APPENDIX B: 28-DAY SAMPLE STUDY SCHEDULE FROM TULANE SCHOOL OF MEDICINE

Day 1
Objective Self Assessment

General Overview & Begin Biochemistry

Assignments Source Details Complete 150 sample questions, and note trouble areas to focus on. Learn about the test, and how to best use First Aid as a resource. Understand the role of ATP. Know where the electron transport chain and oxidative phosphorylation occur and how they fit into the overall metabolic scheme. Review the main classes of cell receptors and signaling mechanisms. Est. Time 3 hrs 4 hrs 2.5 hrs

Complete sample test materials NBME CD-ROM for NBME or download from www.nbme.org General overview of Read Through Section First Aid material to be covered Introductory Material from First Aid, and Skim Section II Basic Metabolism Chapters 5 & 6, and sample Lippincotts questions at end of each Biochemistry chapter. Bookmark figure 6.2 and refer to it before studying each biochemical pathway.

Day 2
Objective Structure & Metabolism of Carbohydrates

Continue Biochemistry
Assignments Chapters 11, 12, 13 & questions Source Lippincotts Biochemistry Details Est. Time Review the digestion of sugars and disorders 3 hrs of fructose, galactose, and lactose metabolism. Spend more time on glycogen metabolism, its regulation, and related disorders. Use Figure 13.7 to memorize the glycogen storage disease Know the start and end points, hormonal 1.5 hrs regulation. Energy yield and various fates of pryruvate. Study it by comparison to glycolysis. Know 1 hr the reactions & regulation unique to gluconeogenesis. Focus on start and end points, place in overall 1 hr metabolism, and regulation. Shim reactions an focus on G6PD deficiency 1 hr

Glycolysis Gluconeogenesis Citric Acid Cycle Hexose Monophosphate

Chapter 7 & questions

Lippincotts Biochemistry

Chapter 8 & questions, Review Lippincotts Figure 6.2 again! Biochemistry Chapter 9 & questions Chapter 10 & questions Lippincotts Biochemistry Lippincotts Biochemistry Source Lippincotts Biochemistry

Day 3
Objective Lipid Metabolism

Continue Biochemistry
Assignments Chapter 17 & questions Details Est. Time Focus on roles of pancreatic lipase and bile 3 hrs salts. Fatty acid metabolism: know where synthesis occurs, relationship to glucose metabolism, and role of triacylglycerols for storage of fatty acids. Review mobilization of and oxidation of fatty acids. Finally, carefully review eicosnoids, focusing on figure 17.20 Gain senses of what these are, but do not 1 HR memorize structure of pathways. Focus on related disorders instead, using figures 18.10, 19.4 Review Cholesterol synthesis (esp. the role of 2 hrs HMG CoA reductase) and its regulation. Understand synthesis and role of bile salts. Review biology of lipoproteins and their role in atherogenesis. Key figure are 20.12, 20.14, 20.16 Know the major enzymes deficiencies in 1 hr 36 steroid synthesis and know where steroid receptors act in the cell. Study figures 20.19,

Phospholipids &Glycolipids

Skim Chapters 18, 19

Lippincotts Biochemistry Lippincotts Biochemistry

Cholesterol & Steroid Chapter 20, Sect. I VII Metabolism

Steroid Hormones

Chapter 20, Sect. VII

Lippincotts Biochemistry

20.20

Day 4
Objective Protein & Enzymes

Continue Biochemistry
Assignments Chapter 1-4 & questions Source Lippincotts Biochemistry Details Est. Time Become familiar with basic properties of 4 hrs amino acids, levels of protein structure, hemoglobin, and collagen. For enzymes, focus on appreciating (not memorizing) the Michaelis-Menten equation, types of enzyme in clinical diagnosis. Learn the various pancreatic proteases and 2 hrs how they are regulated. Understand transamination and oxidative deamination, but dont memorize Pathways. Spend more time on urea cycle and ammonia metabolism focus on figures 21.4, 21.11, 21.17 Emphasize relevant disorders. Focus on 1 hr figures 22.2, 22.16

Digestion of Dietary Chapter 21 Proteins and Nitrogen

Lippincotts Biochemistry

Metabolism of Amino Chapter 22 Acid Carbon Skeletons

Lippincotts Biochemistry

Day 5

Continue Biochemistry
Source Lippincotts Biochemistry Lippincotts Biochemistry Lippincotts Biochemistry Lippincotts Biochemistry Details Est. Time Focus on the porphyrias and bilirubin 1 hr metabolism. Focus on figures 23.5 and 23.7 Know what they are and know the related 1 hr disorders. Dont get too bogged down in details just study figures 14.12 and 15.14, then move on. Know the daily energy requirements and 3 hrs vitamin deficiencies. Focus on absorption of vitamin B12 and pernicious anemia, as well as vitamin D. Focus on figures 28.12, and 28.18 Understand differences between de novo and 2 hrs salvage purine synthesis. Study purine degradation and the Pathophysiology of gout and ADA deficiency. Study figures 29.7, 29.9,29.10 Details Est. Time Synthesize the information youve reviewed 5 hrs this week by studying insulin, glucagon, the fed/starved states, and the metabolic aspects of diabetes mellitus. Time spent on these topics will be VERY WORTHWHILE Details Est. Time Study general principles of pharmacology. 2 hrs Specific agents will be covered with relevant organ systems. Know different types of adrenergic and 5 hrs cholinergic receptors cold. Study figures 3.3, 3.6, 4.2, 5.2, 6.15, and 7.10. Details Est. Time Rely heavily on charts. Start building buzzword 10 hrs associations with characteristics of each organism and how is identified (with a special stain, culture medium, etc.) Also, time spent with Qbank questions here will be golden

Objective Assignments Heme, Porphyrins, Chapter 23 Serotonin, Histamine and Catholamines Gylcosaminglycans and Skim Chapter 14, 15 Glycoproteins Nutrition and Vitamins Chapter 27, 28

Nucleotide Metabolism

Chapter 29

Day 6

Finish Biochemistry
Source Lippincotts Biochemistry

Objective Assignments Ingrative Metabolism Chapters 24, 25, & 26

Day 7
Objective Pharmacokinetics & Pharmacodynamics Autonomic Drugs

General Pharmacology
Assignments Chapter 1, 2 Chapters 3 7 Source Lippincotts Biochemistry Lippincotts Biochemistry

Day 8
Objective Bacteria

Begin Microbiology
Assignments Chapter 1 15 Source Clinical Microbiology made Ridiculously Simple

Day 9

Continue Microbiology

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Objective Antibiotics

Assignments Chapter 28 33

Source Lippincotts Pharmacology

Fungi

Chapter 20

Antifungal

Chapter 34

Details This is high yield material, read, review and continue to do Qbank questions to keep building buzzword associations. Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations. Lippincotts This is high yield material, read, review and Pharmacology continue to do Qbank questions to keep building buzzword associations. Source Details Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations Lippincotts Review antiviral agents, particularly Pharmacology mechanisms of action. Clinical This is high yield material, read, review and Microbiology made continue to do Qbank questions to keep Ridiculously Simple building buzzword associations Lippincotts Review antiprotozal and antihelminthic agent, Pharmacology particularly multi-drug regimens Underground Good for group study and another way to Clinical Vignettes keep sharpening buzzword recall. Microbiology

Est. Time 6 hrs

1.5hr

1 hr

Day 10
Objective Viruses

Finish Microbiology
Assignments Chapter 22-29 Est. Time 6 hrs

Antiviral Parasites

Chapter 37 Chapter 30, 31

1 hr 2 hrs

Antiparasites Clinical Vignettes

Chapter 35, 36

1 hr 3 hrs

Day 11
Objective Review Immunology

Immunology & General Pathology

Assignments Part VII Source Medical Microbiology & Immunology: Examination and Board Review BRS Pathology BRS Pathology Details Excellent, concise summary of immunology Est. Time 4 hrs

Cellular injury Inflammation

Chapter 1 Chapter 2

Hemostasis

Chapter 3

BRS Pathology BRS Pathology BRS Pathology BRS Pathology

Genetic Disorders Chapter 4 Immune Dysfunction Chapter 5 Neoplasia Chapter 6

Environmental Chapter 7 Pathology Nutritional Disorders Chapter 8

BRS Pathology BRS Pathology

Focus on mechanisms of cellular injury and 0.5 hr differences between necrosis & apoptosis Distinguish mechanisms and histological 1 hr characteristics of acute vs. chronic inflammation Know coagulation cascade, types of embolism, 1 hr and types of shock. 0.5 hr Focus on immune deficiency disorders, 0.5 hr autoimmunity, and collagen vascular disease Distinguish between tumor suppressor genes 1 hr & oncogences, know mechanisms of carcinogenesis, and the properties of malignant cells. Quickly review 0.5 hr Review vitamin deficiencies to refresh biochem memory 0.5 hr

Day 12

Cellular Biology

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Objective Assignments DNA, RNA, Proteins Chapter 30 33

Source Lippincotts Biochemistry

Cell Membranes

Chapter 1

Details Est. Time Know mechanisms of DNA repair, different 3.5 hrs types/roles of RNA, mechanism of translation, and molecular biology techniques. Focus on figure 30.2, 30.16, 30.19, 30.22,31.11, 32.9 BRS Cell Biology & Know properties of membranes and 1 hr Histology membrane proteins BRS Cell Biology & Know contents of nuclei, and RNA Histology import/export mechanisms. BRS Cell Biology & Review organelles and function Histology BRS Cell Biology & Know different types of collagen, basement Histology membrane composition, and other ECM components. BRS Cell Biology & Review types of epithelia and locations of Histology each. Review connective tissue focusing on bone histology 0.5 hr

Nucleus

Chapter 2

Cytoplasm

Chapter 3

0.5 hr

Extracellular Matrix

Chapter 4

1 hr

Epithelia & Connective Chapter 5,6 Tissue Day 13 Objective Cell Physiology Embryology Cellular Physiology & General Embryology Assignments Chapter 1 Chapter 1-4

1.5 hrs

Source BRS Physiology BRS Embryology

Birth Defects Exam

Chapter 17, 18 Diagnostic Test

BRS Embryology Board Simulator Series Body Systems Review Source BRS Embryology

Details Est. Time Know mechanisms of ion transport, action 1 hr potentials. Know stages from zygote through embryo. 3 hrs Review 3 Germ cell layers and their derivative tissues. 1.5 hrs Good opportunity to identify weakness in organ system areas. 2 hrs

Day 14

Thorax
Details Know the congenital cardiac abnormalities, and fetal circulation. Also understand the stages of fetal lung maturation. Est. Time 3.5 hrs

Objective Assignments Embryology of thorax Chapter 5, 11

Thoracic Anatomy

Chapter 12 (Also use Netters Atlas for reference ) Histology of thoracic Chapters 11, 15 viscera

High Yield Gross 3 hrs Anatomy BRS Cell Biology & Be able to distinguish arteries and veins in 1 hr Histology cross section. Understand architecture of the gas diffusion barrier in the lungs.

Day 15
Objective Cardiovascular Physiology

Cardiovascular System
Assignments Chapter 3 Source BRS Physiology Details Est. Time Review hemodynamic, electrophysiology, 1.5 hrs cardiac cycle, blood pressure regulation, response to exercise, volume loss, altitude. Understand pre-load, after-load, Frank-Starling curve and condition. Study this chapter thoroughly 1.5 hrs

Cardiac Pathology

Chapter 10

BRS Pathology

39

Vascular Pathology Cardiovascular Pharmacology

Chapter 9 Chapter 1619 , 21

BRS Pathology Lippincotts Pharmacology

Study this chapter thoroughly Know drugs used to treat CH, HTN, arrhythmias, angina, and hyperlipidemia

1 hr 5 hrs

Day 16

Respiratory System & Begin Hematology

Source BRS Physiology BRS Pathology Details Est. Time Know varies lung volume measurements, and 1.5 hrs understand acid base disorders. Study this chapter thoroughly 1.5 hrs 0.5 hr Good opportunity for group review 2 hrs

Objective Assignments Respiratory Physiology Chapter 4 Respiratory Pathology Chapter 14 Respiratory Pharmacology Clinical Vignettes Chapter 22

Histology of Bone Marrow, Spleen, & Lymph Nodes

Lippincotts Pharmacology Volume 1: Cases 1-19, Volume Underground 2: Cases 52-66 Clinical Vignettes Patho-physiology Chapters 10, 12 (and a BRS Cell Biology & histological atlas for further Histology review

Familiarize yourself with lymph nodes architecture and understand the spleen. Understand RBC, WBC, platelet

3 hrs

Day 17
Objective Anemia Hematopoietic & Lymph reticular Neoplasia Hemorrhagic Disorders Drugs affecting coagulation Anticancer Drugs Clinical Vignettes

Finish Hematology
Assignments Chapter 11 Chapter 12 Source BRS Pathology BRS Pathology Details Est. Time Know Patho physiology and lab differentiation 2 hrs of various etiologies of anemia Distinguish between leukemia & lymphoma. 2 hrs Understand different types of each. Know how to diagnose and correct each disorder. 1 hr 1.5 hrs 1.5 hrs 2 hrs

Chapter 13 Chapter 20 Chapter 38 Volume 1: Cases 74-102

BRS Pathology Lippincotts Pharmacology Lippincotts Pharmacology Underground Clinical Vignettes Patho-physiology Source BRS Embryology

Day 18
Objective Embryology of Gut and Body Cavities

Gastrointestinal System
Assignments Chapters 10, 16 Details Est. Time Understand rotation of gut and related 1.5 hrs malformations. Know which structures are derived of foregut, midgut, hindgut, in addition to vascular supplies. 2 hrs 1.5 hrs 1 hr

Abdominal Anatomy

Chapter 3 (Also refer to Netters atlas) Histology of GI Tract Chapter 6 GI Physiology Chapter 6

High Yield Gross Anatomy BRS Cell Biology & Know layers of gut wall. Understand liver Histology structure, portal blood flow, and bile flow BRS Physiology Understand innervations of gut and gut hormones Source BRS Pathology BRS Pathology Details Study this chapter thoroughly Study this chapter thoroughly

Day 19
Objective Gastrointestinal Pathology Hepatobiliary and Exocrine Pancreatic

Gastrointestinal System
Assignments Chapter 15 Chapter 16 Est. Time 2 hrs 2 hrs

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GI Pharmacology Clinical Vignettes

Chapter 24 Volume 1: Cases 40-73

Lippincotts Know GI drugs as well as antiemetic Pharmacology Underground Good opportunity for group review Clinical Vignettes Patho-physiology Source BRS Embryology High Yield Gross Anatomy Details

2 hrs 2 hrs

Day 20
Objective Embryology of GU

Genitourinary System
Assignments Chapter 6, 13, 14 Est. Time 3 hrs

Anatomy of Pelvis and Chapters 4, 5 Perineum Histology of GU Organs Chapter 18, 19, 20

Know the maturation sequence of 3 hrs spermatocytes and ovarian follicles. Know the anatomy of the nephron. BRS Cell Biology & Know the maturation sequence of 3 hrs Histology spermatocytes and ovarian follicles. Know the anatomy of the nephron. Source BRS Physiology Lippincotts Pharmacology BRS Pathology BRS Pathology BRS Pathology Details Est. Time 1.5 hrs 1.5 hrs Study this chapter thoroughly 1.5 hrs

Day 21
Objective Renal Physiology Diuretics Renal & Urinary Tract Pathology Male Reproductive Pathology Female Reproductive Pathology Clinical Vignettes

Endocrine System
Assignments Chapter 5 Chapter 23 Chapter 17 Chapter 18 Chapter 19 Volume 2: Cases 30-51, and 83-103

Know the different types of testicular cancer, 1 hr and the biology of BPH and prostate cancer Understand cervical, uterine cancer 1.5 hrs 2 hrs

Underground Good opportunity for group review Clinical Vignettes Patho-physiology Source BRS Embryology BRS Physiology Lippincotts Pharmacology Lippincotts Pharmacology Underground Clinical VignettesPatho-physiology Board Simulator Series-Body Systems Review Source BRS Embryology

Day 22
Objective Histology of Endocrine System Physiology Insulin and oral hypoglycemic Steroid Hormones Clinical Vignettes

Endocrine System
Assignments Chapter 13 Chapter 7 Chapter 26 Details Est. Time Review structure of endocrine organ, and use 1 hr an atlas for additional pictures. Know hormonal axes 2.5 hrs Know different types of insulin and their half 1.5 hrs lives. Know classes of oral hypoglycemic and side effects. 1 hr Good opportunity of group review 2 hrs

Chapter 27 Volume 1: Cases 25-38

EXAM

Body System III Test 1

Tough questions, but great explanations. Well 1.5 hrs worth the time to push yourself a bit and solidify the material youve learned. Details Know bronchial arches/clefts and their derivatives. Understand the transition from neural plate to mature CNS. Know fate of Est. Time 3 hrs.

Day 23
Objective Embryology of Head Neck, & Nervous System

Nervous System
Assignments Chapter 7, 8, 9, 10

41

neural crest cells. Head & Neck Anatomy Neuroanatomy Chapter 8 (also refer to Netter) Chapter 1-23 High Yield Gross Anatomy High Yield Neuroanatomy Source BRS Physiology BRS Pathology Details Understand Synaptic transmission and axonal conduction Know types of CNS infection, tumors, and vascular disorders. Good opportunity of group review. 2 hrs 6 hrs

Day 24
Objective Neurophysiology Neuropathology Clinical Vignettes

Nervous System
Assignments Chapter 2 Chapter 23 Volume 2: Cases 45-61, Anatomy Cases 40-56. Chapters 8,10, 11, 14, 15 Est. Time 2 hrs 2 hrs 2 hrs

Neuropharmacology

Underground Clinical VignettesPatho-physiology Lippincotts Review drugs used to treat epilepsy, Pharmacology Parkinsons. Also review anesthetics and analgesics. Source BRS Embryology High Yield Anatomy Lippincotts Pharmacology Source BRS Pathology Details

3.5 hrs

Day 25
Objective Embryology

Musculoskeletal System
Assignments Chapter 15 Est. Time 1 hr 3.5 hrs 2 hrs 2 hrs

Anatomy of Limbs and Chapters 1, 6, 7 (also use Back Netter) Histology Chapter 7, 8, 10 Anti-inflammatory Chapters 39, 40 Agents and Autacoids

Day 26
Objective Dermatologic Pathology Musculoskeletal Pathology Clinical Vignettes

Musculoskeletal System
Assignments Chapter 21 Details Est. Time Focus on malignancies (melanoma, SCC, BCC) 1.5 hrs and refer to a dermatology atlas so that you can differentiate between them. 1.5 hrs 2.5 hrs

Chapter 22

BRS Pathology

Volume 3: Cases 9-18, and 96- Underground Good opportunity of group review. 104. Also Anatomy: Cases 62- Clinical Vignettes84 Patho-physiology Body Systems II Test I Board Simulator Series-Body Systems Review Touch questions, but great explanations. Well worth the time to push yourself a bit and solidify the material youve learned.

Exam

2 hrs

Day 27
Objective Clinical Vignettes

Behavioral Science & Biostatistics

Assignments All cases Source Details Underground Clinical VignettesBehavioral Science Lippincotts Pharmacology High Yield Est. Time 3 hrs

Psychotropic Drugs Biostatistics

Chapter 9-12, 13 Read entire book

3 hrs Understand sensitivity, specificity, PPV, NPV. 4 hrs

42

Biostatics

Be prepared to calculate risk, odds ratio, etc.

Day 28
Final Review Exam Logistics Rest & Relax

Final Review & Exam Logistics

Review Any Remaining Topics and finish practice questions Prepare exam bag-with ID, ticket, directions to center, lunch. 4 hrs

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APPENDIX C: 5-MONTH SAMPLE STUDY SCHEDULE (LATE APRIL TEST DATE)

Time Frame Week 5 December Week 1 Week 2 Week 3 Week 4 Week 5 January Week 1 Week 2 Week 3 Week 4 Week 5 March Week 1 Week 2 Week 3 Week 4 Week 5

Content Topic to Review Heme/Onc & Pulmonary Heme/Onc & Pulmonary Cardio & Immunology Renal Biochemistry Microbiology Microbiology GI & Embryology Path, Pharm, & Musculoskeletal Neuro Endo & Repoductive

Pages in First Aid 46 pages 46 pages 52 pages 30 pages 52 pages 60 pages 60 pages 54 pages 60 pages 44 pages 42 pages

November (begin studying during Thanksgiving break)

February Human Behavior course in progress Behavior & Psych Practice questions Practice questions CBCE Exam Shelf Exams 34 pages

This sample schedule is meant to be used as a framework for you to build your own individualized study plan; in addition to First Aid readings, challenge yourself to complete a set number of question bank items per week (or even per day as you get closer to the exam). Many thanks to Taimur Khan and Ryan Roach for their assistance in creating this sample schedule.

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APPENDIX D: TULANE STUDENT USMLE STEP 1 OWL CLUB SURVEY RESULTS

Questions Completed Vs. Score

270 260 250 240 230 220 210 200 190 180 170 0

Score

y = 0.0053x + 213.71 R = 0.1256

1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000 Number of Questions Completed

% of time studying Qs vs. score

Series1 Linear (Series1)

270 250 Score 230 210 190 170 150 0 20 40 60 80 100 % of studying doing questions y = -0.0069x + 226.63 R = 4E-05

45

Number of Respondents
10 15 5 70 60 50 40 30 20 10 0

Number of Respondents

0 59 Pathology 5 Physiology 3 Cardiology 6 Microbiology Inflammation Biochemistry Pharmacolo Neurology Infectious Renal 9 12 3 14 1 10 14 1 4 7 4 1

Endocrine

Anatomy

Pathology

Heme/Onc

Biochemistry

Neurology

Ethics

Biostatistics

Pharmacolo

Which subject do you wish you spent more time on?

Studying which subject was most beneficial (i.e. most represented on the test)?

Genetics

Pulmonary

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Score Distribution

270 250 230

Score

210 190 170 150 130 110 C/O 2010 C/O 2011
Class

C/O 2012

Class Median Min Max

C/O 2010 224 148 265

C/O 2011 232.5 173 264

C/O 2012 225 142 263

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