USMLE STEP 1

SYLLABUS
OUTLINE

General Principles
Biochemistry and Molecular Biology

 Gene expression: DNA structure, replication, and exchange
 DNA structure: single- and double-stranded DNA, stabilizing forces,
supercoiling
 Analysis of DNA: sequencing, restriction analysis, PCR amplification,
hybridization
 DNA replication, mutation, repair, degradation, and inactivation
 Gene structure and organization; chromosomes; centromere, telomere
 Recombination, insertion sequences, transposons
 Mechanisms of genetic exchange, including transformation, transduction,
conjugation, crossover, recombination, linkage plasmids and
bacteriophages
 Gene expression: transcription, including defects
 Transcription of DNA into RNA, enzymatic reactions, RNA, RNA degradation
 Regulation: cis-regulatory elements, transcription factors, enhancers,
promoters, silencers, represents, splicing
 Gene expression: translation, including defects
 The genetic code
 Structure and function of tRNA
 Structure and function of ribosomes
 Protein synthesis
 Regulation of translation
 Post-translation modifications, including phosphorylation,
 addition of CHO units
 Protein degradation
 Structure and function of proteins
 Principles of protein structure and folding
 Enzymes: kinetics, reaction mechanisms
 Structural and regulatory proteins: ligand binding, self-assembly
 Regulatory properties
 Energy metabolism, including metabolic sequences and
regulation, and disorders
 Generation of energy from carbohydrates, fatty acids, and essential amino
acids; glycolysis, pentose phosphate pathway, tricarboxylic acid cycle,
ketogenesis, electron transport and oxidative phosphorylation,
glycogenolysis
 Storage of energy: gluconeogenesis, glycogenesis, fatty acid and
triglyceride synthesis
 Thermodynamics: free energy, chemical equilibria and group transfer
potential, energetics of ATP and other high-energy compounds
 Metabolic pathways of small molecules and associated diseases
 Biosynthesis and degradation of amino acids (e.g., homocystinuria, maple
syrup urine disease)
 Biosynthesis and degradation of purine and pyrimidine nucleotides (e.g.,
gout, Lesch-Nyhan syndrome)
 Biosynthesis and degradation of lipids (e.g., dyslipidemias, carnitine
deficiency, adrenogenital syndromes)

 Biosynthesis and degradation of porphyrins
 Biosynthesis and degradation of other macromolecules and associated
abnormalities, complex carbohydrates (e.g., lysosomal storage disease),
glycoproteins, and proteoglycans (e.g., type II glycogen storage disease)
Biology of cells

 Structure and function of cell components (eg, nucleus, cytoskeleton,
endoplasmic reticulum, plasma membrane)
 Signal transduction (including basic principles, receptors and channels,
second messengers, signal trasnduction pathways)
 Cell adhesion and cell motility
 Intracellular sorting (eg, trafficking, endocytosis)
 Cellular homeostasis (eg, turnover, pH maintenance, proteasome, ions,
soluble proteins)
 Cell cycle (eg, mitosis, meiosis, structure of spindle apparatus, cell cycle
regulation)
 Structure and function of basic tissue components (including epithelial
cells, connective tissue cells, muscle cells, nerve cells, and extracellular
matrix)
 Adaptive cell response to injury
 Intracellular accumulations (eg, pigments, fats, proteins, carbohydrates,
minerals, inclusions, vacuoles)
 Mechanisms of injury and necrosis
 Apoptosis

Human development and genetics

 Embryogenesis: programmed gene expression, tissue differentiation and
morphogenesis, homeotic genes, and developmental regulation of gene
expression
 Congenital abnormalities: principles, patterns of anomalies,
dysmorphogenesis
 Principles of pedigree analysis, including inheritance patterns, occurrence
and recurrence risk determination
 Population genetics: Hardy-Weinberg law, founder effects, mutation-
selection equilibrium
 Genetic mechanisms: chromosomal abnormalities, mendelian inheritance,
multifactorial diseases
 Clinical genetics, including genetic testing, prenatal diagnosis, newborn
screening, genetic counseling/ethics, gene therapy
Biology of tissue response to disease

 Inflammation, including cells and mediators
 Acute inflammation and mediator systems
 Vascular response to injury, including mediators
 Inflammatory cell recruitment, including adherence and cell migration, and
phagocytosis
 Bactericidal mechanisms and tissue injury
 Clinical manifestations (eg, pain, fever, leukocytosis, leukemoid reaction,
and chills)

and repair: thrombosis. principles of poisoning and therapy)  Temperature regulation  Fluid. age. gases. smoke inhalation. toxicology  Drug interactions . metabolic proficiency. efficacy. agricultural hazards. expenditure. including occupational exposures  Physical and associated disorders (eg. obesity. trans-fatty acids. burns. electrolyte. gender.and dose-effect relationships (eg. structure-activity relationships  Concentration. temperature. granulation tissue. metabolism. scar/keloid formation  Regenerative processes  Neoplasia  Classification. distribution. body weight. alkalosis) Pharmacodynamic and pharmacokinetic processes  Pharmacokinetics: absorption. increased water pressure)  Chemical (eg. pharmacogenetics)  Drug side effects. altered cell differentiation. overdosage. tolerance. fibrosis. types of agonists and antagonists and their actions  Individual factors altering pharmacokinetics and pharmacodynamics (eg. volatile organic solvents. vapors. acidosis.  Chronic inflammation  Reparative processes  Wound healing. and storage of energy at the whole-body level  Assessment of nutritional status across the life span. dehydration. protein. bulimia)  Adaptation to environmental extremes. high-altitude sickness. heavy metals. including essential. hemostasis. dosage intervals  Mechanisms of drug action. oncogenes. and acid-base balance and disorders (eg. including calories. excretion. essential nutrients. disease. anorexia. potency). histologic diagnosis  Grading and staging of neoplasms  Cell biology. hypoalimentation  Functions of nutrients. radiation. decreased atmospheric pressure. compliance. angiogenesis. cholesterol  Protein-calorie malnutrition  Vitamin deficiencies and/or toxicities  Mineral deficiencies and toxicities  Eating disorders (eg. and molecular biology of neoplastic cells: transformation. and proliferation  Hereditary neoplastic disorders  Invasion and metastasis  Tumor immunology  Paraneoplastic manifestations of cancer  Cancer epidemiology and prevention Multisystem processes  Nutrition  Generation. biochemistry.

and laboratory diagnosis  Molecular basis of pathogenesis  pathophysiology of infection  Latent and persistent infections  Epidemiology  Oncogenic viruses  Fungi and fungal infections  Structure. approval. drug development. function. tolerance and clonal deletion  Immunologic mediators: chemistry. physiology. biogenic amines. natural killer cells. and macrophages  Production and function of T lymphocytes. immunoglobulin and antibodies: structure and biologic properties  ntigenicity and immunogenicity. assay. and laboratory diagnosis  Pathogenesis and epidemiology  Parasites and parasitic diseases  Structure. T-lymphocyte receptors  Production and function of B lymphocytes and plasma cells. cytokines. chemokines . physiology. scheduling)  General properties of autacoids. assay.  Regulatory issues (eg. physiology. cell activation and regulation. including peptides and analogs. including drug effects on rapidly dividing mammalian cells Microbial biology and infection  Microbial classification and its basis  Bacteria and bacterial diseases  Structure and composition  Metabolism. classic and alternative complement pathways. prostanoids and their inhibitors. and laboratory diagnosis  Pathogenesis and epidemiology  Principles of sterilization and pure culture technique Immune responses  Production and function of granulocytes. and laboratory diagnosis  Viruses and viral diseases  Physical and chemical properties  Replication  Genetics  principles of cultivation. including mechanisms of action and resistance  General properties of antineoplastic agents and immunosuppressants. and smooth muscle/endothelial autacoids  General principles of autonomic pharmacology  General properties of antimicrobials. cultivation. antigen presentation. and regulation  Genetics  Nature and mechanisms of action of virulence factors  Pathophysiology of infection  Epidemiology and ecology  Principles of cultivation. molecular biology.

probability  Disease prevalence and incidence  Disease outcomes (eg. specificity. erythrocyte antigens. correlation and covariance)  Health impact (eg. complement fixation. hemolytic disease of the newborn Immunopathogenesis Quantitative methods  Fundamental concepts of measurement  scales of measurement  Distribution. community surveys)  Sampling and sample size  Subject selection and exposure allocation (eg. ELISA. predictive values  Fundamental concepts of study design  Types of experimental studies (eg. class I. central tendency. graft-versus-host disease)  Isoimmunization. case series. cross-sectional. variability. cohort. case-control. protective immunity  Immunologic principles underlying diagnostic laboratory tests (eg. transfusion (eg. II molecules. immunopharmacology  Immunologically mediated disorders  Hypersensitivity (types I-IV)  Transplant rejection  Autoimmune disorders  Risks of transplantation. clinical trials. stratification. MHC structure and function. RIA.  Immunogenetics. agglutination)  Innate immunity  Alterations in immunologic function  T. fatality rates)  Associations (eg. community intervention trials)  Types of observational studies (eg. risk differences and ratios)  Sensitivity. randomization.or B-lymphocyte deficiencies (eg. transplantation Immunizations: vaccines. systematic assignment)  Outcome assessment  Internal and external validity  Fundamental concepts of hypothesis testing and statistical inference  Confidence intervals  Statistical significance and Type I error  Statistical power and Type II error . DiGeorge Syndrome)  Deficiencies of phagocytic cells  Combined immunodeficiency disease  HIV infection/AIDS and other acquired disorders of immune responsiveness  Drug-induced alterations in immune responses. self-selection.

fetal maturation. nutritional deficiencies. GM-CSF)  Anticoagulants. and adverse effects of drugs for treatment of disorders of the hematopoietic system  Blood and blood products  Treatment of anemia. erythropoietin)  Drugs stimulating leukocyte production (eg. and Immunologic disorders  Infections of the blood. splenic rupture)  Neoplastic disorders (eg. ITP)  Anemia of chronic disease  Transfusion complications.Hematopoietic and Lymphoreticular Systems Normal processes  Embryonic development. iron deficiency anemia. O2 and CO2 transport. regeneration. mechanical injury to erythrocytes. drugs stimulating erythrocyte production (eg. lymphoma. hemoglobinopathies. effects and complications of splenectomy. transport proteins  production and function of leukocytes and the lymphoreticular system  production and function of platelets  production and function of coagulation and fibrinolytic factors Abnormal processes  Infectious. and changes associated with stage of life  Cell/tissue structure and function  production and function of erythrocytes. cryoglobulinemias. including acquired and congenital  Anemias and cytopenias (eg. coagulopathies. Inflammatory. DIC)  Bleeding secondary to platelet disorders (eg. leukemia. hereditary spherocytosis)  Cythemia  Hemorrhagic and hemostatic disorders (eg. anti-HIV) . and lymphatics  Allergic and anaphylactic reactions and other immunopathologic mechanisms  Acquired disorders of immune deficiency  Autoimmunity and autoimmune diseases (eg. hypersplenism. transplant rejection  Traumatic and mechanical injury (eg. thrombolytic drugs  Antiplatelet drugs  Antimicrobials (eg. Reticuloendothelial system. pernicious anemia. and perinatal changes  Organ structure and function  Repair. TTP. Coombs positive hemolytic anemia. antimalarials. use. von Willebrand)  Vascular and endothelial disorders (eg. hemoglobin. multiple myeloma)  Metabolic and regulatory disorders. hemolytic-uremic syndrome)  Systemic disorders affecting the hematopoietic and lymphoreticular system (eg. G-CSF. systemic lupus erythematosus)  Idiopathic disorders Principles of Therapeutics  Mechanisms of action.

including general and adolescent  Patient interviewing. other "boundary" issues  Ethics of managed care  Organization and cost of health care delivery . lead)  Gender and ethnic factors (eg. herbal treatments with bone marrow depression)  Progression through the life cycle. and professional behavior  Consent and informed consent to treatment  Physician-patient relationships (eg. chelating agents. related past experience  Family and cultural factors. and behavioral considerations affecting disease treatment and prevention. and society (eg. confidentiality)  Death and dying  Birth-related issues  Issues related to patient participation in research  Interactions with other health professionals (eg. transference)  Patient adherence. plasmapheresis) Gender. jurisprudence. radiation therapy for lymphomas. ethnicity. and social and interpersonal development  Sexual development (eg. including socioeconomic status. including psychosocial. sleep deprivation)  Interactions between the patient and the physician or the health care system (eg. consultation. cultural. referral)  Sexuality and the profession. ethical conduct. including coping mechanisms  Psychodynamic and behavioral factors. motor skills. hydrocarbons. menopause)  Influence of developmental stage on physician-patient interview  Psychologic and social factors influencing patient behavior  Personality traits or coping style. and environmental  Emotional and behavioral factors (eg. childhood leukemia)  Occupational and other environmental risk factors (eg. diet. heavy metals. "blood doping" among athletes)  Influence on person. depression and immune responses. ethnic. anxious or angry patients)  Multicultural ethnic characteristics  Medical ethics. and interactions with the family  Establishing and maintaining rapport  Data gathering  Approaches to patient education  Enticing patients to make lifestyle changes  Communicating bad news  "Difficult" interviews (eg. splenectomy. family.  Antineoplastic and immunosuppressive drugs  Drugs used to treat acquired disorders of immune responsiveness  Other therapeutic modalities (eg. and gender  Adaptive and maladaptive behavioral responses to stress and illness (eg. occupational. including birth through senescence  Cognitive. puberty. language. drug-seeking behavior.

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myasthenia gravis)  Traumatic and mechanical disorders (eg. including metabolic (eg. language. hypothalamic function. blood supply. delirium. balance. including brain and spinal cord. and spinal reflexes  Brain stem. and changes associated with stage of life  Organ structure and function  Spinal cord.and postsynaptic receptor interactions. including primary and metastatic  Acquired metabolic and regulatory disorders (eg. fetal maturation. and blood supply  Brain. inflammatory. peripheral nerve injury)  Neoplastic disorders. Down syndrome)  Degenerative disorders (eg. Reye syndrome)  Vascular disorders (eg. cerebral palsy. subdural and epidural hematomas. meningitis. and degradation of neurotransmitters and neuromodulators  Pre. including gross anatomy and blood supply. basal ganglia and cerebellum  Autonomic nervous system  Peripheral nerve  Cell/tissue structure and function  Axonal transport  Excitable properties of neurons. diabetic neuropathy)  Idiopathic disorders affecting the nervous system  Congenital disorders. neural tube defects. including channels  Synthesis. circadian rhythms and sleep. cerebrovascular occlusion. cord compression. axons and dendrites. hearing. limbic system and emotional behavior. including neural tube derivatives. taste. vision. control of eye movement  Sensory systems. choroid plexus Abnormal processes  Infectious. venous sinus thrombosis. neural crest derivatives  Repair. Huntington disease. reticular formation. storage. cerebral ventricles. trophic and growth factors  Brain metabolism  Glia. memory. including gross anatomy. multiple sclerosis. release. including cranial nerves and nuclei. cognition. mental retardation.Central and Peripheral Nervous Systems Normal processes  Embryonic development. amyotrophic lateral sclerosis) . hemorrhage)  Systemic disorders affecting the nervous system (eg. pain. and perinatal changes. cerebrospinal fluid formation and flow. Alzheimer dementia. regeneration. reuptake. myelin  Brain homeostasis: blood-brain barrier. lupus. and olfaction  Motor systems. Parkinson disease. arterial aneurysms. including proprioception. and immunologic disorders (eg. gross anatomy. peripheral neuropathy.

learning disorders)  Disorders related to substance use  Schizophrenia and other psychotic disorders  Mood disorders  Anxiety disorders  Somatoform disorders  Personality disorders  Physical and sexual abuse of children. restless legs syndrome/periodic limb movement. antidepressants. high-dose glucocorticoids)  Antimigraine agents  Drugs affecting autonomic nervous system (eg. ethnic. antipsychotic agents. boxing. and behavioral considerations affecting disease treatment and prevention. amphetamines  Antiparkinsonian drugs  Skeletal muscle relaxants. anxiolytics. mannitol. and society (eg. occupational. pets)  Influence on person. CFS shunting. blindness. and sleep disorders including narcolepsy. accident prevention. pain syndromes. epilepsy. use. nutrition.  Paroxysmal disorders (eg. dementia. parasomnias)  Disorders of special senses (eg. mood-stabilizing agents)  Anticonvulsants  Analgesics  Stimulants. headache. radiation. processes and their evaluation  Early-onset disorders (eg. anticholinesterases)  Other therapeutic modalities (eg. family. deafness)  Psychopathologic disorders. dementia. including psychosocial. and adverse effects of drugs for treatment of disorders of the nervous system  Anesthetics  Hypnotics  Psychopharmacologic agents (eg. circadian rhythm disorders. post-traumatic stress disorder) Principles of therapeutics  Mechanisms of action. carbon monoxide exposure)  Gender and ethnic factors . and elders  Other disorders (eg. seizures. adults. sleep disorders)  Occupational and other environmental risk factors (eg. sleep deprivation. surgery) Gender. developmental disabilities. and environmental  Emotional and behavioral factors (eg. drug abuse. dissociative. impulse control. cultural. botulinum toxin  Neuromuscular junction blocking agents (postsynaptic)  Antiglaucoma drugs  Drugs used to decrease intracranial pressure (eg. generation reversal.

Raynaud disease)  Systemic disorders affecting the skin (eg. and structural disorders (eg. effects of ultraviolet light and radiation)  Neoplastic disorders  Keratinocytes (eg. and perinatal changes  Organ structure and function  Cell/tissue structure and function. antihistamines). regeneration. acne)  Influence on person. (eg. gangrene)  Viral infections (eg. carbuncle. sun exposure. cellulitis. antimicrobial agents. basal cell carcinoma. including anti-inflammatory agents (eg. fetal maturation. rubella. scleroderma. decubitus ulcers. nevi. thermal injury. cryotherapy) Gender. corticosteroids. discoid lupus erythematosus. hyperhidrosis)  Vascular disorders (eg. roseola. occupational. scabies. postmenopausal hair changes)  Skin defense mechanisms and normal flora Abnormal processes  Infectious. laser. and adverse effects of drugs for treatment of disorders of the skin and connective tissue. male pattern baldness. family. tattoo removal. and immunologic disorders  Bacterial infections. actinic keratosis. hypervitaminosis. necrotizing fasciitis. herpes infections. dermatophytosis (eg. urticaria. emollients. cultural. T-cell lymphoma. sunscreen. vitamin deficiencies. Ehlers-Danlos syndrome. Marfan syndrome) Principles of therapeutics  Mechanisms of action. regulatory. and ichthyosis)  Melanocytes (eg. retinoids. allergic dermatosis)  Traumatic and mechanical disorders (eg. eccrine function  Repair. thermal regulation. tinea)  Parasitic infections (eg. including barrier functions. cytotoxic and immunologic therapy (eg. Kaposi sarcoma)  Other (eg. and behavioral considerations affecting disease treatment and prevention. PUVA. melanoma)  Vascular neoplasms (eg. use. verrucae)  Fungal infections. inflammatory. hemangiomas. ethnic. and environmental  Emotional and behavioral factors (eg. skin appendage tumors)  Metabolic. vasculitis. abscess. senile purpura. alopecia. including psychosocial. squamous cell carcinoma. psoriasis) . seborrheic keratosis. dermatomyositis.Skin and Related Connective Tissue Normal processes  Embryonic development. lice)  Immune and autoimmune disorders (eg. acne. and changes associated with stage of life or ethnicity (eg. chickenpox. psoriasis. including mycoses. keratinolytics)  Other therapeutic modalities (eg. and society (eg. measles. methotrexate.

keloid) . Occupational and other environmental risk factors  Gender and ethnic factors (eg.

ethnic. bone infarcts)  Systemic disorders affecting the musculoskeletal system (eg. regulatory. family. gold. allopurinol. gout)  Vascular disorders (eg. synovitis. glucocorticoids. septic arthritis. fibrositis. radiation. polymyositis. osteogenesis imperfecta. osteoporosis. polyarteritis nodosa. repetitive motion injuries)  Neoplastic disorders (eg. calcitonin. alcohol abuse. diet. bicycle helmets)  Influence on person. and society (eg. osteomalacia. systemic lupus erythematosus. osteomyelitis)  Inflammatory disorders (eg. ankylosing spondylitis. and perinatal changes  Organ structure and function  Cell/tissue structure and function  Biology of bones. osteosarcoma. diabetes mellitus)  Idiopathic disorders (eg. tenosynovitis)  Immunologic disorders (eg. and structural disorders (eg. Dupuytren contracture. dwarfism. rheumatoid arthritis. tendons. use. osteodystrophy. rehabilitation) Gender. sprains. fractures in elderly. fetal maturation. dislocations. casts. colchicine. Lyme disease. occupational. seat belts. polymyalgia rheumatica) Principles of therapeutics  Mechanisms of action. osteoporosis. scoliosis. cytotoxic agents)  Drugs affecting bone mineralization (eg. estrogen analogs)  Other therapeutic modalities (eg.Musculoskeletal System Normal processes  Embryonic development. regeneration. and changes associated with stage of life Abnormal processes  Traumatic and mechanical disorders (eg. diphosphonates. cultural. and behavioral considerations affecting disease treatment and prevention. fractures. and immunologic disorders  Infectious disorders (eg. surgery. strains. and adverse effects of drugs for treatment of disorders of the musculoskeletal system  Nonsteroidal anti-inflammatory drugs and analgesics  Muscle relaxants  Antigout therapy (eg. and environmental  Emotional and behavioral factors (eg. disc disease. including psychosocial. uricosuric drugs)  Immunosuppressive drugs (eg. Paget disease)  Degenerative disorders (eg. joints. osteoarthritis)  Infectious. exercise. metastatic disease)  Metabolic. dermatomyositis. inflammatory. skeletal muscle  Exercise and physical conditioning  Repair. and fractures) .

athletes. Occupational and other environmental risk factors (eg. musicians)  Gender and ethnic factors (eg. bone mass) .

mesothelioma. pleural effusion)  Systemic disorders affecting the respiratory system Principles of therapeutics  Mechanisms of action. perfusion. pneumothorax. and immunologic disorders  Infectious diseases  Infectious diseases of the upper respiratory tract (eg. mucolytics. sleep apnea)  Neoplastic disorders (eg. hypoventilation. abscess. polyps. decongestants. Goodpasture syndrome)  Inflammatory disorders  Pneumoconioses  Acute and chronic alveolar injury (eg. ventilation-perfusion imbalance. Mycobacterium. fetal maturation. Wegener granulomatosis. use. disorders of gas exchange. pneumonia. cough suppressants. expectorants. metastatic tumors)  Metabolic. alveolar structure  Repair. sarcoidosis. gas exchange  Pleura  Nasopharyx and sinuses Abnormal processes  Infectious. acute respiratory distress syndrome. including mechanics and regulation of breathing  Lung parenchyma. chlorine gas/smoke inhalation)  Obstructive pulmonary disease  Restrictive pulmonary disease (eg. regeneration. and changes associated with stage of life  Pulmonary defense mechanisms and normal flora  Organ structure and function  Airways. bronchiectasis. including ventilation. thromboembolic disease. pharyngitis)  Acute infectious diseases of the lower respiratory tract and pleura and their complications (eg. bronchodilator drugs. asthma)  Autoimmune disorders (eg. endemic fungal infections. and adverse effects of drugs for treatment of disorders of the respiratory system (eg. inflammatory.Respiratory System Normal processes  Embryonic development. anti- . bronchogenic carcinoma. Nocardia/Actinomyces)  Immunologic disorders  Allergic and hypersensitivity disorders (eg. empyema)  Chronic infectious diseases of the lower respiratory tract (eg. pulmonary edema. regulatory. sinusitis. and structural disorders (eg. foreign body aspiration. including surfactant formation. neonatal respiratory distress syndrome)  Vascular and circulatory disorders (eg. and perinatal changes  Cell/tissue structure and function. idiopathic fibrosis)  Traumatic and mechanical disorders (eg. atelectasis. pulmonary hypertension.

mechanical ventilation. and environmental  Emotional and behavioral factors (eg. cultural. including psychosocial. nasal CPAP. substance abuse. asthma. protective parents. antimicrobial agents. sarcoidosis. and society (eg. surgical procedures. lung cancer) . school issues. including transplantation) Gender. family smoking)  Occupational and other environmental risk factors  Gender and ethnic factors (eg. smoking. occupational. physical therapy. antineoplastic agents)  Other therapeutic modalities (eg. oxygen therapy. and allergies)  Influence on person. chronic obstructive pulmonary disease. family. pets. ethnic. inflammatory and cytotoxic drugs. tuberculosis. and behavioral considerations affecting disease treatment and prevention.

endocarditis. systolic and diastolic dysfunction. and shock)  Vascular disorders (eg. microcirculation. acute rheumatic fever. aneurysms. and perinatal changes  Organ structure and function  Chambers. aortic dissection with Marfan syndrome. transplant rejection. and blood volume  Circulation in specific vascular beds  Cell/tissue structure and function  Heart muscle. and lymph flow  Mechanisms of atherosclerosis  Neural and hormonal regulation of the heart.and high-output heart failure. including systemic. inflammatory. mechanics. regeneration. vasculitis. atrial natriuretic peptide)  Endothelium and secretory function. low. pericarditis)  Inflammatory and immunologic disorders (eg. and changes associated with stage of life Abnormal processes  Traumatic and mechanical disorders (eg. blood vessels. metabolism. fetal maturation. atherosclerosis)  Systemic diseases affecting the cardiovascular system (eg. and tissue metabolism  Repair. cor pulmonale. myocarditis. heart sounds. and immunologic disorders  Infectious disorders (eg. valves  Cardiac cycle. vascular smooth muscle. varicosities. and blood volume. and scleroderma)  Congenital disorders of the heart and central vessels  Infectious. amyloidosis. including responses to change in posture. ischemic heart disease. and secretory function (eg. myocardial infarction.Cardiovascular System Normal processes  Embryonic development. and adverse effects of drugs for treatment of disorders of the cardiovascular system  Coronary and peripheral vasodilators  Antiarrhythmic drugs  Antihypertensive drugs  Measures used to combat hypotension and shock  Drugs affecting cholesterol and lipid metabolism . occlusions. exercise. systemic hypertension. pulmonary. systemic lupus erythematosus. dysrhythmias. biochemistry. temporal arteritis) Principles of therapeutics  Mechanisms of action. coronary. systemic hypotension. cardiac conduction  Hemodynamics. tamponade. valvular disease. oxygen consumption. use. obstructive cardiomyopathy)  Neoplastic disorders  Metabolic and regulatory disorders (eg.

thrombolytic agents  Inotropic agents and treatment of heart failure  Immunosuppressive and antimicrobial drugs  Drugs to treat peripheral arterial disease  Other therapeutic modalities (eg. exercise. obesity. stress)  Gender and ethnic factors (eg. and society (eg. ischemic heart disease. occupational. altered lifestyle)  Occupational and other environmental risk factors (eg. hypertension) . grafts. diet)  Influence on person. ethnic. smoking. angioplasty.  Drugs affecting blood coagulation. family. valves. pacemakers. alcohol. and environmental  Emotional and behavioral factors (eg. including psychosocial. other surgical procedures) Gender. cultural. and behavioral considerations affecting disease treatment and prevention.

motility disorders. postsurgical obstruction)  Perforation of hollow viscus and blunt trauma  Inguinal. and adverse effects of drugs for treatment of disorders of the gastrointestinal system  Treatment and prophylaxis of peptic ulcer disease and gastroesophageal reflux (eg. Meckel diverticulum)  Neoplastic disorders.Gastrointestinal System Normal processes  Embryonic development. esophagitis. gingivostomatitis. antacids. portal hypertension. including alimentary canal. and immunologic disorders  Infectious disorders (eg. hepatitis. hemorrhoids. volvulus. cathartics. gastrointestinal. mucosal protective agents. drugs to dissolve gallstones) . peritonitis. pancreatic. use. and changes associated with stage of life  Gastrointestinal defense mechanisms and normal flora Abnormal processes  Infectious. malabsorption. and digestion and absorption  Cell/tissue structure and function  Endocrine and neural regulatory functions. Crohn disease. and abdominal wall hernias  Esophageal and colonic diverticula (eg. antibiotics)  Drugs to alter gastrointestinal motility (eg. and perinatal changes  Organ structure and function. antisecretory drugs. oral rehydration)  Pancreatic replacement therapy and treatment of pancreatitis  Drugs for treatment of hepatic failure (eg. fetal maturation. proteins. including GI hormones  Salivary. cholecystitis. food poisoning)  Inflammatory disorders (eg. liver and biliary system. hepatic failure. ulcerative colitis)  Traumatic and mechanical disorders  Malocclusion  Hiatus hernia  Obstruction (eg. motility. gastritis. peptic ulcer. annular pancreas. bile salts. femoral. lactulose) and biliary disease (eg. ischemia. pancreatitis)  Immunologic disorders (eg. prokinetic drugs)  Fluid replacement (eg. antidiarrheal drugs. motility drugs. cholelithiasis)  Vascular disorders (eg. regeneration. angiodysplasia)  Systemic disorders affecting the gastrointestinal system Principles of therapeutics  Mechanisms of action. salivary glands and exocrine pancreas. and processes  Synthetic and metabolic functions of hepatocytes  Repair. intussusception. inflammatory. hepatic secretory products. including Enzymes. including benign and malignant metabolic and regulatory disorders (eg. esophageal atresia. traveler's diarrhea. antiemetic drugs.

feeding tubes) Gender. psychogenic polydipsia)  Influence on person. stents. and antimicrobial drugs  Other therapeutic modalities (eg. family. compliance in diabetes mellitus. surgical procedures. occupational. iodine deficiency)  Gender and ethnic factors  . antineoplastic.  Anti-inflammatory. radiation exposure. and environmental  Emotional and behavioral factors (eg. ethnic. immunosuppressive. factitious use of insulin. including psychosocial. and society  Occupational and other environmental risk factors (eg. and behavioral considerations affecting disease treatment and prevention. cultural.

dopamine)  Anti-inflammatory. papillary necrosis)  Lower urinary tract (eg. including renal metabolism and oxygen consumption. bladder. antimicrobial. nephrogenic diabetes insipidus. immunosuppressive. and acid-base disorders  Drugs used to enhance renal perfusion (eg. diabetes mellitus. systemic lupus erythematosus. interstitial nephritis. acute tubular necrosis)  Tubular and collecting duct disorders (eg. regeneration. urethritis)  Inflammatory and immunologic disorders  Glomerular disorders (eg. use. primary (eg. hormones produced by or acting on the kidney  Repair. transplant rejection)  Metabolic and regulatory disorders  Renal failure. and perinatal changes  Organ structure and function  Kidneys. and antineoplastic drugs . hepatitis. including transport processes and proteins  Urinary concentration and dilution  Renal mechanisms in acid-base balance  Renal mechanisms in body fluid homeostasis  Micturition  Cell/tissue structure and function. urinary bladder and collecting system) and metastases  Vascular disorders (eg. cystitis. and IgA nephropathy)  Tubular interstitial disease (eg. glomerulonephritis. nephrotic syndrome. and changes associated with stage of life Abnormal processes  Infectious. obstructive uropathy)  Neoplastic disorders. antidiuretic drugs  Drugs and fluids used to treat volume. Wegener granulomatosis) Principles of therapeutics  Mechanisms of action. inflammatory.Renal/Urinary System Normal processes  Embryonic development. renal. electrolyte. polycystic kidney disease)  Renal calculi  Traumatic and mechanical disorders (eg. renal artery stenosis)  Systemic diseases affecting the renal system (eg. ureters. pyelonephritis. urethra  Glomerular filtration and hemodynamics  Tubular reabsorption and secretion. and adverse effects of drugs for treatment of disorders of the renal and urinary system  Diuretics. and immunologic disorders  Infectious disorders  Upper urinary tract (eg. fetal maturation. acute and chronic (eg. Fanconi syndrome. amyloidosis. renal tubular acidosis.

incontinence. dialysis. urinary tract infections) . renal transplantation) Gender. and behavioral considerations affecting disease treatment and prevention. hemodialysis. heavy metals)  Gender and ethnic factors (eg. benign prostatic hyperplasia)  Other therapeutic modalities (eg. living related kidney donation. family. disease progression. transplants)  Occupational and other environmental risk factors (eg. including psychosocial.  Drugs used to treat lower urinary tract system (eg. drug-induced interstitial nephritis. bladder function. cultural. and environmental  Emotional and behavioral factors (eg. and society (eg. occupational. ethnic. diet)  Influence on person.

varicocele)  Neoplastic disorders (eg. sepsis. delayed and premature puberty)  Benign prostatic hyperplasia  Systemic disorders affecting reproductive function (eg. postpartum disorders of the fetus (eg. including breast  Female function (eg. and adverse effects of drugs for treatment of disorders of the reproductive system and management of normal reproductive function  Female reproductive tract  Fertility drugs . and the postpartum period  Obstetric problems (eg. gestational diabetes. renal failure)  Disorders relating to pregnancy. female reproductive. sex steroids. sexually transmitted diseases. inflammatory. and gestational hormones  Reproductive system defense mechanisms and normal flora Abnormal processes  Infectious. breast [including fibrocystic changes]. polycystic ovaries. orgasmic dysfunction. third-trimester bleeding)  Complications affecting other organ systems (eg. menopause)  Male structure  Male function (eg. orchitis. torsion of testis. delayed and premature puberty)  menopausal syndrome  Male (eg. use. gynecomastia. puberty)  Intercourse. thyroid disorders)  Disorders associated with the puerperium (eg. postpartum hemorrhage.Reproductive System Normal processes  Embryonic development. obesity. depression)  Antepartum. including labor and delivery. infertility. orgasm  Pregnancy. spermatogenesis. macrosomia) Principles of therapeutics  Mechanisms of action. cord compression. trophoblastic disease)  Metabolic and regulatory processes  Female (eg. toxic shock syndrome. postmaturity. and perinatal changes  Organ structure and function  Female structure. menstrual cycle. breast abscess. autoimmune hypogonadism. impotence. placenta  Cell/tissue structure and function. prematurity. lactation. endometriosis. gestational uterus. ectopic pregnancy. male reproductive. fetal maturation. female incontinence. intrapartum. eclampsia. and immunologic disorders (eg. including hypothalamic- pituitary-gonadal axis. the puerperium. anovulation. cystic mastitis)  Traumatic and mechanical disorders (eg. cirrhosis. the puerperium. infertility. myotonic dystrophy. puberty.

progestogen replacement. cultural. and society (eg. including psychosocial. unwanted)  Gender identity. anabolic steroids) Gender. treatment of menopause  Stimulants and inhibitors of labor  Estrogen and progesterone antagonists  Stimulators and inhibitors of lactation  Male reproductive tract  Fertility drugs  Androgen replacement and antagonists  Gonadotropin-releasing hormone and gonadotropin replacement  Abortifacients  Antimicrobials  Antineoplastics  Restoration of potency  Other therapeutic modalities affecting the reproductive system (eg. radiation)  Family planning and pregnancy (eg. and behavioral considerations affecting disease treatment and prevention. family. ethnic. other methods of contraception (eg. rape. infertility)  Occupational and other environmental risk factors (eg. child abuse . libido  Effects of traumatic stress syndrome.  Oral contraception. sexual orientation. sexually transmitted diseases)  Influence on person. and environmental  Emotional and behavioral factors (eg. violence. tampons. condoms)  Estrogen. sexuality. occupational.

surgery. adrenal cortex. radiation) Gender. and adverse effects of drugs for treatment of disorders of the endocrine system  Hormones and hormone analogs  Stimulators of hormone production (eg. adrenal disorders)  Vascular disorders (eg. parathyroid. posterior and anterior pituitary gland  Thyroid gland  Parathyroid glands  Adrenal cortex. diabetes mellitus. thyroid. subacute thyroiditis. inflammatory. thiazolidinediones)  Antiobesity agents  Other therapeutic modalities (eg. and changes associated with stage of life Abnormal processes  Infectious. use. pancreatic islets. neural crest. including vitamin D  Thyroid hormones  Catecholamine hormones  Renin-angiotensin system  repair. Graves disease. and immunologic disorders (eg. sarcoidosis)  Traumatic and mechanical disorders  Neoplastic disorders (eg. including psychosocial. secretion. thiouracils)  Hormone antagonists  Potentiators of hormone action (eg. and environmental . and metabolism  peptide hormones  Steroid hormones. ethnic. hirsutism) Principles of therapeutics  Mechanisms of action. including hormone synthesis. and perinatal changes  Organ structure and function  Hypothalamus. and behavioral considerations affecting disease treatment and prevention. pituitary.Endocrine System Normal processes  Embryonic development. adrenal medulla  Pancreatic islets  Ovary and testis  Adipose tissue  Cell/tissue structure and function. hypothalamus. occupational. action. pancreatic islet disorders. regeneration. pheochromocytoma)  Metabolic and regulatory processes (eg. cultural. fetal maturation. pituitary apoplexy)  Systemic disorders affecting the endocrine system  Idiopathic disorders (eg. thyroid. sulfonylureas)  Inhibitors of hormone production (eg. pituitary. parathyroid.

iodine deficiency)  Gender and ethnic factors . family. radiation exposure. Emotional and behavioral factors (eg. and society  Occupational and other environmental risk factors (eg. compliance in diabetes mellitus. psychogenic polydipsia)  Influence on person. factitious use of insulin.

I didn’t study it all so I cannot comment but based on others’ opinions. In my opinion. Cardiovascular system. Step1 secrets is another rather useful book I encountered. I only went through it twice but I found it to be quite helpful. In that case you may have to annotate it and make up for the deficiencies in this book. You can even go one step further and make it your primary book. throw every other book away even First Aid. Some Americans call it medsuperfluous. Oversimplification is evident at a lot of places and requires rigorous supplementation by more detailed textbooks.com. It is written in a beautiful manner utilizing a very student friendly approach and doesn't run aggressively amok anywhere. It’s unnecessarily detailed at some places and understated in others. They are discussed separately. It has essentially all of the Kaplan series condensed into a single book. it has everything arranged neatly in a question-and-answer format and written in simple language. If a high 99 is not your aim or if you realize that studying simple textbooks may ensure something like a 90-99 score rather than pursuit of a high 99 having to utilize detailed textbooks and running the risk of losing score. This question resource has consistently .g. typically arranged system-wise e. Studying this book alone carefully can give you a 90+ score.OTHER BOOKS First Aid is a favourite amongst American medical students. If nothing else works or you have run into anxiety. USMLE World: It can be found at usmleworld. It has little of everything that should benefit you in the actual exam. You may like to study it once early in your coursework and once later before the exam. This helps you to save time flipping through different books in case you like to apply a systems approach at some point during your coursework. QUESTION RESOURCES: You have the following question banks. that’s the book for you. Still it has the benefit of complementing your Kaplan textbook study. Pick this book and just study it. Kaplan medessentials is a similar book to First Aid. You may use it if you like a very quick glance at a lot of information. it still has enough information to guarantee a 99 on Step1 provided you study it comprehensively and carefully.

Furthermore it has a habit of testing knowledge that is both Step1 irrelevant and not given in recommended textbooks (not even in their own textbooks!).high ratings amongst students and Americans love using it to supplement their study of First Aid. You can buy it for 100$ for one month. Kaplan Qbank relies quite extensively on knowledge given in their textbooks and at times. USMLErx: This can be accessed at usmlerx. Repetition of facts in first aid ensures adequate retention in memory. it feels they are exclusively focused on specific knowledge pointers in their questions. This is the work of contributors of First Aid. My advice is to solve all questions and read their explanation regardless of whether you get any question correct or incorrect. You don’t have to attempt all of the questions given. Subscriptions greater than a month have substantial discounts. Overall I would recommend this Qbank. good explanations and a huge question resource. Instead of Kaplan you may want to utilize this resource early in your coursework. If you start it late in coursework. It is very expensive: 130$ per month and additional months purchased have substantial discounts. It’s preferable to use this resource early in your coursework. This can be an advantage if you are using First Aid as well. you ensure adequate revision and security of keeping it in memory. You can get their books but they’re all pirated and illegal material. Americans don’t prefer using this resource. that’s pirated and illegal. Typically this should be used to maximum effect about 1-2 months before your actual exam. This is the least expensive of all qbanks with a single month subscription at 70$. Questions typically use 2-3 step thinking processes and require good integration of concepts. They don’t release any textbooks. The explanations given in this resource are the best amongst all others and some Americans actually solely rely upon the explanations for their revision. So it heavily relies on info resource of First Aid. a lot more questions directly test knowledge rather than careful integration of facts. It has the advantage of using Qtutorials (refer to their website). rather than good integration of concepts as done by usmleworld. Best utilized early in coursework.com. . You can get their books but again. KAPLAN Qbank: This can be accessed at kaplanmedical. I would highly recommend buying this for a single month at least. so it’s a tough question resource. good media. In addition. Others recommend using it as soon as possible but I have a different opinion.com. However some questions may not correctly reflect the standard and format of current USMLE exams and rely somewhat on typical case scenario facts and explanations.

I used this book late in my study but I recommend using it early. but this is to tell you that the style keeps evolving in order to maintain a very high standard of this exam. The reason for its inception is to reflect the current trends in the USMLE Step 1 exam. the examiners know that many students rely heavily on First Aid. the same reason I am doing it for. Umar Tariq on it. Step1 is an ever-evolving exam.ayazmk@yahoo. . Remember this is an official First Aid release. the examiners are very well aware of what guide-books and short-cuts students love using.com or Dr. you may get those varieties sometimes only cardiologists can decipher with a degree of confidence. it would be available online in a few months times and would be entirely free of cost so you may start using this questions resource early or late in your coursework depending upon your choice. First Aid Q & A book: Similar to usmlerx. Explanations are good and have cross referencing to First Aid text which may help your revision. kindly contact me at dr. I am sure it would prove to be a big boost to your CV and provide help to your colleagues. as stated by some examinees! Now you must have a sound knowledge of heart sounds. 650 organized systems wise and 350 organized into a full length exam with 7 blocks (remember current USMLE has only 322 questions in 7 blocks). If you are interested in authoring MCQs for this Qbank. Mededia Qbank: Surprised? Stay tuned for more updates in near future! I assure you this would be a very high quality Qbank with MCQs according to the new format of more clinical scenarios and quality better than all mentioned qbanks. It has 1000 questions. If you are as unlucky as I was. Apart from that. It may be a less expensive substitute to usmlerx questions resource as well. Umar Tariq and we would be happy to include you as a co-author/ contributor on submission of some high-quality MCQs and would mention your name on the main book cover. I am working with Dr. As an example heart sounds that appeared in previous Step1 exams could typically be resolved by simply contemplating the question stem and not even listening to the sounds. Therefore we decided to make a brand new collection of questions resource that would adequately aid your Step 1 preparation. In fact they state questions are taken from usmlerx resource. By no means you can't get a 99 by studying First Aid alone.

NBME’s are also not reflective of current USMLE style. Behavioural sciences. you may like to use it early in coursework but remember that some questions are factually incorrect. You may buy about 2 or 3 such exams. Use one early. others are vague and their explanations may not reflect high yield material. There are 192 questions in each exam. When purchased together. Unfortunately various questions are again not reflective of current exam and are typically "easy". Because there is little quality check and control over the type of questions. Kaplan Qbook: This is an official release of Kaplan Medical. It is very important to use atleast one exam early in coursework and another late in coursework to gauge your performance levels. NBME exams: These exams can be purchased at NBME website for about 45$ each and has 200 questions each arranged in 4 blocks. Integration of concepts is rarely tested. as expected. USMLE World Self-Assessment forms: They can be accessed at usmleworld. But you have to use these exams to quantitate your performance levels. The most poorly composed section is. over NBME which allows neither. a lot more questions do not reflect the USMLE style than questions that do. Since it’s free. another in the middle and the last one late in your coursework to ensure adequate progression in your study. contributed by various authors. Wikitestprep. I recommend buying 3. It follows the same philosophy of .org: This is a spin-off of Wikipedia with about 800+ questions free of cost. Best used late in your coursework and you should attempt to study all the explanations.com and have a cost of 30$ each. In addition a projected 3 digit score is given to you at the end of your exam that is highly predictive of your actual USMLE Step 1 score. They are two in number. they cost 50$ in total. It has various blocks of 50 questions each organized in a subject-wise manner (not systems wise). They have the added advantage of allowing you to study questions you got incorrect or correct and read all explanations. strengths and weaknesses. Two blocks of 50 questions each of absolute madness. from a total of 7. Most questions are very easy making the marking very stringent and strict. I did go through it randomly at first.

you may have to rely on textbooks already stated above. The best way is to begin as early as possible in your medical studies. .Kaplan's Qbank somewhat hinting more at retrieval of an examinee's memory rather than integration of concepts. However USMLE is a difficult exam that needs honesty and time commitment. Strictly avoid using textbooks authored in the subcontinent as not one single such textbook lives up to the standard of the books above. Study only good American textbooks. The textbooks above ensure you get a sound grasp on the subject in question. or even Goljan alone For behavioural science. your time wasn’t lost! You can carry that knowledge over to studying for Step2 CK as well during your final year. In case you wished to appear in Step 1 during your medical studies but became very anxious or your NBME score is not so good. As I already explained earlier. Only sit this exam once you are sure of your preparation. I recommend you to study the following textbooks during your medical education: Snell’s Anatomy Snell’s Neuroanatomy Ganong’s Physiology Lippincott Biochemistry and Molecular Biology Katzung’s Pharmacology (Board Review Series) Levinson’s Microbiology and Immunology Medium Robbins supplemented by Goljan. Using NBMEs is one way of assessing your preparedness. In that case you may begin to feel confident enough to give Step2 Ck before your Step1 because you had already had some feel of how Step1 looks like. studying during your medical school is substantially better than after your graduation. Using these resources ensure you’re automatically geared towards Step1 prep. You cannot study this exam for the fun or sake of it because that may seriously backfire with a very low score. GETTING STARTED WITH IT ALL: You have the choice to study either during your medical studies or after your graduation.

You can maintain a notebook to serve that purpose. and study Goljan. learn or not. You may form good concepts but as soon as that happens. Understand. jump straight to Lippincott. Using videos for referencing again and again is time consuming and frustrating. Don’t try to be a copycat and emulate others’ . First few months. Americans get about 2 months off at end of their 2nd year. Unfortunately this cross referencing is something you’d have to do extensively throughout your Step1 study. you’d immediately forget later on. In these first few months.Here’s a tour through a Step1 preparation. Don’t limit these subjects to a mere 3 or 4 reads. Don’t be afraid to open Snell’s neuroanatomy or Ganong’s Physiology to clarify difficult concepts. First just go through the Kaplan. write them for your records somewhere. You may need to use the videos. Choice is yours. try to immediately jump back to these subjects and revise them. Try to get a feel of what Step1 syllabus content is like. Do justice to all your subjects. Doing all of that would take quite a lot of time. is not a matter. You don’t have to use question resources at this moment. Alternatively you may annotate the Kaplan books. Be patient. getting started: A lot of us subcontinent people use Kaplan. Remember subjects like Pharmacology and Microbiology require constant attention. use your major textbooks extensively. This ensures adequate retention of facts in your memory. Don’t rush through your study schedule or try jumping ahead. If grasping DNA synthesis from Kaplan’s biochemistry textbook is difficult. So the initial stage of your study is simply quick pass through the syllabus content + careful pass through selected and difficult topics with extensive cross referencing from major textbooks and maintenance of important pointers in a notebook. Once done. So keep all the major textbooks readied. It’s indefinitely high yield to do as many quick reads of these subjects as is possible. First Aid and Usmleworld. You don’t necessarily have to listen to all these videos. A good detailed textbook is a very good substitute. Next you may want to use video lectures to aid you in understanding difficult concepts and also for the sake of simply touring through the Step1. This means that as soon as you’re done with your first pass.

quickly hit Pharmacology. Remember now your momentum is very important. but make sure you do attempt atleast a sufficient number of questions. You don’t have to attempt the whole question resource. pick up a notebook and write the important facts in that. Go through those facts at regular stages. If you take breaks or delay your exam. learn all the rate limiting enzymes and hormonal and allosteric controls. they don’t give you the advantage of mixing your questions. As already stated. My recommendation would be to use either question resource. especially in the whole context of all metabolic pathways. This should give you an idea where you land and how far are you from your goal. in Biochemistry’s case. Read the explanations to all questions. Although you can find illegally printed textbooks to these question resources. Find the right solution to studying yourself. This would especially help you. Intermediate stage: This stage introduces the question resources. you can modify that final stage of your preparation in whatever manner you like. If you remain consistent in this stage. . At least go through remaining subjects once but the aforementioned ones should be given special attention to because of the ease with which they are forgotten. Final stage: Once again. At the end. Allosteric controls form an important testing component and is especially tricky to understand. Depending upon your goal and the difference from your goal. try and attempt an NBME exam. Use this approach and apply to all subjects. and try attempting questions systems wise. you may like to check it out as well. Microbiology and especially Behavioural science and revise these subjects. At this stage you may use either timed or self-paced mode. you would drastically improve your final score. hit the questions. As soon as MedEdia releases its questions resources free of cost. you can rely on Usmlerx or Kaplan Qbank. If you just finished a revision of Biochemistry.timetables. you would only end up wasting time. making random timed or self-paced blocks and maintain a record of used and unused questions.

When you’re done with your Kaplan. MRIs. Mix in another NBME and/or Usmle world Self Assessment forms which have already been referenced to above. .com’s question resource. Make sure you have been following CTs. NOW you may contemplate delaying your exam. and went to the exam. They supplement those explanations into First Aid. my first and second blocks were almost sacrificed which must have led to reduction in my eventual score. Last but definitely not least. Do not even think about opening a new book at this stage. Check your permit. to good effect. In your final day.Now is the time to start usmleworld. Eventually I took a pill of Bromazepam. passport and National ID card. slept for 4 hours. using your own familiar handwriting towards the end of your preparation would most likely keep your anxiety levels in check. Energy drinks did some trick but really. Prometric appointment. Keep using First Aid also. photomicrographs. but you have to have a realistic appraisal of your own intellect and ability. It happens sometimes to me that I can’t go to sleep even after 4-5 hours and by chance. it happened the very last night too. Here’s an important point: IF your NBME score is far off from your goal. What they state is approximately what your abilities are. and a very realistic goal. Keep focused on learning heart sounds as well. Make a list of things you need to take. The whole day was a battle with drowsiness. You can try doing that too. It wasn’t anxiety. You must have both a very high goal. throw those books away and concentrate only on First Aid and your own notes from Kaplan and question resource explanations in last two weeks. you may take a day off after a stressful spell that spanned several months. gross specimens and X-Rays all along because these are heavily tested. Americans at this stage do 2 blocks of 48 questions (46 in real exam) everyday and spend time reading all explanations. especially towards the week leading up to your eventual exam. Some tips about what to do during your last day and exam day: I had the biggest misfortune of totally screwing up my sleep the very last day. NBMEs usually are a very accurate gauge of your performance. all those notes you made into your notebook. It’s only you who can tell you what your abilities are. Always aim for the very high.

I would advise you to take a sleeping pill the last night and ensure a good night’s sleep. This helped strengthen my knowledge of these subjects. Anthony Trevor's Pharmacology lectures. All these mentioned lectures were the works of genius people indeed and by all means. As I have stated in the ideal preparation above. So much for a "first read" I guess? In July I managed to cover some major portions of usmleworld questions resource especially microbiology and pharmacology. Dr. I was confident because I had the fortune of having studied good textbooks in preference to local ones. still others only less than half (Immunology. From February through June. I managed to cover some subjects atleast once (Pharmacology. My experience with Step 1 preparation: I started at the beginning of my fourth year. You may elect to skip the other lectures. Anatomy). This is critically important before your exam that drowsiness doesn’t take over. Later I finished my first pass through Physiology and Behavioural science (I told you I developed a deja vu right after studying this!). Time passed and I started wasting time too. I started as usual: Buy Kaplan textbooks and the Video lectures. You can use energy drinks during the day of your exam but make sure you have used them before to be sure they don’t end up causing diarrhoea instead during the exam. cross-referencing to good textbooks is important and I felt the need always to do that. I listened to Dr. Perhaps I realized that . James' Neuroanatomy lectures. I may have listened to others too somewhat. and Dr. Lionel Raymon's biochemistry lectures. they are of little value in revision. You can try this same methodology with the exception of including Behavioural sciences in the "twice" category with Microbiology. you should listen to what they have to say about their subjects. But I didn't use all the video lectures because quarter-way through I realized that although they are helping me solidify my concepts. I would cover Pathology text with my medical studies in fourth year. I'd study Goljan and Medium Robbins. but I don't clearly remember. Pathology) and remaining none (Physiology. when they had a class test. others twice (Microbiology). Behavioural sciences). For example. Biochemistry.

. and immediately started covering Physiology and Behavioural sciences which I had neglected (and I'd advise you to not do as I did). especially Parasitology. given that I had yet to seriously cover behavioural sciences and Physiology also. On June 5th. by all means start your exam preparation! Till November I had managed another pass at least once through most subjects.. I finalized my date for June 10th. I also immediately revised all of Pathology which I hadn't touched ever since I gave my fourth year exam. and then picked up First Aid Q and A book. The latter was significant because it motivated me once again for Step 1. ENT. My score was projected 244. had to spend substantial time applying for electives and finally started seriously in April. Now it was already May 12th. Community Medicine and Special Pathology were the subjects and I somehow managed a third position and distinction in Pathology. I attempted the second usmle world self assessment form .27th I think (right after that was Eid-ul-Azha day). In that time I also went through Katzung board review pharmacology and some part of Levinson. and combining with the very final quick revision of kaplan series. which is why if you are a student in 3rd year. I realized that this was very decent. I felt more relieved than happy that the break in my tempo didn't destroy my hopes. I lost my way.. Needless to say. I had attempted Usmle world self-assessment form 1 on May 18th and my projected score was 256. In November I picked up First Aid and went through it in 2 weeks. But this exam had seriously upset my rhythm and because my first ward in final year was a maternity duty (day and night for 2 weeks = no time for Step 1 prep). I picked up first aid and finished it in next 8 days. Afterwards I went through that once.. It would have been very realistic if I started in 3rd year. I registered for NBME form 3. All of a sudden it turned into a hi-octane study mode. I attempted it on November. I somehow managed to pick myself up. especially revising the behavioural science explanations. This really helped me immensely.attempting the Step1 at end of my fourth year was overly ambitious. with the exception of Physiology and Behavioural sciences (yet again). This was why I stated how important is your study momentum when taking into the final date. I gradually navigated my way through immediate revisions. This continued on into June. Cursing myself for wasting time. time for my professional exams at end of fourth year arrived. Eye. Then I picked up usmleworld once again and navigated my way through it studying the majority of explanations. After that. I attempted all 1000 questions and wrote a majority of explanations in my notebook.

I arranged my things together: Passport. reflect this trend and style. Then the final day came. Second block suffered as well but after that. even under the veil of anonymity internet provides you! . went and bought snacks. 46 questions per block. Usmleworld doesn't give a score beyond 265 so it states it as 265+ instead. a sandwich. through sheer willpower I fought with my drowsiness and the exam and eventually finished it. I'd occasionally open a few books but I would advise you against it. At some stages I felt that questions were unnecessarily stretched with clinical information. The new Mededia Qbank is designed to. But the damage was done. I was happy. The repercussions include ban from taking USMLE exam for a limited number of years! So don't disseminate exam information anywhere. In the final few days I went through explanations to the exam questions I just gave and my own notebook. I will not write what topics were tested or what was the distribution of subjects and I strictly advise you not to do that either.org described it as.online. I thought I fell asleep at 10PM only to wake up moments later. Moral of the story? A good night's sleep before your exam! The exam really was very much like what usmle. My projected score was 265+. At 9:30 PM I went to bed. and damage continued into the first block of my exam. therefore. Exam has increased in difficulty overall. and energy drinks. permit. framed into clinical vignettes more so than not so. ID etc. Sleeplessness continued till late night at 3AM when I finally took Bromazepam and went to sleep for good. to guard against unnecessary anxiety induction. and timing did become an issue for me especially in the first block where I had to resort to guesswork towards the end but this was more attributable to my sleep problems rather than the exam itself.