A 58-year-old man with type 2 diabetes and persistent microalbuminuria takes metformin and lisinopril. An additional oral glucose-lowering drug is started.

Four weeks later:

• HbA1c: 8.4% → 7.8%
• Serum creatinine: 1.0 → 1.24 mg/dL
• Urine glucose: negative → 3+

He feels well, has no edema or signs of volume depletion, and his BP is 126/76 mmHg.

Which physiological change within the juxtaglomerular apparatus best explains the acute change in renal hemodynamics?

A. Increased NaCl delivery to the macula densa → afferent constriction
B. Decreased NaCl delivery → efferent dilation
C. Reduced Ang II signaling → efferent dilation
D. Reduced prostaglandins → afferent constriction
E. Increased nitric oxide → efferent constriction

I'm not looking for some reassurance but I mean to ask people in 60s or people who closely know someone who was scoring in 60s in nbmes, did you/they pass or fail?

The green tick boosts my dopamine, I look forward to seeing it. If it shows, I’m happy and I feel great and proud. If it doesn’t, my mood crashes down and i feel like yanking my hair out/flipping the table/breaking the tablet…etc.

Help?

Hi everyone! I am currently planning out my upcoming dedicated period but am struggling to decide how to plan around a friend’s 4-day bachelorette trip and could use some advice!

Basically, if I try to fit my dedicated period in the time before the trip, it would be about 4 weeks, which I know is common, but feels like it could be a bit rushed. Although I’ve gotten through 100% of UWorld for shelfs so far during MS3, I haven’t taken any practice exams, am ending on OBGYN. I have scored in the low to high 70s so far on my shelf exams and halfway done with rotations. I am thinking of rads/anesthesia, so my goal is most likely a 260+.

My other option is to give myself 6 weeks of dedicated, with the last day of the trip being 8 days away from my test date. 6 weeks is honestly what I was hoping for, but I am a little worried about how a trip might mess up my studying/scores. Would 8 days be enough time to catch up if I need it?

Of note, the bachelorette trip is in a cabin in the mountains and I could most likely find downtime to study and avoid alcohol during, even though that’s not ideal.

Any advice is appreciated!

Posting this as I am currently on the fence between freaking out and feeling I have plenty of time to improve. My class (US MD school) just received our first CBSE exam results before finishing preclinical this December, and mine were pretty rough. 41 overall, struggled significantly in pathology, physiological, and nutrition disciplines. Throughout preclinical I’ve passed all of our NBME-based exams +/- 4 points from the class average, so I feel that I decently understood the material at the time I was actively working on it. However, I have a bad tendency to brain dump and immediately move on after finishing a block, and while I knew this would come back to bite me, I didn’t expect it to bite this much. For additional context, I hadn’t studied prior to taking the CBSE, we haven’t covered neuro/psych (which was on the exam), and had very poor sleep the night before. While I’m still months out from taking actual Step 1, I’m still slightly freaking out, worried I’m screwed, and looking for any advice. Thanks in advance!

I’ve heard people say the exam felt similar to the NBMEs, Free 120, or even UWSAs, but I’m curious how much of that similarity was in the actual questions versus the underlying concepts.

My take is that we might be looking at it the wrong way. The person writing your actual exam isn't necessarily using the same wording or clinical scenarios you've practiced in UWorld or the NBMEs. You might recognize the underlying concept, but the way it's presented could be completely different from what you're used to.

That can feel uncomfortable at first because you're suddenly applying familiar knowledge to unfamiliar scenarios. But if you've prepared thoroughly, worked through the NBMEs, and consistently scored in a range that suggests you're ready, you should have the foundation to reason through questions you've never seen before.

For those who've taken the exam, did this match your experience? Did the questions feel familiar because you'd seen similar concepts before, or did the exam genuinely challenge you with unfamiliar ways of testing them?

As i heard recently anatomy is heavily tested for step 1?

So which system is more spotted on???

I recently scored a 45% on an nbme. I’ve scheduled the test as far out as possible without having to pay $700. I am open to rescheduling i just dont know what to do. I’ve been studying for step for months, going through uworld section by section, I just need advice on how to proceed. How can I raise my score im so exhausted plz help. What should my game plan be?

Reading the explanation feels like learning, but a week later it is gone.

Do you rewrite it, make cards, or test yourself again later?

Hey everyone,

I’m looking for some advice and reassurance. My exam is in exactly 10 days and I just experienced a score drop on NBME 33, which has me feeling pretty anxious.
Here are my scores
NBME 26 (Baseline): 60%
NBME 29: 68%
NBME 30: 73%
NBME 31: 76%
NBME 33: 69% (Recent drop)

I felt like my upward trend was solid until this last form. I still have the New Free 120 left to take. What should i do ??

hey everyone. I just scored 51% raw correct on NBME 27, my first NBME, taken timed and closed-book. I've completed around 70% of UWorld, and my exam is tentatively scheduled for January 12, 2027.

I'm feeling anxious and would really appreciate honest advice.

• Is January 12 still realistic with around 11 weeks left?
• Should I focus on reviewing NBME mistakes, finishing UWorld, or revising weak subjects?
• Has anyone started with a similar score and passed within this timeframe?

I'd appreciate advice from people who've been in a similar situation. Thank you!

Is there any UWorld discount group, folks???

If not, let's organize it.

Ive got 20 days til my exam. I’ve done one pass of FA and revised a few systems but doing it again cover to cover seems like SUCH A HASSLE i genuinely cannot bring myself to study or read it.

Is there a better way or maybe another resource to do last minute revision

Hi, I’m studying for step one. I will start revision the whole systems, I finished them but at a different period, some of them months ago and other one month or two, and I need to do this during one month, then I will take one month for basic and another month for NBME and take the exam at beginning of February, my question is should I revision system from mehelman pdf instead of FA? Is it a good or a bad idea?? I want to finish it as soon as possible, but in a good way that makes me answer UWorld questions in the easiest way, so what’s your advice??

Hi

To those who took the exam recently, was it full of biochemistry questions and details?

Any help please :(

29-69
30-69.5
31- 69
32- 65.5
33- 58.5
34- 67.5
Free 120(2026)- 68.3 (today)

Am i ready? what should I do?

hey, i know that there a lot of qbanks and AI that help to do questions and study, i personally still can get over 55% on the NBME's and been using the AI and all. my question is, did anyone ever heard of and used narqb for studying for step1?

So I’m currently 10 weeks out. I’ve been using FA as my main study source then UW and mehlman videos. I decided to do an offline form just to see what it’s like and got 68%. BUT I haven’t covered biochem, micro, immunology, I’ve just mainly covered the organ systems but even that doesn’t really feel well solidified. Idk if the 67% was luck or what but I didn’t necessarily feel confident doing it.

My question is, do I have enough time to cover everything else alongside review of the organ systems? What helped you get through those systems the quickest apart from sketchy?

And also if anyone can give their thoughts on NBME 23. Thank you!!

Before taking Step 1, people around me made it sound like I was about to go through the most traumatic experience of my life 😭

Every conversation was the same. The questions will fu*k you up, the vignettes are insanely difficult, you'll walk out having no idea if you passed or failed, be careful with your breaks, sleep properly, eat properly… like bro

The funniest part is that these same people passed. And so did I.

I'm not saying Step 1 is easy, but I feel like people make it way more terrifying than it needs to be. If you've been consistently scoring 68%+ on your NBMEs and have done enough practice exams to get used to the timing, just trust your preparation.

Obviously, you'll get questions you're unsure about, flag half a block, and probably leave feeling weird about how it went. That's normal. You don't need to know everything or feel confident about every question to pass.

Honestly, I think we sometimes make the exam scarier than it actually is by constantly hearing everyone's horror stories.

Anyone else feel this way, or was the real deal genuinely worse than you expected?

Hello everyone

I’m a non US img giving step 1 in November , I’m done with most of the topics & 50% uworld , I feel like I’ve stuck in loop doing the same thing daily & I’m done with only 1 NBME in which I scored 58%(a month ago) - I really have to give step 1 as I chose a window period of Sep- Nov. I’m scared of questions getting wrong in NBME & low scores , so I’m avoiding it week by week.
Im only reviewing FAwhen I get a question wrong
Please give any advice to what to do in this final few days to improve my scores , any help will be really appreciated.
Thank you 🙏

I have noticed that some posts talk about nbme % and some are mentioning EPC?

I have not taken any nbme yet.

What is EPC?

And what nbme % should i target to have before i book my test?

Thank you

Hello! I’m starting to get into my step 1 studying and keeping up with my 800+ reviews each day is just not sustainable for me. I’m using AnKing step 1 deck and I would like to study only the high yield tagged cards from the cards I’ve already unsuspended over my past 1.5 years of med school. Can anyone guide me on the best way to do this? Do I create a new sub deck or filtered deck? I basically want to be able to reduce the amount of cards I have due each day by making sure I’m only studying high yield cards. Much appreciated!