USMLE Step 1 Guide

APPENDIX B: 28-DAY SAMPLE STUDY SCHEDULE FROM TULANE SCHOOL OF MEDICINE

Day 1

General Overview & Begin Biochemistry

Objective

Assignments

Source

Self Assessment

Complete sample test materials NBME CD-ROM for NBME or download from www.nbme.org General overview of Read Through Section First Aid material to be covered Introductory Material from First Aid, and Skim Section II Basic Metabolism Chapters 5 & 6, and sample Lippincott’s questions at end of each Biochemistry chapter. Bookmark figure 6.2 and refer to it before studying each biochemical pathway.

Day 2

Continue Biochemistry

Objective Structure & Metabolism of Carbohydrates

Assignments Chapters 11, 12, 13 & questions

Source Lippincott’s Biochemistry

Glycolysis

Chapter 7 & questions

Lippincott’s Biochemistry

Gluconeogenesis

Chapter 8 & questions, Review Lippincott’s Figure 6.2 again! Biochemistry

Citric Acid Cycle

Chapter 9 & questions

Hexose Monophosphate

Chapter 10 & questions

Day 3

Continue Biochemistry

Objective Lipid Metabolism

Assignments Chapter 17 & questions

Source Lippincott’s Biochemistry

Phospholipids &Glycolipids

Skim Chapters 18, 19

Lippincott’s Biochemistry

Lippincott’s Biochemistry Lippincott’s Biochemistry

Cholesterol & Steroid Chapter 20, Sect. I –VII Metabolism

Lippincott’s Biochemistry

Steroid Hormones

Lippincott’s Biochemistry

Chapter 20, Sect. VII

Details

Est. Time

Complete 150 sample questions, and note trouble areas to focus on.

3 hrs

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

4 hrs

Understand the role of ATP. Know where the electron transport chain and oxidative phosphorylation occur and how they fit into the overall metabolic scheme. Review the main classes of cell receptors and signaling mechanisms.

2.5 hrs

Details Est. Time Review the digestion of sugars and disorders 3 hrs of fructose, galactose, and lactose metabolism. Spend more time on glycogen metabolism, its regulation, and related disorders. Use Figure 13.7 to memorize the glycogen storage disease Know the start and end points, hormonal 1.5 hrs regulation. Energy yield and various fates of pryruvate. Study it by comparison to glycolysis. Know 1 hr the reactions & regulation unique to gluconeogenesis. Focus on start and end points, place in overall 1 hr metabolism, and regulation. Shim reactions an focus on G6PD deficiency 1 hr

Details Est. Time Focus on roles of pancreatic lipase and bile 3 hrs salts. Fatty acid metabolism: know where synthesis occurs, relationship to glucose metabolism, and role of triacylglycerols for storage of fatty acids. Review mobilization of and oxidation of fatty acids. Finally, carefully review eicosnoids, focusing on figure 17.20 Gain senses of what these are, but do not 1 HR memorize structure of pathways. Focus on related disorders instead, using figures 18.10, 19.4 Review Cholesterol synthesis (esp. the role of 2 hrs HMG CoA reductase) and its regulation. Understand synthesis and role of bile salts. Review biology of lipoproteins and their role in atherogenesis. Key figure are 20.12, 20.14, 20.16 Know the major enzymes deficiencies in 1 hr 36 steroid synthesis and know where steroid receptors act in the cell. Study figures 20.19,

20.20

Day 4

Continue Biochemistry

Objective Protein & Enzymes

Assignments Chapter 1-4 & questions

Digestion of Dietary Chapter 21 Proteins and Nitrogen

Lippincott’s Biochemistry

Metabolism of Amino Chapter 22 Acid Carbon Skeletons

Lippincott’s Biochemistry

Details Est. Time Become familiar with basic properties of 4 hrs amino acids, levels of protein structure, hemoglobin, and collagen. For enzymes, focus on appreciating (not memorizing) the Michaelis-Menten equation, types of enzyme in clinical diagnosis. Learn the various pancreatic proteases and 2 hrs how they are regulated. Understand transamination and oxidative deamination, but don’t memorize Pathways. Spend more time on urea cycle and ammonia metabolism focus on figures 21.4, 21.11, 21.17 Emphasize relevant disorders. Focus on 1 hr figures 22.2, 22.16

Objective Assignments Heme, Porphyrins, Chapter 23 Serotonin, Histamine and Catholamines Gylcosaminglycans and Skim Chapter 14, 15 Glycoproteins

Source Lippincott’s Biochemistry

Details Est. Time Focus on the porphyrias and bilirubin 1 hr metabolism. Focus on figures 23.5 and 23.7

Lippincott’s Biochemistry

Nutrition and Vitamins Chapter 27, 28

Lippincott’s Biochemistry

Nucleotide Metabolism

Chapter 29

Lippincott’s Biochemistry

Know what they are and know the related 1 hr disorders. Don’t get too bogged down in details – just study figures 14.12 and 15.14, then move on. Know the daily energy requirements and 3 hrs vitamin deficiencies. Focus on absorption of vitamin B12 and pernicious anemia, as well as vitamin D. Focus on figures 28.12, and 28.18 Understand differences between de novo and 2 hrs salvage purine synthesis. Study purine degradation and the Pathophysiology of gout and ADA deficiency. Study figures 29.7, 29.9,29.10

Day 6

Finish Biochemistry

Day 5

Source Lippincott’s Biochemistry

Continue Biochemistry

Objective Assignments Ingrative Metabolism Chapters 24, 25, & 26

Source Lippincott’s Biochemistry

Details Est. Time Synthesize the information you’ve reviewed 5 hrs this week by studying insulin, glucagon, the fed/starved states, and the metabolic aspects of diabetes mellitus. Time spent on these topics will be VERY WORTHWHILE Details Est. Time Study general principles of pharmacology. 2 hrs Specific agents will be covered with relevant organ systems. Know different types of adrenergic and 5 hrs cholinergic receptors cold. Study figures 3.3, 3.6, 4.2, 5.2, 6.15, and 7.10.

Day 7

General Pharmacology

Objective Pharmacokinetics & Pharmacodynamics

Assignments Chapter 1, 2

Source Lippincott’s Biochemistry

Autonomic Drugs

Chapters 3 – 7

Lippincott’s Biochemistry

Day 8

Begin Microbiology

Objective Bacteria

Assignments Chapter 1 – 15

Day 9

Continue Microbiology

Source Clinical Microbiology made Ridiculously Simple

Details Est. Time Rely heavily on charts. Start building buzzword 10 hrs associations with characteristics of each organism and how is identified (with a special stain, culture medium, etc.) Also, time spent with Qbank questions here will be golden

37

Objective Antibiotics

Assignments Chapter 28 – 33

Fungi

Chapter 20

Antifungal

Chapter 34

Day 10

Finish Microbiology

Objective Viruses

Assignments Chapter 22-29

Antiviral

Chapter 37

Parasites

Chapter 30, 31

Antiparasites

Chapter 35, 36

Clinical Vignettes

Source Lippincott’s Pharmacology

Details This is high yield material, read, review and continue to do Qbank questions to keep building buzzword associations. Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations. Lippincott’s This is high yield material, read, review and Pharmacology continue to do Qbank questions to keep building buzzword associations.

Est. Time 6 hrs

Source Details Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations Lippincott’s Review antiviral agents, particularly Pharmacology mechanisms of action. Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations Lippincott’s Review antiprotozal and antihelminthic agent, Pharmacology particularly multi-drug regimens Underground Good for group study and another way to Clinical Vignettes – keep sharpening buzzword recall. Microbiology

Est. Time 6 hrs

Est. Time 4 hrs

Day 11

Immunology & General Pathology

Objective Review Immunology

Assignments Part VII

Cellular injury

Chapter 1

Source Medical Microbiology & Immunology: Examination and Board Review BRS Pathology

Inflammation

Chapter 2

BRS Pathology

Hemostasis

Chapter 3

BRS Pathology

Genetic Disorders Chapter 4 Immune Dysfunction Chapter 5

BRS Pathology BRS Pathology

Neoplasia

Chapter 6

BRS Pathology

Environmental Chapter 7 Pathology Nutritional Disorders Chapter 8

BRS Pathology

Day 12

BRS Pathology

Details Excellent, concise summary of immunology

1.5hr

1 hr

1 hr 2 hrs

1 hr 3 hrs

Focus on mechanisms of cellular injury and 0.5 hr differences between necrosis & apoptosis Distinguish mechanisms and histological 1 hr characteristics of acute vs. chronic inflammation Know coagulation cascade, types of embolism, 1 hr and types of shock. 0.5 hr Focus on immune deficiency disorders, 0.5 hr autoimmunity, and collagen vascular disease Distinguish between tumor suppressor genes 1 hr & oncogences, know mechanisms of carcinogenesis, and the properties of malignant cells. Quickly review 0.5 hr Review vitamin deficiencies to refresh biochem memory

0.5 hr

Cellular Biology

38

Objective Assignments DNA, RNA, Proteins Chapter 30 – 33

Source Lippincott’s Biochemistry

Details Est. Time Know mechanisms of DNA repair, different 3.5 hrs types/roles of RNA, mechanism of translation, and molecular biology techniques. Focus on figure 30.2, 30.16, 30.19, 30.22,31.11, 32.9 BRS Cell Biology & Know properties of membranes and 1 hr Histology membrane proteins

Cell Membranes

Chapter 1

Nucleus

Chapter 2

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

0.5 hr

Cytoplasm

Chapter 3

BRS Cell Biology & Review organelles and function Histology

0.5 hr

Extracellular Matrix

Chapter 4

BRS Cell Biology & Know different types of collagen, basement Histology membrane composition, and other ECM components. BRS Cell Biology & Review types of epithelia and locations of Histology each. Review connective tissue focusing on bone histology

1 hr

Epithelia & Connective Chapter 5,6 Tissue Day 13

1.5 hrs

Objective Cell Physiology

Cellular Physiology & General Embryology Assignments Chapter 1

Source BRS Physiology

Embryology

Chapter 1-4

BRS Embryology

Birth Defects

Chapter 17, 18

BRS Embryology

Exam

Diagnostic Test

Board Simulator Series Body Systems Review

Good opportunity to identify weakness in organ system areas.

2 hrs

Day 14

Thorax

Objective Assignments Embryology of thorax Chapter 5, 11

Source BRS Embryology

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

Est. Time 3.5 hrs

Thoracic Anatomy

High Yield Gross 3 hrs Anatomy BRS Cell Biology & Be able to distinguish arteries and veins in 1 hr Histology cross section. Understand architecture of the gas diffusion barrier in the lungs.

Chapter 12 (Also use Netter’s Atlas for reference ) Histology of thoracic Chapters 11, 15 viscera

Day 15

Cardiovascular System

Objective Cardiovascular Physiology

Assignments Chapter 3

Source BRS Physiology

Cardiac Pathology

Chapter 10

BRS Pathology

Details Est. Time Know mechanisms of ion transport, action 1 hr potentials. Know stages from zygote through embryo. 3 hrs Review 3 Germ cell layers and their derivative tissues. 1.5 hrs

Details Est. Time Review hemodynamic, electrophysiology, 1.5 hrs cardiac cycle, blood pressure regulation, response to exercise, volume loss, altitude. Understand pre-load, after-load, Frank-Starling curve and condition. Study this chapter thoroughly 1.5 hrs

39

Vascular Pathology Cardiovascular Pharmacology

Chapter 9 Chapter 16–19 , 21

BRS Pathology Lippincott’s Pharmacology

Study this chapter thoroughly Know drugs used to treat CH, HTN, arrhythmias, angina, and hyperlipidemia

Day 16

Respiratory System & Begin Hematology

Objective Assignments Respiratory Physiology Chapter 4

Source BRS Physiology

Respiratory Pathology Chapter 14

BRS Pathology

Details Est. Time Know varies lung volume measurements, and 1.5 hrs understand acid – base disorders. Study this chapter thoroughly 1.5 hrs

Respiratory Pharmacology Clinical Vignettes

Chapter 22

Histology of Bone Marrow, Spleen, & Lymph Nodes

Lippincott’s Pharmacology Volume 1: Cases 1-19, Volume Underground 2: Cases 52-66 Clinical Vignettes – Patho-physiology Chapters 10, 12 (and a BRS Cell Biology & histological atlas for further Histology review

Day 17

Finish Hematology

Objective Anemia

Assignments Chapter 11

Source BRS Pathology

Hematopoietic & Lymph reticular Neoplasia Hemorrhagic Disorders Drugs affecting coagulation Anticancer Drugs

Chapter 12

BRS Pathology

Chapter 13

BRS Pathology

Chapter 20

Clinical Vignettes

Volume 1: Cases 74-102

Lippincott’s Pharmacology Lippincott’s Pharmacology Underground Clinical Vignettes – Patho-physiology

Day 18

Gastrointestinal System

Objective Embryology of Gut and Body Cavities

Assignments Chapters 10, 16

Chapter 38

Abdominal Anatomy

Chapter 3 (Also refer to Netter’s atlas) Histology of GI Tract Chapter 6

Source BRS Embryology

1 hr 5 hrs

0.5 hr Good opportunity for group review

2 hrs

Familiarize yourself with lymph nodes architecture and understand the spleen. Understand RBC, WBC, platelet

3 hrs

Details Est. Time Know Patho physiology and lab differentiation 2 hrs of various etiologies of anemia Distinguish between leukemia & lymphoma. 2 hrs Understand different types of each. Know how to diagnose and correct each disorder.

1 hr 1.5 hrs 1.5 hrs 2 hrs

Details Est. Time Understand rotation of gut and related 1.5 hrs malformations. Know which structures are derived of foregut, midgut, hindgut, in addition to vascular supplies. 2 hrs

High Yield Gross Anatomy BRS Cell Biology & Know layers of gut wall. Understand liver Histology structure, portal blood flow, and bile flow BRS Physiology Understand innervations of gut and gut hormones

1.5 hrs

GI Physiology

Chapter 6

1 hr

Day 19

Gastrointestinal System

Objective Gastrointestinal Pathology Hepatobiliary and Exocrine Pancreatic

Assignments Chapter 15

Source BRS Pathology

Details Study this chapter thoroughly

Est. Time 2 hrs

Chapter 16

BRS Pathology

Study this chapter thoroughly

2 hrs

40

GI Pharmacology

Chapter 24

Clinical Vignettes

Volume 1: Cases 40-73

Day 20

Genitourinary System

Objective Embryology of GU

Assignments Chapter 6, 13, 14

Anatomy of Pelvis and Chapters 4, 5 Perineum

Lippincott’s Know GI drugs as well as antiemetic Pharmacology Underground Good opportunity for group review Clinical Vignettes – Patho-physiology

2 hrs

Source BRS Embryology

Est. Time 3 hrs

Details

2 hrs

High Yield Gross Anatomy

Know the maturation sequence of 3 hrs spermatocytes and ovarian follicles. Know the anatomy of the nephron. BRS Cell Biology & Know the maturation sequence of 3 hrs Histology spermatocytes and ovarian follicles. Know the anatomy of the nephron.

Histology of GU Organs

Chapter 18, 19, 20

Day 21

Endocrine System

Objective Renal Physiology

Assignments Chapter 5

Source BRS Physiology

Diuretics

Chapter 23

Renal & Urinary Tract Pathology Male Reproductive Pathology Female Reproductive Pathology Clinical Vignettes

Chapter 17

Lippincott’s Pharmacology BRS Pathology

Chapter 18

BRS Pathology

Chapter 19

BRS Pathology

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

Underground Good opportunity for group review Clinical Vignettes – Patho-physiology

Day 22

Endocrine System

Objective Histology of Endocrine System Physiology

Assignments Chapter 13

Source BRS Embryology

Chapter 7

BRS Physiology

Insulin and oral hypoglycemic

Chapter 26

Lippincott’s Pharmacology

Steroid Hormones

Chapter 27

Clinical Vignettes

Volume 1: Cases 25-38

EXAM

Body System III – Test 1

Lippincott’s Pharmacology Underground Clinical VignettesPatho-physiology Board Simulator Series-Body Systems Review

Day 23

Nervous System

Objective Embryology of Head Neck, & Nervous System

Assignments Chapter 7, 8, 9, 10

Source BRS Embryology

Details

Est. Time 1.5 hrs 1.5 hrs

Study this chapter thoroughly

1.5 hrs

Know the different types of testicular cancer, 1 hr and the biology of BPH and prostate cancer Understand cervical, uterine cancer 1.5 hrs 2 hrs

Details Est. Time Review structure of endocrine organ, and use 1 hr an atlas for additional pictures. Know hormonal axes 2.5 hrs Know different types of insulin and their half 1.5 hrs lives. Know classes of oral hypoglycemic and side effects. 1 hr Good opportunity of group review

2 hrs

Tough questions, but great explanations. Well 1.5 hrs worth the time to push yourself a bit and solidify the material you’ve learned. Details Know bronchial arches/clefts and their derivatives. Understand the transition from neural plate to mature CNS. Know fate of

Est. Time 3 hrs.

41

neural crest cells. Head & Neck Anatomy Neuroanatomy

Chapter 8 (also refer to Netter) Chapter 1-23

Day 24

Nervous System

Objective Neurophysiology

Assignments Chapter 2

Source BRS Physiology

Neuropathology

Chapter 23

BRS Pathology

Clinical Vignettes

Volume 2: Cases 45-61, Anatomy Cases 40-56.

2 hrs

Neuropharmacology

Chapters 8,10, 11, 14, 15

Underground Clinical VignettesPatho-physiology Lippincott’s Review drugs used to treat epilepsy, Pharmacology Parkinson’s. Also review anesthetics and analgesics.

Day 25

Musculoskeletal System

Objective Embryology

Assignments Chapter 15

Source BRS Embryology

Est. Time 1 hr

Anatomy of Limbs and Chapters 1, 6, 7 (also use Back Netter) Histology Chapter 7, 8, 10 Anti-inflammatory Chapters 39, 40 Agents and Autacoids

High Yield Gross Anatomy High Yield Neuroanatomy

2 hrs 6 hrs

Details Understand Synaptic transmission and axonal conduction Know types of CNS infection, tumors, and vascular disorders. Good opportunity of group review.

Details

High Yield Anatomy

Est. Time 2 hrs 2 hrs

3.5 hrs

3.5 hrs 2 hrs 2 hrs

Lippincott’s Pharmacology

Day 26

Musculoskeletal System

Objective Dermatologic Pathology

Assignments Chapter 21

Source BRS Pathology

Musculoskeletal Pathology Clinical Vignettes

Chapter 22

BRS Pathology

Volume 3: Cases 9-18, and 96- Underground Good opportunity of group review. 104. Also Anatomy: Cases 62- Clinical Vignettes84 Patho-physiology

2.5 hrs

Exam

Body Systems II – Test I

2 hrs

Day 27

Behavioral Science & Biostatistics

Objective Clinical Vignettes

Assignments All cases

Source Details Underground Clinical VignettesBehavioral Science

Est. Time 3 hrs

Psychotropic Drugs

Chapter 9-12, 13

3 hrs

Biostatistics

Read entire book

Lippincott’s Pharmacology High Yield

Board Simulator Series-Body Systems Review

Details Est. Time Focus on malignancies (melanoma, SCC, BCC) 1.5 hrs and refer to a dermatology atlas so that you can differentiate between them. 1.5 hrs

Touch questions, but great explanations. Well worth the time to push yourself a bit and solidify the material you’ve learned.

Understand sensitivity, specificity, PPV, NPV. 4 hrs

42

Biostatics

Day 28 Final Review Exam Logistics

Be prepared to calculate risk, odds ratio, etc.

Final Review & Exam Logistics Review Any Remaining Topics and finish practice questions Prepare exam bag-with ID, ticket, directions to center, lunch.

4 hrs

Rest & Relax

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APPENDIX C: 5-MONTH SAMPLE STUDY SCHEDULE (LATE APRIL TEST DATE)

Time Frame

Content Topic to Review

Pages in First Aid

November (begin studying during Thanksgiving break) Week 5

Heme/Onc & Pulmonary

46 pages

Week 1

Heme/Onc & Pulmonary

46 pages

Week 2

Cardio & Immunology

52 pages

Week 3

Renal

30 pages

Week 4

Biochemistry

52 pages

Week 5

Microbiology

60 pages

Week 1

Microbiology

60 pages

Week 2

GI & Embryology

54 pages

Week 3

Path, Pharm, & Musculoskeletal

60 pages

Week 4

Neuro

44 pages

Week 5

Endo & Repoductive

42 pages

December

January

February – Human Behavior course in progress March Week 1

Behavior & Psych

Week 2

Practice questions

Week 3

Practice questions

Week 4

CBCE Exam

Week 5

Shelf Exams

34 pages

This sample schedule is meant to be used as a framework for you to build your own individualized study plan; in addition to First Aid readings, challenge yourself to complete a set number of question bank items per week (or even per day as you get closer to the exam). Many thanks to Taimur Khan and Ryan Roach for their assistance in creating this sample schedule.

44

APPENDIX D: TULANE STUDENT USMLE STEP 1 OWL CLUB SURVEY RESULTS

Score

Questions Completed Vs. Score

270 260 250 240 230 220 210 200 190 180 170

y = 0.0053x + 213.71 R² = 0.1256

0

1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000 Number of Questions Completed

% of time studying Qs vs. score

Series1 Linear (Series1)

270

Score

250 230 210 190 170

y = -0.0069x + 226.63 R² = 4E-05

150 0

20

40

60

80

100

% of studying doing questions

45

2 3

0 2 1 1

Pulmonary

14 Renal

Infectious…

1

Genetics

Microbiology

4

Neurology

Cardiology

7

Pharmacolo…

Physiology

4

Pharmacolo…

1

Biostatistics

9

Ethics

12 1

Biochemistry

6

Neurology

3

Inflammation

5

Biochemistry

5

Heme/Onc

15

Pathology

10

Anatomy

Pathology

Number of Respondents 70 60 50 40 30 20 10 0

Endocrine

Number of Respondents

Studying which subject was most beneficial (i.e. most represented on the test)?

59

1

Which subject do you wish you spent more time on?

14

10

46

Score Distribution

270 250 230 Score

210 190 170 150 130 110 C/O 2010

C/O 2011

C/O 2012

Class

Class

C/O 2010

C/O 2011

C/O 2012

Median

224

232.5

225

Min

148

173

142

Max

265

264

263

47