exposure. and changes associated with stage of life Abnormal processes • infectious. keloid) ________________________________________________ MUSCULOSKELETAL SYSTEM Normal processes • • • • embryonic development. osteogenesis imperfecta. tendons. polymyalgia rheumatica) traumatic and mechanical disorders (eg. cultural. tattoo removal. regeneration. dermatomyositis. dwarfism.

gas exchange o pleura o nasopharyx and sinuses cell/tissue structure and function. and immunologic disorders o infectious diseases infectious diseases of the upper respiratory tract (eg. atelectasis. Goodpasture syndrome) o inflammatory disorders pneumoconioses acute and chronic alveolar injury (eg. estrogen analogs) other therapeutic modalities (eg. chlorine gas/smoke inhalation) obstructive pulmonary disease restrictive pulmonary disease (eg. bisphosphonates. radiation. Wegener granulomatosis. sinusitis. mesothelioma. foreign body aspiration. athletes. colchicine. metastatic tumors) • • 28 . alveolar structure repair. and behavioral considerations affecting disease treatment and prevention. bicycle helmets) influence on person. sarcoidosis. including ventilation. bone mass) __________________________________________ RESPIRATORY SYSTEM Normal processes • • embryonic development. fractures in elderly. inflammatory. fetal maturation. bronchiectasis. sleep apnea) neoplastic disorders (eg. gold. polyps. rehabilitation) o o o o Gender. cytotoxic agents) drugs affecting bone mineralization (eg. including psychosocial. surgery. diet. allopurinol. exercise. including surfactant formation. casts.• muscle relaxants antigout therapy (eg. pneumonia. glucocorticoids. pharyngitis) acute infectious diseases of the lower respiratory tract and pleura and their complications (eg. uricosuric drugs) immunosuppressive drugs (eg. Mycobacterium. Nocardia/Actinomyces) o immunologic disorders allergic and hypersensitivity disorders (eg. bronchogenic carcinoma. endemic fungal infections. acute respiratory distress syndrome. regeneration. pneumothorax. cultural. and changes associated with stage of life pulmonary defense mechanisms and normal flora • • • Abnormal processes • infectious. occupational. including mechanics and regulation of breathing o lung parenchyma. and society (eg. osteoporosis. musicians) gender and ethnic factors (eg. asthma) autoimmune disorders (eg. calcitonin. idiopathic fibrosis) traumatic and mechanical disorders (eg. abscess. and fractures) occupational and other environmental risk factors (eg. alcohol abuse. ethnic. empyema) chronic infectious diseases of the lower respiratory tract (eg. family. perfusion. and environmental • • • • emotional and behavioral factors (eg. and perinatal changes organ structure and function o airways. seat belts.

including responses to change in posture. physical therapy. use. school issues. surgical procedures. mechanics. microcirculation. and perinatal changes organ structure and function o chambers. including psychosocial. hypoventilation. cardiac conduction o hemodynamics. chronic obstructive pulmonary disease. vasculitis. family. occupational. anti-inflammatory and cytotoxic drugs. antineoplastic agents) other therapeutic modalities (eg. exercise. and immunologic disorders o infectious disorders (eg. pulmonary edema. family smoking) occupational and other environmental risk factors gender and ethnic factors (eg. and structural disorders (eg. and environmental • • • • emotional and behavioral factors (eg. and tissue metabolism repair. mechanical ventilation. fetal maturation. substance abuse. acute rheumatic fever. ethnic. and blood volume. oxygen consumption. and lymph flow o mechanisms of atherosclerosis o neural and hormonal regulation of the heart. myocarditis. metabolism. and secretory function (eg.• • • metabolic. mucolytics. and behavioral considerations affecting disease treatment and prevention. decongestants. blood vessels. inflammatory. systemic lupus erythematosus. tamponade. atrial natriuretic peptide) o endothelium and secretory function. smoking. including systemic. sarcoidosis. coronary. pulmonary hypertension. disorders of gas exchange. vascular smooth muscle. and adverse effects of drugs for treatment of disorders of the respiratory system (eg. protective parents. bronchodilator drugs. neonatal respiratory distress syndrome) vascular and circulatory disorders (eg. pericarditis) o inflammatory and immunologic disorders (eg. and changes associated with stage of life • • Abnormal processes • infectious. pets. heart sounds. tuberculosis. lung cancer) _________________________________________ CARDIOVASCULAR SYSTEM Normal processes • • embryonic development. thromboembolic disease. and society (eg. obstructive cardiomyopathy) neoplastic disorders • • 29 . valvular disease. cough suppressants. valves o cardiac cycle. oxygen therapy. including transplantation) • Gender. nasal CPAP. endocarditis. regeneration. asthma. pulmonary. regulatory. and allergies) influence on person. antimicrobial agents. ventilation-perfusion imbalance. and blood volume o circulation in specific vascular beds cell/tissue structure and function o heart muscle. pleural effusion) systemic disorders affecting the respiratory system Principles of therapeutics • mechanisms of action. biochemistry. expectorants. cultural. temporal arteritis) traumatic and mechanical disorders (eg.

bile salts. including enzymes. diet) influence on person. and changes associated with stage of life gastrointestinal defense mechanisms and normal flora • • Abnormal processes • infectious. and perinatal changes organ structure and function. systemic hypertension. motility. scleroderma) congenital disorders of the heart and central vessels Principles of therapeutics • mechanisms of action. including psychosocial. systemic hypotension. cultural. use. occupational. hepatic secretory products. regeneration. alcohol. inflammatory. cor pulmonale. thrombolytic agents o inotropic agents and treatment of heart failure o immunosuppressive and antimicrobial drugs o drugs to treat peripheral arterial disease other therapeutic modalities (eg. valves. systolic and diastolic dysfunction. occlusions. and immunologic disorders 30 . other surgical procedures) • Gender. hypertension) GASTROINTESTINAL SYSTEM Normal processes • • • embryonic development. and environmental • • • • emotional and behavioral factors (eg. including GI hormones o salivary. grafts. liver and biliary system. pancreatic. stress) gender and ethnic factors (eg. and adverse effects of drugs for treatment of disorders of the cardiovascular system o coronary and peripheral vasodilators o antiarrhythmic drugs o antihypertensive drugs o measures used to combat hypotension and shock o drugs affecting cholesterol and lipid metabolism o drugs affecting blood coagulation. ischemic heart disease. family. dysrhythmias. pacemakers. altered lifestyle) occupational and other environmental risk factors (eg. angioplasty. fetal maturation. aneurysms.and high-output heart failure. ethnic. and society (eg. obesity. ischemic heart disease. and behavioral considerations affecting disease treatment and prevention. varicosities.• • • • metabolic and regulatory disorders (eg. low. atherosclerosis) systemic diseases affecting the cardiovascular system (eg. smoking. gastrointestinal. salivary glands and exocrine pancreas. amyloidosis. and processes o synthetic and metabolic functions of hepatocytes repair. exercise. including alimentary canal. and digestion and absorption cell/tissue structure and function o endocrine and neural regulatory functions. myocardial infarction. proteins. and shock) vascular disorders (eg. aortic dissection with Marfan syndrome.

antacids. and perinatal changes organ structure and function o kidneys. esophagitis. intussusception. hepatic failure. use. antineoplastic. and antimicrobial drugs other therapeutic modalities (eg. Crohn disease. stents. portal hypertension. pancreatitis) o immunologic disorders (eg. occupational. annular pancreas. peptic ulcer. Monday morning stomach) influence on person. ulcerative colitis) traumatic and mechanical disorders o malocclusion o hiatus hernia o obstruction (eg. and adverse effects of drugs for treatment of disorders of the gastrointestinal system o treatment and prophylaxis of peptic ulcer disease and gastroesophageal reflux (eg. oral rehydration) o pancreatic replacement therapy and treatment of pancreatitis o drugs for treatment of hepatic failure (eg. including psychosocial. surgical procedures. encopresis. volvulus. fetal maturation. angiodysplasia) systemic disorders affecting the gastrointestinal system o Principles of therapeutics • mechanisms of action. hepatitis. urethra o glomerular filtration and hemodynamics o tubular reabsorption and secretion. pancreatitis and alcohol. motility drugs. esophageal atresia. ureters. malabsorption. cholecystitis. postsurgical obstruction) o perforation of hollow viscus and blunt trauma o inguinal. food poisoning) o inflammatory disorders (eg.• • • • • infectious disorders (eg. and behavioral considerations affecting disease treatment and prevention. gastritis. prokinetic drugs) o fluid replacement (eg. cholelithiasis) vascular disorders (eg. antisecretory drugs. peritonitis. including transport processes and proteins o urinary concentration and dilution o renal mechanisms in acid-base balance 31 . including benign and malignant metabolic and regulatory disorders (eg. antidiarrheal drugs. and society (eg. mucosal protective agents. cathartics. antiemetic drugs. ischemia. family. irritable bowel disease. inflammatory bowel disease. motility disorders. chronic laxative abuse) occupational and other environmental risk factors gender and ethnic factors (eg. immunosuppressive. feeding tubes) • Gender. and environmental • • • • emotional and behavioral factors (eg. hemorrhoids. cultural. peptic ulcer. antibiotics) o drugs to alter gastrointestinal motility (eg. and abdominal wall hernias o esophageal and intestinal diverticula (eg. Meckel diverticulum) neoplastic disorders. drugs to dissolve gallstones) o anti-inflammatory. ethnic. traveler’s diarrhea. lactulose) and biliary disease (eg. diets) ________________________________________ RENAL/URINARY SYSTEM Normal processes • • embryonic development. femoral. bladder. gingivostomatitis.

nephrogenic diabetes insipidus. and behavioral considerations affecting disease treatment and prevention. and environmental • • • • emotional and behavioral factors (eg. systemic lupus erythematosus. occupational. dialysis. ethnic. benign prostatic hyperplasia) other therapeutic modalities (eg. interstitial nephritis. and adverse effects of drugs for treatment of disorders of the renal and urinary system o diuretics. living related kidney donation. and changes associated with stage of life Abnormal processes • infectious. bladder function. hormones produced by or acting on the kidney repair. including psychosocial. transplants) occupational and other environmental risk factors (eg. dopamine) o anti-inflammatory. cultural. renal transplantation) • Gender. nephrotic syndrome. regeneration. urinary tract infections) ____________________________________________ REPRODUCTIVE SYSTEM Normal processes 32 . polycystic kidney disease) o renal calculi vascular disorders (eg. including renal metabolism and oxygen consumption. and immunologic disorders o infectious disorders upper urinary tract (eg. electrolyte. including primary (eg. diabetes mellitus. Fanconi syndrome. use. renal tubular acidosis. hepatitis. family. and society (eg. transplant rejection) traumatic and mechanical disorders (eg.• • o renal mechanisms in body fluid homeostasis o micturition cell/tissue structure and function. antidiuretic drugs o drugs and fluids used to treat volume. inflammatory. and acid-base disorders o drugs used to enhance renal perfusion (eg. antimicrobial. urethritis) o inflammatory and immunologic disorders glomerular disorders (eg. and antineoplastic drugs o drugs used to treat lower urinary tract system (eg. incontinence. pyelonephritis. cystitis. Wegener granulomatosis) • • • • • Principles of therapeutics • mechanisms of action. drug-induced interstitial nephritis. immunosuppressive. obstructive uropathy) neoplastic disorders. urinary bladder and collecting system) and metastases metabolic and regulatory disorders o renal failure. renal artery stenosis) systemic diseases affecting the renal system (eg. amyloidosis. glomerulonephritis. acute tubular necrosis) o tubular and collecting duct disorders (eg. disease progression. renal. acute and chronic (eg. heavy metals) gender and ethnic factors (eg. and IgA nephropathy) tubular interstitial disease (eg. diet) influence on person. hemodialysis. papillary necrosis) lower urinary tract (eg.

prematurity. orchitis. infertility. postmaturity. postpartum disorders of the fetus (eg. trophoblastic disease) metabolic and regulatory processes o female (eg. impotence. torsion of testis. the puerperium. female incontinence. depression) o antepartum. cystic mastitis) traumatic and mechanical disorders (eg. including breast o female function (eg. third-trimester bleeding) o complications affecting other organ systems (eg. puberty. endometriosis. and immunologic disorders (eg. and the postpartum period o obstetric problems (eg. use. sepsis. gestational uterus. fetal maturation. myotonic dystrophy. spermatogenesis. eclampsia. macrosomia) • • Principles of therapeutics • mechanisms of action. other methods of contraception (eg. postpartum hemorrhage. thyroid disorders) o disorders associated with the puerperium (eg. and adverse effects of drugs for treatment of disorders of the reproductive system and management of normal reproductive function o female reproductive tract fertility drugs oral contraception. intrapartum. toxic shock syndrome. puberty) o intercourse. menopause) o male structure o male function (eg. gynecomastia. polycystic ovaries. female reproductive. breast [including fibrocystic changes]. lactation. sexually transmitted diseases. condoms) estrogen. male reproductive. and perinatal changes organ structure and function o female structure. anovulation. inflammatory. and gestational hormones reproductive system defense mechanisms and normal flora Abnormal processes • • • • infectious. delayed and premature puberty) menopausal syndrome o male (eg. cirrhosis. placenta cell/tissue structure and function.• • • • embryonic development. varicocele) neoplastic disorders (eg. progestogen replacement. orgasm o pregnancy. orgasmic dysfunction. sex steroids. cord compression. delayed and premature puberty) benign prostatic hyperplasia systemic disorders affecting reproductive function (eg. ectopic pregnancy. breast abscess. including labor and delivery. menstrual cycle. including hypothalamic-pituitary-gonadal axis. the puerperium. renal failure) disorders relating to pregnancy. obesity. treatment of menopause stimulants and inhibitors of labor estrogen and progesterone antagonists stimulators and inhibitors of lactation o male reproductive tract fertility drugs androgen replacement and antagonists o gonadotropin-releasing hormone and gonadotropin replacement o abortifacients o antimicrobials 33 . infertility. gestational diabetes. autoimmune hypogonadism.

inflammatory.• o antineoplastics o restoration of potency other therapeutic modalities affecting the reproductive system (eg. parathyroid. violence. action. thyroid. including hormone synthesis. sarcoidosis) traumatic and mechanical disorders neoplastic disorders (eg. adrenal medulla o pancreatic islets o ovary and testis o adipose tissue cell/tissue structure and function. pituitary. and metabolism o peptide hormones o steroid hormones. and immunologic disorders (eg. thyroid. use. posterior and anterior pituitary gland o thyroid gland o parathyroid glands o adrenal cortex. pheochromocytoma) metabolic and regulatory processes (eg. libido effects of traumatic stress syndrome. pituitary. adrenal cortex. sexuality. and changes associated with stage of life • • Abnormal processes • • • • • • • infectious. including psychosocial. sexual orientation. cultural. ethnic. including vitamin D o thyroid hormones o catecholamine hormones o renin-angiotensin system repair. sexually transmitted diseases) influence on person. regeneration. pancreatic islet disorders. family. and perinatal changes organ structure and function o hypothalamus. Graves disease. secretion. hirsutism) Principles of therapeutics • mechanisms of action. tampons) Gender. unwanted) gender identity. pituitary apoplexy) systemic disorders affecting the endocrine system idiopathic disorders (eg. subacute thyroiditis. pancreatic islets. rape. neural crest. and adverse effects of drugs for treatment of disorders of the endocrine system 34 . infertility) occupational and other environmental risk factors (eg. and society (eg. radiation) family planning and pregnancy (eg. diabetes mellitus. child abuse ______________________________________________ ENDOCRINE SYSTEM Normal processes • • embryonic development. hypothalamus. fetal maturation. and environmental • • • • • • emotional and behavioral factors (eg. parathyroid. occupational. and behavioral considerations affecting disease treatment and prevention. adrenal disorders) vascular disorders (eg.

surgery. cultural. radiation) Gender. thiouracils) hormone antagonists potentiators of hormone action (eg. occupational. factitious use of insulin. iodine deficiency) gender and ethnic factors APPENDIX B 28-day Step 1 Study Schedule from Georgetown School of Medicine 35 . and environmental • • • • emotional and behavioral factors (eg.• o o o o o o other hormones and hormone analogs stimulators of hormone production (eg. including psychosocial. and society occupational and other environmental risk factors (eg. sulfonylureas) inhibitors of hormone production (eg. ethnic. and behavioral considerations affecting disease treatment and prevention. thiazolidinediones) antiobesity agents therapeutic modalities (eg. psychogenic polydipsia) influence on person. radiation exposure. family. compliance in diabetes mellitus.

36 .

galactose. 12. and sample questions at end of each chapter. Review the main classes of cell receptors and signaling mechanisms. Learn about the test. energy yield. and related disorders. Review Figure 6. and note trouble areas to from www. Time 3 hrs Glycolysis Gluconeogenesis Citric Acid Cycle Chapter 7 & questions Chapter 8 & questions. Study it by comparison to glycolysis. Focus on start and end points. and how to best use First Aid as a resource. and various fates of pyruvate.5 hrs 1 hr 1 hr 1 hr Hexose Monophosphate Chapter 10 & questions Shunt .org focus on. and regulation.Day 1 Objective Self Assessment General Overview & Begin Biochemistry Assignments Complete sample test materials from NBME Source Details NBME CD-ROM or download Complete 150 sample questions.5 hrs Day 2 Objective Structure & Metabolism of Carbohydrates Continue Biochemistry Assignments Chapters 11. Bookmark figure 6. its regulation. and Skim Section II Chapters 5 & 6. Understand the role of ATP. and lactose metabolism. Use Figure 13. 13 & questions Source Lippincott's Biochemistry Details Review the digestion of sugars and disorders of fructose. Skim reactions and focus on G6PD deficiency Est. Know where the electron transport chain. Est.2 again! Chapter 9 & questions Lippincott's Biochemistry Lippincott's Biochemistry Lippincott's Biochemistry Lippincott's Biochemistry 1. Lippincott's Biochemistry 4 hrs 2.nbme. place in overall metabolism. and oxidative phosphorylation occur and how they fit into the overall metabolic scheme.7 to memorize the glycogen storage diseases. Spend more time on glycogen metabolism. Time 3 hrs General overview of material to be covered Basic Metabolism Read Through Section Introductory First Aid Material from First Aid . hormonal regulation.2 and refer to it before studying each biochemical pathway. Know the start and end points. Know the reactions & regulation unique to gluconeogenesis.

12. Review cholesterol synthesis (esp. carefully review eicosanoids. Review mobilization of and oxidation of fatty acids.Day 3 Objective Lipid Metabolism Continue Biochemistry Assignments Chapter 17 & questions Source Lippincott's Biochemistry Details Focus on roles of pancreatic lipase and bile salts. hemoglobin. relationship to glucose metabolism.16.11.14. 1 hr Chapter 20. 20.19. Spend more time on urea cycle and ammonia metabolism focusing on figures 21. For enzymes. Review biology of lipoproteins and their role in atherogenesis. and the use of enzymes in clinical diagnosis.4. Understand transamination and oxidative deamination. Details Become familiar with basic properties of amino acids. Key figures are 20.4. and role of triacylglycerols for storage of fatty acids. Focus on related disorders instead. I-VII Lippincott's Biochemistry 2 hrs Steroid Hormones Chapter 20. VII Lippincott's Biochemistry 1 hr Day 4 Objective Protein & Enzymes Continue Biochemistry Assignments Chapters 1-4 & questions Source Lippincott's Biochemistry Est. Sect. and collagen. modes of enzyme regulation. but do not memorize structures or pathways. Study figures 20. Understand synthesis and role of bile salts. but don't memorize pathways. focusing on figure 17.17.20. types of enzyme inhibition. Sect. 20. levels of protein structure. Time 3 hrs Phospholipids & Glycolipids Cholesterol & Steroid Metabolism Skim Chapters 18. 19. 21. using figures 18. Time 4 hrs Digestion of Dietary Proteins and Nitrogen Metabolism Chapter 21 & questions Lippincott's Biochemistry 2 hrs . Know the major enzyme deficiencies in steroid synthesis and know where steroid receptors act in the cell. Finally. 19 Lippincott's Biochemistry Gain a sense of what these are. focus on appreciating ( not memorizing) the Michaelis-Menten equation. Learn the various pancreatic proteases and how they are regulated. Fatty acid metabolism: know where synthesis occurs. 21. the role of HMG CoA reductase) and its regulation. 20.20 Est.10.

Focus on absorption of vitamin B12 and pernicious anemia.18.2. 29. Time 2 hrs Chapters 3-7 Lippincott's Pharmacology 5 hrs . Histamine and Catecholamines Glycosaminoglycans and Skim Chapters 14. then move on.3. 15 Glycoproteins Nutrition and Vitamins Chapters 27. Chapter 23 Serotonin. Focus on figures 23.9. Time 5 hrs Day 7 Objective Pharmacokinetics & Pharmacodynamics Autonomic Drugs General Pharmacology Assignments Chapters 1.5 and 23.6. Focus on figures 28. as well as vitamin D. Est.12. glucagon. Don't get too bogged down in details .15.just study figures 14. 1 hr Day 5 Continue Biochemistry Source Lippincott's Biochemistry Details Focus on the porphyrias and bilirubin metabolism.10. 26 Source Lippincott's Biochemistry Details Synthesize the information you've reviewed this week by studying insulin.10.7. Study purine degradation and the pathophysiology of gout and ADA deficiency. Time spent on these topics will be VERY WORTHWHILE. the fed/starved states.7. 29.4.2 Source Lippincott's Pharmacology Details Study general principles of pharmacology.Metabolism of Amino Acid Carbon Skeletons Chapter 22 Lippincott's Biochemistry Emphasize relevant disorders. and 28. 28 Lippincott's Biochemistry Know what they are and know the related disorders. Study figures 29.2. 7. 3. and the metabolic aspects of diabetes mellitus. Study figures 3. 6. 25. Specific agents will be covered with relevant organ systems. Know the daily energy requirements and vitamin deficiences. Focus on figures 22. 22.16. Est. Porphyrins. 2 hrs Day 6 Objective Integrative Metabolism Finish Biochemistry Assignments Chapters 24.12 and 15. 1 hr Lippincott's Biochemistry 3 hrs Nucleotide Metabolism Chapter 29 Lippincott's Biochemistry Understand differences between de novo and salvage purine synthesis. Est. Know different types of adrenergic and cholinergic receptors cold. Time 1 hr Objective Assignments Heme. 4. 5.2.

Start building buzzword associations with characterisitics of each organism and how is identified (with a special stain. This is high yield material. particularly multi-drug regimens Good for group study. culture medium. read. read. Est. 1 hr 2 hrs Antiparasitics Clinical Vignettes Chapters 35. 36 1 hr 3 hrs . This is high yield material. Time 6 hrs Fungi Chapter 20 Clinical Microbiology made Ridiculously Simple Lippincott's Pharmacology 1. Review antiprotozoal and antihelminthic agents. particularly mechanisms of action. review and continue to do Qbank questions to keep building buzzword associations.Microbiology Review antiviral agents.5 hrs Antifungals Chapter 34 1 hr Day 10 Objective Viruses Finish Microbiology Assignments Chapters 22-29 Source Clinical Microbiology made Ridiculously Simple Details This is high yield material. time spent with Qbank questions here will be golden. Est. review and continue to do Qbank questions to keep building buzzword associations. Est. review and continue to do Qbank questions to keep building buzzword associations. Time 10 hrs Day 9 Objective Antibiotics Continue Microbiology Assignments Chapters 28-33 Source Lippincott's Pharmacology Details This is high yield material. etc. This is high yield material. read. review and continue to do Qbank questions to keep building buzzword associations. 31 Lippincott's Pharmacology Clinical Microbiology made Ridiculously Simple Lippincott's Pharmacology Underground Clinical Vignettes . read. Time 6 hrs Antivirals Parasites Chapter 37 Chapters 30. and another way to keep sharpening buzzword recall.Day 8 Objective Bacteria Begin Microbiology Assignments Chapters 1-15 Source Clinical Microbiology made Ridiculously Simple Details Rely heavily on charts. review and continue to do Qbank questions to keep building buzzword associations.) Also. read.

Day 11 Objective Review Immunology Immunology & General Pathology Assignments Part VII Source Medical Microbiology & Immunology: Examination and Board Review BRS Pathology BRS Pathology BRS Pathology BRS Pathology BRS Pathology BRS Pathology Focus on immune deficiency disorders. know mechanisms of carcinogenesis. Time 3. concise summary of immunology. Est. Know coagulation cascade. types of embolism. Details Excellent. RNA. 30.33 Source Lippincott's Biochemistry Details Know mechanisms of DNA repair.5 hr .16. 32.19. and types of shock. 0. autoimmunity. Est. 1 hr 0.5 hr 0.2.5 hr 1 hr 1 hr 0.5 hr Day 12 Objective DNA.5 hr 1 hr Environmental Pathology Chapter 7 Nutritional Disorders Chapter 8 BRS Pathology BRS Pathology 0.11. Quickly review Review vitamin deficiencies to refresh biochem memory. different types/roles of RNA. and collagen vascular disease Distinguish between tumor suppressor genes & oncogenes. Focus on figures 30.5 hr 0. 31. Time 4 hrs Cellular Injury Inflammation Hemostasis Genetic Disorders Immune Dysfunction Neoplasia Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Focus on mechanisms of cellular injury and differences between necrosis & apoptosis Distinguish mechanisms and histologic characteristics of acute vs. 30. mechanism of translation. Proteins Cellular Biology Assignments Chapters 30 . and the properties of malignant cells. chronic inflammation. and molecular biology techniques.9. and RNA import/export mechanisms. 30.22.5 hrs Cell Membranes Nucleus Chapter 1 Chapter 2 BRS Cell Biology & Histology Know properties of membranes and membrane proteins. BRS Cell Biology & Histology Know contents of nuclei.

and other ECM components. Est. 11 Est. Details Know the congenital cardiac abnormalities.5 hrs Day 13 Objective Cell Physiology Embryology Birth Defects Exam Cellular Physiology & General Embryology Assignments Chapter 1 Chapters 1-4 Chapters 17. BRS Cell Biology & Histology Review types of epithelia and locations of each. Review 3 Germ cell layers and their derivative tissues.Cytoplasm Chapter 3 BRS Cell Biology & Histology Review organelles and function 0. and fetal circulation. 1 hr Epithelia & Connective Tissue Chapters 5. basement membrane composition.6 1.5 hrs Thoracic Anatomy Histology of thoracic viscera Chapter 2 (Also use Netter's Atlas for reference) Chapters 11. 3 hrs 1 hr .5 hr Extracellular Matrix Chapter 4 BRS Cell Biology & Histology Know different types of collagen.5 hrs 2 hrs Day 14 Objective Embryology of thorax Thorax Assignments Chapters 5. Time 3. Know stages from zygote through embryo. Details Know mechanisms of ion transport. Review connective tissue focusing on bone histology. action potentials. Understand architecture of the gas diffusion barrier in the lungs. 15 High Yield Gross Anatomy BRS Cell Biology & Histology Be able to distinguish arteries and veins in cross section. 18 Diagnostic Test Source BRS Physiology BRS Embryology BRS Embryology Board Simulator Series Body Systems Review Source BRS Embryology Good opportunity to identify weaknesses in organ system areas. Time 1 hr 3 hrs 1. Also understand the stages of fetal lung maturation.

after-load. Time 1. Volume 2: Cases 52-66 Chapters 10. Distinguish between leukemia & lymphoma. arrhythmias. HTN. electrophysiology. platelet lineages. 12 (and a histologic atlas for further review) Source BRS Physiology BRS Pathology Lippincott's Pharmacology Underground Clinical Vignettes . & Lymph Nodes BRS Cell Biology & Histology Familiarize yourself with lymph node architecture. Study this chapter thoroughly. Study this chapter thoroughly. Est. Understand different types of each. Study this chapter thoroughly. Time 2 hrs 2 hrs Chapter 13 BRS Pathology 1 hr . and conduction. Frank-Starling curve. Source BRS Pathology BRS Pathology Details Know pathophysiology and lab differentiation of various etiologies of anemias. Details Know the various lung volume measurements.base disorders. cardiac cycle. Est. and understand acid . Understand RBC. responses to exercise.5 hrs 0.5 hrs 1. and hyperlipidemia.Patho-physiology Good opportunity for group review. Spleen. Understand pre-load. 3 hrs Day 17 Objective Anemia Hempatopoietic & Lymphoreticular Neoplasia Hemorrhagic Disorders Finish Hematology Assignments Chapter 11 Chapter 12 Est. volume loss. 21 BRS Pathology BRS Pathology Lippincott's Pharmacology 1.Day 15 Objective Cardiovascular Physiology Cardiovascular System Assignments Chapter 3 Source BRS Physiology Details Review hemodynamics. Time 1. WBC. blood pressure regulation. Know how to diagnose and correct each disorder. altitude.5 hrs 2 hrs Histology of Bone Marrow.5 hrs Cardiac Pathology Vascular Pathology Cardiovascular Pharmacology Chapter 10 Chapter 9 Chapters 16-19. angina. Know drugs used to treat CHF.5 hrs 1 hr 5 hrs Day 16 Objective Respiratory Physiology Respiratory Pathology Respiratory Pharmacology Clinical Vignettes Respiratory System & Begin Hematology Assignments Chapter 4 Chapter 14 Chapter 22 Volume 1: Cases 1-19. and understand the spleen.

BRS Physiology Source BRS Pathology BRS Pathology Understand innervation of gut and gut hormones Details Study this chapter thoroughly. Time 2 hrs 2 hrs Day 19 Objective Gastrointestinal Pathology Hepatobiliary and Exocrine Pancreatic Pathology GI Pharmacology Clinical Vignettes Gastrointestinal System Assignments Chapter 15 Chapter 16 Chapter 24 Volume 1: Cases 40-73 Lippincott's Pharmacology Underground Clinical Vignettes . Time . 2 hrs 2 hrs Day 20 Objective GenitoUrinary System Assignments Source Details Est. 1.5 hrs 2 hrs Day 18 Objective Embryology of Gut and Body Cavities Gastrointestinal System Assignments Chapters 10. midgut. portal blood flow. Know which structures are derived of foregut. hindgut.5 hrs Abdominal Anatomy Histology of GI Tract GI Physiology Chapter 3 (Also refer to Netter's atlas) Chapter 6 Chapter 6 High Yield Gross Anatomy BRS Cell Biology & Histology Know layers of gut wall. in addition to vascular supplies.Patho-physiology Know GI drugs as well as antiemetics. 16 Est.5 hrs 1.Patho-physiology Source BRS Embryology Details Understand rotation of gut and related malformations.5 hrs 1 hr Est. Understand liver structure. Good opportunity for group review. Study this chapter thoroughly. 2 hrs 1. Time 1. and bile flow.Drugs affecting coagulation Anticancer Drugs Clinical Vignettes Chapter 20 Chapter 38 Volume 1: Cases 74-102 Lippincott's Pharmacology Lippincott's Pharmacology Underground Clinical Vignettes .

Know the anatomy of the nephron.5 hrs Chapter 27 Lippincott's Pharmacology 1 hr . 20 BRS Embryology High Yield Gross Anatomy BRS Cell Biology & Histology Know the maturation sequence of spermatocytes and ovarian follicles. uterine cancer. 5 Chapters 18. Time 1 hr 2.5 hrs 1.Embryology of GU Organs Anatomy of Pelvis and Perineum Histology of GU Organs Chapters 6. and 83-103 Underground Clinical Vignettes . Know hormonal axes Know different types of insulin and their half lives.5 hrs 1 hr 1. Est.5 hrs 2 hrs Volume 2: Cases 30-51. Good opportunity for group review. 19. 13. and use an atlas for additional pictures. 3 hrs 3 hrs 3 hrs Day 21 Objective Renal Physiology Diuretics Renal & Urinary Tract Pathology Male Reproductive Pathology Female Reproductive Pathology Clinical Vignettes GenitoUrinary System Assignments Chapter 5 Chapter 23 Chapter 17 Chapter 18 Chapter 19 Source BRS Physiology Lippincott's Pharmacology BRS Pathology BRS Pathology BRS Pathology Study this chapter thoroughly. Details Est. Know the different types of testicular cancer.5 hrs 1.5 hrs 1. 14 Chapters 4. Time 1. and the biology of BPH and prostate cancer Understand cervical. Know classes of oral hypoglycemics and side effects.Patho-physiology Day 22 Objective Histology of Endocrine System Physiology Insulin and oral hypoglycemics Steroid Hormones Endocrine System Assignments Chapter 13 Chapter 7 Chapter 26 Source BRS Embryology BRS Physiology Lippincott's Pharmacology Details Review structure of endocrine organs.

10 Source BRS Embryology High Yield Gross Anatomy BRS Cell Biology & Histology Review histology of skin. Time 2 hrs 2 hrs 2 hrs 3. 15 Source BRS Physiology BRS Pathology Underground Clinical Vignettes .Patho-physiology Lippincott's Pharmacology Details Understand Synaptic transmission and axonal conduction Know types of CNS infections.5 hours 2 hrs . bone. 2 hrs EXAM Body Systems III - Test 1 Tough questions. 6. 8. and vascular disorders. and cartilage Details Est. Est. tumors. Anatomy Cases 40-56. Understand the transition from neural plate to mature CNS. & Nervous System Head & Neck Anatomy Neuroanatomy Chapter 8 (also refer to Netter) Chapters 1-23 High Yield Gross Anatomy High Yield Neuroanatomy 2 hrs 6hrs Day 24 Objective Neurophysiology Neuropathology Clinical Vignettes Neuropharmacology Nervous System Assignments Chapter 2 Chapter 23 Volume 2: Cases 45-61. Also review anesthetics and analgesics. Chapters 7. muscle. 14. 10. 1.5 hrs Day 25 Objective Embryology Anatomy of Limbs and Back Histology Musculoskeletal System Assignments Chapter 15 Chapters 1.Clinical Vignettes Volume 1: Cases 25-38 Underground Clinical Vignettes . 11. Good opportunity for group review. Review drugs used to treat epilepsy. Time 3 hrs Objective Assignments Embryology of Head. but great explanations. Est. Chapters 8. Know fate of neural crest cells. 9. 7 (also use Netter) Chapters 7. Well worth the time to push yourself a bit and solidify the material you've learned.Patho-physiology Board Simulator Series Body Systems Review Good opportunity for group review. Parkinson's. Time 1 hr 3. 8. 10 Neck.5 hrs Day 23 Nervous System Source BRS Embryology Details Know branchial arches/clefts and their derivatives.

40 and Autocoids Lippincott's Pharmacology 2 hrs .Anti-Inflammatory Agents Chapters 39.

1. specificity. etc. NPV.with ID. lunch. odds ratios. Est.Behavioral Sci.Day 26 Objective Dermatologic Pathology Musculoskeletal System Assignments Chapter 21 Source BRS Pathology Details Focus on malignancies (melanoma.5 hrs 2 hrs Volume 3: Cases 9-18. Lippincott's Pharmacology High Yield Biostatistics Understand sensitivity. Time 3 hrs 3 hrs 4 hrs Day 28 Objective Final Review Exam Logistics Final Review & Exam Logistics Assignments Source Details Review Any Remaining Topics and finish practice questions. Details Est. and 96-104. Time 1. Well worth the time to push yourself a bit and solidify the material you've learned. Time 4 hrs Rest & Relax . SCC.5 hrs Musculoskeletal Pathology Clinical Vignettes Chapter 22 BRS Pathology Good opportunity for group review.Patho-physiology Also Anatomy: Cases 62-84 Exam Body Systems II . Be prepared to calculate risk. Prepare exam bag . 2 hrs Day 27 Objective Clinical Vignettes Psychotropic Drugs Biostatistics Behavioral Sciences & Biostatistics Assignments All cases Chapters 9-12. Est. directions to center. PPV. BCC) and refer to a dermatology atlas so that you can differentiate between them. but great explanations. 13 Read entire book Source Underground Clinical Vignettes . Underground Clinical Vignettes .Test 1 Board Simulator Series Body Systems Review Tough questions. ticket.

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