269 USMLE Step 2 CK

269 USMLE Step 2 CK

For the scum disappears like forth cast out; while that which is for the good of mankind remains on the earth.” Quran 13:17

Khaled Abd-ElMaksod
Tanta Medical School, Egypt. YOG: 2014
Exam date: October 2015 Score: 269

A- Abbreviations

B- Summary
C- Stages
D- UpToDate
E- Clinical Mastery Series F- Playing sport
G- CK Qs pattern
H- Exam experience I- Tips
J- Miscellaneous topics K- Final word

A- Abbreviations:
Kaplan: KL
FA-1: First aid for step 1

CMS: Clinical mastery series

UW: Usmle World Qbank.

KQB: Kaplan Question Bank.

MTB: Master the Boards

MTB 2 CK 2nd Ed: MTB-2
MTB for step 3: MTB-3

UpToDate: UTD
Obstetrics and Gynecology: O&G

Q: Question

B- My experience summary:
For those who will whine and complain that my experience is too lengthy, here is the summary. I wrote this detailed experience as I am sure it is going to be helpful to someone. I cleared step 1 with a score of 259 before preparing for CK, and this helped me a lot during preparing for CK exam.
I studied for 9 months. First 6.5 months, I worked as GP in rural health care unit, 3days weekly on average. I studied 6-8 hours/ day, and at work days 4-6 hours/ day.
Last 2.5 months I studied with full dedication and that was the period in which my performance improved significantly. I studied for 8-10 hours/ day.
My 1st read was MTB -2 mainly for IM, I compared it with KL IM to discover there is no significant difference. O&G: KL mainly + blue print Qs Surgery: MTB3 + KL in trauma, Ortho, Pre and Post Op. Psychiatry, biostats: FA-1
Then I subscribed to UW for 6 months. I did it online timed random from the start. UW cumulative score 79%. I did half of wrong Qs after that. So I did the Qs of UW one time only. While doing UW timed random, I did my 2nd read of books and after each subject I did CMS 2 exams of this subject. My scores in CMS was 80%-90% most of the time, except psychiatry which was so difficult, I scored in 70s.
Then in the last month, I focused on my weak points, I revised the UW tables (especially the difficult ones) again and again, I did NBMEs.
NBME 4+6 at the same day (to simulate exam) 12 days before exam:
NBME 4 online – 269 / 12 wrong Qs
NBME 6 offline – 12 wrong Qs
NBME 7 offline – 8 days before exam -> 21 wrong Qs
UWSA + FRED at the same day 4days before exam
UWSA –> 265/15 wrong Qs
FRED -> 90%

C- Stages of my preparation:

1st stage –> 1st read of books:
What I did:
1- IM – 1st read:
The period of preparation was 9 months. I started the preparation 2 and half months after step 1 exam. 1st thing I did as usual is reading tons of experiences of Top scorers. When I started studying, my aim was to integrate step 1 contents with CK, so I planned to take the info related to step 2 CK from FA-1 and then I annotate it in MTB-2 as I decided to make it my primary source in Internal medicine. To be honest, my problem with CK is that I wanted to study it with the preparation method I used in step 1. That is to have a book as the primary source, FA in case of step 1 and MTB 2 CK (for IM) in case of CK, and then I annotate from UW and other sources into MTB 2 CK, exactly like what I did in step 1. This turned to be wrong and time wasting. And I will clarify why later. To continue, I found that taking notes from FA-1 into MTB is an obsessive act and it will waste my time. My excuse was that I wanted to make MTB 2 CK in IM an ultimate source, exactly like FA in step 1. I realized later that Step 2 CK curriculum is much bigger than step1 and no source can cram all the info and you should work to develop your skills and increase your concentration, your stamina, your time management ability and to focus on high yield info better than spending months making an ultimate comprehensive source for CK which if I managed to do will turn out to be a book with thousands of pages which I won’t find time to cram and when I finish reading I will discover I forgot most of its content. I did this as I didn’t trust my memory to be the ultimate source, I have strong points, but my memory was not one of them. There was no problem in step 1 regarding this as FA is comprehensive and at the same time summarized and to the point. I discovered later that MTB was not the problem, but simply there is NO source in CK like FA in step 1. Lesson after lesson and many mistakes and struggling while preparing for CK made me realize that I am in front of a new challenge, and my old tricks, my old methods which I used to do well in FA will no longer help me. I should EVOLVE to face the new challenge. I will elaborate about this later. To continue, I realized that annotating FA into MTB is an impossible mission so I came to an agreement with myself to refer to parts I wanted to revise in FA while studying for CK. I was studying IM from MTB 2 CK and I faced 2 problems. First problem is the outdated info in it, and second problem that I compared every chapter in IM with Kaplan IM, to discover at the end that Kaplan IM has no significant additional info to add to MTB 2 CK and I should have ignored it. Later when I did UW, I realized that tons of info in MTB is outdated. And that made me not trusting this book at all few months before exam, so that I always read it with caution and try to use UpToDate as a reference to correct old info, but that was not in my first read. To summarize, my plan in IM was to read the system in MTB-2 and compare to KL and annotate extra info and also to read the analogous part in FA step 1 which I realized in the middle of the 1st read that FA thing is overkill. I used to do a block of KQB after each chapter I finish. The sum of all blocks I did in IM was around 5-8 blocks not more than this. This is because my plan that I described was time consuming to a great extent. If you asked me what was the advantage of these few blocks I did from KQB? I will say that the long Qs stem is good to get adapted to exam long Qs stem.

2- Pediatrics – 1st read: I asked seniors about whether to study pediatrics from Kaplan and to use it as my main source or to use MTB step 3. I decided to make MTB3 my main source and to annotate Kaplan Peds into it. Again a time-consuming stupid plan, and again trying to simulate my step 1 plan. The annotating from Kaplan into MTB3 was so exhausting as a lot of info in Kaplan were not in MTB3. So after a few chapters, I decided to make KL my main source in Peds. What made me refuse this at the start is the way in which is the info is presented in KL. KL is not organized and boring. You feel that each topic is formed of some random phrases not connected to each other so the yield you get from reading it is so low, not to add that KL is so outdated just like MTB or even worse. So the yield from reading KL was yield in contrast to the yield from UW explanations. In UW, They write the explanation in a professional manner, linking the disease pathophysiology and management. They make you feel that the disease is one unit no just random phrases. And UW always takes care to explain everything to you. Why we use this investigation before this investigation, Why the algorithm started with this step, Etc. So they don’t overwhelm you with info that is not organized and a significant part of it is not even hi yield. The KL I used is the 2013-2014 edition which is present as PDF and on most bookstores in my country. And you should know that Kaplan LNs are not updated, and the editions don’t differ to a significant degree. Even MTB-2, I read some reviews that mentioned that the 3rd edition is not that different from the 2nd one. The problem that after I finished Peds from KL, I felt I am not left with a good source to revise it quickly later but that I am left with a burden that will make my steps slower. I planned at the beginning of my preparation to do the analogous chapter in IM and Peds together, I did this in some chapters and removed the common info between IM and peds from KL Peds. Again I was obsessed here with the idea to make an ultimate source and to remove any duplication which exhausted me as topics are repeated in IM and Peds and then in surgery. Removing the duplications is also time-consuming, leaving the books as they are will make it harder for me to revise again. In Peds, I did some chapters along with IM, and some chapters I did separately. Some I removed the common diseases from peds and some

chapter I just read without the comparing troublesome mission which was in vain when I look back. I planned to do KQB 1 block after each chapter, but I was running out of time.

3- Surgery – 1st read:
In surgery, MTB3 was well written, well organized but deficient just like other branches. My seniors told me that Kaplan surgery is important to read especially the Trauma, Orthopedics and Pre and Post Op chapters. To make the job easier for you, the Part 1 of the book is the same as the Clinical vignettes part of the book. So either this or that is sufficient. I read the whole MTB3 and Kaplan in surgery. I felt dumb in trauma Qs in UW but we will come to that later. I didn’t do any Qs in surgery at that stage.

4- Obstetrics and Gynaecology – 1st read: Kaplan book in O&G was highly recommended by many seniors. And in fact, they were right, it is way better than KL Peds and KL surgery. I read it and didn’t read MTB3 in O&G. I was sick of comparison and annotating blah blah blah. But I should say it has the common disadvantages in KL books, not updated, many low yield info that you feel that you can’t grasp anything after you finish reading it. I used to highlight the info I don’t know as I go through Kaplan, so that in the 2nd read, I will read the highlighted info only, and that made my 2nd read of KL O&G quicker. At that time, exam takers said they had many O&G Qs in the exam, so I wanted to supplement KL. I asked a friend, and he recommended Blue prints in O&G. I had no time so I did only the part of Qs and explanations that followed each chapter. I took notes from half of the chapters I did but had no time to take notes from the other have or to revise the notes I took from the 1st half later lol. But they were not bad, at least a practice. Some will ask is it a must, my answer is no although you don’t know in exam if that Qs was easy for you due to a Q u did months before it or not. Why I didn’t do UW instead, that is because I wanted to save it for the 2nd round.

5- Psychiatry – 1st read: Psychiatry I found Kaplan to be bad and not even updated to DSM- V, so I stuck to my step 1 source in psychiatry, which is FA for step 1. I used my notes in Biostats plus FA. In Ethics, I used my notes which were a summary from 100 cases by Conrad Fischer, In addition to some notes from UW-1. So in Psychiatry, I didn’t do anything more than what I did in step 1. I discovered weeks before exam that my sources in psychiatry were not enough and I should supplement. I will come to that later.

What should you do:
That was my plan and now I am going to tell you what I would have done if went back.

I kept looking for a good source for studying in CK and the source was beside me from the start, but I didn’t notice. NO book is good, UW TABLES should have been your primary books and I should have annotated any extremely important info from other books to them. You will ask from where I can get these tables, these tables were collected by more than1 group member and posted on the group. Why should I use UW TABLES instead of MTB or KL. Simply as UW is the most updated source, so have a look on updated so that when you read from other sources, the right info is stored first and based on which all info in other books is revised and scrutinized. The other cause is that UW curriculum is vast, so either you read thousands of pages to remember nothing at the end or you FOCUS on the highest yield info, that is UW tables and then you can use UW, CMS, NBME Qs as a guide to your weak points to revise from UW or if not in UW from UpToDate. So, reading outside the core curriculum presented by UW should be guided by Qs from the afore-mentioned sources, so that UTD doesn’t become a tool which waste your time.

1- IM: So, In IM I would have made UW tables my main source and I will read MTB 2 CK and add any extra important info into the book I will make from UW tables. Even if you used MTB for reading only without annotating it, there is no harm. The MTB and KL are not for last-weeks revision for the reasons I mentioned above. I would have done KQB, 1 block following each chapter IF I had time.

2- Peds: I would have used UW tables as a main source and Read KL Peds quickly to scan for any extra DISEASES (like those in Cardio chapter), not extra info. And even this is not that important! My performance was bad in Peds after 2 times read of KL, one focused revision of UW Peds was way better and more helpful. To do UW in Peds and then do many Qs like from CMS to highlight your weak points which you will study from UW and use UpToDate to look for info that r not present in UW, this is better than reading KL Peds again and again But this applies more −like most of my experience- to those who cleared step 1 before CK, as some info that is not well illustrated in CK Peds sources, yet frequently asked- comes from genetics, metabolism, immunology, etc.

3- Surgery: What I did is the best plan. Study surgery from MTB-3 plus Trauma, Ortho, Pre&Post op. chapters from Kaplan.

4- O&G: I would have done the same, except to make UW tables my main source and to make reference to important topics in KL not in the tables and this should be done with caution so as not to annotate the whole KL into the UW tables. Again, this will save you from memorizing some outdated algorithms or old management protocols then replacing these with new info later when you do UW! As correcting an old info in your brain is usually more difficult than memorizing for the first time.

5- Psychiatry: I would have made FA step 1 + UW tables my primary source. I also would have used UpToDate to know the sequence in which drugs are given in each psychiatric disease as this was outside step 1 scope, so it was not in FA-1. In the end, I will post the link of some notes I made in psychiatry which supplemented my primary sources.

2nd stage UW online:

Like many seniors, I decided to do UW online timed random from the start.
Here are the reasons:

1- at that time, no offline UW 2015 or late 2014 version was available. And in Ck, UW is updated extensively and even more frequently than UW for step 1.
2- I wanted to do the Qs TIMED very early, as TIME MANAGEMENT is a big problem in CK, and even some people with +250 reported that they answered 2-5 Qs randomly in the end of some blocks in the exam. And those who told me after their exam that they managed time well in the exam, said that when they did UW or NBME they had about 10 minutes left in the end of each block. In Exam, they said that they finished on time. That through me in hell literally, as if those who finish 10 minutes earlier at home, finish the longer exam ON time, so what will happen with someone like me who finish UW timed blocks with 1 minute left or even worse I sometimes don’t manage to do the last 2 Qs. At the last 1-1.5 month, I managed to finish 7-10 minutes earlier. But this would not have occurred if I didn’t start doing the Qs timed months earlier.
3- I wanted to the Qs random to adapt to exam pattern earlier too. But this exhausted me in the annotation, I will annotate a Q in the east and the next one will be annotated in the west. That made me finish 20-30 Qs per day maximum and this is a reason why I took long to prepare for CK. When I was doing the last 10 blocks of the bank I discovered I could have saved half of the time I spent annotating by highlighting the extra info in UW and then take a screen shot via Dropbox of the highlighted explanation and then to revise UW from these screenshots. You should know that annotation from UW is different in CK than in Step 1. In step 1, you were annotating lines (2-5 lines in most of Qs). While in CK, you can annotate complete explanations or big part of them. So, if annotation is taking time when u do Qs 1st time timed random, do it timed but system-wise. This will save your time but will give a bit lesser yield. So it is left to your choice.

So my plan was to do UW timed random. That is why, I subscribed to UW for 6 months! And I don’t regret that. Each block took me 3 days to annotate (by the last third of the bank I would finish 30 Qs per day). I used sticky notes in MTB and Kaplan (depending on the assigned primary source in each subject). The sticky notes were alternative to the method I used in step 1 when I wrote down the notes inside the FA book and page looked disgusting after annotating KL and UW into it. While doing the Qs timed random, I would read with my study partner the books of MTB or KL for the 2nd time, along with the UW that are annotated along the journey. And I did CMS after each subject I read for the 2nd time. All of this I did, but most of my daily studying at that stage (70%) was focused on UW.
Now it is a suitable time to talk about my crisis with UW. I found that many seniors with
+255 and +260 scored above 80% in UW 1st time. So I couldn’t remove from my mind the idea that if I scored below 80%, I will score in 240s in exam. I finished 70% of the bank and my cumulative score is 77%. Some can consider it good, but when I compared it with them, I was so anxious. After doing sport in the last 2 months, and after copying all difficult to memorize tables from UW, sticking them to the walls of my room and revising them again and again each time I felt bored and not able to study from books or to do Qs, after that, my score in UW got stabilized above 80% or even 85% but this was only in the last 12 blocks of the bank.
When I finished the bank for the 1st time which was 5.5 months after I subscribed to UW, I
was done with 2nd read of the books and also was done with CMS. The sport + revising tables stuck to the wall + scoring in 80s at the last couple of blocks made me feel I am ready, so I decided not to postpone. I felt I am ready, even before doing any NBME. That was a feeling, and I asked my seniors for advice and they encouraged me not to postpone. I had 3 weeks left before exam only.
But let’s go 2 weeks back. At this time, I had around 5 UW blocks left, and CMS of IM and O&G. I decided to do CMS 2 exams followed by 2 blocks on NBME 3. I had 16 mistakes in these 2 blocks of NBME 3!!!, and this SHATTERED me. I almost got into despair and felt that world is falling around. But looking back, this painful experience motivated to change my way of reading the Q. My old method from step 1 was to read last line then the whole stem then the choices. After I recovered from NBME 3 shock, I kept thinking what should I do to decrease the distraction while reading the stem. I came with an idea to screen the choice

after reading the last line, so that when I get back to the stem, I know what I am looking for so that distraction can decrease. I told Khayri Shalhoub about this approach, he said it will be good and added that I should read the main complaint also as it is important. So my approach was to read last line to know what is the Q asking about (btw they knew we do this so the last line now is not of great help yet it is important to read) then read the 1st line to know the MAIN COMPLAINT then the screen the choices then go back to read the whole stem. To add, in step 1 I read the Q without using the highlighting option but I decided to use it in CK as Qs were longer with more distractors, so I tried to do the highlighting and see if it will improve my score or not. This was after I did 1/3 or 1/2 of UW -I don’t remember-, the important thing that I did this earlier because simply don’t try a new approach in exam, you should test it earlier. So this was my approach in exam which helped me do the Qs faster without losing focus.

Now I have 3 weeks left. I get past the NBME 3 crisis when in the following 2 weeks I tried the new approach for doing Qs + sport + UW tables stuck to the wall + UW score stable above 80% or 85%. I finished UW with a cumulative score of 79%. I calmed myself with the fact that NBME and UWSA are the real predictors and not UW cumulative score.

How I dealt with the UW Qs and the Qs in general: I am a perfectionist. I become dissatisfied if I did a Q right with difficulty. Imagine how I feel when I answer the Q wrong. I used to ANALYZE the Qs to look for the reason of the confusion, the reason why I choose this stupid answer, etc. This Q confused me as I didn’t know the normal DTR and that Q I did wrong as always forget the normal QT interval. So, I used the Qs to extract all possible weak points I have, either weak points in info or in the thinking skills, and I made a long list of them and as I move on, I check if I still have the same weak points or I am strengthening them.

3rd stage – Last 3 weeks:
I was worried as I don’t have enough time to do my marked and wrong Qs. I didn’t care to do UW again, as my theory is that doing the same Q 2 times is harmful as in the 2nd time, not all your brain faculties will work. You may remember a hint from the Q stem and then you will answer the Q right by recall. So by doing this again and again, your brain get dumb after being more at work when you encountered the Qs for the 1st time. That is why I decided to do only the marked and wrong Qs. They were around 600 Qs, so at the end I did half of the wrong Qs and the other hard I only revised the objective without solving them again. I was somewhat not happy with that as I felt I went to exam without mastering the UW 100%, I mean the concepts in the explanations, not the Qs themselves. I reminded myself that I did UW 2 times only in step 1, so This is my way.. slow but not repeater. But as I said earlier, my notes from UW were revised as I went through the books for the 2nd time with my study partner. Add to this the tables of UW stuck to my room walls which I revised again and again. But in the 3 weeks left, I decided not to come near MTB or KL by any mean. I didn’t want to fill my brain with low yield info or info that is written in a bad way. Also I didn’t want some outdated info to distract me. So, I focused on UW tables, reading explanations of wrong Qs, and some of my UW notes (which I wish I have done them all if I had enough time and energy).

At this stage, I was unmotivated to cram whole book or even all of UW notes, but my approach was smart. I used all the available time but efficiently by working on weak points. Foe ex. I always find some confusion between different antibiotic regimens, so I made a note for them. I collected all DSM-V criteria for Diagnosis of Psychiatric disease, Made a summary from UTD to the sequence of treatment of psychiatric diseases, studied ECG tutorial. When I a Q remind me of a weak point, I go and revise it. If it is big part that is always annoying me, I try to make colorful and organized table for it. So I studied for 10 hours at this stage, but I felt like I am playing and not studying ex. making notes, reading confusing parts in UTD, making collections and mnemonics and posting them on FB. That was running from the classic studying, but to look back, it was a very efficient way of studying. What is the point of reading a certain part you heartily memorize, again and again? Another thing that worried me before exam was that I didn’t do my 1st NBME except 12 days before exam date. But as I said before, I took the decision to take exam earlier when I felt I am ready and nothing else I can do. So, I said to myself, take it before the burnout or before your performance go into a plateau. As I was short in time, I decided to do NBME 4 and NBME 6 in a row!! I felt I can do that as this was not the 1st sequence of blocks. From the middle of UW 1st time, I did the blocks 2 by 2, then 3 by 3, then at the last fourth of the bank, I did the blocks 4 by 4, I mean 4 blocks after each other exactly like NBME. So, as I said 12 days before exam, I did NBME4+6 to simulate exam. NBME 4 I did online and I scored 269/12wrong Q. NBME 6 I did offline 12 wrong Q. The next 3 days I used my way of analyzing the Qs to look for weak points and problems with dealing with the Qs. So, I revised the part that these 2 NBMEs directed me to stress on. This is in addition to revising the UW tables that I choose and stuck to the wall. For NBME 7, my decision after the bad feedbacks from its takers and how it was way more difficult than other, so I was reluctant to do it. I decided to do it one block per day, to know ideas in its Qs. But after my score in NBME4 which I never expected, I got a high dose of confidence and decided to do NBME 7 4 blocks in a row but offline. I got 21 Qs wrong. (I think it will give a score of around 260). But I don’t recommend doing it offline, as 5-8 Qs were lacking. Also, there was a stupid arrow which pointed to the answer in some Qs, sometimes it pointed to the right answer, sometimes pointed to the wrong answer (when the Q was difficult lol), so I had to correct the chosen answer in some Qs, and this confused me more in the exam and made my angry as my score will be biased. 3 days after NBME 7, I did UWSA and FRED at the same day. UWSA score was +265/15 wrong Qs. In FRED, I got 90% correct. IN these days, I did the same of what I did after NBME 4+6. Nothing like cramming a whole book or doing UW Qs again or anything I did at the last 2 weeks as I didn’t want to exhaust my mind.

D- UpToDate: I thank God that I heard from seniors that UpToDate is an important tool. In fact this is the most important reference in CK. UW explanations are COPIED from UpToDate. The advantage of this reference is that it has the MOST UPDATED guidelines, algorithms for diagnosis, and treatment protocols. It is sad how people study CK from outdated sources and take the exam without having UpToDate online subscription. But

having an active subscription also can be a curse, as others can leave the main track and keep digging and go beyond the required info for CK.
So, this is how I used it. I used it to clear my doubts i.e to read about these parts I always get confused about. I will search for the concept that will help me differentiate between seemingly similar diseases. But this doesn’t mean to read the whole topic. Also, read the summary and recommendation of the topic you want to read and if you still need to read more go to the text. Most of the time, SUMMARY and RECOMMENDATIONS are enough.
Also, UpToDate contains helpful algorithms and tables, but again study what you need. Don’t make this source lead you. Also, I used UpToDate to revise the outdated data I found while going through MTB. The third use of UpToDate was to use it to look for trusted answers for Qs of NBME and CMS −if I can’t find in UW- instead of looking on the groups and get exposed to people giving answers without a reference. At the end, when you search for the answer yourself, it is better and the more you depend on yourself, the more self-confidence you get and the less time you spend arguing on the groups.

E- Clinical mastery series: Before 2015, nearly no one used CMS or even heard about. It started when some +260 scorers praised them. These are Qs designed by the same faculty who write NBME Qs, so these Qs are more or less near to exam pattern and more focused on CK curriculum than KQB for ex. After I finished the first read of MTB and KL, and while doing UW online timed random, I used to make these CMS exams as a motivator for me to do the 2nd read of the subjects along with reading notes of UW Qs I did. Then after I finish each subject, I would do the 2 CMS exams on this subject. And I mentioned above, I used UTD to look for the trusted explanations for doubtful Qs in most of the exams.

F- Playing sport: 2 months before exam, I was so stressed, my UW score with fluctuating between upper 70s and lower 80s with no stable increase, and at that time, I was studying for 7 months. I decided to run daily to relieve the stress in a healthy way. I was so stressed and on the verge to explode at any time and I discovered that I did many mistakes in UW duo to lack of concentration. Also, I found by analyzing my mistakes that I feel dumb while reading the Q stem, I can forget the beginning of the stem when I read the end and I can feel lost in the middle, and even the Qs I do right, I do with after a struggle. I felt at that time that I am a person who strives not to drown, nit a good swimmer. My daily running helped me to increase my concentration, cheer me up and also delayed the burn out. I ran daily as I needed this and felt that this helped me. Even at the night exam, I felt I am so tense, I ran 4 Km to exhaust myself to be able to sleep. The irony is that after this marathon, I stayed at the bed more than 3 hours unable to sleep, and I slept only for 4.30 hours before going to exam.

G- CK Qs pattern, and how they are different from step 1 Qs:
In step 1, they will analyze the data in the history and examination and give you the summary. In CK they want you to drown, they want you to miss an abnormal data as it is buried between many NORMAL lab values, or you can miss it as you didn’t know the normal lab value. For example in step 1, they will tell you that a patient had hypokalemia and lower body weakness. IN Ck, they will give you a long list of lab values and K level is hidden between the other values. In case of muscle power, they will tell right arm +5 power, left arm +5, right leg +2 and left leg +3. And then you have to EXTRACT yourself!! So this needs someone to memorize the lab values very well, and know the normal and abnormal plus being quick highlighting the important data while going through the stem.
One other problem is the distractors! They will give you a presentation pointing to one diagnosis, and they will add a symptom that u know for sure it is related to another disease. You can get distracted by forgetting the whole stem and clinging to that line and choosing a wrong answer instead. Here are some solutions: when you feel that 2 diseases confuse you, check UTD to see if the DD in UTD mentioned something to differentiate. That happened with me in neuromuscular disease and I made a table to comparison based on UTD to differentiate. Another thing that can help u not to be distracted by a distractor is to know the chief complaint very well. The 3rd thing is to be able to draw a full picture, and if something is not in harmony with the full picture, ignore it. Sometimes, this is just an atypical presentation or a rare presentation of the disease and that is why you confused it with another disease.

H- Exam experience (This experience I wrote right after my exam):
1st thing I want to tell that u can’t give true advice with your impression after exam. Most of exam takers even those who score high feel bad after exam. For me I didn’t feel that bad as I expected that exam will be more difficult than the most difficult NBME. I knew that for sure and expected that. In all NBMEs except 7 I felt they r easy. For NBME 7, It was tough but not lengthy so I managed to know the trick in many Qs. But in exam many Qs are difficult or vague and u don’t have time to think clearly in these Qs, as Qs are long and in 95% of the time, I don’t have time to revise my marked Qs. So, even with me being able to finish NBMEs 7-10 minutes before the block time end, I barely finished on time in exam. Most of the blocks, I would have 30 sec- 2 minutes left. I knew that time management is a problem in the exam so I did the Qs timed from the start of my preparation. Exam had many doable Qs but u need to be 100% focused, if u lost your concentration for a few minutes u can lose easy Qs. After exam, I am more convinced that UW is the most important source. Of course no source will be sufficient to cover all of exam Qs, not even 80%. U will need to use your judgment, your common sense and how to weigh the choices and give your best guess. I had doubt in 10 Qs or more per block and some Qs I was not able to find a clue I can think of an answer based on. And again I expected that. I would have Qs that I feel I am not satisfied by my answer, I mark them but I know that I won’t have time to get back to it. I had 3 Qs giving u nearly the same scenario and asking u the same Q. U will doubt yourself but this is normal, I had this sort of repeated Qs in step 1. I had many Qs scattered in different blocks with the same choices but with different scenario about the transient synovitis, septic arthritis, LCPD, SCFE so they want from u to differentiate between similar diseases. I had 3 heart murmurs which I forgot to prepare for :/ . I had 2 U/S images in Obstetrics and I tried to do them by using the vignette and in 1 I didn’t know what to do so I choose a random answer. I had many psychiatry Qs and most of them were not that direct, more difficult than UW psych Qs. Biostats Qs were not that difficult but u need to understand and to focus in numbers and calculations, pure math skills. I had one abstract which was difficult for me. And I have no idea what will be my score. I am trying to suppress any exam Qs, as I so intimidated to discover more mistakes and feel worse. My advice for now is to focus to understand and memorize all UW concepts especially those given in tables. Again, UW tables charts and algorithms are so important. I could have done better, If I studied them again but ALhamdullah. Don’t waste your time with Kaplan books and MTB in last months before exam. Better to do all NBMEs and CMS and use them as a guide for your weaknesses and doubts which UpToDate can help u with. I decline to share exam Qs as I don’t want to remember and simply because I forget 80% of exam Qs once I come out to the center and this is good btw.

I- Tips:
1- Don’t and I mean, don’t underestimate CK. Don’t think that CK will be a piece of cake after step 1. That is a LIE. I know people who score -10 and -20 from their step 1 score. Also, u can notice from my experience that I suffered and changed my way many times to get a good score in CK, although I got 259 in step 1.
1- If you found that there is a Q you have no idea about, don’t waste your time with it, freaking out and being stubborn will compromise the whole block as you r taking time to this Q from other Qs which u could have done right if u had enough time.
2- DO 15 or 20 before going for exam to warm up, so that initial stage of dumbness many of us face when we start doing Qs is skipped.
3- Know that what can lower your score is the easy Qs u do wrong due to anxiousness or lack of concentration or enough time. Make your priority always during preparation not to do an easy Q wrong.
4- Qs with media (Pics or sounds): You can sometimes depend on the stem to do it right without fully identifying the photo for ex.
J- Miscellaneous Topics:
1- Vaccination tables: source CDC
These are immunization schedules for everyone (more simplified than these for Health care professionals)

For other tables:

2- Preventive medicine: UW tables + AAFP recommendations which are based on USPSTF recommendations. Follow them except congenial hip dysplasia, iron def. anemia screening in infants screening, GDM screening as they are different from UW– recommendations.pdf

3- My psychiatry notes: UW+UTD UTD% 29.rar

4- Empiric antibiotics:– therapy/1040897549274057
5- Pain management:

6- Patient safety: from Kaplan LNs for behavioral sciences
7- Bias:

8- Chemotherapy for Hem/Onc diseases:
9- ECG: ECG made easy. If you are short in time, study it from ECG tutorial topic in UTD 10- Normal values mnemonics, based on UW normal values:

K- Final word: Don’t think I am a supernatural. I am a normal guy who studied efficiently, with dedication, persistence, and strong will power. I am not the genius guy who can master and retain everything from the 1st read. But I try to understand everything and I love to integrate info, to connect the dots, make comparisons. To succeed, use others experiences (at this place I want to recommend Khayri Shalhoub experience for you to read too), don’t start from zero, but also understand yourself, understand your Pros and Cons, don’t copy and paste a senior experience. Make the plan that suits you the best. No one understands you better than yourself.

I want to thank all friends and colleagues who helped me: (arranged alphabetically): AbdulHaq Yousufzai − AbdulRahman Alnakeeb – Ahmed Azmy −Ahmed Elzanaty − Ahmed Marey −Ahmed Zaghloul − Danny Markabawi − Faeq Alkoukhon − Fatima Syed − Khaled Hamada − Khayri Shalhoub − Lewis Forad − Maymona Mohammed − Mohammed Ismail. I hope I didn’t forget anyone of those who helped me.


If you liked this experience, check out the following experiences:

Mishref El Dwainy – USMLE Step 2 CK – 256 Experience – IMG Middle East

USMLE Step 2 CK – 255 Experience

USMLE Step 2 CK – Experience – 255

December 13, 2017
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