Study tomorrow is the Family Medicine Shelf Exam

Ok so today is supposed to be my day to get all caught up on my studies for the shelf exam I have tomorrow. The shelf exam is a national exam given to medical students after they complete a rotation. Tomorrow I take the family medicine shelf exam which is touted as being a very difficult exam especially if you face it early in your 3rd year prior to having completed many of your rotations. Why is it so difficult? Family medicine is a very broad specialty. You see internal medicine, pediatrics, and OB/GYN etc. This means that the exam can cover any of these areas. You have to be prepared to answer a wide variety of questions. 

I have been studying everyday for the past month by reading a couple of different clinical books about family medicine. I also have been doing practice questions from a variety of sources. The main problem is that after you finish a long 11 hour day of seeing patients the last thing you want to do is study. I probably have not put in the amount of hours studying that I should have, so I am hoping that is the case for everyone and that the national curve will reflect accordingly. 

Here is an easier example question:

A 50-year-old man has had progressive weakness and shortness of breath with exertion for 3 months. He appears malnourished; conjunctivae are pale and there are scattered petechiae. Labs:

Hemoglobin 6g/dl

Mean corpuscular Volume: 114 mm3

Leukocyte count 2500/mm3 with hypersegmented neutrophils

Reticulocyte count 0.5%

Platelet count 60,000/mm3

The most likely cause of his condition is a deficiency of which of the following?

a.) Folic Acid

b.) Iron

c.) Thiamine (Vit. B1)

d.) Vitamin B6

e.) Vitamin C

f.) Calcium

g.) Potassiun

h.) Copper

i.) All of the above

j.) none of the above

There are a couple of things that they a testing here. You need to understand that this patient has anemia by understanding his lab values. Just knowing that the patient has anemia will not get you the answer though. You also need to know that the patient has megaloblastic anemia. Then you need to understand that the 2 major causes of megaloblastic anemia are folic acid deficiency and vitamin B12 deficiency. In the answer choices they do not have Vitamin B12 listed, nor do they explain any neurological symptoms that are often caused by vitamin b12 deficiencies. So this leaves you with one answer that fits the scenario and that is choice a = folic acid deficiency. The questions are usually 2 - 3 step logic and it is easy to get turned around even if you understand the tested concepts fairly well.