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mdsurgeon - 08/01/08 12:34

Patient: I'm in a hospital! Why am I in here?

Doctor: You've had an accident involving a bus.

Patient: What happened?

Doctor: Well, I've got some good news and some bad news. Which would you like to hear first?

Patient: Give me the bad news first.

Doctor: Your legs were injured so badly that we had to amputate both of them.

Patient: That's terrible! What's the good news?

Doctor: There's a guy in the next ward who made a very good offer on your slippers.

success100 - 07/23/08 13:10

Hi, Guys: I recieved my score one and half ago, 223/93

This is might not a great score from some people's eyes, but for me I will happily take it. Considering after the exam I am just hoping passing without rewrite this big monster in my life. I did not even dare to tell your guys when I took the exam, let alone writing exam experence. Because I had strong feeling I did really really poor in the exam.

Now I will start my story, I am a mom with full time job, I have to spend about 3and half to fours commuting to work. I graduate long long time ago, well more than 10 years, I took my step 2 first because I thought it would be easier, at least those preparation stuff sounds tangible, we can grasp more easily. Then after 3month I took step 2, I took CS in last year June. Then I started my step 1 preparation. I used Kaplan 2004 version that I bought on ebay. I decided to start with biochemistry which I hated most when I was in medical school. I readed books carefully, it took me about one month to finish the first reading of only biochemistry book, but at the end of month, I couldn't remember anything. I decided to reread it again before I proceed to next book. So I did 2nd reading this time took me about 15-20 days. Guys remember I can only study about maximum 4 hrs duing week days, I can study more during weekend. But after the 2nd reading, I still feel there are a lot of things I don't understand, then I did quick 3rd reading for biochemistry, it took me about 10 days this time.After this 3 reading for biochemistry only, 2 months already passed. Then I thought, oh, my god, when can I take the exam, even after those 3 reading, I am still not comfortable with this Biochemistry things. I have to do something else. I bought UW 6months, this time I started with the subject that I am most comfortable with, I read pathology books, then I started doing Qs from pathology, after I bought UW q-bank, it forced me to read books faster. I finished UW with accumulated score 65-70 percentile, timed, subjectivise. I found that I am Qs oriented person, I can only learn after I do the Qs, just by reading, my poor doesn't retain that much. Then I bought Q bank for 2 month, I thought I would get higher score in q-bank after I finish UW, but actually I did not, I got similar score in q-bank 65. When I did Qs, I put all the things that I thought important or I got wrong in first aid. First aid is my bible, I used 2007 version by the way. Without FA I can not imagine that I can take this test. I put all those Kaplan step 1 books on bookshelf, by just looking at them, I felt so tiring, to be honest, most subject I just read Kaplan once, I depend almost totally on the questions bank and FA.

MY NBME score;

form 1: on line, 4 mon before exam, 450/ 209/84
form 2: download version, 3mon before exam, 151/200
form 4: download version, 2mon before exam, 156/200
form3: on line, 1 and half mon before exam. 560/94 ( I forgot 3 digit score)
form5: on line, 1 mon before exam 470/ 86
form 6: on line, 15 days before exam 460/85

I felt so frustrated after I took form 5, i thought of postpone the exam, because it seemed like my final score could not touch 90. But as I said I tooke step 2 first, when I did form 1 for step 2, 2mon before my real exam, I got 580. I felt so happy, I did form 2 for step 1 mon before exam, I got 480, I postponed my exam for 1 mon for step 2, I personally felt that I did not gain extra score by postponing it, my step 2 score was well below form 1 that I got.
So I decided not posponing my step 1, actually there was another reason I could not postpone, because I am working full time, I could not get any day off during vacation season such as July or August. I thought this process is already long enough, I don't want to suffer anymore, just appear for the exam and see my luck.

Exam Day:

I took break after each block, I know that I can not concentrate too long.

First 2 blocks seemed the easiest one, I marked 4-5 Qs in each block.

Blocks 3-6 mixed easy and difficult Qs, marked 8-12 QS in each block.

Block 7 is the worst one, I am not sure what happened, either because you will feel tiring towards the end of day or what , I counted I marked 23 Qs, a lot of Qs I don't know in this block, just clueless, not like other people say I could narrow down to 2 choices, I could not narrow down anything, I left test center with this down feeling. Extremely terrible.......


Now guys I have to stop here, because I have to go back to work.

Thank you all of you stay there accompany me get through those days.

Keep you hope up, you will get there.

Hopefully my story can give some encouragement to future test taken particularly for those people like me has so many reponsiblities in their life.


Best of luck, everyone !!!!!!!!!!!!!!!!!!!!!!!!!!!!

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* Re:My Score and my exam experience !- warn

321 - 06/13/08 07:42

plz tell me

Total break time
&
Best way to manage break..

Thanks.



my2k - 06/13/08 11:29

Total break time is 45 minutes plus 15 minute tutorial..If you'll fly through tutorial..you'll have about 57-58 minutes remaining total for the break.
My advice: take break as often as you can. I did it almost after every block. complete 1 block ..get out of the room.. take a bite of energy bar...some sips of water...(takes hardly 3-4 minutes) ..go back in...if you do it 5 times..that will be 20 mins max. that leaves you with 37 minutes...Keep about 15 minutes for lunch...and rest of the time for bathroom breaks..
Break time is more than enough..don't worry about that...Grab energy bars, chocolate, energy drinks, water, sandwich, banana...eat properly...not too little..not too much..you don't want to get dizzy with a full tummy or get hypoglycemic by not eating anything in between..
Hope this helps..All the best for your exam tomorrow...
Happy studying !


2confused2bdoctor - 06/13/08 12:38

hey, good luck..well my2k is right..take break every block if you can.I did same so your brain doesnt get tired sitting in cubicle and your eyes can relax too. Drink some water and take about 5 mins and for break take about 20 mintues..even if you take 5 min break every block and 15-20 mintutes for lunc that should be enough. Dont eat heavy carb food..just some energy food..and fruits if that helps..quick energy. Now about the exam, dont change your answers for the one you dont know unless you are sure about changing the answer because the moment you change the answer chances are you gona pick the wrong one so with stay confidence with your answers and no second thoughts, you will ace it. good luck and pray..stay positive..get some good sleep.

* My exam experience
#303522
penne007 - 05/20/08 11:11

hey guys,

Sorry this is sooo late, I gave my exam on May 13th, then I got so busy in my relaxing lol, anyways then after that I was confused if I should write my exam experience now or after the results since I have no clue how I did on the exam. Anyways the night before I was a little nervous but I revised whatever I could. I took a benydryl (since I have past experiences of not sleeping the whole night right before the exam which screwed me over) so I slept peacefully. Woke up in the morning feeling rested ( I am not telling any of you to take a benydryl & sleep thats your personal choice), & went off to the exam. By the grace of God I was not nervous at all & actually was pretty calm before the exam. Sat down for my first block & started from bottom to top of the Q as I practiced (I like it better that way). Anyways the first 2 block seemed EASY!! I even had 5 mins left over at the end, after the 2 blocks I took a 5 min break, ate a nutrigrain bar & started the 3rd block which was not that easy but doable, then I took a 5 min break had some powerade, went to the bathroom rinsed my face in cold water & started my 4th block which was HORRRIBLE!!!. After the 4th block I took a 20 min Lunch break & started my 5th block which was ok i guess , took a 5 min break had a almond joy started the 6th block which was confusing & I almost ran out of time had to guess 3 Q. Took a 5 min break calmed my self down started the 7th block by now I am not tired but I just want to go home, I cant concentrate anymore even if this block was actually doable & I ran out of time had to guess 5 questions. I finished the exam but I didn't feel tired at all rather confused on how I did. I didn't feel like the exam was hard but not easy either I would say deffinitely doable. I am more worried now because I just hope I pass since I am just an average student.

I can't remmeber Q from the exam like other people but I Can tell you some of the topics I recieved:

1) Cancer drugs- I had many of these esp about the mechanism of action & side effects luckily I was prepared for this
2) Pharmacology - mostly they would ask the mech of action & esp what receptors the drugs act on!! esp those drugs for siezure, also they showed the typical charts for drugs & the action on BP & HR they used alot of Beta & alpha blockers which for some reason confused me even when i was prepared for those Q, they had MOA of psychiatric drugs esp the action on Dopamine receptors
3) Calcium - know everything thing about calcium - they had those charts with the arrows & they confused the crap out of me, I spent so much time thinking, read the PTH , 1-25 DHC, Parathyroid like hormone , calmodulin , action on troponin etc
4) Embryo - not much but they kept testing the thyroglossal cyst & branchial cyst , gets confusing
5) Biochemistry - Know the chart in FA on pg 160 (regulation of metabolic pathways) they asked so many Q with those regulatory enzymes thank the Lord I did this chart really well 2 night before. Know the actions of Vitamins esp Vit C , had alot of biochem esp the glycogen storage & lysosmal storage diseases, I hate BioChem but I made sure I did it well & thank God
6) OBGYN - I know this sounds wierd but I had alot from this section which i was not expecting, esp on STD, Rx in STD if they are pregnant, can't remmember others
7) CT of head which was easy the typical bleeding meanaing everything about brain hematomas & which artery or vien ruptured, CT abdomen they wanted me to identify some tiny vessel near the liver ,I couldn't get that one
8) Umair's Q deff important I had some similar like wilson's disease , translater Q in Behavorial science, & FDA vs herbal drug Q in behavorial science, go over those
9) pneumonia & meningitis know everything about it esp Mycoplasma pneumonia
10) DO the NBME reallllllly well I had some Q from nbme I remember seeing similar ones esp the histo slides !!!! It was a carbon copy
11) Musculoskeletal - know diagrams for the actin myosin, toponin, I wish I had went over that,
12) cell biology - the typical diagram for the desmosomes, hemidesmosome, integrin etc
13) Genetics - had tons & as usual I was confused lol, I can't even remmeber what they asked
14- biostats - another subject i dislike, had atleast 2-3 in every block the typical case- control, acurracy. percission, cohort studies, probability, prevalance, incidence, relative risk ( they love RR )
15) behavorial science - had atleast 1-2 in every block deffinitely doable except for some wierd ones but overall not to worried about if you have gone over some kaplan ethics & UW behavioral science Q , very similar to UW & NBME

Advice :
1)For me most of the Q seemed short like UW & NBME, I felt those Q banks were more than enough but everyone has thier own comfort

2) I love FA I felt it was sooooo impt there were so many things they ask from there

3) Golijan Audio - he is amazing so many things he says stick in your head, I wish I had time to go over his Patho notes I am sure it would have benefited my score but I had no time

4) going over as many NBME's as possible I only got to do NBME 3 but it helped alot!!

5) everyday I spent time doing atleast 2 blocks straight & hours going over it, as well as eating lunch at 2 pm so in the real exam I didn't feel tired or hungry & was able to do 4 blocks before lunch beacuse after lunch you feel tired & want to go home

6) I did alot of Q esp NBME 1 week before my exams & only Q. Q , Q , Q now some people feel thats bad because you get nervous & tired but for me that helped because on the real exam I was comfortable with the exam Q

7) Make sure you revise your weak subjects in the last week !!! (I said revise not study ok =0) )
this really helped me on the exam because I hate biochem but I forced myself to spend time on it before the exam so everything stayed fresh & that helped

8) Please take breaks in the exam if you need it don't worry we have plenty of break time esp if you skip the tutorial so use your breaks, it really helps


My scores:

NBME 2 (months before the exam) - 390
NBME 4 (1 week before the exam) - 410
NBME 3 ( 3 days before the exam ) - 130 (offline which is equal to 195 I think)
UW - timed & mixed is 55% cumulative score & 60% on individual tests during the last week

as I said I am an average student expecting an average score but right now I just hope I pass, The Lord has been good to me so far & even on the exam whatever I got to revise days before the exam helped me alot so I am very thankful to God no matter what the results, so please keep me in your prayers & good luck to everyone that is taking the exam.

also I had no audio or visual Q & if I gave my exam May 13th tues when can i expect my results?

OK i have compiled some links and ethics cases.
#300761
umair_y - 05/11/08 05:55

OK i have compiled some links and ethics cases.I hope they are helpful.




MEDICAL ETHICS 137 cases:

1.A 25- year old mother refused immunization for her 2-month old son. The social worker spoke to the mother. (Important for Board examination)
Next step in management: immunization should be given for the benefit of the child.
Correction: IMMUNIZATION CAN BE WITH HELD FROM THE CHILD IF PARENTS ARE AGAINST IT.BECUZ LACK OF IMMUNIZATION POSES VERY LITTLE THREAT AND IT IS NEITHER LIFE OR LIMB SAVING.
HOWEVER IF GLOBAL CAMPAIGN ON IMMUNIZATION REFUSED APPROPRIATE HEALTH AUTHORITIES SHUD BE NOTIFIED {BREAK CONFIDENTIALETY BECAUSE POSING RISK TO OTHERS}

2. A 30-year old mother refused surgery for suspected appendicitis for her 6-year old daughter. The social worker spoke to the mother. (Important for Board examination)
Next step in management: surgical removal of the appendix should be preformed for the benefit of the child. (RULE: PARENTS CANNOT WITHHOLD LIMB OR LIFE SAVING PROCEDURE TO THEIR CHILD)

3. A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death is certain without surgery. (Important)
Next step in management: amputation should NOT be preformed.
Adolescent patients or adults who are competent in making decisions have an absolute right to determine what shall be done with their own bodies. However, most pediatric patients are not competent to make their own decisions. Please remember, children (15 years or older) are usually able to give a genuinely informed consent. Therefore physicians may respond to their request, except in a case of irreversible sterilization.

4. A 17-year old girl is a Jehovah™s Witness. She refuses a lifesaving blood transfusion. She is aware of the consequences. She spoke to the social worker. (Important)
Next step in management: blood transfusion should NOT be given because she is competent to make the decision.

5. A 5-year old girl is a Jehovah™s Witness. She requires emergency blood transfusion. Her mother refuses blood transfusion. A social worker along with two physicians spoke to the mother. (Important)
Next step in management: blood transfusion should be given because the patient is not competent. Mother cannot refuse her daughter™s treatment. (LIFE saving)

6. A 2-year old boy was brought to the ER by his parents for an injury. Physicians made the diagnosis of child abuse. There are three other children living in the same household. Both parents confess to child abuse but request the physician to keep it confidential. Social worker was involved. (Important)
Next step in management: the case should be reported to Child Welfare Agency (CWA). All children should be removed from the parents.

7. A 15-year old boy with STD (sexually transmitted disease) came to see a physician. He asked the physician not to tell his parents. (VERY IMPORTANT)
Next step in management: the physician should treat the patient and notify the appropriate health authority, but should not tell his parents.

8. A 16-year old boy wants to use a condom. He comes to the clinic for free samples. He requested the physician, however, not to tell his parents. (Important)
Next step in management: condom should be given and physician should not tell his parents.

9. A 30-year old male patient is recently diagnosed with HIV. He lives with his wife and two other children but is promiscuous. He requested the physician not to tell his wife. He lost his job recently. Social worker spoke to the patient. (Very Important)
Next step in management: physician should notify the appropriate authority (e.g. department of health) for the safety of other specific persons who are engaged in unsafe sexual practices. The physician however, should ask the patient to divulge the diagnosis to his wife and other sexual partners.

10. A very small premature infant was born in the delivery room by NSVD (normal spontaneous vaginal delivery). The attending physician decided not to resuscitate the newborn. Physician spoke to the mother. Mother started to cry. Newborn expired after 30 minutes. Is the physician liable for the newborn™s death?
Answer: NO. Please remember, no physician in the USA has ever been found liable for withholding or withdrawing any life sustaining treatment from any patient for any reason.

11. A physician picked up a car accident victim from the street and brought him to the ER in his car. He did not want to wait for an ambulance because the patient™s condition was critical. Physical examination in the ER reveals quadriplegia. Is the physician liable for this consequence? (Very Important)
Answer: YES, because the physician did not protect the neck of the patient resulting in quadriplegia.

12. A policeman brought an alcoholic patient to the ER. The policeman asked the physician to give him a sample of gastric contents by putting a nasogastric tube for laboratory study. The patient refused insertion of a nasogastric tube. (Very Important)
Next step in management: nasogastric tube should not be placed. Blood alcohol level however should be preformed. The policeman should not give orders to a physician.

13. A 60-year old man with a history of myocardial infarction (MI) suddenly develops ventricular tachycardia. A physician from another department was present. The patient needs resuscitation. (Very Important)
Next step in management: the physician must resuscitate that patient. Physician should not refuse treatment because he belongs to another department.

14. A 15-year old homosexual boy wanted to change his sexual orientation. He was not successful. He needed help. He requested the physician not to tell his parents. (Important)
Next step in management: physician should help him avoid homosexual activities. Physician should not tell his parents about his homosexual activities.

15. A 15-year old homosexual boy is brought by his parents to a physician. His parents do not accept their son™s sexual orientation. The boy refuses to change. (Important)
Next step in management: physician should tell his parent that homosexual activity is considered as an alternative life style. Parents should talk to his son but should not force him to change his homosexual activities.

16. A 16-year old girl becomes pregnant. Her mother wanted her to abort this pregnancy. The girl wanted to continue her pregnancy despite difficulties. Her boyfriend is a high school drop out. (Important)
Next step in management: physician should advise to continue this pregnancy because the girl is competent to make this decision.

17. A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the doctor not to tell her parents about this pregnancy. (Important)
Next step in management: abortion should be done and parents should not be notified. Please remember, strict requirements for parental consent may deter many adolescents from seeking health care.

18. Can a physician provide sterile needles for intravenous drug abusers? (Important)
Answer: YES. It reduces the risk of acquiring HIV or hepatitis. The patients should be referred to appropriate health facilities.

19. A 26-year old pregnant woman went for antenatal check up. Sonogram revealed a 27-week old fetus with erythroblastosis fetalis. Doctor recommended intrauterine fetal blood transfusion. She refused the procedure. Social worker discussed the case with the mother. (Important)
Next step in management: doctor should receive a court to do the procedure which will help the fetal condition.

(A HIGHLY DEBATABLE ASPECT.MOTHER IS LIABLE FOR WITH HOLDING LIVE SAVING PROCEDURE TO VIABLE FOETUS WHICH DOESNT PUT THE MOTHER AT RISK OF SERIOUS DAMAGE.HOWEVER AMERICAN OBSTETRIC ASSOCIATION MENTIONS NOT TO DO ANY OBS PROCEDURE ON REFUSAL OF MOTHER.MOTHER SHUD BE TOLD THAT SHE IS COMMITING AN ASSAULT AND THE CASE BE TAKEN IN COURT.COURTS ARE NOW RECOGNISING THE RIGHTS OF A VIABLE FOETUS)

20. A 20-year old man tells his doctor that he is going to kill girlfriend. She lives in the university dormitory. Doctor called the university and alerted them about the threat. However, university security people did not protect her. She was killed by her boyfriend. Who should be responsible for this killing? (Important)
Answer: the 20-year old man is responsible. Doctor did the right thing by notifying the university or the police. The university is also responsible because they did not take any preventive measures.

21. A 20-year old pregnant woman refuses cesarean section for complete placenta previa. Fetus is full-term and healthy. Social worker spoke to mother. (Important)
Next step in management: doctor can go to court to get permission for cesarean section for the benefit of the fetus.

22. A 30-year old pregnant woman ingested alcohol and illicit drugs (e.g., cocaine, crack) which are harmful to the fetus. What should a physician do? (Important)
Answer: the physician should be careful in reporting this case because the pregnant woman may not come back for prenatal care, which is important for both the mother and the fetus. However, if the baby™s urine toxicology test is positive for illicit drugs, case should be reported to CWA (child welfare agency). CWA suggests separate custody for the child.

23. A physician wants to study a group of children aging from 10-12 year old. Physician already got the consent from the parents. However, he didn™t discuss the study with the children. A child refused to participate. Should the physician force the child to participate? (Important)
Answer: no, because a child can refuse to participate in a research study.

24. A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with the patient who understood the procedure. Can the patient give consent? (Important)
Answer: yes. If a psychiatric patient understands the procedure, he or she can give the consent.

25. A 65-year old schizophrenic patient needs coronary angiography because of suspected myocardial infarction. Cardiologists explained the procedure to the patient who did not understand the procedure. Who can give the consent on behalf of the patient? (Important)
Answer: the patient™s relative can give the consent. If nobody is available to give the consent, court order should be obtained. If a psychiatric patient does not understand the procedure, he or she cannot give the consent.

26. A 25-year old woman developed postpartum psychosis. The newborn developed cyanosis due to congenital heart disease. The newborn needs cardiac surgery. Surgeon discussed the procedure with the mother. She understood the procedure. Can she give the consent? (Important)
Answer: yes, because she understood the procedure.

27. A newborn is diagnosed with either trisomy 18 or 13 with TE (tracheoesophageal) fistula which requires suregery. Mother request surgeon to repair the TE-fistula. What should a surgeon do? (Important)
Answer: surgeon should refuse to do the reparative surgery because these conditions (trisomy 18 or 13) are nonviable. If the patient survives, surgeon can put a gastrostomy feeding tube for nutrition. However, please remember that a patient with trisomy 21 (Down syndrome) with TE fistula should be operated on.
(LAW OF MEDICAL FUTILITY APPLIED HERE)

28. A 45-year old terminally ill patient wanted to die. He has pancreatic cancer and has been suffering from constant pain. He asked the physician to give him some medication which can expedite his death. What should a physician do? (Very Important)
Answer: physician cannot give any medication which will expedite the death. However, physician can prescribe medication to minimize the pain. The dose should be appropriate. Physician-assisted suicide is illegal everywhere (except in the state of Oregon).

29. A 47-year old man came to a doctor for chronic low back pain and dysuria. The diagnosis of metastatic prostate cancer was made after appropriate investigation. Should the doctor tell the bad news to the patient? (Important)
Answer: yes physician must tell the truth to the patient.

30. A surgeon wanted to perform cholecystectomy on a patient. The surgeon is not sure whether the patient has decision-making capacity. What is the next appropriate step? (Important)
Answer: consultation with a psychiatrist or neurologist may be helpful. Sometimes it is necessary to discuss the case with hospital attorneys, ethic committees, or ethic consultants. In a difficult case, the ultimate judge of a patient™s competency is a court.

31. A 45-year old widow was admitted to an ICU (intensive care unit) with ruptured intracranial aneurysm. She is comatose and is placed on a mechanical ventilator. She has a 20-year old son who did not keep any relation with his mother. However, he came to see his mother. His mother made a written proxy advance directive which indicates that her 50-year old female neighbor should make the substitute decision. Who is the right person to make the substitute decision in this situation? (Important)
Answer: 50-year old neighbor should make the substitute decision. Please remember, the most appropriate person to make the substitute decision is someone designated by the patient while still competent, either orally or through a written proxy advance directive. Other substitute decision makers, in their usual order of priority, include a spouse, adult child, parent, brother or sister, relative, or concerned friend. For a patient who has no other decision maker available, a phblic official may serve as a decision maker.

32. The right of patients to refuse medical intervention: patients can refuse dialysis, cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition and hydration, even if such a decision results in the patient™s death. A patient™s decision to withdraw (discontinue) or to withheld (not to initiate) life-sustaining treatment is not considered suicide and physician participation is not considered physician-assisted suicide. Physicians do not have any legal risk.

33. Can a medical student introduce himself or herself as a ˜doctor™ to the patient? (Important)
Answer: no. a patient can refuse a medical student from performing any procedure. However, medical students are allowed to perform a procedure under appropriate supervision If the patient agrees to that.

34. Should a bus driver hide history of epilepsy from his employer? (Important)
Answer: no. He has requested his physician not to mention his epilepsy to the employer because this would result in the loss of his job. The physician is obligated not only to his patient but to the community. The patient should notify his employer and try to find a non-driving job in the company. If the patient disagrees, physician may notify the appropriate authority for the safety of the patient and the community.

35. A 50-year old make is diagnosed with stomach cancer. He requested the physician not to tell his wife. The following day, the wife calls to inquire about her husband™s diagnosis. (Important)
Answer: the physician should not divulge the husband™s diagnosis. However, the physician should encourage the patient to reveal his diagnosis to his wife.

36. A 29-year old man is diagnosed with presymptomatic Huntington™s disease. This disease is an autosomal dominant (50% chance of having the disease in each pregnancy). He requested his physician not to tell the diagnosis to his wife. The wife wants to have children. (Important)
Answer: physician should ask the patient to seek genetic counseling and to urge him to discuss the matter with his wife. Since there is a risk of harm to the future children, physician can divulge the diagnosis to protect the future children.

37. A 18-year old man is diagnosed to have suspected bacterial meningitis. He refuses therapy and returns to the college dormitory. What should a physician do in this situation? (Very Important)
Answer: physician should report to the college authority and recommend that the suspected individual should be isolated during the course of his illness.

38. A 39-year old nurse is diagnosed with hepatitis B antigen-positive. She is working in a dialysis unit. She told her doctor. However, she did not tell the hospital authority because she is afraid to lose her job. (Very Important)
Answer: physician should ask the nurse to divulge her medical condition to the hospital authority. If she refuses, physician should notify the hospital authority for the protection of patients.

39. A 20-year old man with severe head injury was admitted to a small hospital. The patient needs neurosurgical intervention which is available in a nearby university hospital. Hospital refused to accept a patient who has no medical insurance.
Answer: university hospital must accept the patient.

40. A 30-year old man needs a second prosthetic valve. He is a drug addict. Surgeon does not want to perform surgery because the patient does not take care of himself. Is this the right decision? (Important)
Answer: no. Surgery should be performed if it is medically indicated.

41. A newborn male is diagnosed with anencephaly. His 1-year old sibling needs a kidney. His parents requested the physician to remove the kidney from the anencephalic child and to transplant that kidney in the 1-year old sibling. What should a physician do?
Answer: surgeon should perform the kidney transplant.

42. A 50-year old man is in a persistent vegetative state. Physician decided to discontinue nutrition and hydration for that patient. Is this the right decision?
Answer: yes. This is an acceptable practice in most states. Few states require clear evidence that the patient would have chosen this course.

43. A medical student requested his attending to perform a pelvic examination on a patient who is anaesthetized for appendectomy. Is this ethically acceptable?
Answer: no. The patient did not give consent to perform a pelvic examination.

44. A 20-year old woman slashed her wrists and wanted to die. She was unconscious and was brought to the ER. What should a physician do? (Important)
Answer: physician should take care of the patient. Psychiatric consultation and social worker evaluation are indicated. A suicide attempt is very often a ˜cry for help™.

45. A 90-year old man was diagnosed with having Alzheimer™s disease 10 years ago. It is difficult to feed him. He cannot recognize his family members. He developed recurrent aspiration pneumonia. What should a physician do?
Answer: physician should discuss this with the family and should respect their decision.

46. A 1-day-old infant was diagnosed with hypoplastic left heart syndrome. The patient is stabilized with the use of prostaglandin. Physician discussed this case in detail with the parents. What should the parents decide in this situation?
Answer: the parents can choose a staged surgical repair of the heart, a final heart transplantation if the organ is available, or allow the infant to die.

47. A 55-year old woman with severe developmental disability recently is diagnosed with breast cancer. Her mental age is estimated at a 2-year old level. Her family members do not want any more intervention. What should physician do?
Answer: physician should discuss this case with the hospital ethics committee members. The usual consensus is ˜not to do anything™ because of her severe mental disability. (NEVER, SHE IS COMPETENT, COMPETENT PATIENT APLLY BEST INTEREST STANDARAD)

48. A 49-year old woman with cervical cancer has a history of noncompliance. She had surgery a month ago. She missed several appointments. Can a physician force her for chemotherapy? (Important)
Answer: no. Physician can talk to her regarding the importance of chemotherapy. However, the patient must make the final decision.

49. An internist has been managing a diabetic patient for the last 10 years. The patient™s condition is progressively getting worse. The patient is also not happy with the physician™s management. What should a physician do in this situation?
Answer: physician should find another physician (e.g., endocrinologist) who might be more successful with the patient in this particular circumstance.

50. An internist recently refused to see a patient who he has been seeing for the last 5 years. Internist stated that the patient was rude to him. The patient went to see another physician who requested the patient™s medical record. What should the internist do in this situation?
Answer: internist should provide the medical records of the patient to the new physician.

51. An internist refused to see a complicated hypertensive patient who he has seen for the last 10 years. Internist did not give any notice to that patient. The patient was angry with the physician. The patient was recently admitted to a hospital with the diagnosis of stroke. Is the internist responsible for the patient™s condition?
Answer: yes. The legal charge of abandonment can arise when the physician without giving timely notice, ceases to provide care for a patient who is still in need of medical attention. Internist is not obligated to find him another physician. However, patient should have sufficient time to arrange for another physician.

52. A physician went to vacation for 2 weeks. He did not find another physician to cover him. He is very sincere. One of his patients with hypertension developed severe headache. The patient has an appointment with the doctor as soon as he comes back from vacation. The patient did not look for another physician and decided to wait. The patient suddenly collapses and was diagnosed to have intracranial hemorrhage. Is the physician responsible for this patient? (Important)
Answer: yes. The physician has a legal obligation to arrange for coverage by another physician.

53. An ophthalmologist performed a cataract surgery on a patient who went home after the operation. In the evening, the patient started vomiting and complained of severe headache. The ophthalmologist refused to accept that the symptoms were due to postoperative complications. The patient wanted to see the doctor immediately but he refused to see that patient. The patient went to the nearest ER and was diagnosed to have dislocation of the lens and partial retinal detachment. Is the physician responsible for the patient™s condition?
Answer: yes ophthalmologist failed to judge the patient™s condition seriously enough to warrant attention.

54. A 70-year old Chinese man is diagnosed to have severe osteoarthritis. He told his doctor that he is using Chinese herbal medicine. He is feeling better. However, he had two episodes of dizzy spells since he started that herbal product. What should a doctor suggest to this patient? (Important)
Answer: the doctor should suggest to discontinue the herbal product which may be causing the dizzy spells.

55. A 35-year old woman is diagnosed to have chronic throat infection. She is frustrated with the conventional medicine. She told her doctor that she is using an alternative homeopathic medicine. She is feeling much better and she has no other complications. What should a doctor suggest to this patient?
Answer: the patient can continue an alternative homeopathic medicine. Alternative medicine therapy is accepted in the society and is also used along with conventional therapy.

56. A 45 year old woman is diagnosed to have UTI (urinary tract infection). She told her doctor that she could not afford to purchase antibiotics. However, she is using herbal medicine that is cheaper. She is complaining of fever and dysuria. What should a doctor suggest to this patient? (Important)
Answer: the patient should discontinue the herbal medicine immediately and should start antibiotics as soon as possible.

57. A 13-year old boy with suspected meningitis refuses therapy. His parents also support that decision because they are supposed to go on vacation the following day. What should a physician do in this situation? (Important)
Answer: the patient should be admitted and treated in the hospital. If they refuse, legal action should be taken. (MENINGITIS TREATMENT IS LIFE SAVING)

58. A 2-year old girl is admitted with the diagnosis of intestinal obstruction. Her mother has a psychiatric problem. Her mother is not capable of giving the consent. Her father died one year ago. What should a surgeon do in this situation?
Answer: legal steps may be taken to provide a surrogate decision-maker.
(IN EMERGENCY LIKE THIS ONE USE IN LOCUM PARENTIS I.E PHYSICAIN DECIDES)
59. A 67-year old widow has been using hypnotics for the last 5 years. She is addicted. Her doctor wants to withdraw her from her present medication by trial on placebos. Is the physician making a right decision? (Important)
Answer: no. The physician cannot use placebos because his decision is deceptive. The problem of addiction should be discussed directly with the patient. The use of deceptive placebo is indicated in the following conditions:
(a) the patient insists on a prescription;
(b) the patient wishes to be treated;
© the alternative to placebo is either continue illness or the use of a drug with know toxicity;
(d) high response rates to placebo (e.g., postoperative pain, mild mental depression).

60. A 50-year old man is diagnosed to have multiple sclerosis. In the morning, the surgeon asked the man his opinion on the surgical procedure and he agreed. In the evening, the man refused to give consent for the same surgical procedure. He is also disoriented to place and time. Is the patient capable of making the decision?
Answer: no the patient has impaired capacity.

61. A 55-year old woman with diabetes is diagnosed to have gangrene on both feet. She was brought to the hospital. She told the doctor the she is feeling fine and she has no medical problems. Can she give consent for the amputation of both legs?
Answer: no. The appointment of a surrogate should be sought to get the consent for the surgery.

62. A 17-year old boy came to a surgeon for bilateral vasectomy. He is the father of one child and does not want to have any more children. He does not want to tell his girlfriend and parents. He lives with his parents. What should a surgeon do in this situation? (Important)
Answer: surgeon should not perform bilateral vasectomy and should offer him less radical alternatives. Please remember, a mature minor may not comprehend the implications of this procedure.

63. A 16-year old girl came to a doctor for bilateral tubal ligations. She is a mother of one child and does not want to have any more children. She does not want to tell her boyfriend and parents. She lives with her parents. What should a doctor do in this situation? (Important)
Answer: obgyn doctor should not perform bilateral tubal ligation and should offer her less radical alternatives.

64. A 16-year old boy wants to donate one of his kidneys to his friend who is suffering from ESRD (end stage renal disease). The boy™s parents did not agree with his decision. What should a physician do in this situation? (Important)
Answer: the physician cannot accept his kidney. However, he can donate one of his kidneys if his parents agree.

65. A 15-year old boy wants to participate in a research study. He told his parents who did not agree. He lives with his parents. Can this boy participate in the research study?
Answer: no the boy needs consent from his parents to participate in a research study.

66. A 17-year old boy lives independently. He is married and has one child. He wants to participate in a research study. Does he need his parents permission? (Important)
Answer: no. He is an emancipated minor who lives independently from his parents physically and financially.

67. A 70-year old man is diagnosed with terminal esophageal cancer and requires an insertion of a gastrostomy tube. He has signed a DNR (Do Not Resuscitate) order about a month ago. Should the preexisting DNR order stand or be suspended during the surgical procedure? (Very Important)
Answer: attending physician, surgeons, and the patient or surrogate should discuss the matter and either affirm or suspend the order in anticipation of surgery. If a patient is competent and wishes a preexisting DNR order to stand, resuscitation should not be performed in the event of an intrasurgical arrest.

(BAD ANSWER, DNR ONLY REFERS TO CPR AND NOTHING ELSE IF NOT CLEARLY
MENTIONED IN DNR ORDERS) MY ANSWER IF PT COMPETENT ASK SPECIFICALLY TO GASTROSTOMY.AND PROCEDE AS WISHED BY PT.IF PT INCOMPETENT ASK FAMILY FOR PTS WISH.IF CONFLICT AMONG FAMILY ON WISH OF THE PT GO TO ETHICS COMMITEE. (REMEMBER IF CONFLICT AMONG FAMILY IS NOT BASED ON WISH OF PT.GO FOR THE WISH WHOEVER TRULY REPRESENTS IT.)

68. An infant, born at 30 weeks gestation, appears to be SGA (small for gestational age) with multiple malformations. Amniocentesis study was not performed. Infant needs resuscitation at birth. What should a physician do in this situation? (Important)
Answer: physician must resuscitate the patient in the delivery room because the diagnosis is uncertain.

69. A 60-year old man is diagnosed with terminally ill colon cancer and needs resuscitation. He did not sign a DNR order. The physician has decided to perform a ˜slow code™ on his own. Is this the right decision? (Important)
Answer: no. Please remember, a performance of ˜slow code™ or ˜show code™ is not acceptable to the patient. This decision by the doctor represents the failure to come to a timely and clear decision about the patient™s resuscitation status.

SLOW CODES REFER TO WHEN FAMILY SAYS TO DO CPR BUT PHYSICAIN THINKS ITS FUTILE AND JUST TO SHOW FAMILY DOES CPR WITHOUT FULL PROTOCOL.

70. A 20-year old man is diagnosed with suspected bacteremia and meningitis. He refuses antibiotic therapy. He collapses and requires resuscitation. What should a physician do in this situation?
Answer: the physician should resuscitate the patient despite the patient™s refusal to antibiotic therapy. THOUGH ANTIBIOTICS STILL NOT USED.

71. A 50-year old woman is diagnosed with severe aortic stenosis. She collapsed in a doctor™s office and is required resuscitation. She is waiting for valve replacement surgery. What should a physician so in this situation?
Answer: this condition is called ˜physiological futility™. In severe aortic stenosis, vigorous resuscitation is highly unlikely to restore adequate cardiac output. Therefore, the physician might reasonably refrain from resuscitation.
PHYSIOLOGICAL FUTILITY IS WHEN CHANCES OF SURVIVAL WITH CPR LESS THAN 1%.
72. A 14-year old boy is diagnosed with terminally ill cancer. He is not responding to chemotherapy. His parents want to continue the treatment. However, the boy does not want to continue his suffering. The physician told the parents that chemotherapy will not be helpful. What is the appropriate decision at this point? (Important)
Answer: the boy™s decision should be respected because the treatment is futile.
(WRONG PT MINOR PARENTS REQUEST SHUD BE UPHELD)GIVING CHEMOTHERAPY DOESNT PUT PT ON LIFE AND DEATH SITUATION
73. A surrogate pregnant mother made a surrogacy contract with a couple in which she will give the baby to the couple. She developed complications in the first trimester and wanted to abort. Is she allowed to do that? (Important)
Answer: yes. If her life or health becomes threatened from continuing the pregnancy, she should retain her right to abortion.

74. A physician became sexually involved with a current patient who initiated or consented to the contact. Is it ethical for a physician to become sexually involved?
Answer: no. Sexual involvement between physicians and former patients raises concern. The physician should discuss with a college or other professional before becoming sexually involved with a former patient. The physician should terminate the physician-patient relationship before initiating a romantic or sexual relationship with a patient.
IDEALLY ON STEPS SHUD BE HER DOC BUT SUPRESS UR OWN FEELINGS
75. A physician decided to take care of his own family members and relatives. He is a very smart physician. Is this a right decision?
Answer: no. The physician should encourage all friends and family members to have their own personal physician.

76. A male patient wants to have a copy of his medical records. What should a physician do in this situation?
Answer: the physician should retain the original of the chart. Information should only be released with the written permission of the patient or the patient™s legally authorized representative (e.g., attorney).

77. A 30-year old female wants to have an abortion. Her physician objects to abortion on moral, religious, or ethical grounds. What should a physician do in this situation? (Important)
Answer: physician should not offer advice to the patient.
IF SHE IS NOT COMFORTABLE DOING ABORTION ON MORAL GROUNDS REFER THE PT TO SOMEONE ELSE.

78. A physician sees patients at a reduced fee. He spends very little time with each patient. Is the physician doing the right thing?
Answer: no. The physician is not providing optimal care.

79. A surrogate pregnant mother signed a surrogacy contract with a couple. Male partner gave sperms which were artificially inseminated to the surrogate mother. Surrogate mother has a genetic relation to the child. She wants to void the contract after the baby is born. Is she allowed to breach the contract? (Important)
Answer: yes. Surrogate contracts, while permissible, should grant the birth mother the right to void the contract within a reasonable period of time after the birth of the child.

80. A surrogate pregnant mother signed a surrogacy contract with a couple. Both male and female parents gave sperm and ovums respectively. The surrogate mother wants to void the contract and she has no genetic relation. Is she allowed to breach the contract? (Important)
Answer: no. Genetic parents have exclusive custody and parental rights.

81. A surrogate pregnant mother signed a surrogacy contract with a couple. The couple got divorced. Male partner gave sperms and the female partner gave ovums. They do not want to continue the surrogate pregnancy. What should be the decision at this point? (Important)
Answer: the couple is genetically related to the fetus. They have the right not to continue with this pregnancy.

82. A surrogate pregnant mother signed a surrogacy contract with a couple. The couple got divorced. Male partner gave sperms but the female partner could not give ovums. They do not want to continue the surrogate pregnancy. What should be the decision at this point? (Important)
Answer: female partner has no right to terminate this pregnancy because she has no genetic relation. Surrogate mother has genetic relation and she has the right to continue this pregnancy even if the male partner disagrees.

83. A 3-year old girl is diagnosed with blood cancer. She has been waiting for an umbilical cord transfusion. Her mother delivered a newborn baby girl. Umbilical cord blood was obtained and was transfused to the 3-year old sibling. What is the duty of the physician?
Answer: physician should obtain an informed consent of the risks of donation and he or she should follow the normal umbilical cord clamping protocol. Physician should protect both the children.

84. A 31-year old man has decided to donate one of his kidneys for a large amount of money. Is this the right decision?
Answer: no. However, the donor can receive some payment to cover his medical expenses. Only the potential donor not the donor™s family or another third party may accept financial incentive. Payment should occur only after the organs have been retrieved and judge medically suitable for transplantation.

85. A couple has decided to have a child through artificial insemination. They asked the physician for sex selection of the child. What should a physician advise in this situation? (Important)
Answer: physician should not participate for sex selection for reasons of gender preference. However, sex selection of sperm for the purpose of avoiding a sex-linked inheritable disease is appropriate.

86. A 30-year old man has donated his sperms which were kept frozen. He died in a car accident. He did not leave any specific instructions regarding sperm donations. His wife wants to make use of them. A woman requested her to donate his sperms. What is the appropriate decision? (Important)
Answer: the donor™s wife can use the semen for artificial insemination but not to donate it to someone else. The donor should give clear instructions at the time of donation. The donor has the power to override any decision.

87. The donor and recipient of sperms are not married. Who would be considered the sole parent of the child? (Important)
Answer: the recipient. Except in cases where both donor and recipient agree to recognize a paternity right.

88. The residents and medical students were asked by an attending to follow certain orders for a patient. The residents and medical students believe the orders reflect serious errors in clinical or ethical judgment. What is the appropriate way to handle the situation? (Important)
Answer: The residents and medical students should not follow those orders. They should discuss with the attending issuing those orders. They should also discuss the situation with a senior attending physician, a chief of staff, or a chief resident.

89. A physician used a newly prescribed drug to his patient. The patient got sick after the drug was ingested and required hospitalization. Should the physician report this drug™s side effect to FDA (Food and Drug Administration)? (Important)
Answer: yes. FDA should be notified only if the drug causes serious adverse events such as those resulting in death, hospitalization, or medical or surgical intervention.

90. A 39-year old female has been suffering from chronic cholecystitis. The surgeon advised cholecystectomy. The patient wants a second opinion. The surgeon agreed. The patient went to another surgeon and has decided to be operated by the second surgeon. What should the second surgeon do in this situation? (Important)
Answer: the second surgeon should accept the patient because the patient has the right to choose the surgeon. First surgeon should accept the patient™s decision.

91. A 45-year old male was admitted to the hospital with mild chest pain. He wants to leave the hospital before completion of therapy. How do you manage the patient? (Important)
Answer: The patient is asked to sign a statement that he is leaving against medical advice (AMA). The patient may however leave without signing that statement. This document is a legal evidence that the patient was warned by the physician about the risk of leaving. Please remember, discharge AMA does not apply to children.

92. A 55-year old man requested his physician to misrepresent his medical condition to receive disability or insurance payment. What is the appropriate response of the physician in this situation?
Answer: The physician must refuse that request.

93. What is the responsibility of a fellow physician who is aware of drug abuse, alcohol abuse, or psychiatric illness of his colleagues or of a medical condition that is harmful to patients? (Very Important)
Answer: the physician should protect the patients. The fellow physician should report to the appropriate authority (i.e., report to the hospital authority; report to the Dean for a medical student™s problem).

94. A 60-year old male has been suffering from severe pain due to terminal prostate cancer. The patient is receiving lower doses of narcotics and sedatives. How can a physician relieve his suffering? (Important)
Answer: The physician should increase the dosage of narcotics and sedatives up to the maximum recommended amount. Listening, spending more time with him, and reducing psychological distress can reduce the suffering.

95. A 25-year old female medical student or resident noticed a mistake made by a junior attending physician during rounds. She is afraid of that attending physician. What is the appropriate way to handle the situation? (Important)
Answer: She should discuss the situation with a more senior attending physician for appropriate interpretation, advice, and assistance.

96. A 26-year old male medical student or resident made a mistake during patient care. He is afraid of what might result. What is the appropriate way to handle the situation?
Answer: He should disclose the mistake to the attending physician and try to learn from that mistake. The patient should be notified as well.

97. A 63-year old female health care worker is concerned about taking care of patients with HIV infection or multidrug-resistant tuberculosis. What is the appropriate way to handle the situation? (Important)
Answer: The physician should provide appropriate care to patients despite personal risk. Institutions should reduce the risk of infection by appropriate equipment, supervision, and training. Her concern should be taken seriously.

98. A 30-year old male physician has an opportunity for financial incentive if he sees more patients and refers them unnecessarily. What is you opinion about this?
Answer: The physician should provide only care that is in the patient™s best interest.

99. Two physicians are discussing a case inside the elevator of a hospital. What is your opinion about this?
Answer: They should not do that because they have to maintain the patient™s confidentiality.

100. The patient™s confidentiality should be maintained except in the following situations:
Physicians should override third parties in case of domestic violence, child abuse, elderly abuse, gunshot wounds, syphilis, and tuberculosis. They should report these cases to appropriate governmental authorities.

101. A physician is experiencing a very difficult ethical issue regarding a complicated case. He is confused. What should be the next step?
Answer: he should discuss the matter with other faculty members in his health care team, colleagues, or hospital ethics committee.

102. What is the final plan of action in an ethical issue?
Answer: Both patient and physician should agree regarding final management. The patient should be well informed about the medical condition. The physician should be sympathetic and knowledgeable regarding the relevant medical condition.

103. DNR (do not resuscitate) order. This is appropriate if the patient or surrogate signed that order or if CPR (cardiopulmonary resuscitation) would be futile. Physicians should write DNR orders and the reason for them in the chart. Please remember, œslow or œshow codes are not acceptable. Foods and fluids are considered therapies that should be stopped. (Important)

104. (A) Brain death (adult): (Important)
(i) Definition by the President™s Committee:
Death is an irreversible cessation of circulation and respiratory functions or irreversible cessation of all functions of the entire brain and brain stem.
(ii) The criteria of brain death by the staff of Massachusetts General Hospital and the Harvard Committee:
Death occurs when there is absence of all signs of receptivity, responsivity, and all brainstem reflexes, and the EEG is isoelectric. Sometimes metabolic disorders and intoxications may mimic the above findings.
(iii) The guidelines of brain death:
(a) The diagnosis should be made also by another physician and confirmed by clinical findings and EEG.
(b) The family should be notified. They should not make the decision about discontinuing medical treatment except in a situation where the patient has directed the family to make the decision.
© The physician should discuss with another physician before removing supportive measures (e.g., ventilators).
(d) Family members may request organ donation, and in many states physicians may request the family to make an organ donation.
(B) Brain death (children):
(i) Definition: same as in adults.
(ii) Criteria: similar in children and adults, but the period of observation is longer in children.
Children 1wk-2mo of age: two separate examinations 48 hours apart
Children 2mo-1yr of age: two separate examinations 24 hours apart
Children more than 1 yr of age: two separate examinations 12 hours apart
Spontaneous movements must be absent, with the exception of spinal cord reflex withdrawal and myoclonus.
Generalized flaccidity should be present. The presence of clinical criteria for 2 days in term and 3 days in preterm infants indicates brain death in majority of asphyxiated newborns. The absence of cerebral blood flow on radionuclide scan and silence of electrical activity on EEG are not always observed in brain-dead newborns. There is no universal consensus about the definition of neonatal brain death. The decision is made after discussion with the family and health care team. If there is difference of opinion, the ethics committee should be consulted. The decision is made on the basis of what is in the best interest of the infants and children.

105. Practice guidelines for physicians:
(i) The best way to practice medicine is to select useful diagnostic techniques and therapeutic measures which are most appropriate to a particular patient and clinical condition.
(ii) Practice guidelines can reduce the health care costs, which improve health care to patients who even do not have adequate health care benefits.
(iii) Please remember, guidelines do not and should not be the only way of managing an individual patient.

106. Some important points about patients:
(i) For a patient with an incurable disease, the major goal of therapy should be the enhancement of the quality of life.
(ii) The patient care begins with a personal relationship between the patient and the physician. If a patient has confidence on the physician, reassurance may be the best therapy. The patient must understand that the physician is giving the best possible care available.

107. Patients who do not have decision-making capacity about their medical care:
The patients who do not have decision-making capacity usually arrange for surrogates who make decisions for them. Their choices depend on their values. Psychiatrists are helpful in mentally impaired patients. Family members are usually the surrogates, because they know the patients very well.
Advanced directives: statements made in advance in case patients lose their decision-making capacity in the future. These directives indicate the names of surrogates and which interventions are acceptable or not acceptable to them. These are achieved by oral conversation (most common form), living will, health care power of attorney, or physicians can ask the patient in advance.
Absence of advance directives and surrogates: physicians can make the decision using all information and should respect the patient™s values. Physicians must know the laws of the state in which they practice.
Patient preferences are known:
The decision is made with the patient™s best interest in mind.
Disagreements between potential surrogates or between the physician and surrogate: Physicians can consult with the hospital ethics committee or with other physicians. The courts should be only the last resort.

108. Down syndrome with different medical conditions: (Very Important)
(a) Duodenal atresia at birth: surgical repair is recommended as it is done regularly.
(b) VSD (ventricular septal defect) in newborn period: initial conservative medicals management is followed by surgical repair as it is done regularly.
© Cyanotic heart disease at birth: immediate medical management, which is followed by surgical repair, as it is required routinely.
(d) Cosmetic surgical condition (e.g., rhinophyma or big nose): there is no urgency to repair the underlying condition, but it can be done as it is performed regularly.
(e) Neural tube defects (e.g., meningomyelocele): surgical repair is recommended as it is done regularly.
Please remember, a patient™s management should be discussed with his/her parents and the decision made with the best interest of the patient in mind.

109. A healthy male patient with Down Syndrome lives independently. He went to a doctor for facial cosmetic surgery. Can he make his own decision? (Important)
Answer: yes. The patient can make his decision if he understands the procedure and the consequences. He lives independently which indicates that he is capable of making his own decision.

110. A patient went to the doctor due to throat pain. The doctor asked the patient what her problem was. The patient said that she woke up at six o™clock in the morning, went to the bathroom, ate breakfast, and went to drop her children at school. She then came back home, stared cooking and continues to talk about irrelevant things. What should the doctor do to stop the patient from rambling? (Important)
Answer: the doctor should ask the patient to tell him what problems she has related only to her throat.

111. A patient went to a doctor for abdominal pain but remained quiet throughout the visit. He did not tell the doctor enough about his symptoms. What should the doctor do? (Important)
Answer: the doctor must ask the patient detailed questions about his abdominal pain. It is the doctor™s obligation to find out as much as he can about the patient. Without enough information, the doctor will not be able to make an accurate diagnosis.

112. A patient walked into his doctor™s office with acute abdominal pain. He has been suffering from ulcerative colitis. The patient is noncompliant and did not visit for the past six months. What should the doctor do in this situation? (Very Important)
Answer: The doctor should find out more about the patient™s abdominal pain before making any other decision. The doctor should always be responsible with the patients.

113. A terminally ill pancreatic cancer patient with multiple metastases is admitted to the hospital.
He is in critical condition. The patient wants to know his prognosis. What should the doctor say?
Answer: the doctor should tell the patient politely that he will discuss his condition with him and his family. The doctor should never specify the longevity of the patient.? The doctor should tell the truth even when the patient is a child. The doctor should not hide any medical information from the patient.

114. A patient is recently diagnosed with cancer. He is nervous but is eager to know about his medical diagnosis. What should the doctor™s reply be? (Important)
Answer: the doctor should gently tell the patient his condition.

115. A patient is recently diagnosed with cancer. Previously, he had an episode of a nervous breakdown after hearing a family death and had to be admitted to a hospital. He loves his family members and tends to be very open with them on all issues. How should the doctor tell the patient about his current state? (Important)
Answer: the doctor should call his family members and discuss the patient™s medical condition openly and politely.
(WRONG IF DISCLOSING BAD NEWS CLEARLY PUTS PT IN NERVOUS BREAKDOWN CONDITION WAIT AND GRADUALLY TELL THE PT.NEVER BREAK CONFIDENTIALETY)

116. A male patient was admitted with severe myocardial infarction. He was admitted to the ICU and his condition is very critical. He does not know the reason for his admission. The patient is unstable. What should the doctor tell the patient? (Important)
Answer: the doctor should wait until the patient is stabilized and then gently tell him his medical condition.
(HIDING SOMETHING FROM THE PT MAKES HIM MORE SUSPICIOUS AND MAY LEAD TO ALL KIND OF MISCONCEPTION IN PTS MIND SO NEVER WAIT TO TELL PT UNLESS TELLING IS CLEARLY DETREMENTAL)
117. A mother gave birth to a premature baby who was admitted to the NICU (neonatal intensive care unit). The baby is on a mechanical ventilator. The mother wants to hold the baby. What should the doctor do in this situation? (Important)
Answer: the mother should be allowed to hold the baby.

118. A male patient is recently diagnosed with HIV. Should the doctor ask about his sexual orientation (i.e., male, female, or both)? (Important)
Answer: yes, the doctor should ask the patient directly but politely about his sexual orientation.

119. A homosexual male patient went to a doctor. The patient™s partner was recently diagnosed with HIV. Should the doctor ask the patient whether his partner is penetrating him or he penetrates his partner?
Answer: yes, because the person who is being penetrated has a higher incidence of HIV due to trauma in perianal area.

120. A 6-year old boy comes to the ER after drowning. He expired in the ER despite appropriate resuscitations. The family members became angry which is a reflection of a sense if guilt and helplessness. What is the appropriate way of giving information to the family members?
Answer: the physician should give the information clearly and compassionately when there is no hope for survival. Parents need to know that everything was done to save the child.

121. A pregnant woman who is Rh (-) ve became sensitized. She had H/O induced abortions. Her husband is not aware of his wife™s previous abortions. He wants to know from the physician how she became sensitized. (Very Important)
Answer: the physician should tell the man to ask his wife. The physician should not mention anything about the patient™s H/O abortions.

122. A mother brought her infant to the ER. The radiologist test reveals old fractures of the ribs. She did not know anything about that. (Very Important)
Answer: this is a case of child abuse. This case should be reported to child welfare agency.

123. A physician is examining a child with respiratory distress. The child™s mother became anxious during the physical examination. Please remember, a patient™s management should be discussed with his/her parents and the decision made with the best interest of the patient in mind. (Important)
Answer: child abuse.

124. A mentally retarded patient became pregnant. The patient does not want an abortion. Her mother and husband want an abortion. What should a physician do in this situation? (Important)
Answer: abortion should not be performed.
BCUZ SHE IS COMPETENT UNLESS PROVED OTHERWISE
125. A male physician is examining an adolescent or adult female patient. What should a physician do in this situation? (Important)
Answer: a chaperone should be present during the physical examination. The same rules apply when a physician is examining a patient who appears to be seductive. (Important)

126. A female physician is examining an adolescent or adult male patient. What should a physician do in this situation? (Important)
Answer: a chaperone should not be present during the physical exam.

127. A suspected HIV patient expired in a car accident. He signed for organ donations. What
should a physician do in this situation?
Answer: his HIV status is not certain. The organs can be preserved until the HIV status is confirmed. If the test for HIV is positive, organs should be discarded.

128. A patient who expired in a car accident signed in his license for organ donations. His license has expired. He always wanted to donate his organs. What should a physician do in this situation? (Important)
Answer: physician cannot accept organs because the signed consent has expired.
ASK FAMILY MEMBERS ABOUT WISHES OF THE PT IF HE WANTED TO DONATE ORGANS.JUST AHVING AN ORGAN DONOR CARD DOESNT TELL PT INTENT.MAY BE HE SHUD HAVE DONE TO SHOW OFF OR GET A BONUS OR FORCRD BY SOMEONE.EVEN IF DONOR CARD HAD NOT EXPIRED AND FAMILY UNANAMOUSLY SAID THAT PT DIDNT WANTED TO DONATE ORGANS DONOT ACCEPT ORGANS FOR TRANSPLANT

129. A male physician sexually harassed a female patient during the physical examination. The patient complained to a nurse. What should the nurse do in this situation?
Answer: the nurse should tell the patient to make an official report to the hospital authority or to an appropriate agency.

130. A chronic male smoker comes to the physician for his heart problems. The physician wanted his patient to quit smoking. What should the physician advise in this situation?
Answer: the physician should ask the patient to quit smoking immediately because patients are usually more responsive when they are ill. The physician should assist the smoker to move one step closer to quitting.

131. A terminally ill patient did not sign a DNR (do not resuscitate) order, however, he signed a DNI (do not intubate) order. What should the physician do in this situation?
Answer: the physician should follow his orders i.e., the patient should be resuscitated but should not be intubated, despite severe hypoxic condition of the patient.

132. A terminally ill patient signed a DNR order, however, he did not sign a DNI (do not intubate) order. He wants to be intubated but not resuscitated. What should a physician do in this situation?
Answer: the physician should follow his orders i.e., the patient should be intubated but should not be resuscitated.

133. An adolescent car accident victim was brought to the ER in an unconscious state. The patient needs immediate surgical interventions. The surgeon was unable to contact any family member to obtain consent. What should a surgeon do in this situation? (Important)
Answer: the surgeon should do the procedure without waiting to obtain consent for the benefit of the patient.

134. An obgyn doctor is recently diagnosed with HIV infection. He is receiving medication for HIV. His physical and mental conditions are normal. Should he tell his patients or fellow physicians about his HIV status?
Answer: no, however, the doctor should take appropriate precautions for infection control. He does not have to tell his fellow physicians about his HIV status including the physicians who are referring patients to him. The doctor is allowed to see patients if he takes appropriate precautions. However, he should notify the hospital authority.

135. A physician is scared of seeing an HIV patient with an open wound. Can a physician refuse to see a patient?
Answer: yes, however, a physician™s refusal to see a patient is unethical but is legal.

136. An elderly semi comatose patient may require surgical intervention. His family members are confused about the surgery. They asked the surgeon for his opinion. What should the surgeon™s response be?
Answer: the surgeon can give his opinion and act as a moral surrogate for the benefit of the patient. (Very Important)
137. A 12-year old boy is diagnosed with a terminal illness (e.g., malignancy). He asked the doctor about his prognosis. His parents requested the doctor not to tell him the bad news. What should the doctor do in this situation? (Very Important)
Answer: the doctor should tell the truth politely and compassionately to the patient.
YES TOTALYY CORRECT CHILD NEEDS TO BE BE TOLD OF HIS TERMINAL ILLNESS IF HE CAN UNDERSTAND THE SITUATION AND IRREVERSIBILTY OF DEATH.TRY TO CONVINCE PARENTS FIRST.

138. A 55-year old woman is recently diagnosed with right breast cancer. The doctor told the patient that she would require surgery for removal of the right breast. She started to cry. What should a doctor do in this situation?
Answer: first, the doctor should give her some tissue paper for wiping her tears. Then, the doctor should be sympathetic to her and console her. He might tell her that similar reactions are usually expected from other patients with breast cancer. Please do not mention that she will be fine with a breast implant or without a right breast because she is already 55-years old.

139. A mother is carrying a 500 gram premature fetus, which develops acute fetal distress. The physician wanted to perform a cesarean section. Mother refused cesarean section. What should the doctor do in this situation?
Answer: the physician should arrange a bedside conference with the mother along with other physicians, social worker, and administrator to discuss the matter.

A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death is certain without surgery. (Important)
Next step in management: amputation should NOT be preformed.
Adolescent patients or adults who are competent in making decisions have an absolute right to determine what shall be done with their own bodies. However, most pediatric patients are not competent to make their own decisions. Please remember, children (15 years or older) are usually able to give a genuinely informed consent. Therefore physicians may respond to their request, except in a case of irreversible sterilization.

I found this question in one forum. Is it correct? can a child (minor)has a right to refuse the treatment? please correct me if I am wrong.



A 24 yr old male is brought to the emergency room by a group of friends because he attempted to hang himself. On initial examination, it was evident that he has sustained a cervical vertebral fracture... he was quadriplegic, but made it evident that he didn't want any treatment. The possibility of respiratory paralysis was almost certain, unless an emergency spinal surgery was performed which has a success rate of 80% . It was known that he has been living with 2 of his best friends for past 7yrs. Upon contacting them, they revealed that he has been very depressed for over 1yr after the death of his girl friend. They said that he never talked about suicide. The friends didn't want forced treatment even if the condition is life threatening. What is the best action the Physician should take next?

1- Don't treat because the patient didnt want any treatment
2- Don't treat because the friends didn't want forced treatment
3- Go ahead with the surgery
4- Take it to the hospital ethics commitee
5- Go to the court.



5. A patient is recently diagnosed with cancer. Previously, he had an episode of a nervous breakdown after hearing a family death and had to be admitted to a hospital. He loves his family members and tends to be very open with them on all issues. How should the doctor tell the patient about his current state? (Important)
Answer: the doctor should call his family members and discuss the patient™s medical condition openly and politely.

116. A male patient was admitted with severe myocardial infarction. He was admitted to the ICU and his condition is very critical. He does not know the reason for his admission. The patient is unstable. What should the doctor tell the patient? (Important)
Answer: the doctor should wait until the patient is stabilized and then gently tell him his medical condition.

11.You are a 4 yr medical student with a pt who has been in a severe motor vehicle accident. the pt has a subdural hematoma that led to cerebral herniation before it coudl be drained. over the last few days ,the pt has lost all brain stem reflexes nas is now brain dead. i have the closest relationship with the family than anyone on the team. the ventilator is to be removed soon and organ donation is considered.

who should ask for consent for organ donation???

a.you, because you haev the best relationship with the family

b the resident since u are only a student

c.attending on record

d.hospital administration

e.organ donor network.

12.A man arrives at the ER on a ventilator after an accident. He is brain dead by all criteria. He has an organ donor card in his wallet indicating his desire to donate. The organ donor team contacts the family. The family refuses to sign consent for donation.
What should be done??

a.remove organs anyway

b.wait for the pts heart to stop to remove organs.

c.Stop the ventilator & remove organs

d.Seek a court order to overrule the family

e.Honor the wishes of the family , no donation

13/You are the staff physician in a state penitentiary in a state where capital punishment is legal. An execution is in progress & the warden calls u because the technician is unable to start the IV line. The warden wants u to start the line & supervise the pharmacist.

What should u tell him ?

A no problem, I will start the line

b.i can start the line but I will no push the medications

c.i am sorry I cannot participate

d.i can take care of all of it.

14.you have been invited toe participate in a œmedical jeopardy game sponsored by a pharmaceutical manufacuterer. the winners receive a 100$ gift certificate to the medical school booksto

The Journey of Imam...
#301762
imam - 05/14/08 19:43

1st of all thank GOD, My mother n family members for their blessings, ma friends for their support n all my forum family for ur amazing support n best wishes.

Start:

It took almost 6-8 months journey with 2-3 breaks

read 1st KAPLAN notes+ Goljan 600pages
then KAP DVD's +goljan tapes

then once again read Kaplan notes
i travelled 2 US . Its a long break.

Next:

started with UW mixed, unused, timed.
It was very hard 2 me getting thru UW
Am very depressive by doin UW, n not getting gud scores,
while doin UW strted FA daily n whereevr i screwed up, i used 2 see FA for the ans,
U will find 90%of of them in FA. i slowly improved with FA

aftr doin 60% UW
i gave NBME 2 online got 440

then listout my weak areas
n went back thru kaplan Physio, Golajn Patho videos n notes , pharma notes n my weak areas in NBME 2.

then again go thru NBME 3 -500
n again make out my weak areas
n revised kaplan all subs in 10 days
done with FA

n gave NBME 1 offline-164/200
NBME 4 offline -174/200

n me with gud confidence and gave a final thump with FA n hit the exam on Apr24th.

while doin all these wenever i screwed up, i used 2 search in google web, wiki 2 clarify my doubts n pointed in my notes.


ABOUT EXAM:
i wud like 2 say its really doable exam with GOOD BASICS n ALL HY coNCEPTS, but Not so much easy without proper prep.
as U have to correlate and hav 2 go thru ur memory hooks and align them n find out the answers FROM THE GIVEN CHOICES.
U wont find the choices some times n hav 2 chose frm the BEST among.

Just be prepared n stay in xam mood frm a week before.
I have changed my sleep times, wake up times frm 1 week before the xam n stopped late night readings n adjusted my self to be active all the day by doin q's or reviewing the FA thse last week.

Mine appointment time is 9.30 am, i reached there by 8.45 am n reported. I opened my bag n arranged all my Junk food in locker to be easily taken during breaks. aftr freshed up, i received 3 yellow sheets n 2 marker pens for scribble. in One i wrote my noin big letters n put infront of me on desk. and started ma xam by 9.05 am.

the countdown starts here n ends by 5:05 pm . NO one can stops It.

as am very familier with tutorial I spent jus 5 mins on it , this 5 mins time i used to relax.
after sitting comfort , n adjusting my self took a deep breath n started.

My 1st Q is micro and the havoc continued . i got around 30 Q's frm micro in 1st block.
i never be able 2 believe, and concluded i caught Up. coz i hav no time 2 review it . The last 2 days i spent on Biochem , immuno, n molecular biology. But here I fail 2 guess.

continued the the 2nd block , it's not bad.
i took a break of 5 mins
3rd the easiest . am done in 45 mins n hav enough time to review . evry one will get 1 block like this.
took 5mins break
4th the Toughest. I feel exhausted . all 45 q's lengthy, some weird q's frm mol.biology, n genetics.
my mind blasted like anything and not able 2 manage time 2 q's left n block end.
I took a break here, had lunch n some lemon DEW n took rest n 2 captivate energy n decided to fight again and not to repeat the mistake again.

done the 5th one. its Okay. am feeling tired . come out n took 5 mins break n had some chocolate.

I felt the freedom as am goin thru block by block.
I hav done 5 blocks n only 2 left .its an amazing feel what i had tht time.

started 6th one its an easier one. coool.
still i hav 20 mins break time n come out n had a banana and some red bull , took rest for 10 mins n ia am in a hurry to complete .

7th one a little bit tough , think its due to exhaustaion n we'll not able to think for the ans, we just in a hurry to finish the xam, i may hav done the same. even i am reluctunt to rewiew the marked ones.
the feel U feel aftr U finish is Greatest of All.

THE EXAM:

50% patho, physio
25% micro ( i am the exception i think, i got 80-90 micro q's )
10-15 anatomy , embryo
20 pharma
10-20 immuno
10-15 BS


the ques looks like UW,the content like NBME.
kaplan patho qs, immuno, embroyo-anat q's helped me.
they r classic vignettes n u find the same clues thr.
some weird q's will always be there. They r real distractors. They test just howmuch Stubborn u are. Dont be panic n lose some easy q's .

be prepared. Dont be afraid of that, try 2 make out in 1 min, if U find tht U cant get in one min , just make a best guess n move. N forgot totally abt them

RESOURCES:

Kaplan notes n videos
Goljan audios n notes
FA
wikipedia
google.

jus stick to these resourses.
n be thorough with HY concepts ..dont search for what is HY..
evry point given in FA is Hy, its jus like all the previous q's collected n assembled in a stylish manner.
u will be do gr8 if u start FA early.
n skim thru it 2-3 times bfore xam .
n u shud be able 2 revise it whole in last 2 days
and ur UW notes .

q bank:
UW and downloaded kaplan q bank .

My Results:
UW timed,mixed,unused 50-54 % cumulative
70-76% in last 10 blocks.

NBME 2 - 440 : 45 days befor the xam
NBME 3- 500 : 18 days befor the xam.

usmle CD 44/41/39 : 2weeks before

offline
nbme 1 : 162/200
nbme 4 : 174/200
both 1 week before th xam

n forum q''s helped me a lot.

all ur supports and esp Raji- the goddess of forum,berkamp
ebnalfady , 2c2b, okt3 questions
my best pals... SHINEY , Harsh , aimhigh.
all my forum family kosaraju,sam,rachana, john,2b2 md, sameena, spartan, ultradoc,dream,spartam, neurosynapsis,srija, lisa,hardtarget,vinay, maz,typhoid,manik, indiangirl,slick,meharad, elba, hoxgene,durham,usmled,calidoc,r11000010101, syndrome,99hope, and all the frnds whos wishes saved me.

* finally gave the exam
#333481
superpsycho - 09/01/08 22:06

3 months and 20 days of hard hard work....
and am here today finished the exam....
minimum of 6 hours a day study and plenty plenty of qbanks.....
then only we can crack the step....
anyways i haven yet got my results... so won be telling much b4 i get the score....
its doable if u r thorough with UW.... ery much similar to it....
but many questions are out of UW too... so basic concepts to be strong.....very strong...
especially biochemistry and the cell biology.... they hit us at basics....
and unfortunately they even asked me that aminoacid structures.....
this was tough....
and got one audiovisual stuff.... its was on cvs... mostly hypertrophic lv because of AS....
not sure of it.... all murmurs just murmured:-)
2nd and last blocks were real difficult.... many were unheard of..... but rest of them were ok ok.... and as i said, its doable....
breaktime is best to be utilized..... take less initially and then only u can have more breaks towards the end which is a must....
got my confidence only after doing the UW self assessment....
got 650 and 710..
i would especially thank rizowana for a good support.... also ebnafaldy and all those who wished me b4 the exam....
thanks a lot guys..... will post when i get my results....
all take care:-)

Hi Rizowana,

Thank U so much for posting the collection. It will help me a lot while I prepare for the step (Just began my prepartion). Good luck to U for other steps and matching and whatever U do in ur life. Take care n thanks again.

Soma.

I'm done USMLE steps forever
#289339
ge2 - 04/03/08 00:58

Dear friends in this Forum:

I got my step 1 report today, I'm very happy I got 99/238. Although I am not a very active visitor, I did visit this site frequently during the last month of my preparation. Thank you everyone, for your great questions and discussions, I learned so much from this site.

My experience may not apply to everyone. I graduated from Medical School more than 15 years ago. I had been doing research in a lab (unrelated to clinic) in US for many years. I started to do observership last summer, which probably help me a lot to be familiar with Clinic. I started to prepare step 2 in October, all my materials used for step 2 were Kaplan step 2 (2007, yellow color) + UW. I really like K-step 2 books, Uworld is also definitely a must for me to prepare the exam. I took my step 2 around December 20th, and I was so surprised that I passed with 99/247. To be honest, age makes me lose my confidence. When I got my score, I gained my confidence back a lot.

After I™m done my step 2, I bought step 1 Kaplan books (some books are 2005, some are 2006 version). I started to prepare right after Christmas and New Year, read FA (2006 version) first, then Pathology (feel easy), Pharmacology (not bad ), Anatomy (the book is too thick, so some part of it I felt so boring and could not finish it), Biochemistry and immunology is my weakest point, it was so hard for me to pick it up as an old graduate, I could not get it for most part of immunology after first reading. For Physiology, the book again was too thick for me, so I used BRS series (3rd edition), and for behavioral science, I used high yeild (Barbara Fadem, 2nd edition) book, I liked this book a lot. My plan was to finish book readings within one month, so I had to rush a lot, and with not time to review each book at all. By the way, everybody suggests to use Golgen Pathology, I wish I had time to do it, unfortunately, because short of time, I don™t even know where to get those material. Maybe because I had done step 2, I didn™t find pathology was hard.

After I had done book reading once, I started to do UW in Febrary, my plan was to do 100 questions per day. I usually studied in Library from 9:30 am (after sending kids to school) until 9:30 pm. When I did UW, I wrote detailed notes, and also refer to books as well if important things in doubt. I did pretty thorough on each question. Each night, after I came home, I usually spent about ½ h to 1 hour or so in this forum to do some questions, and learned a lot from your guys discussion.

After I finished UW, I read FA once again, I was much more clear this time about basic concepts. Then I reviewed my 6 notebooks that I wrote down when I did UW, then went for exam on March 10th. I wish I could have two more weeks to do book review one more time, then I would be much more confident before exam.

During my exam, I™m feeling like doing UW. Some questions I have never heard about it, some questions are very basic, I knew that I saw them somewhere before and I knew that I should know the answers , but I had to guess, and later on I found that my guess were wrong. There are about 10 questions that I found out I answered wrong after exam, same as step 2. So, mistakes were allowed.

My average UW is 68-69, tutor mode, mixed. Online NBME 2 about 10 days before exam: 590, NBME3 about 3 days before exam, 630. My real exam is close to NBME.

Wish you guys all the best luck! If you have any questions, please don™t hesitate to ask!

my experience
#341706
superpsycho - 09/24/08 11:16

AM A FRESH GRADUATE

PREPARATION PERIOD-HARDLY 4 MONTHS

BEGAN WITH KAPLAN NOTES EXCEPT FOR PATHO..... FINISHED IN A MONTH....

FOR PATHO READ GOLJAN PATHO REVIEW 550 PAGES ONE... BOOK....
DIDN HAVE THE MOOD TO HEAR AUDIO... I USED TO DOZE OFFFFF....

THEN, DID KAPLAN QBANK OFFLINE... I DON REMEMBER THE AVERAGE... SORRY... AT THAT TIME I DIDN GET IDEA THAT I CAN CALCULATE... BUT I USED TO SCORE AROUND 30/50
IN 23 DAYS

THEN SOMEHOW I DID LANGE AND NMS QBANKS.... BOTH NOT THAT HIGH YIELD... BUT IMPROVE UR READING CAPACITY.... I TOOK AROUND 10 DAYS FOR THEM....

THEN, I DID USMLERX IN 26 DAYS.... MY AVERAGE WAS 69% THE QUESTIONS IN IT ARE LIKE REPETITIVE AND MAKES U PERFECT ON FIRST AID AND A FEW MORE POINTS....

FIRST AID WAS MY CENTRE OF STUDY.... FOR REVISING....

THEN, I TOOK UW EXACTLY 29 DAYS BEFORE THE EXAM DATE.... BELIVE ME... I WAS NEVER SURE... BUT STILL WENT AHEAD.... I FINISHED UW IN 18 DAYS!!!! EXACT.... DID 7 BLOCKS A DAY... THEN USED REVISED IT IN 2 DAYS....MADE NOTES OF IMPORTANT POINTS....

HEAR ME... ITS POSSIBLE AND I HAVE DONE IT...

THEN, TOOK UWSA...

MY SCORE WAS
UWSA1 248/650
UWSA2 257/710

REVISED THEM IN 5 DAYS...

DIDN HAVE TIME FOR NBME......I WANTED TO TAKE IT BUT THEN LEFT IT OFF THINKING THAT ANYWAYS I DON GET EXPLANATION FOR THE ANSWERS...

THEN REVISED ALL WHAT I HAD WRITTEN AND FIRST AID....

DAY BEFORE EXAM, I READ TILL 4 PM.... READ WHATEVER I COULD.... THEN CLOSED OFF THE BOOKS..... HAD A WALK WITH MY COUSINS.... HAD SOME FUN....

SLEPT WELL FOR 7 HOURS.....

REACHED THE EXAM CENTRE AT 8... STARTED AT 9.... MY BLOCKS WERE VERY DIFFICULT...

ESPECIALLY 2 AND 7.... BLOCK 6 WAS BIT OK... OTHERWISE all were to the level of UWSA

bit more difficult infact.... so expect a higher difficulty and an average of 10 less than wht u get in UWSA....

AND MY FINAL SCORE IS 240/99

AM GLAD TO JOIN THE CLUB OF 99....

THANKS TO ALL OF THE PEOPLE OF THE FORUM... ESP RIZOWANA... AND GOOD LUCK TO HER TOO... BYE...
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