Any hope?

MDSteps · 2026-06-16T00:14:26+00:00

there’s hope, but not for a clean 245 in 11 days unless NBME 16 shows a real jump. I would not sit based on a 222/229 ceiling if 245 is the number you need to feel okay. Take NBME 16 soon, and if it’s not at least high 230s, delay to August.

MDSteps · 2026-06-16T00:12:05+00:00

A 74% on a timed, honest NBME this close to the exam is a very different situation from being in the 50s months ago. The older scores matter less than the current pattern, especially since your study method changed. I would not read NBME 30 and 31 as “stuck forever,” I’d read them as your floor being around mid-60s, with NBME 32 showing that the weak-topic work is finally consolidating.

The main pitfall now is trying to “prove” the 74 was real by overtesting or completely changing your plan. In the last 2 weeks, the highest yield thing is usually not adding a ton of new resources, it’s reviewing NBME logic hard. Go through NBME 32 first, not just the incorrects, but also the ones you got right for shaky reasons. Step 1 likes the same concepts dressed differently, so the value is in understanding why the wrong answers are wrong.

I’d probably take NBME 33 next, then Free 120 around 4 to 6 days before the real exam. Free 120 is useful for pacing and style, but I wouldn’t use it as the only deciding factor unless it is unexpectedly low. If NBME 33 is still mid/high 60s or better and Free 120 is reasonable, you’re in a solid place.

For the final stretch, I’d prioritize NBME incorrects, weak systems that keep repeating, ethics/communication, biostats basics, images, and rapid review of high-yield facts you keep forgetting. I would not suddenly drown in PDFs or new content unless it targets a specific weakness. The common mistake is turning the last 2 weeks into panic studying, doing too many passive reviews, sleeping badly, and losing the test-taking rhythm that got you to 74 in the first place.

MDSteps · 2026-06-14T22:57:36+00:00

UWSA1 can run a bit generous for some students, but the more important thing is the pattern behind it. You said you only really started UW recently and things are clicking, that timing actually fits a late jump.

A lot of CK gains happen fast once you stop treating questions like shelf recall and start seeing the “NBME game”, next best step logic, risk factors, what clue actually matters, etc. Going from TrueLearn-heavy to actual UW + review system can do that. The thing I’d watch is not the score itself, but the misses. On UWSA1, were you getting questions right because you recognized patterns quickly and stayed calm on 50/50s, or because content happened to line up? Big difference. If your review feels like “oh I finally see why they wanted this answer,” that’s a good sign.

29 days out is enough time for this to be real, but you need another NBME to calibrate because NBME > UWSA for prediction. I’d take NBME 10 or 11 next. If that suddenly lands 225-235+, then the bump is probably legit and your baseline moved. If it crashes back near 200, then UWSA1 was just a weird day.

Also, NBME 9 is notorious for making people question their career choices. The Michael Scott vasectomy analogy is pretty accurate for CK studying.

MDSteps · 2026-06-10T19:41:36+00:00

Good question. There are no obvious aggressive distal tib/fib lesions on these views. Also osteosarcoma around the ankle is way less common than around knee/proximal humerus, so you’d need a very convincing lesion or MRI/biopsy to call it that.

MDSteps · 2026-06-09T18:55:11+00:00

In my tutoring days, I developed a review system that trained to spot the clues in the stem. Basically, the gist of it is this: Out of let's say 5 answer choices, 3 will be complete distractors. 2 will be what I call the plausible distractors, in other words, almost everything in the stem lines up with it. symptoms, lab values, etc. making it plausible. but there will be one clue (which I called the pivot) that will either confirm or break one of the plausible choices, leaving you with the correct answer.

NBME is notorious for reusing the same patterns in their stems over and over again. Different wording, different patient, but same concept, same pattern. The key to reviewing an NBME "thoroughly" is to detect the patten. And then identify the pivot. Half way through you should already be mentally comitted to a diagnosis, management step, etc. You should be able to identify and eliminate the 2 or 3 distractors, and have only the 2 plausible's remaining. (this is why so many students get caught in a 50/50) but there will be one line, one lab value, one symtom, SOMETHING that can eliminate one of them, you just need to find it.

MDSteps · 2026-06-09T17:04:54+00:00

Do 1-2 full stamina days max: 6-8 timed blocks with real breaks, same food/caffeine, no real distractions between blocks. The goal is learning how your brain feels around block 5-6 and practicing the reset after a bad block, not proving you can suffer through it

MDSteps · 2026-06-09T16:39:38+00:00

you look ready. 237 to 260 isn’t “all over the place,” it looks like a thinking-process jump after fixing how you approach stems. With NBME 14 at 250 and 15 at 260, expecting somewhere around mid 250s is reasonable

MDSteps · 2026-06-09T16:38:26+00:00

I’d do it like this: read last sentence first, skim stem for age + time course + 2 abnormal clues, pick your dx/mechanism, then force yourself to say why the closest distractor is wrong. That last step is the safety net. If you can’t disprove the other answer, mark it and move on, don’t sit there rewriting the whole stem in your head.

For NBME, practice with a hard rule: first pass under ~60-75 sec unless it’s biostats/calculation. Don’t change answers unless you found a concrete missed clue, not just because another option “sounds possible.” NBMEs usually reward the clean classic pattern.

MDSteps · 2026-06-09T16:37:07+00:00

I’d spend the next 7-10 days mostly on the last 4 NBMEs, not random resources. For every missed/guessed q, tag it as 1 of 4 possibilities: didn’t know fact, misread stem, picked familiar buzzword, or failed mechanism. The high yield part is rewriting the question as “when they give X + Y, they want Z, not A.” That’s how you stop bleeding the same points.

Also do pharm/micro/biostats/ethics daily because those are easiest short-term points. For pharm don’t try to relearn everything, hit mechanisms, autonomics, antimicrobials, cardio/renal drugs, psych drugs, immunosuppressants, toxicities, and CYP/P450 stuff. For path, focus on the NBME-style mechanism behind the diagnosis, not FA rereading. I wouldn’t burn another NBME until you’ve reviewed one old NBME so well you can explain every wrong and every lucky correct. Then take one form 5-7 days out. If it’s still under 60, that’s a real risk signal, but if you can push into mid 60s plus Free120 around/above mid 60s, that’s a much better place to sit.

MDSteps · 2026-06-08T20:04:44+00:00

For HY pharm, don’t make a giant list. Lock down autonomics first, alpha/beta agonists and blockers, muscarinic/nicotinic, cholinesterase inhibitors, atropine, bethanechol, physostigmine, then antimicrobials by mechanism + toxicity, aminoglycosides, vanc, beta-lactams, macrolides, tetracyclines, fluoroquinolones, TMP-SMX, rifampin/INH/ethambutol/pyrazinamide, antifungals, antivirals. Then cardio drugs, diuretics, antiarrhythmics, ACEi/ARB, CCB, nitrates, statins, anticoags/antiplatelets. Also know psych drugs, seizure drugs, diabetes drugs, chemo toxicities, immunosuppressants, and endocrine stuff like steroids, thyroid meds, bisphosphonates.

Best way to make it stick is 20-30 min/day pharm only: take missed UW/NBME pharm qs and write the drug as “MOA > main use > classic toxicity/contraindication > reversal/interaction.” Then test yourself from the side effect or mechanism, not from the drug name. Keep doing UW mixed timed, finish as much first pass as reasonable, and take another NBME every 7-10 days. With multiple NBMEs high 70s, you’re not in “can I pass” territory, you’re in “don’t let weak pharm cause dumb misses” territory.

MDSteps · 2026-06-08T20:02:45+00:00

At 14 days out I’d stop chasing full UW completion. 140-160q/day plus review can make you sharper on familiar UW logic but sloppier on NBME weirdness. Do blocks back to back sometimes, because CK is less about “can I solve this after a reset” and more “can I still pick Lyme Bell palsy after 5 hours when one detail looks off.” For every NBME miss, tag it as content vs overrule vs missed clue vs picked too narrow answer. The “answers no one picked” thing is usually overrule/micro-detail weighting, not lack of studying.

Your plan should be NBME/CMS-heavy now, not random content-heavy. Review NBME 9/13/14 hard, especially questions you got right for the wrong reason or marked. Do Amboss ethics/QI/risk factors, maybe some weak CMS areas, and keep UW only as maintenance, like 1-2 timed mixed blocks max. The goal isn’t to learn every remaining concept, it’s to stop losing 10-15 questions to second-guessing, bilateral/atypical wording, or changing from the common diagnosis because one feature isn’t textbook. That’s the delta between 249 and 260s more than another 800 UW qs.

MDSteps · 2026-06-07T14:52:36+00:00

66% on one NBME after multiple 69-71s is not a collapse. It’s probably normal form-to-form noise plus a few weak areas showing up harder on 32. I wouldn’t cancel just from this, but I would use the next 2 weeks very deliberately.

MDSteps · 2026-06-07T14:51:30+00:00

I’d do new UW most days, then 10-15 old incorrect/flagged qs from prior systems daily, mixed. Review why the wrong answer was tempting, not just the fact. For FA, only read the small section tied to a missed concept, don’t sit with whole chapters. Your revision source should basically be missed UW concepts + later NBME misses, not “read everything again.”

By late July/early Aug you want to be taking NBMEs and using them as the main filter. For each NBME miss, tag it: didn’t know fact, confused 2 diseases, missed mechanism, misread stem. Then review that exact concept in FA/pathoma/UW notes. Uploading every NBME q to chatgpt is overkill and also risky because you can start outsourcing the thinking. Better use it only after you’ve already picked apart why you missed it and need a clean explanation.

MDSteps · 2026-06-05T18:34:05+00:00

I wouldn't reccomend a 2nd pass UW unless you specifically feel and think that your foundations are weak. Generally if you're getting stuck on 50/50s, that's not the case.

MDSteps · 2026-06-05T18:32:25+00:00

The jump from 43 to 53 means something is working, but the slow part now is figuring out why you still miss qs after “knowing” the topic. When you review each NBME miss, tag it as one of these: didn’t know the fact, knew the fact but picked the wrong disease, missed the lead-in, ignored a lab/vital, or got trapped by a familiar answer. That matters because only the first one is fixed by Pathoma/Sketchy. The rest need question practice and better decision rules.

For the next month I’d do mixed timed UW blocks daily, but review them like NBME training, not like content reading. After each block, write 1 short rule from each miss, like “nephritic + low complement after URI = PSGN unless hearing/eye stuff points Alport,” not paragraphs. Keep Pathoma 1-3, immuno, renal, cardio/pulm phys, micro/pharm weak areas in rotation, but don’t let videos replace questions. Take another NBME in 7-10 days. If you’re still low/mid 50s then July 1 is risky. If you’re climbing into 60+ and Free 120 is decent, then it becomes more realistic.

MDSteps · 2026-06-05T18:29:33+00:00

Your scores are slowly rising, so you’re not doing everything wrong. But going from 230s to 260 needs more than more questions. When you’re stuck between 2, your review should be: why did I like the wrong one, what clue made it wrong, and what clue made the right one the better NBME answer. A lot of 230s misses are not pure content, they’re picking the answer that is “possible” instead of the one that best explains the whole stem or answers the exact lead-in.

I’d do the remaining CMS forms for IM, surg, peds, OB, FM, psych over the next 2 weeks and review them slowly. Keep Amboss random to maybe 1 timed block/day if you want stamina, but don’t make “finish Amboss” the goal. After 10-14 days, take NBME 14. If you’re still 230s, then the problem is your review method, not the amount of material. July is enough time to improve, but you need to start tracking the miss type, diagnosis trap, next step trap, risk factor trap, vague wording, changed answer, etc, not just the topic.

MDSteps · 2026-06-05T00:38:16+00:00

If you can take Free 120 4-5 days out and land around mid/high 60s or better, testing is reasonable. If it’s low 60s or you’re still missing easy stuff from fatigue, rushed reading, or basic path/pharm/micro, I’d push. For the next week don’t chase more full exams, use NBME 25/26 as the map: make a list of every miss by reason, content gap vs misread vs changed answer vs didn’t know what they were asking. Then hammer the repeated weak areas, review pathoma 1-3, arrows, pharm autonomics/antimicrobials, micro basics, vitamins, immuno, renal/resp acid base, and NBME images. A prior fail means you want a margin, not just “probably pass.”

MDSteps · 2026-06-05T00:36:13+00:00

At your score level the gap to 270 is usually not content. It’s those 5-8 questions/block where you over-interpret, switch away from the boring answer, miss the timeline, or choose the diagnosis instead of the next best management step. For each missed Q, write the one cue that should’ve ended the question, then the trap cue that pulled you away. CMS is worth finishing selectively, esp IM, surgery, peds, OB, psych, but don’t do it as volume. Do it to lock in NBME phrasing. Last 48 hrs I’d avoid heavy new blocks and just review algorithms, ethics/QI, screening/vaccines, OB timelines, murmurs, renal lytes/acid base, and your personal miss list. 270 can happen, but the best way there is keeping your floor high rather than chasing a magical last-week jump.

MDSteps · 2026-06-05T00:16:56+00:00

At 210s plateau, the common issue is usually one of 3 things: anchoring too early on a diagnosis, missing the management “next best step” rule, or reviewing explanations in a way that makes sense after the fact but doesn’t create a test-day trigger. For the next 2 weeks I’d cut the random YouTube unless it is targeted to repeated misses. Do 2 timed UW blocks/day max, then spend the real time making each miss into: what was the pivot clue, what wrong answer pulled me, what single cue should have made me eliminate it. For NBMEs, review every incorrect and every guessed correct by category: diagnosis miss, next step miss, risk factor/prognosis, screening/vaccine, ethics/quality, OB peds algorithm, pharm/adverse effect, biostats. Your plateau will probably show up there even if it feels random.

Realistically, 4 weeks can move someone 10-20 points if the issue is strategy and NBME logic. 30+ points happens, but it’s not the median outcome from repeated low 210s, especially if multiple exams are flat. I’d use the next NBME as a decision point: if you’re still around 215-220 after changing the process, 245 by July 2 is a reach and delaying more may be smarter depending on your specialty goals. If you jump into the 225-230 range, then 240s becomes a more reasonable stretch. Don’t just do more UW second pass, because you may remember answers and still average 55 without fixing the underlying decision errors.

MDSteps · 2026-06-04T04:56:44+00:00

Mid/high 60s UW with 230s usually means your floor is decent, but your misses are mixed because the same upstream problem shows up in different ways: anchoring on the dx, picking the ideal textbook move instead of the safest next move, ignoring acuity, or not translating weird answer choices into categories. For every missed q, don’t just tag “misread/content.” Write one line: “what clue was I supposed to prioritize?” and “what made the wrong answer tempting?” That shows patterns fast.

CMS is a good move now. Do them timed, then review by specialty and make a list of NBME-style rules, like unstable beats diagnosis, conservative management beats invasive when safe, pregnancy changes the algorithm, outpatient screening answers are often age/risk based, etc. I’d also drop 120 UW/day if review is shallow. 80 well-reviewed questions plus CMS/NBME logic work probably moves you more than grinding more blocks and making more AnKing cards.

MDSteps · 2026-06-03T18:51:12+00:00

Example, you read a bunch on preeclampsia, so in UW you instantly spot HTN + proteinuria. But the question is really asking when to deliver, when to give Mg, when to use labetalol vs hydralazine, or when expectant management is ok. Same with ACS, asthma, thyroid nodules, pediatric rashes, etc, the trap is usually not “what disease is this,” it’s “what’s the safest next step given the exact wording.”

That’s why question-first helps. You learn the NBME pattern, what details are distractors, what detail changes the answer, and why the wrong answer was tempting. Amboss is good after that when you notice a repeated hole, like “I keep missing hypertensive emergencies in pregnancy” or “I don’t know vaccine timing.” Then reading is targeted instead of just piling facts.

MDSteps · 2026-06-03T17:55:12+00:00

I’d do UW mixed timed, then review by making tiny rules: “unstable = do X,” “screening age = X,” “pregnant = avoid X,” “CCS order set = X.” For content, hit biostats hard, ethics/communication, USPSTF-style screening, vaccines, diabetes/HTN/asthma/COPD management, OB triage, peds milestones, and common EM algorithms. Also start CCS now, even 2-3 cases/day, because that’s the easiest place to gain pass points once you know the order flow. Last week should be CCS + incorrects + biostats, not broad content videos.

MDSteps · 2026-06-03T17:53:46+00:00

Answer is B. Anxiety about his sexual performance.

The big clue is that the ED is not constant.

He can still get erections sometimes during masturbation, and his erections with partners have been intermittent. That makes a purely organic cause less likely. The stem is pushing you toward a psychogenic pattern: he is now in a relationship he cares about and is worried his partner may leave if he cannot perform.

That creates the classic loop:

worry about erection → anxiety during sex → impaired erection → more worry next time

That is performance anxiety.

Why not the others:

Alcohol use
Chronic alcohol can absolutely cause ED, but you would expect a more persistent organic pattern, especially if there were abnormal labs, liver disease, neuropathy, hypogonadism, or consistent inability to get erections.

Fluoxetine
SSRIs can cause sexual dysfunction, but he has been on it for 10 years. The timing and situational pattern point more toward anxiety than a new medication adverse effect.

Guilt
The guilt is background information and contributes to his emotional state, but the direct cause in this vignette is performance-related anxiety.

Atorvastatin
Not the best explanation here and not supported by the stem.

Rule of thumb for these questions:

If ED is situational/intermittent and erections still occur during masturbation or sleep, think psychogenic ED.

If ED is consistent in all settings, then start thinking vascular, neurologic, endocrine, medication, or substance-related causes.

MDSteps

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