USMLE Official 2017 Step 1 Experiences and Scores Thread

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WeedForLunch

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I know this is quite early but most American Students have finished giving the test for this year.
I am an IMG and have been prepping for the steps since quite some time and have seen Phloston, Transposony's and others' threads for their respective years and how helpful they have been.

I intend on giving step in Jan.. let's share timetables, plans and other stuff on how everyone intends on taking on this beast.

P.S. : I think it is not that early.. the 2015/2016 threads were started in September/October.. but in true SDN gunner style..i wanna start it in August.. :)

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how'd you feel right after the real deal? I'm hoping for a 240 and have NO IDEA how to gauge how I did.
I felt ok at first. Then started to worry as I thought about some I got wrong. But overall felt ok...which made me worry more because of all the horror stories of people who felt ok and bombed it.
 
I felt ok at first. Then started to worry as I thought about some I got wrong. But overall felt ok...which made me worry more because of all the horror stories of people who felt ok and bombed it.
Any comments on the depth of amino acid knowledge we need to know?
 
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I felt ok at first. Then started to worry as I thought about some I got wrong. But overall felt ok...which made me worry more because of all the horror stories of people who felt ok and bombed it.

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NBME SPOILER ALERT


I didnt even take this nbme but this is driving me nuts.
Can anyone clarify when peak flow is for the left and right coronary arteries?
Sources say peak for the right is systole, and for the left is diastole.

NBME answer for the RCA was early diastole

Can you please tell which NBME is this from?
 
Anyone who is still around this thread and scored 240+.. how often did you feel like you didn't know anything? And how man you of you crammed things in until the night before?..
I didn't necessarily feel as if I were forgetting things, but I definitely became increasingly aware of how little I knew/know. It's the "you don't know what you don't now" thing. You start to acquire enough knowledge and understanding to ask more questions. At that point, you realize you don't know a whole lot, despite what you have learned...kind of a circular thing. Whatever that psychological phenomenon is where people who know more or are more skilled underestimate themselves and people with less knowledge or skills overestimate their abilities.

Edit: Forgot to answer your other question...I didn't review anything in last few days, just relaxed.
 
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Is NBME 17 suppose to have a harsh curve? I regressed from 16 after a week of studying. Went from a comfortable range to now slightly above passing.
 
Congrats on being done. So everyone from this point on receives scores june 28??

Thanks! And yeah, at least that's what I'm operating on. Pretty sure the NBME website still says June 28.

How did you study? Feedback while it's fresh? : P

So, my biggest regret was DIT. I think it would have been a fantastic resource if I had more time. I spent nearly two weeks on DIT and only started UW about 1.5 weeks in. I thought I'd make a pass of DIT/FA, THEN start UW. Bad idea. I was able to squeeze out dedicated to 5 weeks and I was trying to both go quickly and learn from UW. This caused me to be a bit frantic watching my percentage complete of UW go up. I unfortunately didn't finish UW, but I also used Sketchy and Pathoma. I can remember getting discrete questions correct due to Sketchy and Pathoma. I would 10000% recommend watching the first 3 chapters of Pathoma again in the last week as lots of my questions involved material from there. Wish I would have had time to do so.

Any other qs?
 
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Thanks! And yeah, at least that's what I'm operating on. Pretty sure the NBME website still says June 28.



So, my biggest regret was DIT. I think it would have been a fantastic resource if I had more time. I spent nearly two weeks on DIT and only started UW about 1.5 weeks in. I thought I'd make a pass of DIT/FA, THEN start UW. Bad idea. I was able to squeeze out dedicated to 5 weeks and I was trying to both go quickly and learn from UW. This caused me to be a bit frantic watching my percentage complete of UW go up. I unfortunately didn't finish UW, but I also used Sketchy and Pathoma. I can remember getting discrete questions correct due to Sketchy and Pathoma. I would 10000% recommend watching the first 3 chapters of Pathoma again in the last week as lots of my questions involved material from there. Wish I would have had time to do so.

Any other qs?
Congrats on completing the test. I know you were in a bit of a crunch at the end. Were you able to take another NBME after UWSA1? How far did you manage to get on UWorld?
I think my scores are close to yours and just wanted some perspective. I test Friday.
 
Thanks! And yeah, at least that's what I'm operating on. Pretty sure the NBME website still says June 28.



So, my biggest regret was DIT. I think it would have been a fantastic resource if I had more time. I spent nearly two weeks on DIT and only started UW about 1.5 weeks in. I thought I'd make a pass of DIT/FA, THEN start UW. Bad idea. I was able to squeeze out dedicated to 5 weeks and I was trying to both go quickly and learn from UW. This caused me to be a bit frantic watching my percentage complete of UW go up. I unfortunately didn't finish UW, but I also used Sketchy and Pathoma. I can remember getting discrete questions correct due to Sketchy and Pathoma. I would 10000% recommend watching the first 3 chapters of Pathoma again in the last week as lots of my questions involved material from there. Wish I would have had time to do so.

Any other qs?
Congrats on the giving the exam !!!!!!!!!!!!!!!!!!!!!!! Just wanted your input on Sketchy... U said u had a few qs directly out of it... Im around 7 weeks away from D-day is it worth going over??? What advantage does it have over FA for Pharm and Micro?? How would u go over it in the shortest of time possible you could add it to your schedule using my time frame. Thanks !!
 
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Is NBME 17 suppose to have a harsh curve? I regressed from 16 after a week of studying. Went from a comfortable range to now slightly above passing.
I have heard that 17 and 19 have tough curves. I took 16 and after 2 more weeks of studying I took 17 and scored the exact same as 16.
 
Keep that motivation high friends! Whether your test is this week, in a month, or in a year, a calm mind is the best thing you can have for test day. Keep on keepin' on!
 
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Anyone have a good source for understanding the physiology behind RTAs?

Edit: specifically, why type 4 RTA has low urine pH if aldosterone deficient/defective..
 
Anyone have a good source for understanding the physiology behind RTAs?

Edit: specifically, why type 4 RTA has low urine pH if aldosterone deficient/defective..

Boards and beyond explains this well. Pathoma might go over this too. IT's due to the decreased NH4+ excretion which creates an acidotic state. There's an extra H+ NH4+.
 
Boards and beyond explains this well. Pathoma might go over this too. IT's due to the decreased NH4+ excretion which creates an acidotic state. There's an extra H+ NH4+.
Decreased nh4+ Prodhction yes but that just makes me think that you get less acid, not more. I get that the lack of aldosterone causes hyperkalemia which will decrease the intracellular H+ In the PCT, so it can't make NH4+..
 
Decreased nh4+ Prodhction yes but that just makes me think that you get less acid, not more. I get that the lack of aldosterone causes hyperkalemia which will decrease the intracellular H+ In the PCT, so it can't make NH4+..
If you can't produce NH4+ from NH3 and H+, then that means you have more H+ floating around = increased acidity
 
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surprisingly i have not encountered one practice q asking you to diagnose a RTA or explain the pathophys behind one
And I doubt anyone will ever get a question about it, but it helps to understand mechanisms so you can make connections. For example, this concept can also be applied to Hyperammonemia, generating an acidic environment (H+) to trap NH3 by forming NH4+ in the GI
 
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Sadly not for me :(
Test date 5/3

Anybody know if the permit only disappears on Monday morning, or if it can disappear later on Monday or even on Tuesday?

Even without the delay, it seems like Wednesday tests would roll over until the next week, right? Last week tests on Monday and Tuesday (4/24, 4/25) got their scores? Did anyone from Wednesday (4/26) on get their scores last week? This is more out of concern that you not getting your score Wednesday won't rule out the possibility of scores continuing to not be delayed.
 
Even without the delay, it seems like Wednesday tests would roll over until the next week, right? Last week tests on Monday and Tuesday (4/24, 4/25) got their scores? Did anyone from Wednesday (4/26) on get their scores last week? This is more out of concern that you not getting your score Wednesday won't rule out the possibility of scores continuing to not be delayed.
I'm pretty sure if you test on a Wednesday, you would normally get your score 3 weeks later. So if I tested 5/3, then I would expect my score 5/24 which is this week. But with the delay, who knows.
 
surprisingly i have not encountered one practice q asking you to diagnose a RTA or explain the pathophys behind one
I'm not going to say that you won't get an RTA question on your test, but it really isn't a preclinical topic. Most schools do not teach it to preclinical students. I would be surprised if it were tested on step 1.
 
You got it backward. Hyperkalemia increases intracellular H+. The body tries to compensate for high level of K+ in the serum by exchanging it with H+ from inside the cell => metabolic acidosis. Hence, there are more H+ available compare to NH3 => lower NH4+ excretion => decrease urine pH.

Exactly. The RTA electrolyte findings for urine pH can be tricky. I try to remember them by this way:
RTA Type I: This is the only simple, straightforward RTA. You have decreased function of the H-K Anti-porter, leading to acidosis with less H+ in the urine. So, you have a increased Urine pH. You also have hypokalemia.

RTA Type II: This is due to a defect in the Proximal Convoluted Tubule. You can't reabsorb HCO3-, leading to metabolic acidosis. Now, you would think that the urine would have a higher pH since you can't reabsorb HCO3-, and thus there is more HCO3- left in the kidney. However, the body responds to the metabolic acidosis by decreasing the amount of HCO3- going into the kidney (body wants to retain as much HCO3- as possible to offset the acidosis). so, you actually end up having a decreased urine pH

RTA Type IV: This is due to Hypoaldosteronism. Again, don't fall for the simple trap of "less Aldosterone, less H+ being secreted into the kidney, so we should have an increased urine pH". This time, you have hyperkalemia from the low Aldosterone levels, and Hyperkalemia causes decreased NH3 synthesis (I still have trouble remembering this). This leads to a decreased urine pH (less NH3 able to bind up the free H+ in the lumen of kidney).

TLDR: Type I is straightforward, increased urine pH. Type II and Type IV are "counter-intuitive" in a sense, with decreased urine pH
 
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I'm not going to say that you won't get an RTA question on your test, but it really isn't a preclinical topic. Most schools do not teach it to preclinical students. I would be surprised if it were tested on step 1.
I guess my school is unique. Haha.
Exactly. The RTA electrolyte findings for urine pH can be tricky. I try to remember them by this way:
RTA Type I: This is the only simple, straightforward RTA. You have decreased function of the H-K Anti-porter, leading to acidosis with less H+ in the urine. So, you have a increased Urine pH. You also have hypokalemia.

RTA Type II: This is due to a defect in the Proximal Convoluted Tubule. You can't reabsorb HCO3-, leading to metabolic acidosis. Now, you would think that the urine would have a higher pH since you can't reabsorb HCO3-, and thus there is more HCO3- left in the kidney. However, the body responds to the metabolic acidosis by decreasing the amount of HCO3- going into the kidney (body wants to retain as much HCO3- as possible to offset the acidosis). so, you actually end up having a decreased urine pH

RTA Type IV: This is due to Hypoaldosteronism. Again, don't fall for the simple trap of "less Aldosterone, less H+ being secreted into the kidney, so we should have an increased urine pH". This time, you have hyperkalemia from the low Aldosterone levels, and Hyperkalemia causes decreased NH3 synthesis (I still have trouble remembering this). This leads to a decreased urine pH (less NH3 able to bind up the free H+ in the lumen of kidney).

TLDR: Type I is straightforward, increased urine pH. Type II and Type IV are "counter-intuitive" in a sense, with decreased urine pH
but like the hyperkalemia prevents NH3 synthesis by depleting the cell of H+ I thought? (High extracellular K+ goes down its conc gradient leading to excess H+ in plasma).

Edit: also, is the HCO3- reabsorption in the CD why we don't have as much bicarbonate loss? Or how does the body just stop sending HCO3- to the kidney?
 
but like the hyperkalemia prevents NH3 synthesis by depleting the cell of H+ I thought? (High extracellular K+ goes down its conc gradient leading to excess H+ in plasma).
Hyperkalemia --> H+ leaving cell in exchange for K = alkalotic intracellular environment = less favorable for ammoniagenesis.
 
It's done! I'm so relieved. Overall, it felt easier than I anticipated - for me, it felt easier than UWorld, harder than NBME CBSEs, and actually fairly comparable to my school's NBME organ block exams. Probably about 5% of the questions I just had no clue on, maybe 10% I was completely sure of, 10-20% I narrowed it down to two/made an unsure educated guess, and the bulk I was fairly but not completely confident of. Which is pretty much par for the course for me. There were a decent amount of questions that I knew specifically from UWorld; a few questions also looked familiar to me from previous practice tests (though I don't remember which ones). There were some topics I was (pleasantly) surprised to find had relatively few questions or were not tested in a ton of depth like I expected them to be. There was a pretty even mix of longer questions and shorter questions, as well as first order and higher order.

Tip for test day - these worked for me, but are probably a matter of personal preference: If you have time left at the end of a block, it gets added to your total break time. It usually took me 40-50 minutes to finish the block, so in my leftover time I would get up, leave the testing room, and walk around, drink my caffeine, or eat a small snack. Usually I just power through as long as I can, but this was REALLY helpful for me to not get fatigued/unfocused so I'm glad I did it, especially because I was feeling a little tired. To maximize break time, I highly recommend wearing clothes with no pockets, short sleeves, and shorts/capris to make the check-out/check-in process go more quickly. They check your pockets and ankles every time you come and go otherwise, which can get time consuming. Finally, you are allowed to bring notes/books and look at them between blocks. I brought FA along in case I felt like I wanted to give myself a quick refresher between blocks (which looking back...sounds kinda dumb but I was a nervous wreck lol) but found myself basically just checking my answers from the previous block, which was demoralizing if I missed one. I ended up putting the book in my car after the first break and started trying to clear my head/forget the questions after each block, which I think was better for me in terms of mental stamina, and also in terms of anxiety until we get our results because I won't be able to look up stuff I missed over the next few weeks.

For posterity, I used pretty much UFAP + Sketchy + a little BRS Physio, using the Bros deck to review the more memorization-heavy topics in FA and taking weekly practice tests during dedicated. I also used some other resources (Goljan, Costanzo, Kaplan qbank, Rx qbank) throughout my school's organ systems but not during dedicated. Without having my score back, I'm not sure at this point if I would have done anything differently. The majority of the questions were at least familiar to me, it was just a matter of remembering it.

And my practice test scores - shooting for a 210-220ish

~7 weeks before: CBSE w/ no preparation besides classes - 176
4 weeks before: UWorld sim 1 - 196
3 weeks before: NBME 18 - 190
2 weeks before: NBME 19 - 205
1 week before on same day: free 120 79% and Uworld Sim 2 180 (felt super distracted/anxious during this exam...advisor told me to take an NBME the next day before making a decision)
6 days before: NBME 16 - 213 (advisor told me to just go for it)

I'll update with my real score when it gets here. Thank you all so much for all the help and advice over the last couple days! I was really a hot mess in terms of anxiety and you guys were all so encouraging and supportive - it was really helpful. Wishing the best to all of you guys!

Man i'm so happy you're done, congrats! Time for you to party!
 
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It's done! I'm so relieved. Overall, it felt easier than I anticipated - for me, it felt easier than UWorld, harder than NBME CBSEs, and actually fairly comparable to my school's NBME organ block exams. Probably about 5% of the questions I just had no clue on, maybe 10% I was completely sure of, 10-20% I narrowed it down to two/made an unsure educated guess, and the bulk I was fairly but not completely confident of. Which is pretty much par for the course for me. There were a decent amount of questions that I knew specifically from UWorld; a few questions also looked familiar to me from previous practice tests (though I don't remember which ones). There were some topics I was (pleasantly) surprised to find had relatively few questions or were not tested in a ton of depth like I expected them to be. There was a pretty even mix of longer questions and shorter questions, as well as first order and higher order.

Tip for test day - these worked for me, but are probably a matter of personal preference: If you have time left at the end of a block, it gets added to your total break time. It usually took me 40-50 minutes to finish the block, so in my leftover time I would get up, leave the testing room, and walk around, drink my caffeine, or eat a small snack. Usually I just power through as long as I can, but this was REALLY helpful for me to not get fatigued/unfocused so I'm glad I did it, especially because I was feeling a little tired. To maximize break time, I highly recommend wearing clothes with no pockets, short sleeves, and shorts/capri-length pants to make the check-out/check-in process go more quickly. They check your pockets and ankles every time you come and go otherwise, which can get time consuming. Finally, you are allowed to bring notes/books and look at them between blocks. I brought FA along in case I felt like I wanted to give myself a quick refresher between blocks (which looking back...sounds kinda dumb but I was a nervous wreck lol) but found myself basically just checking my answers from the previous block, which was demoralizing if I missed one. I ended up putting the book in my car after the first break and started trying to clear my head/forget the questions after each block, which I think was better for me in terms of mental stamina, and also in terms of anxiety until we get our results because I won't be able to look up stuff I missed over the next few weeks.

For posterity, I used pretty much UFAP + Sketchy + a little BRS Physio, using the Bros deck to review the more memorization-heavy topics in FA and taking weekly practice tests during dedicated. I also used some other resources (Goljan, Costanzo, Kaplan qbank, Rx qbank) throughout my school's organ systems but not during dedicated. Without having my score back, I'm not sure at this point if I would have done anything differently. The majority of the questions were at least familiar to me, it was just a matter of remembering it.

And my practice test scores - shooting for a 210-220ish

~7 weeks before: CBSE w/ no preparation besides classes - 176
4 weeks before: UWorld sim 1 - 196
3 weeks before: NBME 18 - 190
2 weeks before: NBME 19 - 205
1 week before on same day: free 120 79% and Uworld Sim 2 180 (felt super distracted/anxious during this exam...advisor told me to take an NBME the next day before making a decision)
6 days before: NBME 16 - 213 (advisor told me to just go for it)

I'll update with my real score when it gets here. Thank you all so much for all the help and advice over the last couple days! I was really a hot mess in terms of anxiety and you guys were all so encouraging and supportive - it was really helpful. Wishing the best to all of you guys!

Congrats on being done! Just a question. Any particular reason why you skipped NBME 17? I tanked my score between NBME 16 and NBME 17 and now freaking out.
 
The academic advisor at my school said NBME 17 has a nasty curve and tends to underpredict, and she suggested I skip it since I was dealing with some confidence issues lol

Yeah that was a very good idea. Definitely discouraged me. Btw did you review NBMEs that you saw repeated? About a week away and kind of in a similar position as you were with confidence and everything. Any suggestions on what to do last week? Congratulations sending good vibes your way!
 
Hi everyone. I havent posted here yet but i have been following recently. I took my exam today. ill report back with my score when i get it, but what i know for sure is, aside from the fatigue that hits at literally anytime in the exam, the exam was significantly harder than any nbme currently available. Im hoping my curve will be better because of it. I scored in the 260s on the nbmes and this exam literally blew my mind. Im not gonna complain yet bc it could be that the curve will be great. Who knows. But right now im hoping for a 240.
The best advice i can give to people: get a great night of sleep. I only got 4.5 hours bc i was so nervous. Just know that youve done what you can and leave it. Dont cram that last side effect. Just go to sleep. The chances of that side effect being tested is nearly 0. I will update when i get my score. For now if anyone has any questions let me know ill try to answer
 
Hi everyone. I havent posted here yet but i have been following recently. I took my exam today. ill report back with my score when i get it, but what i know for sure is, aside from the fatigue that hits at literally anytime in the exam, the exam was significantly harder than any nbme currently available. Im hoping my curve will be better because of it. I scored in the 260s on the nbmes and this exam literally blew my mind. Im not gonna complain yet bc it could be that the curve will be great. Who knows. But right now im hoping for a 240.
The best advice i can give to people: get a great night of sleep. I only got 4.5 hours bc i was so nervous. Just know that youve done what you can and leave it. Dont cram that last side effect. Just go to sleep. The chances of that side effect being tested is nearly 0. I will update when i get my score. For now if anyone has any questions let me know ill try to answer

How much histology / radiology were on your test and was First Aid sufficient for the anatomy questions?
 
How much histology / radiology were on your test and was First Aid sufficient for the anatomy questions?
First aid was not sufficient for anatomy. Idk if i got any pure histo Qs on my exam. Most were related to micro. There was a decent amount of radiology. Nothing impossible tho. I actually like radiology bc it helps you answer the question. Im not trying to scare people, i just want people to be mentally prepared for it.
 
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Yeah I watched all B&B and the YouTube video I mentioned. Specifically the summary video.
I watched YouTube --> B&B.

You're the best! This got me a 100% on my UW blocks today!!!! That may seem not that impressive to some but I'm coming from the bottom quartile in biostats!


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First aid was not sufficient for anatomy. Idk if i got any pure histo Qs on my exam. Most were related to micro. There was a decent amount of radiology. Nothing impossible tho. I actually like radiology bc it helps you answer the question. Im not trying to scare people, i just want people to be mentally prepared for it.

Anything you would do differently in your prep in hindsight? Any recommendations for mastering the anatomy outside of FA?
 
What was the general consensus on UWSA1/2 predictive value? I hear it's a mixed bag of opinions


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It depends man. Just take it with a grain of salt. Taking it earlier will be less predictive than later, etc... I've seen it over predict some people by 20 and under predict others. There are a good number of scores I've seen that usually work out to be somewhere in the middle of USWA1 & 2.
 
Sorry if already discussed, but is NBME 18 pretty predictive?

17 and 18 are if you take them close to your date . Like a week or so. In all honesty all so far besides 13 and 19 have been fairly close depending on when you take it. This goes for uworld Self Assessments too


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Anything you would do differently in your prep in hindsight? Any recommendations for mastering the anatomy outside of FA?
I dont know of any source that teaches anatomy efficiently. I dont know if studying brs anatomy or whatever is worth the time. It most likely isnt unless you really dk any anatomy.
Its hard to say what i would have done differently bc every exam is different. My exam had very few side effects. Thats one area i was weak. You just have to try to cover your bases bc increasing exposure is more important than trying to master any one subject. It is a multiple choice exam after all. The answer is there
 
First aid was not sufficient for anatomy. Idk if i got any pure histo Qs on my exam. Most were related to micro. There was a decent amount of radiology. Nothing impossible tho. I actually like radiology bc it helps you answer the question. Im not trying to scare people, i just want people to be mentally prepared for it.
Was it like some crazy weird anatomy like that uworld question of retroperitoneal bleeds from putting in a line above the inguinal ligament?

Random example but that question still doesnt make sense for me
 
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Was it like some crazy weird anatomy like that uworld question of retroperitoneal bleeds from putting in a line above the inguinal ligament?

Random example but that question still doesnt make sense for me
I despise that question.

But I did have a few anatomy questions that weren't in FA/UW. I def learned them first year so hopefully I remembered correctly.
 
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