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Shelves/Comp Prep PlanHi everyone! Here is the study plan I used my fifth semester (it’s a long read). Just as a forewarning, there are various methods that work but this is not a cookie cutter method by any means. Be sure to know your own strengths and weaknesses because what may work for even 70% of the class may not work for you, so I was sure to stay true to what worked for me. I knew I wasn’t smart enough to study straight off questions, and knew I had a lot of content knowledge to fill, so that is why this suited me. I had classmates and friends who had variations of this and used other resources, which proved successful for them; I also had classmates use the “Tyler Gilmore” method because that worked for them- know what works for you. I am posting this because I have been asked enough times so I felt that a document you could repeatedly access might be best, or even to just give you an idea of what you’d like to do for your own study schedule (or what not to do LOL). Resources:FA 2018RxSketchy MicroSketchy PharmBoards & Beyond (for certain sections)Pathoma (book and videos)Becker Physiology (online videos on the Becker website)Dr. Cone Path I and II Reviews (Echos)Tarletons (previously annotated, especially for Pathology) NBME (online: 13, 15 and offline: 7, 12)UpToDateGolijan audio lecturesDr. Neil Biostatistics Youtube videosAnki flashcardsOverall goal: I wanted to finish a pass through FA at least once and also have finished all of Pathoma, Sketchy Micro and Sketchy Pharm at least twice. Looking back, I wish I would’ve finished all of Rx prior to Comp, but this just wasn’t feasible for me. Approach: I was doing a systems-based approach, since this is how FA is broken up. I figured since there are 10 systems, I would dedicate a week to each system and be sure to focus on all the various subjects (Anatomy, Embryology, etc) for that system in that week for 10 weeks total. I would do mixed, random questions in Rx to simulate Comp though. What a typical week would look like:Monday – Thursday: Content Review (This meant finishing the entire section in FA, watch all related Pathoma videos, watch all the associated Sketchy videos, etc). I gave myself four days because we had a lot of ICM work and I would also attend Behavioral and Ethics, so this would take time out of my day. I would also be sure to do a 20-40 Q block per day and review just to make sure I was still doing some questions and had that exposure. This was obviously the most time-consuming, as I would set X number of pages to get through per day and the Rx express videos would take a while to watch. Whenever I came across something I didn’t know, I would look it up on UpToDate. This essentially acted as my new search engine, and it is super useful but can turn into a wormhole if you keep clicking on links and reading various articles. For diseases, I would look at inheritance pattern, clinical presentation and any other important points on UpToDate.For drugs, I looked at mechanism of action and then uses, along with possible side effects on UpToDate. Friday- Saturday: I would do Qblocks and then review them. This was extremely time-consuming for me because I wanted to be as thorough as possible, so this can go as slowly or as quickly as you would like it to go. *TIP: making a “things I don’t know” document that you can review would be great to have here. Sunday: I did a group study with 2-3 close friends and we would just get an ICM room and talk through the content in that system. They focused more on Boards and Beyond videos, while I used Rx Express videos from the Rx website. See what works for you and go from there. *TIP: group study is only as productive as you make it. It’ll take all day if you are thorough, but that’s okay, as long as you are actively teaching each other instead of just passively reading out loud. Anyone can do that. ICM rooms were great because we would draw on the board. Challenge each other! Confirm resources and be sure that you are all sharing accurate information. Some chapters were much shorter than others, so I would add on one of the units in the beginning of the systems section in FA. For example, since I knew “Respiratory” was 27 pages long, I also added on “Immunology” to knock out more sections per week. Daily Schedule (this is what an *IDEAL* sample day looked like for me):Wake up 7/7:15 AMShower and cook breakfast, lunch and dinner (still tried to be healthy until it all went to hell the last two weeks before Shelf exams lol). Listened to a Golijan audio lecture while cooking to passively absorb his high-yield information instead of listening to Spotify or something. Get ready for ICM (Dr. Farooqi was particular about us arriving at certain times, and many days we began at 8:45 AM so I would leave my place around 8:30 to give myself enough time to settle in before we began our small group sessions). ICM Small group 9-11 AM (most days we ran a bit over)Lunch breakBehavioral class 11:40 AM- 1:30 PM FINALLY sat down to begin studying after getting some coffee around 2 PM. This is LATE. I know. I am the type of person who needs to go to class to absorb information, and I enjoyed the lectures we had in both Behavioral and Medical ethics. Again, if you like to Echo or just read off slides, then so be it. Study until 5/5:30 PM and then take a dinner break. 6:15 PM-11 PM continue studying (the library closed so we would get kicked out around this point). Gym 11 PM- 12 AM (3-4x a week)Come home, shower and continue studying until about 2-2:30 AM. Prepare for the next day. Some people cannot function on less sleep, or cannot study late etc. This was suitable for me, and I realized that in order to stay on top of all my daily tasks, I made sure I didn’t go to bed before finishing my daily tasks. This may seem like overkill, but remember that I didn’t start studying until much later because of classes. The plus side to attending lectures was that I didn’t need to review Behavioral as much per week, but the downside is that this was during prime study time. Diagnostic: you will be told to take a diagnostic exam your first couple of weeks into the semester; most people end up doing either NBME 13 or 15. Do not panic if you fail! It was a huge wake up call for me, but I also realized that while I was answering most questions, I knew two or three things to get to the answer but then was missing that final tidbit of knowledge to narrow down between one answer choice or the other. For me, content was the biggest issue. Hence the importance I gave to reviewing material over learning from questions straight. I took another diagnostic about 4 weeks later, and I ended up passing. This was a huge increase in my score, and it helped my confidence in knowing that my studying was taking me somewhere. At this point, compare your diagnostic and your NBME. If you are still doing poorly in systems that you’ve reviewed, then clearly you need to do something differently. If you increased in performance then congrats! You’re doing something right.Becker Simulation test: I took the Becker Simulation test, not really keeping any expectations. Everyone above me had said that this was a really difficult exam and that it’s “demoralizing” etc but I somehow ended up doing a lot better than I expected (most likely a fluke LOL). How accurate is this projected Step score? We’ll find out next March Days off: To be quite honest, I really had no days off. I landed, co-hosted the white coat afterparty as is tradition for fifth semester class reps to host for the incoming firsts, and then began the Monday after. Thanksgiving and my birthday I did “half days” and that was alright with me, because you do need to breathe. I still grabbed food with friends at restaurants, or an occasional movie, but I did a lot less than I normally would have any other semester. Prioritize accordingly. NBME Physiology shelf: Need 63% to pass.First thing I do when I have sheer panic- I go on Reddit and read the posts to mentally prepare myself. Between posts like “hardest exam you’ll take” and “WTF even was that”, I was definitely having anxiety attacks. I had been preparing for Comp all semester, and since I finished content review early November, I was just doing Qblocks and reviewing, and threw in the occasional offline NBME from lending library. The last 5 days before the Physiology shelf, I switched to only focusing on Physiology, since this and Path are my two weaker subjects (go figure). I had started BRS, but it was too dry, so I switched to Becker videos. That is a MARATHON. I somehow finished all the videos but I made sure to really understand what they were explaining. I had at least 3-4 questions on the shelf that were DIRECTLY from Becker. Additionally, I also did BRS questions at the end of each chapter, just as a quick review of fundamentals. I did BRS GI Physio the morning of the shelf and probably got most, if not all, the questions from BRS Physio for that system. My advice looking back? Nothing can really prepare you for that exam completely. You will walk out feeling defeated and wondering if you should even bother studying for the Path shelf. Becker Physiology was great for me, as was BRS. If you have time to read BRS, then READ IT. If you don’t? At least look over the graphs- The Frank Starling curves are $$MONEY$$ in FA and KNOW YOUR ARROWS.I would do Rx questions nightly just to be sure I was still getting question exposure in. 58597-63500NBME Pathology shelf: Need 67% to pass. I’m going to do y’all a favor right now and tell you to know your immunology, microbiology, biochemistry and histological descriptions for Pathology. I think the shell-shocked attitude of our class was because no one was really prepared for a plethora of subjects when we were told this was a pathology shelf lol. Oh yea, know your respiratory burst hint hint. CD markers? Know them. Aldosterone/ADH sounds like renal physiology? Know it anyways. Alveolar gas concentrations? Yup, know that too. It was definitely a strange exam but because of my spastic nature of reading Reddit posts, I knew it was going to be heavy on all the other subjects so I made sure to focus on those. We had 48 hours to study for our Pathology shelf, so this needed some prioritizing. Dr. Lance Miller had sent out our question breakdowns and there was NO way I could literally get through all of Pathoma, so I prioritized based on how many questions would show up for each section. General principles was the largest, and this entails: Immunopath, Neoplasia, Reversible/Irreversible cell injury (basically the first 4 chapters of Pathoma). I made sure to read over these pages, then watch the corresponding Dr. Cone reviews. I used my old handwritten charts and diagrams for certain sections (breast, male genitalia, CNS tumors, etc) because I had made them based off the Pathoma chapters. If you’re weaker in Renal, then READ Pathoma. The text in that book is SO specific and detailed and will definitely aid you in the Path shelf. *Note the Shelves are 125 Qs not 123 Qs as written in the images*28604513405900Comp: Need a 67% (192~194) to passFor our class, if you passed both Shelf exams then you still needed to sit for Comp but were not required to pass it! This was a huge relief because I think the pressure of needing to pass might have caused me to make a lot of silly mistakes as I’m a bad test taker as it is and tend to change my answer choices once I see all the options. If you’re like me, then come to the answer without looking at the answer choices and go with your gut (I’ve learned better than to go against my gut lol). In my opinion, I felt that comp was a lot more fair and less nitpicky than the shelf exams; the questions were broader and all-encompassing, whereas Pathology and Physiology shelf exams would kind of throw me for a loop. I think having shelf exams first was a blessing and a curse, because it allowed me to sit for this exam with less stress, but it is stressful needing to pass two exams instead of one. Be sure to take this exam as seriously as possible because 1) you have it scheduled prior to shelf exams (lol) and 2) allow it to gauge an equivalent Step score. 6285473203100Final words:This document is 90249029 pages long because I am neurotic about organizing my tasks and assignments and like crossing chapters or sections off when I’m done with them. I have included every breakdown of the major resources I have used so that if you’re as neurotic as me, this may help you plan your study schedule. I have not started UWorld, I plan on doing that now that I will begin Step prep. If you want to use UWorld and go directly from there, then do it! Again, do what works for you. Seriously. Knowing myself, I was a pretty average student so I knew where I stood- did well in some classes, could’ve done better in others but Ps GET DEGREES (jk study harder for your classes if you can). RTFQ. I literally got trigger happy and would click questions I thought I had in the bag but missed one crucial component and felt like an idiot afterwards. Don’t resource overload. I found myself in that mess and currently have Anki sitting on my laptop because I panic-downloaded it during an SGA meeting. I use it to make flashcards of my missed questions on Rx because of advice from a friend and it helps! FA is in alphabetical order of systems. If you know you’re weaker in certain systems, then I recommend going out of order of the book and doing those first. It’s tempting to want to go over stuff you know, but that only gives you false confidence. Miss those questions in Rx when you’re studying or in UWorld or whichever resource you choose so that you don’t miss it on Comp/Step. I took the break prior to fifth semester off. I wanted to become revitalized before starting so if you are like me and are afraid of burn-out, then taking break off is fine. Use this time to create a schedule or a plan and to stick with it prior to beginning fifth semester!The following pages are just each resource broken down by section. Good luck, enjoy, and please feel free to reach out to me with any other questions you may have!~Madhura~First Aid 2018Section IIBiochem: pg 33- 94 (61 pages)Immunology: pg 95-122 (27 pages)Microbiology: pg 123-204 (81 pages)Pathology: pg 205-226 (21 pages) Pharmacology: pg 227-250 (23 pages) Epidemiology/Biostats: pg 251-268 (17 pages)Section III Cardiovascular: pg 273-318 (45 pages)Endocrine: pg 319-350 (31 pages)GI: pg 351-394 (43 pages)Respiratory: pg 641-668 (27 pages)Hematology and Oncology: pg 395-432 (37 pages)MSK, Skin, CT: pg 433- 472 (39 pages)Renal: pg 561- 592 (31 pages)Repro: pg 593-640 (47 pages)Neurology, Special Senses: pg 473-536 (63 pages) Psychiatry: pg 537-560 (23 pages)Rapid Review: pg 669-688 (19 pages)PathomaCH 1 Cell injury Cell Death pg 1-10CH 2 Inflammation, Wound Healing pg 11-22CH 3 Neoplasia pg 23-30CH 4 Hemostasis pg 31-40CH 5 RBC pg 41-52CH 6 WBC pg 53- 64CH 7 Vascular pg 65-72CH 8 Cardiac pg 73- 84CH 9 Respiratory pg 85- 98CH 10 GIT pg 99- 114CH 11 Exocrine Pancreas, GB, Liver pg 115-124CH 12 Kidney, UT pg 125-136CH 13 Female Genitalia pg 137-150CH 14 Male Genitalia pg 151- 158CH 15 Endocrine pg 159- 174CH 16 Breast pg 175-180CH 17 CNS pg 181- 194CH 18 MSK pg 195-204CH 19 Skin/Derm pg 205-212Sketchy MicroCH.1CH.2 (gram +)CH.3 (Gram + rods)CH.4 (gram – cocci)CH.5 (gram – enteric tract)CH.6 (Gram – respiratory tract)CH.7 (Zoonotics)CH.8 (Mycobacteria)CH.9 (Spirochetes)CH.10 (Gram indeterminate bacteria)Fungi -Cutaneous Mycoses-Opportunistic Fungal infections-Systemic MycosesParasites-Helminths- Nematodes-Helminths- Trematodes and Cestodes-Protozoa- other tissue-Protozoa of blood-Protozoa of CNS-Protozoa of Intestinal tractViruses-DNA - RNA – negative sense-RNA – positive sense Sketchy PharmAnti-inflammatoryAnti-Neoplastics-Anti-metabolites-DNA and Cellular division-Kinase inhibitors, monoclonal AbAnti-microbialsAutonomic drugsBlood drugsCV drugsEndocrine drugsGIT drugsNeuro/Psych -sedative hypnotics-anesthetics and analgesics-anti-depressants and anxiolytics-mood stabilizers and anti-epileptics -antipsychotics and Parkinson’s Renal drugs Smooth muscle drugsBoards and Beyond:BiochemMolecular BiochemDNA structurePurinesPyrimidinesMetabolismGlucoseGlycolysisGluconeogenesisGlycogenHMP shuntFructose and galactosePDHTCA cycleETCFatty acidsKetone bodiesEthanol metabolismExercise and starvationInborn errors of metabolismAmino AcidsAmino acidsPhenylalanine and tyramineOther amino acidsAmmonia VitaminsB vitaminsB12 and FolateOther vitaminsLipidsLipid metabolismHyperlipidemiaLipid drugsOther topicsLysosomal storage disorderCell BiologyMolecular BiologyDNA replicationDNA mutationsDNA repairTranscriptionTranslationLab TechniquesPCRBlottingELISAMicroarrays Flow cytometryCellular BiologyCell cycleCell structureCytoskeletonConnective tissue GeneticsGenetic ConceptsGenetic principlesGene mappingMeiosisHardy-WeinbergPedigree ImprintingGenetic DisordersDown syndromeTrisomiesMuscular dystrophiesTrinucleotide repeatsDeletion syndromesTurner and KlinefelterBiostatsBiostatisticsBasic statisticsHypothesis testingTests of significanceCorrelation EpidemiologyStudy designsRisk quantificationsSensitivity and SpecificityPPV and NPVDiagnostic testsBiasClinical trials ImmunologyBasic immunology Innate immunityT cellsB cellsComplement systemLymph nodes and SpleenClinical immunologyHSRTransplantsImmune deficienciesPharmacologyGlucocorticoidsImmunosuppressantsAutoimmune disordersSLERASclerodermaSjogren syndrome Vasculitis Infectious DiseaseBasics of MicrobiologyBacteria Shapes and stainsBacterial cultureSpecial growth requirementsVirulenceGrowth and geneticsBacterial identificationBacteria StaphylococciStreptococciOther gram +Gram – rods Other gram –SpirochetesZoonotic infectionsMycobacterium AntibioticsPenicillinsBeta lactamsSulfonamidesProteins synthesis inhibitorsOther antibioticsFungi Fungal pneumoniaFungal skin infectionsOpportunistic infectionsAntifungal drugsParasites and helminthsMalariaProtozoaHelminthsVirusesViral structureDNA virusesHerpes virusRNA virusesViral hepatitisHIVHIV drugsAntiviral drugsCardiologyIntro to cardiac medicineCardiac anatomyCardiac physiologyBlood flow mechanismsRegulation of blood flowPV loopsWigger’s diagramVenous pressureStarling curveCardiac ischemia Cardiac ischemiaSTEMIUnstable anginaStable anginaEKGEKG basicsHigh yield EKGsArrhythmiasCardiac APAV and bundle branch blocksAtrial fibrillationAVNRTWPWAntiarrhythmic drugsCardiac auscultationHeart murmursHeart sounds Heart FailureHeart failure basicsSystolic and diastolic HFRestrictive cardiomyopathyAcute HFChronic HFThe Developing HeartCardiac embryologyShuntsCyanotic congenital heart diseaseCoarctation of the aortaHTNHTNSecondary HTNHTN drugs Other CV topicsValve diseaseShockPericardial diseaseAortic dissectionCardiac tumorsHCMEndocarditisThe heart in non-cardiac illnessesRenalIntro to Renal MedicineRenal embryologyRenal anatomyRenal physiologyRenal physiology IINephron physiologyRenal endocrinologyAcid-BaseAcid excretionAcid-base principlesRespiratory disordersMetabolic alkalosisRTAMetabolic acidosisAcid-base problemsElectrolytesElectrolyte disordersSodium and waterSodium disordersDiseases of the nephronGlomerulonephritisNephritic syndromeNephrotic syndromeMPGNTubulointerstitial nephritisRenal failure Other renal topicsUTICystic kidney diseasesDiureticsKidney stonesRenal and bladderRhabdomyolysisReproductiveEmbryologyEmbryonic genesEmbryogenesisGerm layersErrors in morphologyTeratogens ITeratogens IIPharyngeal archesCleft lip and palatePharyngeal pouchesGenital embryologyPregnancySpermatogenesisPlacentaTwinsPregnancyMaternal-fetal distressHTN Placental complicationsGestational tumorsTORCH infectionsHematologyHemostasisCoagulationPlatelet activationHypercoagulable statesCoagulopathiesPlatelet disorders Antiplatelet drugsAnticoagulants RBCsHemolysis basic principlesExtrinsic hemolysisIntrinsic hemolysisMicrocytic anemiasThalassemiasSickle cell anemiaOther anemiasBlood groupsWBCsALLCLLHodgkin lymphomaNon-Hodgkin lymphomaPlasma cell disordersAmyloidosisMyeloproliferative disordersCancer drugsAntimetabolitesAlkylating agentsAntitumor antibioticsMicrotubule inhibitorsDNA drugsOther cancer drugsOther topicsPorphyriasPulmonologyIntro to pulmonary medicinePulmonary anatomyPulmonary physiologyHemoglobinPulmonary circulationHypoxiaVentilation and perfusionCO2Pulmonary PEObstructive and Restrictive diseasesPFTOLDRLDTx of COPD and AsthmaOther pulmonary topics PneumoniaPleural diseaseLung cancerSleep apneaCFTBSarcoidosisPECXRGastroenterologyAnatomyGI embryologyGI anatomyGI blood supplyGITLiver, GB, PancreasSalivary glandsHernias GI PhysiologyBileBilirubinGI secretionsGI hormonesExocrine pancreasClinical gastroenterologyEsophageal disordersLiver diseaseCirrhosisLiver tumorsWilson’s diseaseGallstonesBiliary disordersGastric disordersMalabsorptionAcute pancreatitisChronic pancreatitisEndocrinologyThyroidThyroid glandThyroid disorderThyroid cancerAdrenals Adrenal glandAdrenal disorderPancreasEndocrine pancreasDiabetes InsulinTx of DiabetesReproductiveReproductive hormonesMale reproductiveFemale reproductiveMenstrual cycleOther topicsPituitary glandParathyroid glandMEN syndromes NeurologyIntro to NeurologyCells of the NSNerve damageBBBNTDermatomes and reflexesNS structuresCerebral cortexSpinal cordSpinal cord syndromesBrainstemCNAuditory systemVestibular systemThalamus, hypothalamus and limbic systemCerebellumBasal ganglia Ventricles and sinuses Neurovascular disordersCerebral and lacunar strokesVertebrobasilar stroke syndromesCNS aneurysmsIntracranial bleedsManagement of TIA-strokeANSANSANS drugs- NEANS drugs- AChThe EyePupilLensRetina Eye movementsVisual fieldsGaze palsiesStructural eye disordersGlaucoma AnesthesiaGeneral anestheticsLocal anesthesiaNeuromuscular blockersOther neurology topicsMeningitisSeizuresNeuroembryology Delirium and dementiaDemyelinating disordersHeadachesBrain tumorsParkinson’s, Huntington’s HIV CNS infectionsMedical Ethics/BehavioralEthics principlesInformed consentConfidentialityDecision-makingPublic healthQuality and safetyGeneral topics in PharmacologyEnzymesEnzyme inhibitorsDose-responseDrug eliminationPharmacokineticsDr. Cone Reviews (Path I and II):Cellular Adaptation & Cell Injury review Inflammation & Repair reviewFluid & Hemodynamics reviewImmunopathology review Neoplasia reviewBlood Vessels review Heart review Lung reviewBone & Soft tissue reviewEndocrine review RBC reviewWBC reviewBleeding Disorders reviewGestational & Placental reviewGallbladder & Pancreas reviewLiver reviewFemale Genitalia reviewRenal reviewMale Genitalia reviewGIT review IGIT review IIGIT review IIICNS review ICNS review II ................
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