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Page 12

whatsoever where I fell in terms of score because the entire exam felt so subjective. Well

anyway, so I just got the score back today (on my birthday):

USMLE Step 1: 262

USMLE Step 2CK: 260

I feel fine about this outcome. I hadn’t felt nearly as prepared going in as I had for Step 1, so I

wouldn’t have been surprised if I had tanked it somehow. I was expecting anything between

240 and 270, so I can’t complain about a 260 since NBME 7 two days before matched that. So I

don’t really think there’s anything more to say about that. It is what it is.

Study resources

Internal medicine:

I own Step-Up to Medicine. This is an internal medicine book, not a comprehensive USMLE

book. I had heard this was really good for the USMLE, but quite honestly, it’s really dense with

text. If you’re the type who likes to read endless text, feel free. This book didn’t help me

though. I looked at it maybe five times randomly for no more than two minutes. I personally

learn better through tables, diagrams, flow charts and questions, not ongoing, superfluous text.

I found having studied hard for Step 1 was sufficient to cover internal medicine for 2CK.

Bottom line is: practice questions are sufficient for IM for 2CK. But if you want a text for this

subject, Step-Up to Medicine is probably the best compendium you can get. There are two 50-

question internal medicine Clinical Mastery Series blocks on the NBME website. Make sure you

do those.

Surgery:

I found Pestana’s Surgery Notes to be good while I was on my surgery rotation. This book is

super-short, so even if you are somewhat close to your 2CK and need a quick surgery review,

this will do the trick. It has 180 (or so) questions in the back of the book, which I went through

first and then went back and read the corresponding areas from the text. I’d consider Pestana’s

notes to be sufficient for fast surgery review, but it’s not essential so don’t lose sleep over it.

I own Case Files Surgery as well and went through about ten of the cases, but it wasn’t concise

enough for USMLE purposes so I jettisoned it. And especially regarding topics like breast

cancer, the information was vague and desultory. This book is OK to use during your clinical

rotation, but I’d choose Pestana’s over this one.

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Most of my surgery I probably learned through practice questions and UpToDate. If I got a

surgery question that I wanted a little bit more elaboration on, I’d just reference UpToDate,

which was always very helpful.

Bottom line: practice questions and UpToDate are the core elements of surgery prep. Pestana’s

is a good review but not essential. I do not recommend going through a tome. That might help

for a surgery rotation, but not for the USMLE. There are two 50-question surgery Clinical

Mastery Series blocks on the NBME website. These questions were just like the ones on my

USMLE. Think of studying for surgery like studying for anatomy for the Step 1 – there’s a

million things we could possibly know but consolidation is key.

Psychiatry:

Case Files Psychiatry was solid for this subject. I would read this on public trans to and from the

hospital during my rotation and learned/reviewed quite a bit from it. It also helped me clarify

some things that I had been confused about for a while. I did find a couple errors in it, but they

don’t undermine the value that the rest of the text has to offer.

I have a friend who strongly recommended FA Psychiatry (and the reviews on Amazon are really

good), but I personally did not read this because I found Case Files to be good enough.

Bottom line: practice questions and Case Files are all you need for psychiatry. FA Psychiatry is

an alternative to Case Files that has received strong reviews. There are two 50-question

psychiatry Clinical Mastery Series blocks on the NBME website; I assume these are just as

valuable as the internal med and surgery ones, but I did not complete these because psych was

my best subject going in and I didn’t feel I needed to review it anymore.

Pediatrics and OBGYN:

Two different rotations, but I’m grouping them together here because I prepped for them the

same way. As I said earlier, I sat my 2CK not having undertaken these rotations, so these were

the two subjects I was most paranoid about.

I found the combination of MTB2 and MTB3 to present a decent introduction to these topics,

but these two texts alone are not nearly sufficient for the 2CK. If you already own these texts,

the combination of them can be a decent opener if you have absolutely no background in

peds/OBGYN, but if you don’t already own these, they’re not necessary.

The way I learned the vast majority of my peds and OBGYN was through practice questions

(including the Clinical Mastery Series) and UpToDate.

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A: Yeah, knowing the spacing/timing of the peds vaccines is very important. I found it was

easier to memorize certain time points (e.g., "what do I give at 2, 4 and 6 months?") as opposed

to memorizing the separate timings for a single type of vaccine (e.g., "when are all of the times

that I give pneumococcal?"). I'd say the yield of this stuff for 2CK would be the equivalent of the

embryo (e.g., aortic arch derivatives, clefts, arches, pouches, etc.) for Step 1. That is, they

could easily tell you what a 12-month-old's vaccination Hx is and then ask what he needs to be

given now. I just think you'd end up kicking yourself if you were posed with a straightforward

question on this and couldn't quite remember. There are enough nebulous questions on the

2CK that it's actually a relief if you can just say "wow, I know there's a clear-cut answer here." I

didn’t have any peds vaccines questions on my exam, but I just got lucky because I hated that

stuff too.

Q: How were the AIDS/HIV on your exam? Should I be very specific about CD4 counts in my

preparation?

A: And yeah, MTB2 would have ****** me on the real deal because IIRC, it says something like

you only give HAART in pregnancy if the CD4 is <400 (can't remember exactly). But before my

exam, I checked UpToDate, and they said you give HAART to pregnant women regardless of

CD4 count. The only difference is that if her CD4 count is normal, you can start HAART after 14

wks gestation, whereas if CD4 is down, you start HAART in first trimester. If I were you I'd make

sure you know HIV and pregnancy ultra-hardcore going into the exam. UpToDate was preter-

clutch. You'll get at least one question on it, and not to mention it's HY on the NBMEs.



In terms of "should you be specific about CD4 counts in preparation.." The answer is a

generalized yes. Know that you wouldn't see MAI or CMV colitis, for instance, unless you were

CD4<50. The USMLE really really likes that. And know prophylaxis and Tx for MAI is

azithromycin (rifabutin, clarithromycin are alternatives). And TMP/SMX is Tx and prophylaxis for

PCP under CD4 of 200, and TMP/SMX is also the prophylaxis for Toxoplasmosis at CD4 of 200;

the only difference is you Tx Toxo with sulfadiazine/pyrimethamine.

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