One Step Back

Still toiling away, gripped by fear as my test date approaches. I took another NBME Self Assessment this weekend and unfortunately, I seem to have gotten dumber since the last practice exam, scoring a 194, which is just barely a pass – I’m talking skin-of-the-teeth. Needless to say, it was very discouraging, so much so that I decided I’d rather clean the basement than deal with any more review on Saturday. However, I created a new intensive study schedule and looked at the historical data (which one can see if one has taken two or more NBME self assessments) so that I could focus this week’s efforts on the weak spots. The good news is that I’ve improved in physio, pharm and micro; and am doing much better with renal and nervous systems-based questions. The bad news is that I’ve been getting steadily worse at reproductive and endocrine system questions, gross anatomy and embryo and I pretty much suck at cardio. それから、this week will be heavy on those areas. I also need to improve in the nebulous category of General Principles of Health & Disease* so I’ll try to focus on that as well.

There is a question I remember from the practice exam that sort of makes me question whether I’m really getting my money’s worth for these tests, which are $45 a pop ($60 for a fancier score report). The question started off talking about Tumor Necrosis Factor (TNF) and then segued into a question about LPS-mediated activation of transcription factors. It was something like ‘LPS-mediated activation of transcription depends on which of the following:

a) c-ras

b) NF-κB

c) p53

d) Rb protein

e) some other distractor I forgot

Apparently, the answer is b**. I chose c and I understand why that’s not the right answer, but for the life of me, I could not find anything in any of the sources I’ve checked that mentions that NF-κB is specifically the thing that is responsible for LPS-mediated activation of transcription. In First Aid (2009), all it says is that LPS induces TNF and IL-1. It doesn’t really go beyond that in my Falcon books either. I couldn’t find anything about NF-κB, in fact, I only vaguely remember it being mentioned once during lecture (or maybe not – perhaps I read it somewhere…). It’s not mentioned at all in the wikipedia*** entry for LPS. This makes me believe that either I’m stupid and can’t retain important information, that school failed to emphasize that this was important information or that this is NOT important information, unless one is a microbiologist, not a doctor****. Which brings me back to questioning the value of these expensive practice tests: they are composed of retired questions and maybe some of these questions were retired because they just aren’t very good questions. Also, while one does receive a score report upon completion, there is no way to review the questions (unless one has an eidetic memory). :::Sigh::: I’m still going to buy more tests from NBME though. I can’t afford not to. They’re made by the people who make the COMP, thus they’re the closest approximation of what my test is going to look like. Heaven forfend I should mess up again. Let’s hope that the next two practice exams (this Friday and next) are a little more encouraging.

*What is this, actually? Some people say that it’s just the first section of First Aid, but really, who knows? If you do, please tell me, so I can study accordingly.

** my pal, who did the Kaplan live course, knew this answer right away. He said they’d warned him that it has shown up on the Step, and that if one sees a micro question that mentions transcription, pick ‘NF-κB’ and move on. Maybe I should’ve done Kaplan instead…

*** I know, wikipedia is not the bible, even though the fancy-shmancy (with Harvard plaques tiling the walls) cardiologist my grandma visits had it open on his desktop during her appointment. He was looking up liver physiology. Incidentally, the wikipedia entry for NF-κB does mention LPS, so I guess wiki’s not that bad.

**** の卵

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