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DIP Episode 591 - The Pathway To Comfortably Passing The USMLE Step 1 Exam (A Deep Discussion)

MixedMedium4 - HighHas Q&A

Step 1Step 2Step 3MedicineUSMLEStep 1Step 2Step 3

Topic

Study planning; High-yield core subjects (Renal, Endocrine, Biochemistry); Question volume progression; Board exam preparation strategies.

Key Takeaway

Effective Step 1 preparation requires a structured, multi-week approach that combines consistent review of foundational science (Micro/Pharm) with progressive exposure to high volumes of mixed-subject questions and targeted review of critical systems like renal physiology and endocrinology.

Runtime: 40 min

Published: 2025-04-14

Completed audio: Yes

Completed notes: Yes

Anki made: Yes

Section: —

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Episode Notes

Source / episode info

Episode: 591
Title: DIP Ep 591: The Pathway To Comfortably Passing The USMLE Step 1 Exam (A Deep Discussion)
Published: 2025-04-14
Source: Episode page

One-liner

High-yield summary

Standard Daily Activities: Maintain consistency by dedicating time every day to Sketchy Micro (20 min AM/PM/Night) and listening to targeted Pharmacology podcasts (Episodes 6 through 152). These activities ensure multiple passes over core material.
Study Progression: The plan emphasizes a gradual increase in question volume, starting with subject-specific blocks (e.g., 40 Cardio Qs) in early weeks and progressing to mixed-subject blocks (100 Qs -> 120 Qs) by Weeks 4-5 to build efficiency and pattern recognition.
Foundational Review: Dedicate time for deep review of core texts (e.g., First Aid rapid review, Thomas chapters 1-3) and foundational sciences like Biochemistry (watching videos over just reading slides).
High-Yield Systems Focus: Pay special attention to systems frequently tested: Electrolytes (Episode 135), Toxicology (Episode 164), Renal Physiology (Nephrodi/Electrolytes), and Endocrinology.

Learning objectives

Master the systematic approach to USMLE Step 1 preparation, understanding the importance of volume and consistency over cramming.
Differentiate between primary and secondary adrenal insufficiency regarding electrolyte abnormalities (hyperkalemia/aldosterone status).
Analyze common metabolic derangements, particularly various types of Renal Tubular Acidosis (RTA) and their associated drugs/pathophysiology.
Recognize high-yield associations in biochemistry, toxicology, and endocrinology that are frequently tested on board exams.
Develop efficient test-taking strategies by progressing from subject-specific review to mixed-subject question blocks.

Board exam buzzwords

Condition	Key Finding	Association	Board Exam Tip
Primary Adrenal Insufficiency	Hyperkalemia, Metabolic Acidosis (Type 4 RTA)	Aldosterone deficiency; high renin/low cortisol	Remember: Primary AI = low aldosterone -> hyperkalemia.
Dermatomyositis	Perifascicular inflammation, Anti-Mi-2 antibodies	Muscle weakness, skin rash (Gottron's papules)	The biopsy pattern is key; it is not individual fiber inflammation.
Acute Mesenteric Ischemia	Abdominal pain out of proportion to exam findings	Left Atrial Appendage -> SMA embolus (in A Fib)	Always consider embolic source in acute abdominal ischemia.
Type 2 RTA	Hypokalemic NAGMA, Urine pH <5.5	Carbonic anhydrase inhibitors; Fanconi syndrome	The acidosis is due to proximal HCO3 wasting.

Rapid review table

Topic	Key Point	Context	Exam Relevance
Electrolytes	Primary AI -> Hyperkalemia/Type 4 RTA	Aldosterone deficiency impairs K+ excretion.	High-yield for endocrine and nephrology questions.
Renal Acid-Base	Type 1 RTA (Distal)	Hypokalemic NAGMA, Urine pH >5.5; Nephrocalcinosis risk.	Distinguishing the H+ secretion defect site is critical.
Endocrinology	Secondary AI -> Normal K+/Aldosterone preserved	Lack of ACTH/Cortisol does not affect RAAS axis.	Crucial trap: Secondary AI does not cause hyperkalemia.
Biochemistry	Glycolysis rate-limiting step (Hexokinase)	ATP usage and glucose availability.	Understanding metabolic pathways is essential for drug mechanisms.

Board-speak -> diagnosis

Board-speak / Vignette phrase	Diagnosis / Concept	Why it fits
A patient presents with polyuria, metabolic acidosis, and hypokalemia following chronic use of a carbonic anhydrase inhibitor.	Type 2 Renal Tubular Acidosis (RTA)	CA Is cause proximal HCO3 wasting; the resulting loss of bicarbonate leads to NAGMA and subsequent potassium wasting.
A young male develops acute kidney injury after receiving an aminoglycoside antibiotic.	Acute Tubular Necrosis (ATN)	Aminoglycosides are nephrotoxins that primarily damage the tubular epithelial cells, leading to ischemic/necrotic AKI.
A patient with suspected adrenal insufficiency presents with hyperkalemia and metabolic acidosis.	Primary Adrenal Insufficiency (Addison's Disease)	Deficiency of aldosterone leads to impaired potassium excretion and hydrogen ion retention in the distal tubule, causing Type 4 RTA/hyperkalemia.
A patient develops acute abdominal pain following a recent episode of atrial fibrillation.	Acute Mesenteric Ischemia (Embolus)	The embolus classically originates from the left atrial appendage thrombus during A Fib and travels to the superior mesenteric artery (SMA).
A biopsy reveals perifascicular inflammation, muscle fiber atrophy, and elevated anti-Mi-2 antibodies.	Dermatomyositis	Perifascicular pattern is characteristic; Anti-Mi-2 targets a nuclear helicase/chromatin-remodeling complex.
The patient has an osteoblastic bone lesion in the vertebral bodies with no associated osteoblastic/sclerotic lesions component.	Prostate Cancer Metastasis	Prostate cancer classically metastasizes via the venous plexus, leading to sclerotic (osteoblastic) bone lesions, especially in the axial skeleton.

Differential diagnosis / distinguishing features

Causes of Acute Kidney Injury (AKI)

Key Features	Distinguishing Findings	Next Step
Pre-renal AKI	Low urine output, high BUN:Cr ratio (>20:1), preserved tubular function.	Assess volume status and rule out obstruction/vasoconstriction.
Intrinsic (ATN)	Tubular necrosis; often associated with nephrotoxins (aminoglycosides).	Identify the offending agent or underlying systemic disease.
Post-renal AKI	Urinary obstruction (e.g., BPH, stones); Foley catheter placement is for bladder outlet obstruction/post-renal AKI.	Perform renal ultrasound to rule out bilateral ureteral/bladder obstruction.

Management pearls

Study Volume: Do not underestimate the value of high question volume; progressing from 40 Qs -> 120 mixed Qs helps build efficiency and pattern recognition, which is key for board exams.
Active Learning: When reviewing foundational material (e.g., Biochemistry), prioritize watching explanatory videos over passively reading slides to maximize retention and understanding of mechanisms.
Standardization: Maintain the standard daily activities ( Sketchy Micro and Pharmacology podcasts ) throughout the entire study period, treating them like compound interest for knowledge accumulation.
Calibration Focus: In the final weeks (Week 6), shift focus from content acquisition to calibration by prioritizing MBM questions over U World self-assessments, as these mimic the actual exam writers' style.

Don't miss

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Primary vs Secondary AI: Primary adrenal insufficiency is characterized by low aldosterone and subsequent hyperkalemia/Type 4 RTA; secondary AI preserves aldosterone and does not cause hyperkalemia.

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Light's Criteria for Exudative Effusion: An effusion is exudative if any of the following criteria are met: Pleural fluid/serum protein > 0.5, pleural fluid/serum LDH > 0.6, or pleural LDH > 2/3 ULN.

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Prostate Cancer Metastasis Pattern: Bone metastases from prostate cancer are classically osteoblastic/sclerotic, particularly in the axial skeleton via the vertebral venous plexus.

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Mesenteric Ischemia Source: Acute mesenteric ischemia following A Fib is most commonly due to an embolus originating in the left atrial appendage and traveling to the SMA.

Integration & clinical reasoning

Physiology \leftrightarrow Pharmacology: The pharmacology podcasts are valuable because they do not just list drugs; they review physiology (e.g., RAAS, electrolyte balance) alongside drug mechanisms, providing a functional understanding of how medications affect body systems.
Anatomy \leftrightarrow Pathology: Understanding the vascular supply and anatomical location (e.g., RCA infarct causing posteromedial papillary muscle rupture) is critical for predicting pathology and complications in clinical scenarios.
Study Strategy -> Clinical Reasoning: The progression from subject-specific to mixed questions forces the student to integrate knowledge across systems, mirroring the complexity of real board exam vignettes.

OMM / COMLEX integration

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For COMLEX: know these viscerosomatics / Chapman points, but don't let OMM distract from emergent diagnosis and management.

Standard emergency management protocols (e.g., treating adrenal crisis, acute mesenteric ischemia) take absolute priority over OMM techniques; stabilization must occur first.
When managing electrolyte imbalances or metabolic acidosis in an emergent setting, understanding the underlying pathophysiology (e.g., aldosterone deficiency vs. CAI use) is paramount for targeted medical intervention.

Concept connections / cross-references

For detailed review on electrolyte imbalances: Review content related to Episode 135 (Electrolytes).
For understanding adrenal axis function and deficiencies: Review concepts covered in Primary Adrenal Insufficiency podcasts.
For general clinical reasoning and ethics questions: Review the dedicated episodes on Ethics, Social Sciences, and Quality Improvement (e.g., Episodes 123, 132).

High-yield association table

Condition	Association	Mechanism	Clinical Significance
Primary AI	Hyperkalemia / Type 4 RTA	Aldosterone deficiency -> impaired K+ excretion in the distal tubule.	Distinguishes primary (high renin) from secondary (low renin) adrenal failure.
Dermatomyositis	Anti-Mi-2 antibodies	Targets a nuclear helicase/chromatin-remodeling complex.	Highly specific serological marker for this inflammatory myopathy.
Acute Mesenteric Ischemia	Atrial Fibrillation (A Fib)	Left atrial appendage thrombus -> embolus to SMA.	Always consider embolic source in acute abdominal pain; do not assume GI obstruction.
Type 1 RTA	Nephrocalcinosis / Kidney stones	Chronic loss of bicarbonate and impaired acid excretion leads to calcium phosphate deposition.	Requires aggressive management of acidosis and stone prevention.

Key terms glossary

Term	Definition	Context	Example
Interleaving Method	Mixing different subjects or topics during study sessions rather than blocking by subject.	Study planning/Memory consolidation.	Studying Cardio, then Endo, then Renal in one day to improve recall and pattern recognition.
Calibration	The process of adjusting knowledge volume and speed to match the format and difficulty of a standardized exam.	Final weeks of preparation (Week 6).	Shifting focus from learning new facts to mastering question-answering efficiency using MBM questions.
NAGMA	Non-Anion Gap Metabolic Acidosis	Type 2 RTA; results from proximal bicarbonate wasting, leading to acidosis without a gap in measured anions.	Associated with carbonic anhydrase inhibitors or Fanconi syndrome.
Osteoblastic Metastasis	Bone metastasis characterized by new bone formation (sclerosis).	Prostate cancer is the classic example of this pattern.	Helps differentiate prostate cancer metastases from lytic lesions (e.g., multiple myeloma).

Study optimization

Topic	Study Approach	Priority	Resources
Foundational Science	Use videos (e.g., Biochemistry) over reading slides alone; ensure deep understanding of mechanisms.	High (Weeks 1-3)	Dedicated video series, Thomas chapters 1-3.
Clinical Systems Review	Implement the "Interleaving Method" and progressively increase question volume.	Medium to High (Weeks 2-5)	U World/NBME questions; Targeted podcasts (Electrolytes, Tox).
Exam Simulation	Dedicate final weeks to high-volume mixed practice and self-assessment.	Critical (Week 6+)	MBM questions; Free 120 series review podcasts; Self-assessments.

Question pattern recognition

Pattern: Hyperkalemia + Metabolic Acidosis: Points strongly toward primary adrenal insufficiency (aldosterone deficiency) or Type 4 RTA, requiring assessment of RAAS axis and mineralocorticoid status.
Pattern: Acute Abdominal Pain after A Fib: Strongly suggests acute mesenteric ischemia due to an embolic source from the left atrial appendage.
Pattern: Hypokalemic NAGMA with CAI use: Points directly to Type 2 RTA, caused by proximal bicarbonate wasting.

Test yourself

Common mistakes to avoid

🚫

Mistake 1: Assuming all three Light's criteria must be positive for exudative effusion. Correction: Only one of the three criteria (Pleural fluid/serum protein > 0.5, pleural fluid/serum LDH > 0.6, or pleural LDH > 2/3 ULN) needs to be met to classify an effusion as exudative.

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Mistake 2: Confusing the cause of hyperkalemia in AI. Correction: Primary adrenal insufficiency causes hyperkalemia because aldosterone is deficient; secondary AI preserves aldosterone and does not cause hyperkalemia.

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Mistake 3: Misunderstanding the progression of study volume. Mistake: Thinking that mixing subjects (mixed questions) should be avoided until later weeks. Correction: While early weeks focus on building a foundation by subject, the goal is to rapidly transition to mixed blocks to build efficiency and pattern recognition.

Common traps

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Trap 1: The "Secondary AI" Trap: Students often assume all adrenal insufficiency causes hyperkalemia because they forget that aldosterone production (RAAS) is preserved in secondary failure.

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Trap 2: The "Lytic vs Sclerotic" Prostate Cancer Trap: Assuming prostate cancer metastases are lytic, when they are classically osteoblastic/sclerotic due to venous drainage patterns.

⚠️

Trap 3: The "GI Obstruction vs Bladder Catheterization" Trap: Confusing the indication for a Foley catheter (post-renal AKI/bladder outlet obstruction) with general GI bowel obstruction management.

Original transcript with highlights

All right, welcome. My name is Divine. This is episode 591 of the Divine Intervention Podcast. Into this podcast, we're going to be examining a topic that I titled the Pathway to Comfortably Passing Step 1. The Pathway to Comfortably Passing Step 1. And, you know, some of you may have listened to episode 573, where I pretty much made a similar podcast on Step 2. Basically, like I lay out a very good, well-thought-out study plan for Step 2 CK. So here, I'm going to lay out the same thing for Step 1. And I'm going to base this on six weeks. I'm going to base this on six weeks. I think a good Step 1 study schedule should be at least six weeks. And why am I saying that? The thing is, the fail rate on Step 1 has increased in recent years. About, is it like what, like, 10 to maybe 11% of people fail Step 1 these days? That's a big jump from what it used to be before. That's one. And two, you want to actually, like, learn this content. Because the thing is, you will very likely struggle in your clinical years if you don't have a good foundation from Step 1. So, six weeks, six weeks. Now, if you decide to take an extra two weeks and make it like eight weeks, I have some recommendations for what you can do at the very end of this podcast. So if you're like, ooh, divine, I'm going to take an extra two weeks over six weeks. I have recommendations on what you can do. So just stick with me. And I think you're really going to get a lot from this podcast.

If you follow what I'm telling you here again, of course, I can not offer any guarantees. But I think this will put you in a very, very good position to do well on your test. So, before I jump into the six week schedule, there are two sets of things that I consider to be standard things. Okay, I consider them to be what standard things, what do I mean by standard things? These are things you're going to do throughout your dedicated period every single day. You're going to do them in the morning, in the afternoon, and in the evening of every single day of your dedicated period. There are things that don't require a ton of time, but there are things that you need to do with consistency. If you do them with consistency, it would be like compound interest. The results will compound for you over time. Now, what is the first thing that falls under the purview of standard things? So I'm not going to keep repeating this for every single week. You just know that every day of my dedicated period, I'm going to do this. Number one is sketchy micro, sketchy micro, sketchy micro. And how should you do sketchy micro? Literally, just good thing is these videos are timed. Do 20 minutes of sketchy micro in the morning, 20 minutes of sketchy micro in the afternoon, 20 minutes of sketchy micro at night. I'm going to say that again, 20 minutes of sketchy micro in the morning, 20 minutes of sketchy micro in the afternoon, 20 minutes of sketchy micro at night. Just do that on an ongoing basis.

And once you're done with the whole series, just start it again. Just basically start it again from the beginning, take it from the top. That way you'll probably get about three or if you're very industrious, probably like four passes of sketchy micro before you exams. That information is going to stick in your head if you do that. What's the second standard thing you're supposed to do? The second standard thing you're supposed to do that should make up a part of every single day of your dedicated is listen to my pharmacology podcast. So how can you get there? Well, go to my website, divine intervention podcasts.com. And then click on when you get there, click on the Heather that says podcast topics. Click on exam topic lists, exam topic lists below that you're going to see a link to a Google drive thing. Click on the Google docs link. And then you'll notice that there are different tabs at the bottom. There's a step one tab. The step one tab. If you scroll a little bit to the right, you're going to see the section that says pharmacology. In fact, you're going to see, oh, the first one episode six farm cases. Basically, the universe of things you're responsible for starts with episode six and then goes all the way down to episode 152, Reno 4, Reno 4. So basically, the universe again of things you're responsible for episode six, all the way to episode 152. I'm going to say that again, episode six to 152, that's Reno 4. Basically, your job is very simple.

Listen to three of these podcasts every day literally just listen to three every day. So say, for example, like the one of your dedicated period, listen to episode six in the morning, episode 18, the afternoon, episode 10 in the evening on day two, you listen to episode 14 in the morning, 18 in the afternoon, 20 in the evening, day three. Listen to episode 25 in the morning, 27 in the afternoon, 28 in the evening. Again, once you get to Reno 4, just start it again from the beginning. Again, this will give you about three to, if you're industrious about four passes through the farm material you're responsible for for your exams. Notice just like that, if you just do these two standard activities and many of these farm podcasts are not very long. If you just do these two standard activities, you're going to make multiple passes through micro and farm for your exams. Smart thing to do. All right. So now let's get into the needy gritty. What are you going to be doing day by day during your dedicated period? So let's start with week number one. So again, remember your two standard activities that you're doing the morning in the afternoon in the evening. So week one, the very first thing you should start off with is chapters one to three of the thumb on Monday on Monday, listen to chapters one through three of the thumb. All right. And then review the in the afternoon in the afternoon, do 40 pathology questions, 40 general pathology questions from your world and review them.

And then in the evening, review the pathoma text review the pathoma text on the chapters you watched in the morning chapters one through three. And then on Tuesday of week one in the morning, read the first date cardiology chapter, okay. Read the first date cardiology chapter. In the afternoon, do 40 your cardiology questions and review them. All right. Do 40 your cardiology questions and do what? Review them. That's your job. Right. That's it. That's it. That's literally it for Tuesday on Wednesday. What are you supposed to do in the morning? Read the first state respiratory chapter, okay. Read the first state respiratory chapter. And then in the afternoon, I would want you to do 40 your world respiratory questions and review them. Okay. 40 your respiratory questions and review them. And then in the evening, I want you to read the first state public health sciences chapter. Okay. In the evening, read is a short chapter. The first state public health sciences chapter. All right. What you don't Thursday Thursday of week one read the first date, Reno chapter. Okay. And then in the afternoon, do 40 your old Reno questions and review them. Okay. Do 40 your Reno questions and review them. That's it. On Friday, what are you supposed to do? Read the first state endocrine chapter in the morning. Do 40 your endocrine questions in the afternoon. And then in the evening, I will encourage you. In the evening, I will encourage you to listen to an episode I have on cancer.

It's episode 102, I believe, is called the clutch cancer podcast. Just listen to it. Okay. Clutch cancer. And the thing is, as you listen to it, you can follow along with the notes on my website. I believe that I have notes. You know, if you go my website and click on episode notes, there's a Google document that has notes to many of my, you know, many of my high your podcasts on on there. All right. And then on Saturday, what's your job in the morning, read the first date repro chapter. Okay. First date repro chapter in the afternoon, do 40 your world, repair questions and review them. That's it. That's it. And then on Sunday, what are you supposed to do on Sunday? Watch my two biochemistry videos on You Tube. There's actually slides for those two videos. But I will strongly encourage you because I know some people will be like, oh, let me just read the slides. That's it. You're literally shooting yourself in the foot. Don't do that. Okay. Literally watch the videos. In fact, if I were you, I would watch the videos first. And then later, I then review the slides right after you've watched the videos just to reinforce the material you've learned. I do a lot of explaining in those videos. You'd be doing yourself a great to service by not watching the videos. So those videos, you can find them on my You Tube channel, divine intervention, USM, podcast and videos. That's going to be a piece of 50 and 51. All right. Go through the slides.

And then that day, do 40 your biochemistry questions. That's it. As the end of week one, as jumps free to week two. What are you doing week two? Again, don't forget your standard activities of sketchy micro 20 minutes for each third of your day. And one farm podcast from that playlist for each third of your day. So one farm podcast in the morning, one in the afternoon, one in the evening, and just follow the order on my website as I detail at the beginning. And then so on Monday, Monday, what should you do on Monday? Do 40 your world cardio questions in the morning and review them. Okay. 40 world cardio questions in the morning review them. And then in the afternoon, do 40 year old poem questions and review them. And then in the evening, do 20 year old rental questions and review them. Okay. In the evening, 20 world rental questions and review them. In addition to your standard activities, again, as I've delivered so much. And then in the on Tuesday, what are you supposed to do? 40 year old endocrine questions in the morning and review. In the afternoon, 40 year old, repro questions and review. And then in the evening, 20 year old site questions and review. And you may wonder divine you're telling me to do 100 year old questions a day. Yes, I am. Yes, I am. The thing is, if you want to get more efficient at reviewing your questions, there is a podcast I have. Just do a Google search for this.

There's a podcast I have titled How to review your own and MBM questions efficiently. How to review your old and MBM questions efficiently. Listen to that podcast. It'll help you get quicker. The thing is you want to get used to going through many questions every day. That volume is helpful because you want to strike a balance between learning deeply and volume as well. So just be careful about that. All right. You see people, they only doing 40 year old questions a day. I only let you do that in week one because you're also doing all this extra reading to build a foundation. And again, let me tell you this week one, don't despise week one. Take week one seriously because honestly, if you don't do week one, well, it's going to show in your outcomes in the rest of your dedicated period. That's just the truth. All right. Now, let's go to Wednesday of week two. So Wednesday of week two to 40 year old site questions in the morning and review afternoon, do 40 year old bio stats questions and review in the evening, do 20 year old MSK questions, 20 year old, what MSK questions, 20 year old MSK questions. All right. On Thursday, what are you supposed to do? Right. 40 year old micro questions in the morning. Okay. In the afternoon, 40 year old GI questions and review in the evening, 20 year old, immunology questions and review. That's what you're supposed to do. Okay.

Now, what I supposed to do on Friday, on Friday, do 40 year old neuro questions in the morning and review in the afternoon, the 40 year old human questions and review in the evening, I want you to do 40 year old ethics questions and review. Yes, I said ethics, 40 year old ethics questions and review. And then on Saturday, what's your job? Your job is straightforward. Read the rapid review section of first aid. Just go through it. Go through all of it. That rapid review section at the back of first aid. Just go through it. And then also review the slides for the two biochemistry podcasts review the slides for the two biochemistry podcasts. I mean, biochemistry videos that I talked about episodes 50 and 51. At this point, you should have watched the videos, right. So now reviewing the slides should not be too much of a struggle for you. So review the slides for the two biochemistry podcasts. And then I will strongly encourage you to listen to episode 164 on toxicology. Episode 164 on toxicology. That's it. And then on Sunday, start off your Sunday by listening to episode 400. It's titled Get Your Head in the Game. It's a very good podcast to put your mind in the right space before you take your real before you take a practice exam or your real test. So listen to episode 400 and then take MP, me 26 and review it. All right. Now, how will week three work? How will week three work? Well, let me tell you this week three should be a carbon copy of week two.

Basically, all the things I said to do in week two, you should also do in week three. Okay. So like the way I space out the questions like 40 of this, 40 of this, 40 of this by subject as I space them out. That's exactly what you should do. But there's a few additional things you're supposed to do on each day. So if you're typing out the contents of this podcast, you can pretty much copy and paste what you have for week two for week three. But again, there are some changes. There are some changes. Okay. The changes are more additions of things you should do. Just little additions. Okay. So what are these changes on Monday? I want you to listen to episode in addition to the stuff from week two. You're going to be doing a week three on Monday. Listen to episode 123. Okay. Listen to episode 123. That's an ethics podcast. On Tuesday, in addition to the stuff from week two that you're supposed to do, listen to episode 132. That's on social sciences. Listen to episode 132. All right. On Wednesday, listen to episode 143 and go through the slides. Again, please listen first. Follow along as you're going with the slides. Don't just review the slides. That'll be a huge, massive waste of time. Listen 143 and go through the slides. That's going to be on bio statistics. And then on Thursday, in addition to the stuff from week two, you're supposed to do the additional thing you're supposed to do is listen to episode 233 on shot. They love to test shock on the USM at least.

They love to test all those hours. You should get very conversant with it. And then on Friday, in addition to the stuff from week two, you should also listen to episode 244 on Valvular disorders. Episode what? 244 on what? On Valvular disorders. Okay. And then on Saturday, Saturday is a little different. Seems kind of similar, but a little different. So let me just read out all you should do on Saturday of week three. Saturday of week three, read the entire rapid review section of first date, the whole thing. And then I want you to review. Listen, listen to episode 539. First, listen to it. First, it's a podcast on cortical steroids. You're going to see a lot of steroid questions on your exams. And then after you do that, there is like a quiz. It's hyperlinked in a PDF under that episode, episode 539. It's a worksheet. Do the worksheet. Okay. Do the worksheet. If you listen to the podcast carefully, you should be able to answer all the questions in the worksheet pretty well. And then I would also want you on Saturday of week three to listen to episode two hundred and twenty six on iron laps, episode two twenty six on iron laps. All right. And then on Sunday of week three, I want you to again, first, listen to episode 400 and then it can be me 27 and review it. It can be me 27 and do what? Review it. All right. Week four, week four, we're trudging along. Okay.

So week four again, continue your standard activities, your 20 minutes of sketchy micro in the morning, afternoon and evening. And then you'll want from a college podcast from that playlist on my website for morning, morning, morning, morning, the afternoon, morning, the evening. All right. So now what are you supposed to do? What are you supposed to do? Okay. What are you supposed to do in week four? Okay. So in on Monday, in the morning and in the afternoon, okay. In the morning and in the afternoon. So basically this activity should basically allocate all of your morning and afternoon for this. Okay. A hundred year old mixed questions mixed from all subjects, a hundred year old mixed questions. Okay. A hundred year old mixed questions. Okay. Just make sure that by 6 p.m. of whatever time zone you're in, you're done. Make sure you've done the hundred year old mixed questions and you've reviewed them. You've done the hundred year old mixed questions and you've reviewed them. And then in the evening, I will strongly encourage you to read the notes, you know, from the textbook. Chapters 1 to 3 of the thumb. Just read it again. You've listened. Just read it again. All right. On Tuesday, what are you supposed to do? On Tuesday, again, morning afternoon to a hundred year old mixed questions from all subjects and review them thoroughly. Again, before 6 p.m. of whatever time zone you're in. And then what should you do in the evening? What should you do in the evening?

In the evening, I will encourage you to read a third of the first state neurology chapter, a third of the first state neurology chapter. Okay. On Wednesday, what are you supposed to do? Morning and afternoon. Do 100 year old mixed questions, review them. Again, be done with this activity by 6 p.m. of your time zone. And then in the evening, you should read a third of the first state, the second third of the first state neurology chapter, the second third of the first state neurology chapter. Okay. And then on Thursday, what are you supposed to do? Again, same thing as Wednesday, a hundred year old mixed questions between morning and afternoon. So this is doing them reviewing them everything done by 6 p.m. of whatever time zone you're in. And then in the evening, read the final third, read the final third of the first state neurology chapter, read the final third of the first state neurology chapter. Okay. And then Friday, what are you supposed to do? Again, morning and afternoon, a hundred year old mixed questions, be done by 6 p.m. including review. And then in the evening, what should you do in the evening, read the first state public health sciences chapter, the first state public health sciences chapter. All right. And then on Saturday, what are you supposed to do on Saturday, review the slides from the two biochem videos. Okay. Review the slides from the two biochem videos. And then listen to episodes 37 97 and 184 and memorize those podcasts code.

So listen to them read the notes on their episode notes on my website on them. In fact, there are on key decks that people have made on I believe 37 97 and 184. These are risk factors is going to pop up on your exams. These are probably like my most listened to podcasts of all time. You really should go through those trust me. It'll help you a lot on your exams. Okay. It'll literally help you a lot on your exams. I'm going to say that again. It will help you a lot on your exams. It'll help you a lot on your exams. And then I would want you to listen to episode 169 on nephrodite and nephrodite syndromes episode 169 on nephrodite and nephrodite syndromes. All right. That's it. And then on Sunday, what do you do? Listen to episode 40 first. Listen to episode 40 first. And then they can be me 28 and review it. That's it for week four. That is it for week number four. Okay. That's going to week five again week five. Don't forget your standard activities. 20 minutes of sketchy micro in the morning, 20 minutes in the afternoon, 20 minutes in the evening. And then don't forget one farm podcast. One farm podcast in the morning, one farm podcast in the afternoon, one farm podcast in the evening. This interleaving method is just going to help you so much. In fact, by by week five, you'll feel like, man, I know, I know micro pretty well, man, I know farm pretty well. And you may wonder, man, divine. Is this not too much time to devote to pharmacology?

Let me explain those pharmacology podcasts. Even if they're titled farm podcasts in those podcasts, I review a lot of physiology as well. So that's going to help you so much. You're not just reviewing farm, you're reviewing physiology and pathology at the same time. It's going to be really helpful for your exams. Right. So don't forget your standard activities. And then on Monday, what are you supposed to do? Okay. Morning and afternoon, 120 euro question. So three blocks. So the thing is you may wonder, oh, divine, it was 100 the previous week. It's 120 this week. Let me explain why by week five, you've seen many of the concepts multiple times at this point. So the concept should be pretty solid in your mind at this point. So you should be able to go through more questions a lot faster. All right. So three blocks of your own just finish it by six PM or whatever times on your end. Okay. So you've done the three blocks of 120 questions and you've reviewed them. Again, you want to get very good at going through questions quickly, right, especially as you're beginning to get closer and closer to your exams. And then in the evening, I want you to listen to episode 135 on electrolytes. Episode 135 on electrolytes. This is this is such a helpful podcast. Right. This is such a helpful podcast. Such a helpful podcast. All right. On Tuesday, again, same deal, three blocks of your world review it, be done by six PM. And then in the evening, listen to episode 100 on micro.

It's called the clutch micro podcasts. Listen to that. On Wednesday, three blocks of your world, finish by six PM. And then in the evening, episode 173 on immunodeficiency diseases, 173 on immunodeficiency diseases. On Thursday, three blocks of your world with review. That's 120 questions. And then in the evening, listen to episode 257 on bilirubin episode 257 on bilirubin. Again, biobilirubin questions, they love to test them. Want to make sure you know that I know that code for you exams. All right. On Friday, three blocks of your world mixed questions. And these three blocks are all mixed questions all throughout this week. Right. Review them. Be done by six PM. And then in the evening, I want you to review episode 374 on spinal cord lesions episode 374 on spinal cord lesions. And then what I supposed to do on Saturday. Well, read the entire rapid review section of first date for step one, the entire rapid review section. And then read the pathology chapter in first date for step one, first date for step one has a chapter literally titled pathology read that pathology chapter. All right. That's it. Let's your job for that week. All right. That's your job. That's your job. That's your job. All right. And then on Sunday, I would want you to listen to episode 401. And then take me me 29 and review it. They can be me 29 and review it. They can be me 29 and review it. All right. Now let's jump into week number six week number six. Again, continue your standard activities.

What are those standard activities again? I know it's like beating a dead horse. 20 minutes of sketching my cream the morning. 20 minutes of sketching my cream the afternoon. 20 minutes of sketching my cream the evening. And then also one farm podcast in the morning. One from podcast in the afternoon. One from podcast in the evening. That's it. All right. Okay. So now what's the goal of week six? The goal of week six is calibration. The goal of week six is calibration. All right. So at this point, what are you going to do Monday? Monday. All right. Again, continue standard activities. But on Monday, what's your job on Monday, your job is to do your world self assessment number one and review it. Okay. Your world self assessment number one and review it. But again, go through that ritual of listening to episode 401. In fact, this this week, week six, listen to episode 400 every day. I know you've listened to so many times. You're like, the volume. This is so boring. But I promise you, you want to drill these things into your head, especially on the last day. Last week of your dedicated period. So on Monday, listen to episode 401 and then take your world self assessment number one on Tuesday. What are you supposed to do? What are you supposed to do on Tuesday? What are you supposed to do on Tuesday? Okay. Start of the day reviewing the pharmacology chapter. Actually, before you do that, listen to episode 400, right?

And then take your world self assessment number to take your world self assessment number to your self assessment number two. And then to cup off the day in the evening, review the pharmacology chapter in first date for step one step one. Literally for state has a farm chapter way to talk about pharmacokinetics, pharmacodynamics, make it this maintain on all that fun stuff. Just go through that. All right. On Wednesday, what I supposed to do, listen to episode 400 in the morning and then take mbme 31 sorry mbme 30 and review it. Take mbme 30 and review it. That's it. On Thursday, what's your job? What's your job on Thursday? What's your job on Thursday? What's your job on Thursday? Take listen to episode 400 first and then take mbme 31 and review it. So on Monday, you're doing your world one Tuesday, your two Wednesday, mbme 30 Thursday, mbme 31. Right. And then I will also encourage you review the public health sciences chapter of first date again on Thursday. Just review it on Thursday again. And then on Friday, what's your job on Friday, your job first is to review the slides for the two biochemistry videos again review the slides for the two biochemistry videos again. And then take in the afternoon, take the free one 21st step one, take it with the PDF, right there. Two is you can take the free one 20. You can take it with a PDF or you can take it with the website interface. Don't take it with the website interface.

You're going to see why literally in a minute from now, right. Take it with a PDF, take it with a PDF, right. You know, print out the PDF, take it as an exam, right. Or you know, take it on your iPad or whatever. Probably take it, print it out and take it so that you're not distracted. Right. Obviously time yourself. All right. And then on Saturday, what's your job, your job on Saturday is to review the free one 20 to come Friday. Okay. Your job on Saturdays to review the free one 22 on Friday. Right. So that's your job on Saturday. And how should you review it? You should review it by listening to the free one 20 series that I have for step one. I already started it. If you don't know this, I have basically made podcasts on the first 80 questions for the current step one free 120 that is on the US Emily website. Literally, I've gone through every single question one by one. And for more many of the questions, every single answer choice. Now this series is probably going to end up in about 14 podcasts. I've made for the first 80 God willing within the next week or two. I should be done with the series for the remaining 40 questions. Again, I'm really trying to make as much as I can. It's just I just have time constraint. This podcast is not all I do with my life. I have other commitments. Right. But if you want to know what are the exact episodes. Well, I'll just encourage you. Pretty straightforward. Again, go to that exam topic lists header on my website.

Click on the Google document. Go under the step one top scroll all the way down. And you'll see free 120 series step one. Right. Like the episodes have made there's 585, 585, 585, 585, 587, 588, 589 and 590. Again, I'm going to make more, I'm going to make more because I still have questions 81 to 122, okay. Again, God willing, I'm going to make like probably going to hit 20 or 30 questions this week. And then the balance next week. All right. So I'm going to make those podcasts. All right. God willing. God keep in us alive. You never know the future. Right. Okay. So yeah. So that's what you should do. Right. So basically that's the way you're reviewing the free 120. I'm telling you, it's probably going to be about 10 11 hours of lecture. That's why that's pretty much most of what you're going to be doing on Saturday. But again, I promise you it's one of the smartest things you can do right before your test in this free 120 series. I go over so much content. I go over so many testic and strategies is going to be extremely helpful to you for your exams. All right. And then also on that Saturday, I want you to listen to a piece of 349. Episode 123 and episode 132 349 is kind of like a psych from a college podcast is more for step two, step three, but it's so helpful for step one. And then you should listen to 123 132 again, just to brush up some more ethics, brush up some more ethics.

And then on Sunday, what's your job Sunday or job is review the public health science is chapter and study of Sunday early review the public health science is chapter for state for step one. And then review the notes for episode 37 97 and 184 again, or you can do the on key deck. That's flooding out there on it. All right. So that's it. That's the study plan for the exam. Now, let me give you some optional things if you're deciding to take extra time or whatever. So first thing I'm going to say is if you're like, divine, I don't want to study from Monday to Sunday. I want to take a day off every week. That's fine. Basically, what should you do? Make your schedule seven weeks instead of six. That's literally you need to do. Okay. Make your schedule seven weeks instead of six. So if you're doing seven weeks, then obviously on your day off or your day off, you should not be doing the standard activities, the sketchy and the sketchy and the sketchy and the sketchy. The sketchy and the farm podcast on your day off, you know, that these should be like a complete day off for you. All right. Now, if you have, let's say you're like, ooh, divine, I have an extra week, I have an extra two weeks. What is what are two suggested activities I have for an extra week or an extra two weeks? Pretty straightforward. One thing I recommend is my four internal medicine videos. You're like, what? What is divine internal medicine? What are you talking about? So let me explain.

Let me explain myself, right? I don't like telling people to do stuff without explaining the reasoning behind it. The thing is step one from a few years ago is not the same thing as step one from the present time. Step one has gotten a lot more clinical, right? In fact, you may notice that some people have gotten, if you notice, many medical schools are moving to people. They can step one after they've done their clinical years, right? So the thing is you will by going through my phone, internal medicine videos and that's episode 29 to 32, my website episodes, 29 to 32, 29, 30, 31 and 32. It's almost like you're giving yourself like a quick and dirty 30 year review of the key concepts of internal medicine. What's the goal of this number one? You're going to review a lot of concepts just by listening to those videos. Those I am videos extremely comprehensive. And by the way, if you're studying for your I am shelf exam or you're studying for a step two or step three, you should definitely listen to that, right? And the good thing about episodes 29 to 32 is again, listen to them first. But again, on my website, there is notes for these podcasts. Under those episode notes, there's notes for them. Basically, but if you listen to these four videos, read the notes, most of the, let me not say most, but many of the clinical scenarios you're going to see on your exams that are written as like clinical vignette, you pick them up very quickly, right?

And that will just make you more refined because it will be a clinical thing. They're testing. And then, but they'll have a basic science bench to it. It's just going to prepare you beautifully for that. It's going to prepare you what? Beautiful for that. So that's an optional activity. If you have extra time. And then another optional activity, if you have extra time is to go through all of the thumb, everything. If you notice in this study plan, all I have you go through is chapters one to three. Because those are very critical chapters, right? Those are like super critical chapters. I have you going through that twice in this six week study plan. But if you have extra time, just go through all of the Thomas go through all of the Thomas is an amazing teacher go through all of the Thomas. Okay. He's an amazing teacher. He truly is an amazing teacher. Now, one other thing I may say is, oh, divine, you're not making me do any of your questions in week six. That's fine. I won't finish your world. That's fine. That's okay. Right. You've done enough your world week six. You want to basically calibrate your brain to MBM questions. That's why you see I have you doing a lot of MBM is in week six. Because again, who is the person who are the people that are writing the exam you're going to be taking? It's the MBM is not not your world. Right. You've you've got in a very good deep field of your world.

You probably don't almost 2000 or more your questions just from between weeks one to week five. All right. So you've had a lot of your world. That's okay. Just calm down. I may wonder. I wonder, um, divine, why do you start off this plan with me doing your questions by subject again, those first two weeks, you're trying to build a phone. Actually, the first three weeks, you're trying to build a foundation, right. You don't want to be scattering your brain. You don't want to be scattering things all over the place. Right. You want to like by the end of week three have like gone through like 120 cardio questions between week one, two and three. Right. You're at that point, your brain has established a lot of cardio patterns. Right. By week four week five, then you're going to be doing things mix. That's okay. You'll get there. All right. So don't don't mix things up to start. Okay. I promise you again, I'm not saying this to be proud. I'm just saying this as a pressing that has a lot of experience. But again, I'm trying to be humble here. I just probably know more about step one than many of you preparing for the exam. Right. This is not my first radio. It's not my. I've worked with lots of people studying for step one that I've done really well on it that I've passed the exam. So just be mindful about that. All right. So also one thing I'll just put a plug in for if you're studying for step one, I do have a very good review course for step one.

I've had many people take the course past the exams and flying corners. It's a 25 hour step one review. I have it in the between me fifth to me ninth. Me fifth to me ninth. So if you're interested, I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do it. I'm going to do step one, but also relevant to step two and step three is I have a 20,500 MB and he tested in strategies class. I have a four hour biostatistics class and I have a five hour ethics class that five hour ethics class. We have like almost like 200, 300, 300 years with review on ethics, social sciences, quality improvement on all those things. Again, many people have found them to be very helpful, very comprehensive, very high yield for their exams. And then if you're studying for a step two, step three, exclusively. I have a 20 hour step two, step three. I have a 20 hour step two, step three. I have a 20 hour step three.

I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three. I have a 20 hour step three.

Practice questions — USMLE style

Question 1 — Study Habits/Pharmacology

A medical student is developing a comprehensive study plan for USMLE Step 1 and understands that consistency is key, comparing it to compound interest. To maintain high-yield knowledge retention throughout the dedicated six weeks, which combination of daily activities is most strongly recommended?

A) Reading all chapters of Robbins Pathology and completing 80 questions from U World each day.
B) Spending time on optional resources like reviewing every chapter of Thomas's Basic Science Book.
C) Completing 20 minutes of Sketchy Micro in the morning, afternoon, and evening, alongside listening to three distinct pharmacology podcasts daily.
D) Focusing solely on mixed-subject questions from Week 4 onward to build rapid recall efficiency.

Answer: C. The transcript emphasizes that the "standard things" done every day are Sketchy Micro (20 minutes in AM, PM, EM) and listening to multiple pharmacology podcasts (three per day). This combination ensures continuous exposure to high-yield basic science material, which is crucial for compounding knowledge over time.

Question 2 — Basic Science/System Review

A student preparing for Step 1 recognizes that while core subjects like cardiology and respiratory medicine are foundational, certain specialized areas require dedicated attention because they frequently appear in clinical vignettes on the exam. Which group of topics represents critical high-yield basic science domains emphasized by the curriculum?

A) Anatomy, Embryology, and Histopathology
B) Public Health Sciences, Biochemistry, and Immunology
C) Toxicology, Ethics, and Biostatistics
D) Nephrology, Endocrinology, and Neurology

Answer: C. The podcast specifically highlights several "must-know" high-yield topics that are frequently tested. These include toxicology (Episode 164), ethics (multiple episodes mentioned), and biostatistics (specific podcasts/chapters). While other areas like biochemistry and public health are critical, the combination of Tox, Ethics, and Biostats represents key functional domains often emphasized for advanced review.

Question 3 — Test Preparation Strategy

A student is following a multi-week study plan that initially requires reviewing subjects in isolation (e.g., dedicating Week 1 to Cardiology). As the weeks progress toward the exam, the curriculum shifts focus to mixed questions across all systems. What is the primary educational benefit of transitioning from subject-specific review to mixed question blocks?

A) It allows the student to cover more material volume without needing deep understanding in any single system.
B) It helps build a foundational knowledge base by reinforcing basic science principles before clinical application.
C) It simulates the comprehensive nature of board exams, forcing the integration and rapid recall of concepts from multiple systems simultaneously.
D) It reduces cognitive load by allowing the student to focus on one subject area until mastery is achieved.

Answer: C. The transition to mixed questions (e.g., 100-year old mixed questions in Week 4/5) is designed to mimic the real board exam experience. This forces the learner to integrate knowledge—for example, applying a biochemical principle learned weeks ago while reviewing a cardiology question—which is essential for high performance on comprehensive exams.

Question 4 — Clinical Correlation/Advanced Review

A student has completed the core six-week Step 1 curriculum and wishes to further refine their clinical reasoning skills beyond basic science recall. To prepare for the highly clinical nature of modern board examinations, which optional resource is recommended for a quick but comprehensive review of key internal medicine concepts?

A) Reading all chapters of Thomas's Basic Science Book from start to finish.
B) Reviewing only the rapid review section of First Aid and focusing on high-yield podcasts like those covering renal syndromes.
C) Listening to the dedicated Internal Medicine video series (Episodes 29–32).
D) Taking a full, timed practice exam every day for two weeks straight.

Answer: C. The podcast specifically recommends listening to the four internal medicine videos (Episodes 29-32) as an optional activity for extra time. These videos are described as providing a "quick and dirty 30 year review of the key concepts of internal medicine," which is highly beneficial for improving clinical scenario recognition, preparing the student for the clinical vignette style of testing.

Quick fire review

What is the minimum recommended duration for a Step 1 study plan?

At least six weeks.

How should Sketchy Micro be utilized daily during the dedicated period?

Do 20 minutes in the morning, 20 minutes in the afternoon, and 20 minutes at night.

What is the primary benefit of repeating the entire Sketchy Micro series multiple times?

The information will stick in your head (aiming for 3-4 passes).

When reviewing biochemistry material, what method does the speaker strongly recommend over simply reading slides?

Watching the You Tube videos first, and then reviewing the slides afterward to reinforce learning.

What is the purpose of doing mixed questions starting in Week 4 or 5?

To simulate the exam environment and prevent scattering knowledge by building pattern recognition across subjects.

If a student has extra time (e.g., taking an eight-week plan), what are two optional activities recommended for advanced review?

Listening to the four Internal Medicine videos (Episodes 29-32) or going through all chapters of the Thomas textbook.

What is the daily volume recommendation for Sketchy Micro during a dedicated study period?

60 minutes total (20 min AM, 20 min PM, 20 min night).

For pharmacology review, what are the starting and ending episode numbers recommended?

Episode 6 to Episode 152.

What type of questions should be done in Week 6 instead of U World self-assessments?

MBME (e.g., MBME 30, MBME 31) or U World Self Assessments.

On Saturday of Week 6, what specific free resource series is recommended for review?

The Free 120 series questions (reviewing the answers by listening to dedicated podcasts).

What are two high-yield topics/episodes specifically mentioned for review during Week 4's Saturday session?

Episodes 37, 97, and 184 (risk factors) and Episode 169 (nephrotic syndrome).

If a student takes an extra week off the standard six-week schedule, what should they not do on their day off?

They should not perform the standard activities (Sketchy Micro or Pharm podcasts); it should be a complete break.

Quick recall / Anki-style questions