Official Internal Medicine Shelf Exam Thread

[startswithb]

Hi,

I took the second Medicine NBME exam and had some more questions that I was hoping someone could help me out with. Thanks in advance.

1. Overweight 65 year old male who smokes 1 pack per day. Brother died of CVA and parents died at 40. BP is 150/102, he has grade 2 hypertensive retinopathy, and PMI is displaced 2cm laterally. Which lab test is best for initial assessment?
a. Plasma renin
b. serum aldosterone
c. Serum creatinine
d. urine metanephrine
e. urinary sodium/creatinine ratio

look for kidney damage, as there is already evidence of other organ damage. They give you his weight, age, and smoking status to make the case for essential HTN vs secondary.

2. 47 year old women with 10 week history of cough. Had a DVT treated with warfarin 6 months ago. Non-smoker. Examination has no abnormalities. Chest X-ray shows 3-cm peripheral lesion. What is the diagnosis?
a. Adenocarcinoma
b. bronchiolitis obliterans with organizing pneumonia
c. chronic idiopathic pulmonary fibrosis
d. pneumoconiosis
e. sarcoidosis
f. small cell cancer
g. squamous cell cancer
h. TB

Female, non-smoker, peripheral lesion=adenocarcinoma

Guessing this one is adenocarcinoma but I didn't go with that one originally because age was 47

3. 37 year old female with 6 week history of puffy eyes and swelling of her legs. Heavy bleeding with menses and increasing pain in arms and legs for the past 6 months. Menses are regular 28 days. No PMH. Takes a multivitamin and calcium carbonate. Had 12 pound weight gain in last 3 months. BMI is 25. Pulse 55, BP 100/70. Exam shows periorbital edema, distant heart sounds, mild tenderness in upper/lower extremities, 2+ edema to calves. Pelvic exam normal. Labs show Na 130, K 3.8, BUN 10, Cr 1, Cholesterol 300, CK 130. What is next best step in diagnosis?
a. HIV
b. CA 125 concentration
c. Serum FSH concentration
d. Serum Glucose
e. Serum TSH
f. Muscle biopsy

Hypothyroid? Yep. Weight gain, low pulse/BP, periorbital and pretibial myxedema.

4. 62 year old women with 2 day history of confusion. Has HTN and DM2. Takes ramirpril and glipizide. Oriented to person but not time or place. Physical exam including neuro is normal. Hematocrit 24%, WBC 3400 (65% neutrophils, 35% lymphs), Ca 13.0, Cr 2.0, Total Protein 9.5, Albumin 4.5. What is next step in management.
a. CT scan of head
b. cefepime
c. IV normal saline
d. lumbar puncture
e. hemodialysis

Treatment for severe, symptomatic hypercalcemia is IV NS.

5. 22 year old man 2 days after closed head injury in MVA. CT scan on admission normal. Received D5 with .45% normal saline. Mental status last 12 hours has been normal. Urine output 50ml/hr last 24 hours. Physical is normal. Labs show sodium 120 and urine osmolality 340. What is next step?
a. fluid restriction
b. CT head
c. ADH
d. bolus normal saline
e. bolus 3% saline

I put 3% because it was a head injury and thought you didn't want to risk cerebral edema but I'm guessing they were looking for fluid restriction?

3% is used for severe hyponatremia manifesting with risks of herniation including altered mental status and seizures. In his case, his mental status is fine, CT is normal, kidney function is good base on urine output, so just water restrict.

6. 52 year old women with polyuria and polydipsia. Takes HCTZ for HTN for 8 years; current BP 120/80. Labs show Na 148 and Cl 110. Water deprivation test done. Over 5 hours urine osmolality increases from 200,250,300,380,400,400 and serum 285, 288, 290, 295, 298, 300. Given desmopressin and urine osm increases to 1000. What is cause of polyuria?
a. HZTZ induced nephrogenic DI
b. Central DI
c. idiopathic neprogenic DI
d. primary polydipsia
e. salt-losing nephropathy

I'm guessing the answer is central DI but I wasn't sure because the urine osm was increasing. I always thought it had to increase less than 50 for it to be considered DI.

The rapid inc in urine osmolality post ADH administration suggests central DI.

7. Lady weeding and fertilizing and develops rash on face, neck and hands. She used sunscreen but no insect repellant. Was scratched by multiple rose bushes. Has bright red papules, vesicles, and bulla, some in linear arrangement on forearms, face, and neck. Wrist has oozing vesicles. What caused this?
a. fertilizer
b. weeds
c. rose bush
d. sun
e. insects

linear vesicles=contact dermatitis, probably from brushing up against weeds. Rose bush sporothrix causes an ulcer and spreading lymphangitis

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[MDSlacker]

Thanks!

 

[freeski]

Just got shelf results today. You have to make 85+ baseline to honor at my school, and a 93+ if you haven't gotten all honors evals.

Scaled: 99, 97%(dunno if this is raw score or percentile?)

I did SUTM, UWorld, MKSAP. Did each resource 2x, looking through stuff I highlighted in SUTM and my questions and answers for UWorld, MKSAP5, making notes about stuff I kept forgetting. Also reading up on my patients of course. The day before I looked at this resource, which I found extremely helpful.

http://atsvid.uthscsa.edu/Mediasite/Play/e18ac39b61e74147a92557429c4672ff

I also did the 2 NBME practice tests, got 99 on both, one taken two weekends before the test, the other taken one weekend before. They were helpful to review and remind me about some obscure stuff that wasn't in other resources.



Didn't really have an issue with time, I had been practicing spending a minute or less on each question. Ended up taking a bit longer than that on the real thing, but had about 30 minutes to review my test which was enough.


Not too many suprises, lots of cardio, pulm, renal. I recall maybe two surgery questions thrown in. Three questions regarding DVTs. There was also a question about recognizing Wallenburg's syndrome. Also recall some electrolyte questions I didn't know(tremor in a rehabilitating alcoholic that wasn't delirium tremens).

Know that beta blockers should be titrated to HR around 60, and adding more won't be effective to treat HTN past that.

Good luck to everyone who still has medicine to come!

I say this with the best of intentions: how do you have time to go through all of those resources twice? I swear I'm not trying to be derogatory, I'm honestly just curious. Sometimes I find it difficult to make time to study during rotations.

 

[RectalProlapse]

Scaled score 99

Uworld IM ?'s (91%), Mksap ?'s, Most of SUTM throughout the rotation, ~40% of First Aid Internal Medicine, the IM section of MTB step 2- 3 days before shelf. Also 98 on both of the IM NBME assessments


Aaron
Saba University School of Medicine

 

[crimsonkid85]

What the heck, everybody is scoring so ridiculously high on the MEDICINE shelf!! I think that's amazing -- but it make me super worried about this shelf b/c I feel like there's almost no time to study....sigh.

 

[Stellar Clouds]

What the heck, everybody is scoring so ridiculously high on the MEDICINE shelf!! I think that's amazing -- but it make me super worried about this shelf b/c I feel like there's almost no time to study....sigh.

People don't typically post on here saying they did ****ty. Learn from what is done with your patients, do lots of questions (+/- SUTM if you want some sort of supplemental reading), and you will be fine.

 

[FutureDoctor015]

Hey does anyone know where I can find answers to the first practice exam for medicine clinical mastery series self-assessment exam?

 

[g8orlife]

Damn... Just finished the shelf and felt like I didn't know half the answers. Just didn't know the exact answer when narrowing down. It wasn't even super complex besides the long stems and time-crunch. I made soooo many easy mistakes (looking them up now). This sucks because I improved so much in second year and did well on step 1.

Ok. Sorry. Just wanted to cyber vent b/c it's too early for happy hour.

 

[Stellar Clouds]

Damn... Just finished the shelf and felt like I didn't know half the answers. Just didn't know the exact answer when narrowing down. It wasn't even super complex besides the long stems and time-crunch. I made soooo many easy mistakes (looking them up now). This sucks because I improved so much in second year and did well on step 1.

Ok. Sorry. Just wanted to cyber vent b/c it's too early for happy hour.

It's never too early for happy hour--especially after a shelf exam

 

[g8orlife]

It's never too early for happy hour--especially after a shelf exam

Ha! True that.

 

[Hopeful Dr]

Damn... Just finished the shelf and felt like I didn't know half the answers. Just didn't know the exact answer when narrowing down. It wasn't even super complex besides the long stems and time-crunch. I made soooo many easy mistakes (looking them up now). This sucks because I improved so much in second year and did well on step 1.

Ok. Sorry. Just wanted to cyber vent b/c it's too early for happy hour.

How did you study? What would recommend studying? please post when you get your score. Thanks!


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[g8orlife]

How did you study? What would recommend studying? please post when you get your score. Thanks!


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I didn't think you'd want advice from me since I don't think I performed well... But sure, I'll post when I get my score.

 

[g8orlife]

How did you study? What would recommend studying? please post when you get your score. Thanks!


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I didn't think you'd want advice from me since I don't think I performed well... But sure, I'll post when I get my score.

 

[g8orlife]

How did you study? What would recommend studying? please post when you get your score. Thanks!


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I still have no idea why you want my advice since I told you that I didn't feel comfortable with the exam, so I'll keep it short.

Got an 85, which is the worst NBME score I've had since starting subject NBMEs @ school last year. But, since I didn't think I even scored an 80% and my school honors at 78, I'll take it.

Studied by watching Kaplan vids, doing MKSAP, and annotating MTB for 2 months. Then, did all of UW in 1 month (on random x 3 wks, systems x 1 wk).
I recommend doing at least these sources (and doing SUTM), but in a manner/learning-style that works for you. I wish I studied in systems based during the entire last month, b/c although that method is not a popular one, it works for me.

 

[g8orlife]

People don't typically post on here saying they did ****ty. Learn from what is done with your patients, do lots of questions (+/- SUTM if you want some sort of supplemental reading), and you will be fine.

+1

 

[startswithb]

I still have no idea why you want my advice since I told you that I didn't feel comfortable with the exam, so I'll keep it short.

Got an 85, which is the worst NBME score I've had since starting subject NBMEs @ school last year. But, since I didn't think I even scored an 80% and my school honors at 78, I'll take it.

Studied by watching Kaplan vids, doing MKSAP, and annotating MTB for 2 months. Then, did all of UW in 1 month (on random x 3 wks, systems x 1 wk).
I recommend doing at least these sources (and doing SUTM), but in a manner/learning-style that works for you. I wish I studied in systems based during the entire last month, b/c although that method is not a popular one, it works for me.

Your school honors at 78? What percentile is that? Probably around 60th. Our school honors at 85 and our clerkship average was 80...

 

[g8orlife]

Your school honors at 78? What percentile is that? Probably around 60th. Our school honors at 85 and our clerkship average was 80...

Yep. While reading this thread, I noticed that my school may have a lower cutoff. I don't know the percentile, b/c we weren't given it nor an average. I did hear during orientation, though, that actual honoring is at least an 86; but that's after our score is scaled/adjusted, so the 78 is scaled to an 86. ... Something like that. Again, I don't know the details behind the grading, so I can't explain it.

 

[g8orlife]

... Thinking about it further, it makes more sense. My school likely gave us our score BEFORE the school adjustments (so we actually got the raw NBME-scaled score), b/c we got it 1) early (released to us within 2 days), 2) there were no percentiles nor averages, and 3) I agree, the honor cutoff seems pretty low,

So, your school likely gave you your score after the school-made adjustments. So, if my thinking is correct, then my actual final score (which I would've been given at your school) is actually in the 90s (likely ~93).

 

[g8orlife]

just got my results back. Got 100 (not sure, this might be curved by my school), 96th Percentile...

^^ FIREitUP's quote would confirm my thinking above.

So, in summary, my school's actual honor is 86 and I'll end up with a 93.

 

[Hopeful Dr]

Questions from NBME 1 that I wasnt able to figure out.

A 32-year-old man comes to the physician for a routine examination. His last office visit was 5 years ago in another community. He underwent an appendectomy 8 years ago. There is no personal or family history of serious illness. Examination shows no abnormalities. Which of the following is the most appopriate screening test for this patient?
A) Test of the stool for occult blood
B) Measurement of serum cholesterol concentration
C) Measurement of serum glucose concentration
D) Complete blood count
E) ECG

A 67-year-old woman comes to the physician because of a 2-day history of passing 12 watery stools daily. She has no other history of abnormal bowel function. Two weeks ago, she was treated in the hospital with antibiotic therapy for right lower lobe pneumonia. She had a myocardial infarction 5 years ago. She underwent a total abdominal hysterectomy 18 years ago for bleeding leiomyomata uteri. She has a 20-year history of rheumatoid arthritis. Current medications include prednisone and aspirin. She appears lethargic. Her temperature is 39.1°C (102.4°F), pulse is 120/min, respirations are 18/min, and blood pressure is 98/68 mm Hg. Examination shows decreased skin turgor. Abdominal examination shows distention and right lower quadrant tendemess with voluntary guarding. Laboratory studies show. Hemoglobin 11.8 g/dL Hernatocrit 36% Leukocyte count 18,900/rnm Platelet count 325,0000mm Serum Na. 149 mEq/L K 3.1 mEq/L Cl- 90 mEq/L HCO5- 32 mEq/L
Flexible sigmoidoscopy shows pseudomembranes. Which of the following is the most likely cause of this patient's current symptoms?
A) Autoimmunity
B) Bowel ischemia
C) Electrolyte imbalance
D) Inflammatory bowel disease
E) Ingested spores
F) Perforation of the colon


A 67-yearold man comes to the physician because of four episodes of regurgitating undigested food after meals during the past 4 months. During the past year, he sometimes has had a vague sensation of solid food sticking in his throat and sometimes has heard gurgling when swallowing. He has not had weight loss. He has hypertension and type 2 diabetes mellitus. Current medications include metoprolol, furosemide, and glyburide. He is 170 cm (5 ft 7 in) tall and weighs 104 kg (230 lb), BMI is 36 kg/m2. The thyroid gland and cervical lymph nodes cannot be palpated due to obesity Rhonchi are heard over the right lower lobe. Abdominal examination shows central obesity with no tenderness or masses. Which of the following is the most appropriate next step in diagnosis?
A) Barium swallow
B) Gastric-emptying scintigraphy
C) CT scan of the neck
D) Esophageal manometry
E) 24-Hour monitoring of esophageal pH

Thanks so much for your help!

B. cholesterol screening in healthy people is q5 years starting age 20

Not sure, I put bowel perf and that's wrong. Anyone else???

A. I don't what this guy has, but this was the right answer. Looks like he is aspirating from the rhonchi.


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[MEN2C]

So if I have like 10 days and all I need is to get like a 64 on the shelf, which resource(s) should I use?

Will Case Files and MKSAP be enough?

 

[Hopeful Dr]

Thanks for the response

You clearly got the questions right, but screening at age 20 is only indicated for people at high risk of CHD (http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm).Otherwise it should start at 35 in men.

Sorry about that, I was going by what was in SUTM and they actually references USPSTF.........


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[Hopeful Dr]

If you haven't already, please post your scores on the practice NBME exams (CSMS) and your actual shelf score. Uworld percentage would help as well. Thanks in advance!

 

[lesterfreamon]

NBME 1 Self Assessment question help please! Let me know if you need more information about each question.

The 42 y/o with random muslce weakness, babinski sign on the right. I just saw the CK activity and put polymositis, but after reading it, I'm assuming its ALS?
Is elevated serum CK activity common with ALS?

77 y/o with progressive swelling of ankles for 1yr and SOB w/ exertion for 3months. I figured with the mitral annular calcifications, she was having some mitral insufficiency. But I'm assuming its LV diastolic dysfunction? Even though there is no JVD?

72 y/o with 12 hours of chest tightness, SOB, and paroxysal nocturnal dyspnea. What is the mechanism of the dyspnea? I have no idea. Increased parenchymal elasticity? Smooth muscle contraction?

32 y/o previously healthy with 6wks of SOB, fatigue and intermittent palpitations, with RV enlargement, dilated pulm artery and increaed pulmonary vascularity? I'm assuming its pulmonary vasospasm with the intermittent palpitations? Not a chronic pressure overload on the RV 2/2 pulmonary hypertension?

52 y/o alcoholic, unable to move lower extremities, oliguria with only a small quantity of bloody urine on bladder catheterization. No clue.. botulism? myasthenia gravis? spinal cord compression? I chose guillain barre... wrong

57 y/o with leg pain, warmth and tenderness over left anterior tibia; increased cortical thickness w/ anterior bowing of tibia and no periosteal reaction; alk phos 100; Whole body bone scan has several areas of increaed uptake, including tibia. What is the cause of these findings? again... no clue lol. Can anyone explain this? areas of spindle cells and dysplastic bone vs decreased bone mineralization vs deecreased osteoid production vs increased bone turnover.

67 y/o who had taken antibiotics and know with pseudomembranes on flex sigmoidoscopy, 2 day history of watery stools, febrile, tachycardic, hypotensive, RLQ tenderness with voluntary guarding. What is the cause of the symptoms? I put colonic perforation... wrong. Bowel ischemia? Other options are autoimmunity, electrolyte imbalance, IBD, ingested spores

22y/o with asthma who was wheezing and did not respond to inhalation of beta agonist. he just had a sore throat, congestion and mild cough for 3 days. what do you give him to prevent relapse. inhaled ipratropium? other options incldue oral antibiotis, oral steroids, oral theophylline, and inhaleld cromolyn sodium. does the infection history not matter? i thought treating the underlying precipitating cause of infection is the most important so i put antibioitics.

Screening test in a 32 y/o whose last office visit was 5 years ago? thats serum cholesterol right? but are there no regulations for screening for glucose?

Thanks!

 

[crimsonkid85]

Oh god, I just took the IM shelf today, and boy, was it a freaking **** show. Every question that I am looking up I am getting wrong. Ughhhhhhhhh......well, I guess I can always do a post about how NOT to study lols.

UPDATE:

well, I actually got a 89% on it, which is kind of disappointing, but it was enough to honor my clerkship. thank god for my evals....

 

[WingedDragon]

Is there a compiled list of answers for the NBME practice tests?

 

[anka24]

Are there different versions of the Shelf administered on the same day? I also took it on Friday and got random ass questions about crop dusters and when to ethically take someone off dialysis.

 

[MedicalBeast]

NMS Medicine Casebook vs Step-Up to Medicine.

I can't decide which book to buy.

 

[tripwm]

Took the shelf on the 20th, got a 96 on the real thing scaled. 98 on both NBMEs and 84 on Uworld.

Some random questions with a picture of some disgusting penis, another with like anthrax poisoning, really random.

Read step up to medicine 11 months earlier during my surgery rotation
just did Uworld 1x + incorrects
MKSAP 5
MKSAP 4 0.8x (didnt finish)
USMLEasy all IM questions
read a bit about my patients, enough to get by, wasnt trying to know everything about every disease, aint nobody got time for that

Just doing questions over and over again is great for the shelf, but you really dont learn anything. You just know how to do well on the shelf, which is all i wanted. Good luck to everyone.

How the hell did you already get your score back? I figure I won't see my scores till next week with these holidays.

 

[ratherbefishing]

Looking through the last few pages, the average SDN raw score is in 80's - haven't seen anyone post below a 77. SDN bias in effect...

When people say XX raw, does that indicate XX out of 100? That is, did people with a raw of 95 miss 5 questions?

 

[tripwm]

Looking through the last few pages, the average SDN raw score is in 80's - haven't seen anyone post below a 77. SDN bias in effect...

When people say XX raw, does that indicate XX out of 100? That is, did people with a raw of 95 miss 5 questions?

Supposedly, NBME shelf exams are set up for a raw score average of 70 (out of 100) with an SD of 8. My school tends to be below national average, but we score 70-72 as a class. This makes me think the true average is around a 75 (no data to back this up). As I have not yet received anything official from these sources following the exams, I'm unsure if the percentiles or means are recalculated for every set up exam takers like the USMLE. Supposedly, I've scored in the 99% on both my surgery and pediatrics shelf exam with raw scores in the mid 90s. I find this very unlikely as I scored around 90th% for my Step 1, and I don't think I've improved to that extent.

Another issue is that some schools only report your percentile, your true raw score, or the score they will give you (meaning if you get a 70/100, you earn a 75% or something similar). It's very reporter biased. We are given raw score, percentile, and score you will be given in the class for your NBME. Again, I'm not given any official NBME score statement, so the accuracy is debateable.

 

[tripwm]

we take it on the computer, so the results come back pretty fast.

As do we. I guess we have lazy whoevers that are sent the scores.

 

[Wordead]

As do we. I guess we have lazy whoevers that are sent the scores.

Some schools pay for faster turnaround, others don't.

 

[bypass123]

93 Scaled 96th Percentile
Read about 100 pages of Step Up, retained almost nothing.
Only did questions after that.
First Aid Q&A - Did all relevant questions, decent questions to start out with.
Pre-Test - Did all 500 questions, pretty good resource that covered some important minutiae.
MKSAP 5 - Did 2/3 of all questions. Good questions but very basic/easy compared to the shelf.
UWorld - 78%. All IM questions except neurology which, fortunately, was extremely low yield on my shelf. Handful of questions were identical to shelf. By far the most important resource.

 

[PBMCs]

Got a 97 and thought the test was pretty easy.

-GI, ID, ambulatory sections from Step Up (I thought this book was difficult to read in that it didn't flow well and was just fact after fact which didn't help me retain much, pretty useless overall)

-Case Files- this series hasn't failed me yet. I usually read it once through 2-3 weeks prior to a shelf, and then go back and read the Next Step, Considerations, and Clinical Pearls sections a few days prior to the shelf.

-MKSAP 5- I did all except the General IM section

 

[Lavan]

Will vouch that it's possible to get a 99 using Case Files at the very beginning followed by UW alone. As always, UW is most important. There are a ton of IM questions, so give yourself plenty of time to make the most of them.

 

[tripwm]

95/100 raw. We were not given percentile or the grade our class assigned us.

Resources:
Throughout rotation
-MKSAP 4/5- used weekly in conjunction with weekly learning concepts (we have no assigned reading, just subjects that we are quizzed over, i.e. Cardiology). Did not do use the Gen medicine chapters.
-Step Up to Medicine- read during rotation
-Step 2 CK IM QBank- all 1,300 with the exception of Neuro, Optho

Week before the test
-NBME Subject exams the day before, didn't see any repeats
-High Yield Medicine by Emma Ramahi (video presentation, ~2 hr long)
-Step 2 CK IM missed and flagged questions
-Master the Boards Step 2 CK-Internal Medicine, Preventive Medicine, Dermatology sections- read it in 2 days without taking notes the weekend before

 

[g8orlife]

Some schools pay for faster turnaround, others don't.

How do you know that? Where'd you read that?

 

[Wordead]

How do you know that? Where'd you read that?

My clerkship director said that.

 

[srikanp]

those of you who read MTB are you all talking about MTB internal medicine ( meant for the ABIM boards) or MTB for step 2?

 

[FlowRate]

Supposedly, NBME shelf exams are set up for a raw score average of 70 (out of 100) with an SD of 8. My school tends to be below national average, but we score 70-72 as a class. This makes me think the true average is around a 75 (no data to back this up). As I have not yet received anything official from these sources following the exams, I'm unsure if the percentiles or means are recalculated for every set up exam takers like the USMLE. Supposedly, I've scored in the 99% on both my surgery and pediatrics shelf exam with raw scores in the mid 90s. I find this very unlikely as I scored around 90th% for my Step 1, and I don't think I've improved to that extent.

Another issue is that some schools only report your percentile, your true raw score, or the score they will give you (meaning if you get a 70/100, you earn a 75% or something similar). It's very reporter biased. We are given raw score, percentile, and score you will be given in the class for your NBME. Again, I'm not given any official NBME score statement, so the accuracy is debateable.

The NBME shelf scores were scaled to 70 +- 8 in the early 90's. Since then, people have done something such that they do better on the boards (more competition, better prep materials, etc.) but the scaling hasn't changed. That's why the actual averages these days are in the mid-high 70's for most clerkships.

Most schools use data from the past 2 years where they compare their current cohort against the historical cohort for purposes of determining a percentile.

 

[vsl5]

Hey guys I have a quick question about resources used as I have multiple books but probably not enough time to go through most of them so I'd like some advice on which books to ditch. I have SUTM, NMS Medicine (not casebook), Case files IM, and Pre-test medicine. Which ones are not worth going through? Also, I have the 2nd edition of SUTM not the 3rd, has this been any issue for any of you? Thanks.

 

[Lavan]

I'd say SUTM and Case Files with UW questions is probably a good bet. The old version should be fine.

 

[Benesyed]

Hi,

I took the second Medicine NBME exam and had some more questions that I was hoping someone could help me out with. Thanks in advance.

1. Overweight 65 year old male who smokes 1 pack per day. Brother died of CVA and parents died at 40. BP is 150/102, he has grade 2 hypertensive retinopathy, and PMI is displaced 2cm laterally. Which lab test is best for initial assessment?
a. Plasma renin
b. serum aldosterone
c. Serum creatinin; eval kidney function (second guess would be E)
d. urine metanephrine
e. urinary sodium/creatinine ratio

2. 47 year old women with 10 week history of cough. Had a DVT treated with warfarin 6 months ago. Non-smoker. Examination has no abnormalities. Chest X-ray shows 3-cm peripheral lesion. What is the diagnosis?
a. Adenocarcinoma; hypercoag state + 3cm lesion + non smoker
b. bronchiolitis obliterans with organizing pneumonia
c. chronic idiopathic pulmonary fibrosis
d. pneumoconiosis
e. sarcoidosis
f. small cell cancer
g. squamous cell cancer
h. TB

Guessing this one is adenocarcinoma but I didn't go with that one originally because age was 47

3. 37 year old female with 6 week history of puffy eyes and swelling of her legs. Heavy bleeding with menses and increasing pain in arms and legs for the past 6 months. Menses are regular 28 days. No PMH. Takes a multivitamin and calcium carbonate. Had 12 pound weight gain in last 3 months. BMI is 25. Pulse 55, BP 100/70. Exam shows periorbital edema, distant heart sounds, mild tenderness in upper/lower extremities, 2+ edema to calves. Pelvic exam normal. Labs show Na 130, K 3.8, BUN 10, Cr 1, Cholesterol 300, CK 130. What is next best step in diagnosis?
a. HIV
b. CA 125 concentration
c. Serum FSH concentration
d. Serum Glucose
e. Serum TSH; sounds like hypothyroidism
f. Muscle biopsy

Hypothyroid?

4. 62 year old women with 2 day history of confusion. Has HTN and DM2. Takes ramirpril and glipizide. Oriented to person but not time or place. Physical exam including neuro is normal. Hematocrit 24%, WBC 3400 (65% neutrophils, 35% lymphs), Ca 13.0, Cr 2.0, Total Protein 9.5, Albumin 4.5. What is next step in management.
a. CT scan of head
b. cefepime
c. IV normal saline; start fluids for hypercalcemia (clinical presentation + Ca levels)
d. lumbar puncture
e. hemodialysis

5. 22 year old man 2 days after closed head injury in MVA. CT scan on admission normal. Received D5 with .45% normal saline. Mental status last 12 hours has been normal. Urine output 50ml/hr last 24 hours. Physical is normal. Labs show sodium 120 and urine osmolality 340. What is next step?
a. fluid restriction; rx asymp ADH (trauma to head can cause SIADH)
b. CT head
c. ADH
d. bolus normal saline
e. bolus 3% saline

I put 3% because it was a head injury and thought you didn't want to risk cerebral edema but I'm guessing they were looking for fluid restriction?

6. 52 year old women with polyuria and polydipsia. Takes HCTZ for HTN for 8 years; current BP 120/80. Labs show Na 148 and Cl 110. Water deprivation test done. Over 5 hours urine osmolality increases from 200,250,300,380,400,400 and serum 285, 288, 290, 295, 298, 300. Given desmopressin and urine osm increases to 1000. What is cause of polyuria?
a. HZTZ induced nephrogenic DI
b. Central DI
c. idiopathic neprogenic DI
d. primary polydipsia; if it was any sort of DI no amount of concentration would really be seen; the fact taht she concentrates urine in response to deprivation indicates something else is going on. But i am not sure. I forget the cutoffs
e. salt-losing nephropathy

I'm guessing the answer is central DI but I wasn't sure because the urine osm was increasing. I always thought it had to increase less than 50 for it to be considered DI.

7. Lady weeding and fertilizing and develops rash on face, neck and hands. She used sunscreen but no insect repellant. Was scratched by multiple rose bushes. Has bright red papules, vesicles, and bulla, some in linear arrangement on forearms, face, and neck. Wrist has oozing vesicles. What caused this?
a. fertilizer
b. weeds; contact derm?
c. rose bush
d. sun
e. insects

 

[change77]

1 week left until I take it. Been using SUTM, Uworld, and am now going to start the MKSAP questions and do the NBME practice exams. I had a question about the content of the exam. Was there a lot of pharm and micro (knowing the bugs)? Or was it mostly next step in Dx and Tx? Did you feel like certain systems were more emphasized or did you feel like it was pretty even? I have been averaging 65% on Uworld (but I use it to learn from mostly) and am hoping that the shelf will be similar is style.

Any input/tips? Thanks!

 

[MedicalBeast]

how many questions are on the medicine shelf? how much time?

 

[abc12341]

MKSAP seems to be very easy whereas UWORLD is much more difficult. Is the shelf like MKSAP or Uworld?

 

[change77]

Alright, so I took the shelf today. My rotation was 8 weeks, but the first 3 weeks of inpatient were very brutal so I had little time to truly study until the last 5 weeks when I switched to only outpatient. I read all of SUTM, did all the MKSAP 5 questions, and most of the UWorld questions (did not do neuro, poisoning, derm/rheumatology so about 300 questions I did not do out of 1300) I was averaging about 65-70% on UWorld, but I do question to learn, not to predict how I am going to do. I also did both the practice NBMEs I got a 77 on the first one and a 85 on the second one. I studied based on systems which I find very helpful. Was able to re-review all my MKSAP questions but did not have time to go back though wrong questions on UWorld (the only thing I would have done differently was re go back though UWorld.. but too many questions, not enough time!)

The questions ranged from very easy (classic Lyme dz, when to use ACE, UC with sclerosing cholangitis, etc.) to wtf I never have even heard about this (weird eye infection that I thought was uveitis but that was not the answer choice, weird rashes, etc.) Most of the time I was able to narrow it down to two good choices and guess from there. Overall, it was pretty average. Not easy, but not ridiculously hard. Mostly pretty challenging. I felt lucky because my weakest subjects were not tested at all (biostats and acid base) but that could have just been luck of the draw. Not too much neuro, mostly renal, cardio, and pulm. Not sure how I am going to end up doing... I could have easily missed most of the questions I marked since I was always between 2 answers. I will edit this and let you know my results on Monday!

And to answer some questions... there are 100 questions and they are more like UWorld (mostly shorter stems though) than MKSAP but I felt like I learned different items from those two separate q banks.

 

[Sugar87]

I need some help from the first NBME:

1. A 22 year old man remains in the hospital 2 days after admission for a closed head injury sustained in a motor vehicle collision. A CT scan of the head on admission showed no abnormalities. He was initially confused, but he has become well oriented with normal vital signs during the past 12 hours. He is currently receiving 5% dextrose in 0.45% saline (50 ml/hr). He has started to eat solids during the past 6 hours. His average urine output has been 50 ml/hr during the past 24 hours. He is alert. Vital signs are within normal limits. Examination shows ecchymosis over the frontal region. The remainder of the examination including neurologic examination, shows no abnormalities. His serum sodium concentration is 120 mEq/L and urine osmolality is 340 mmOsmol/kg. Which of the following is the most appropriate next step in management?

A. Fluid restriction
B. CT scan of the head
C. ADH vasopressin therapy
D. Bolus 0.9% saline
E. Bolus 3% saline

Thanks!

 

[abc12341]

Alright, so I took the shelf today. My rotation was 8 weeks, but the first 3 weeks of inpatient were very brutal so I had little time to truly study until the last 5 weeks when I switched to only outpatient. I read all of SUTM, did all the MKSAP 5 questions, and most of the UWorld questions (did not do neuro, poisoning, derm/rheumatology so about 300 questions I did not do out of 1300) I was averaging about 65-70% on UWorld, but I do question to learn, not to predict how I am going to do. I also did both the practice NBMEs I got a 77 on the first one and a 85 on the second one. I studied based on systems which I find very helpful. Was able to re-review all my MKSAP questions but did not have time to go back though wrong questions on UWorld (the only thing I would have done differently was re go back though UWorld.. but too many questions, not enough time!)

The questions ranged from very easy (classic Lyme dz, when to use ACE, UC with sclerosing cholangitis, etc.) to wtf I never have even heard about this (weird eye infection that I thought was uveitis but that was not the answer choice, weird rashes, etc.) Most of the time I was able to narrow it down to two good choices and guess from there. Overall, it was pretty average. Not easy, but not ridiculously hard. Mostly pretty challenging. I felt lucky because my weakest subjects were not tested at all (biostats and acid base) but that could have just been luck of the draw. Not too much neuro, mostly renal, cardio, and pulm. Not sure how I am going to end up doing... I could have easily missed most of the questions I marked since I was always between 2 answers. I will edit this and let you know my results on Monday!

And to answer some questions... there are 100 questions and they are more like UWorld (mostly shorter stems though) than MKSAP but I felt like I learned different items from those two separate q banks.

Topics that you would highly recommend reading or were surprised were on the exam?