Free 120 Step 2 Explanations

Then, it's your final calendar week of Step one studying. Congratulations! Are you wondering what should yous do in that final week of studying? Ane resources I am a big fan of having my students employ in the final week of Step 1 studying is the NBME Free 120 questions. Only before we get into why it's extremely helpful in that last week, let'southward hash out what information technology is.

What is the NBME Gratuitous 120?

The NBME costless 120 is a set of 120 questions given by NBME that y'all tin can utilize within their spider web interface. The Free 120 simulates the verbal format of the USMLE Step ane, question style and length, and user interface (i.e how the screen looks, how break fourth dimension looks, etc).

It is 3 blocks of xl questions timed exactly like the USMLE Step ane, it gives y'all the exact same tutorial, and it allows y'all to check your answers (without explanations) once y'all've finished.

Free 120 Drawbacks

The major drawback of this simulation examination is that information technology only gives you lot a percentage right and not a scaled score. Nosotros will talk more about that later. At present that we know what the NBME Free 120 is, let'due south talk about how to use information technology and why it'southward helpful.

How to Employ the NBME Free 120

1. Use the Free 120 as a test day simulator iv-v days before your bodily exam appointment.

This is a depression-stress exam every bit there is no scaled score, and it mimics breaks, question style and length, and difficulty to a certain extent. It is substantially a dry out run of what you lot volition do on test day and has no psychological impact on your prep, as it doesn't give a iii-digit score.

Ane fundamental reason you should take the Free 120 that close to your exam is thatthese questions are known to show up verbatim on Step i. Remember, on the Step ane, the graders (or computers who grades it) don't care if you got lucky and picked the correct answer. A correct reply is a point, then NBME is essentially giving you three-5 free points with this Free 120.

2. Utilize the test tutorial in the Complimentary 120 to salvage valuable intermission time on Step 1 exam mean solar day.

This exam mimics the interface you lot will see on exam mean solar day. This includes the test-taking tutorial and interactive questions.

Seeing the tutorial before your test date will allow you to skip it on the day of the exam, which will salve you 15 minutes of intermission fourth dimension. Trust me when I say you volition need all your pause time, as it is very of import to pause in between each block of 40 questions.

3. Acclimate to Step 1 interactive questions.

The interactive questions in the Free 120 include those where y'all heed with your stethoscope for a murmur or listen to breath sounds. Knowing how these will look on the examination solar day volition help lessen your anxiety, as you will not fidget around figuring out how to use these features. Less anxiety is always a good matter on test day.

How is the NBME Complimentary 120 Scored?

The Gratuitous 120 does not generate a iii-digit score. It does give you a percentage correct, which some people take tried to correlate to a Step 1 score, just there isn't any existent data about how predictive it is.

Anecdotally, I can say that if a educatee gets a 75% or higher on the NBME Free 120, they pass Pace 1. That's from a small sample size of about 25-thirty students/friends. In terms of actual score, again, there is no straight correlation between your percentage on the NBME Free 120 and your step ane three-digit score.

NBME Free 120 Question Explanations

To aid you make the best of your time with the NBME Free 120, here are explanations for 25 questions. These are the first 25 questions in Block 1 of the Free 120:

ane. This respond choice refers to aminoglycosides. Penicillin destroys the cell walls of organisms and allows larger drugs like aminoglycosides to enter the jail cell and execute their bactericidal effects.

2. This reply choice refers to Gilbert syndrome. This patient has intermittent jaundice likely brought on by stressors (such as infection, dehydration, etc) and has an elevated indirect bilirubin because of it. This is due to decreased activeness of UDP glucoronyl transferase which
normally volition conjugate bilirubin.

3. This tabular array indicates that the response of the musculus increases in the presence of drug 10 and acetylcholine. This is because acetylcholine works at the nicotinic receptors also as muscarinic receptors. Nicotinic receptors are located at the neuromuscular junction and when they are stimulated, they will crusade muscle contraction.

4. This question is referring to Rhesus (Rh) factor incompatibility. The reason Rho (D) is given during the third trimester is that at that place is slight mixing of fetal and maternal blood at around 28 weeks. This causes the mom who is Rh- to exist exposed to Rh+ blood cells. This will stimulate the mom'due south allowed system to produce antibodies to Rh+ cells. To prevent this from happening, Rho (D) is given. Rho (D) is Rh factor immunoglobulin. This immunoglobulin will bind to the fetal cells and prevent maternal cells from recognizing them (although full mechanism is all the same unknown).

5. This patient has Cardiac Tamponade. In cardiac tamponade, obstructive shock occurs due to decreased right-sided and left-sided heart filling. The reason this occurs is because when the right ventricle fills normally, it expands into the gratis wall and the septum. When there is fluid in the pericardial infinite, this expansion can just occur in the direction of the septum which causes compression of the left ventricular cavity. This leads to the characteristic findings of pulsus paradoxus, hypotension and JVD. The muffled heart sounds are due to the fluid around the heart interim equally an insulator of the eye sounds. The tachycardia is our bodies compensation to the hypotension via activation of sympathetics to increment heart rate and cardiac output.

6. The overall machinery of action of metformin is to decrease hepatic gluconeogenesis via suppression of gluconeogenic enzymes and increase the bodies efficiency when using glucose.

seven. Effectually 10% of people with HIV are first diagnosed due to an incidental finding of thrombocytopenia. In patients with thrombocytopenia, one physical finding includes petechiae (tiny bruises).

eight. This syndrome the patient developed is due to a blazon III hypersensitivity reaction called the arthus reaction.

9. In patients without a history of substance abuse, morphine in a controlled setting has a low likelihood of leading to a psychological addiction. On meridian of that, it is the all-time choice for acceptable pain control post operatively.

x. This adult female has irritant contact dermatitis. In her case its probable due to her new hair dye. This is a blazon IV hypersensitivity and is due to delayed activation of T-cells. The CD markers listed are of import in Co-stimulation of the T-cells so that they may produce cytokines and farther proceed to activate other cells.

xi. Malonyl CoA is involved in fatty acid synthesis. Your torso likes to be in either catabolism or anabolism at one signal in time. It doesn't like to do both simultaneously, then if yous are making fatty acids, the release of them through beta oxidation will exist shut down.

12. This is an open-labeled clinical trial as all study participants know which drug they will receive and which dose of the drug they will receive. There is no randomization or blinding.

thirteen. This patient has a pancreatic adenocarcinoma and likely developed a clot due to this. This may be due to the backlog mucin produced by pancreatic adenocarcinomas equally mucin is thrombogenic. If the clots were in superficial veins and located in multiple different areas, this would be considered Trousseau's Syndrome which is also chosen migratory thrombophlebitis.

xiv. A large ovarian tumor that causes virilization in a female is likely producing testosterone. The only answer choice that corresponds to a tumor that produces testosterone is a Sertoli-leydig tumor. Leydig cells in men will produce testosterone ordinarily but tin occur in females in conjunction with this malignancy.

fifteen. This patient likely has a superficial soft tissue infection due to an infected cut. The reason he has edema in this example is due to the inflammatory cells releasing cytokines. Sure cytokines take been shown to crusade relaxation of the endothelial cell junctions which promotes third spacing of fluid. This causes fluid in the vasculature to enter the interstitium at a rate faster than information technology can be cleared which leads to edema.

sixteen. This patient has a pinealoma. The pineal gland is next to the pretectal expanse. The pretectal area is what is responsible for upward gaze. When it is compressed patients accept an upwards gaze palsy which is referred to every bit Parinaud Syndrome.

17. This patient has a renal infarct. This is probable due to his atrial fibrillation as nonuniform contractions in the atria of the centre atomic number 82 to stasis of blood. This promotes coagulation. These clots then make their style into the left ventricle and then into the aorta and travel to unlike arteries causing infarcts via occlusion of a vessel.

18. This patient has hot-tub folliculitis due to pseudomonas aeruginosa. Probable acquired as information technology entered the follicle which is more open up in a hot environment.

19. This patient has H. Pylori. This organism is a gram – heliobacter which stains with silver. Information technology causes antral ulcers as the antrum is the portion of the stomach with the least acidity (highest pH). The
organism so farther increases the pH of the area it is in by producing urease which breaks downward urea into NH3 which can alkalinize the area and promote further bacterial proliferation.

20. The fibular neck (at the lateral attribute of the leg just below the knee) is the location of the common peroneal (fibular) nervus. At this point it branches into a superficial and deep branch. The superficial branch does sensation to the back of the foot (except for first webbed space) too equally motor function in the lateral foot (eversion). The deep branch provides awareness for the first webbed space and does dorsiflexion of the foot.

21. Fluid accumulates in the most dependent infinite relative to gravity. If one is lying on their dorsum the fluid volition accumulate in the paracolic gutters. If one is standing upward it will go to the lowest area in the torso that can hold fluid. In women this happens to be the Pouch of Douglas which is the space between the uterus and rectum.

22. TNF alpha inhibitors are a mainstay in the handling of many autoimmune conditions. They are typically not first line treatment though and are only used after failure of a commencement line treatment (for
example in rheumatoid arthritis you can use methotrexate first and then if the patient doesn't respond you would so switch them to a TNF alpha inhibitor or add it on).

23. This patient has bullous pemphigoid. It is characterized by tense blisters which do not split up upon rubbing them (negative Nikolsky sign). There are too no oral lesions in this illness. It is due to autoimmune devastation of hemidesmosomes which are located in the basement membrane layer.

24. Farmers tend to use pesticides during their piece of work which contain organophosphates. This leads to acetylcholine excess, as organophosphates piece of work as acetylcholine esterase inhibitors.
Acetylcholine esterase works to breakdown acetylcholine and when information technology is inhibited you will be unable to breakdown acetylcholine leading to all these symptoms. To contrary information technology you must requite a muscarinic antagonist, such as atropine, to block the furnishings acquired by this excess acetylcholine.

25. This adult female is frail and has difficulty swallowing. In patients with oropharyngeal dysphagia (difficulty initiating swallowing) they are at loftier risk for aspiration. Other patients at gamble for aspiration are those with neurological dysfunction (stroke, Alzheimer's etc), alcoholics, or
seizure patients. Aspiration of oral flora (gram+ and anaerobes) leads to aspiration pneumonia.

Nosotros hope this post helped y'all make sense of the NBME Free 120 and how to apply it for Step ane prep!