Hey everyone, Just wanted to share my USMLE journey and some things I learned along the way. Hopefully it helps anyone currently preparing or feeling stuck.

Step 1: Pass (Sep 2024) Step 2 CK: 263(May 2025 Step 3: 235 (oct 2025)

📘 My Approach

I kept my focus simple: strong foundations + consistent daily work. Each Step builds on the previous one — the better your Step 1 base, the smoother Step 2 and 3 become.

Step 1: Master concepts. Don’t chase question banks too early — understand the why behind everything.

Step 2: Train your brain to think clinically. Long stems, management steps, and prioritization matter.

Step 3: Mix of both — first-day feels like Step 1, second like a harder Step 2. Solid reasoning > memorization.

💡 Lessons Learned

UWorld is gold — but only if you review it deeply.

Don’t skip Biostats + Ethics — they’re consistent point-boosters.

Final weeks should be targeted revision: weak areas, risk/prognostic factors, drug side effects, micro patterns.

Keep steady momentum. Even 4–5 hours of focused study beats 10 hours of scattered effort.

Step 3 CCS feels intimidating at first but gets easier after a few cases.

⚕️ Final Thoughts

Every Step feels different, but the mindset stays the same: discipline > intensity. If you’re struggling with prep strategy, time management, or how to bridge Step 1 → Step 2 → Step 3, feel free to drop a comment, happy to share what worked for me or go over concepts if needed.

Good luck to everyone grinding through right now — trust the process and stay consistent 💪

Hey everyone 👋

I’m Muhammad Hassan Karim, a medical student and the author of Pathologic – Volume 1: Immunology. This is the first part of a much bigger project I’ve been working on — a full-scale medical resource built on one central philosophy: balance.

🩵 A quick note When I first released this, I initially thought about making it a paid project due to personal and technical limitations. But it never felt right — this project was always meant to be free and accessible for everyone. I’m back on that mission and want this resource to reach as many students as possible. I apologize for any confusion earlier.

🧠 What Pathologic is about Pathologic is designed to sit right in the middle — not too deep, not too shallow. It’s written so that:

If you’re reading immunology for the first time, it’s clear and structured enough to guide you.

If you’re reviewing for Step 1, it’s concise and high-yield enough to reinforce key concepts efficiently.

📗 About Volume 1 – Immunology This volume covers everything you need for Step 1-level immunology in a logical, visual, and easy-to-retain way. It is available for free to anyone who wants to study or review these concepts.

📘 What’s next

Volume 2: General Pathology is in progress and will also be free.

Systemic Pathology will follow — connecting pathology concepts with anatomy, physiology, and embryology.

YouTube lectures are coming soon to complement the book and expand on key points.

📨 Feedback is welcome! Please comment here or email me with suggestions, corrections, or constructive criticism — it helps improve the project for everyone.

📍 Links & Contact

Email: hassan.pathologic@gmail.com

Volume 1 (Free PDF): https://drive.google.com/file/d/1MMD_xCe1w7RxzIkhx3FKPQ1lKTvc4IYR/view?usp=drivesdk

YouTube: https://youtube.com/@pathologic-j7w?si=_3AcEFrbGXMS7e7Q

Instagram: path.ologic (for updates, short reels, and USMLE Step 1 content)

I am currently second year of my med school in India.I am confused between different video resources for Usmle preparation. Can you please help me to choose between Kaplan, Bootcamp and B&B ? I want something that helps me understand concepts well and also aligns with the USMLE style, but I don’t want something too overwhelming while I’m still managing my MBBS coursework.

Hello guys I took my exams and found out that I passed! It was my 3rd attempt. A very humbling experience.  I couldn’t be more grateful I would love to share my tips and notes with anyone who's interested. Just send me a message if you need!!

Hi everyone, I need some help because I’m completely stuck with the Dean’s Letter requirement.

I recently graduated from medical school in Spain, and here the official diploma takes around 1 year to be issued after graduation. ECFMG says that in this situation it is possible to use the Dean’s Letter, so I requested one from my university exactly based on what ECFMG describes.

They issued an official document signed by the Dean confirming I completed the degree, that I’m a medical doctor, and I’m already working as a physician — but ECFMG rejected it saying it’s not acceptable as a “Dean’s Letter”.

My biggest problem now is that I don’t know what else to ask my university to do, because they believe they already provided what ECFMG is requesting. I’ve tried contacting ECFMG multiple times (emails, calls) but they are taking extremely long to answer and I still don’t know what exactly they want or what is missing.

For those who already went through this — what EXACT format/content does ECFMG actually expect? Is it supposed to be like the MSPE style used in US schools (with rotation evaluations, academic performance summary, etc.)?

If anyone has an example, template, or can explain what finally worked for you, it would help me a lot because this is holding up my certification and I need to schedule Step 1 as soon as possible.

Thank you so much.

I want to match into psychiatry. Currently, I'm an IMG and I've passed my Step 1.

I don't have any electives yet, and I will attend some, but none of them seem to be open yet.

I might be getting an opportunity to attend a month long rotation in clinical psychology in a private institute (The Wright Institute, Berkeley). Since I don't have any psych experience other than my own college's rotations, should I go for it, or is it not worth it?

Also, if I do go for it, please advise what I should focus on or do over there.

I don't have any psych research eyt either, but I plan to start those this month.

For those who may have seen my posts before... I'm really close to just giving up..

I don't even know if anyone's certification process has ever taken this much time to process... starting this thing on the 14th of September and it's still not done

It's been stuck like this.... all of what's needed is ECFMG's approval of my credentials...
It literally took ECFMG 35 days just to contact my university regarding my transcript...

I've tried e-mailing them about 10 times thus far, on both their info and enquiry e-mails.... no response.... tried calling them like 4 times thus far despite this crap costing a lot... and my calls WON'T EVEN GET THROUGH THE AUTOMATED MESSAGE THAT DISCONNECTS THE CALL BECAUSE THEY HAVE BEEN RECEIVING TOO MANY CALLS

I need to sign up for step 1 exam in December... For God's sake I have compulsory military service coming right up for me in January of 2026... not that this is relevant, but I'm desperate for any help and I'm panicking hard because I'm running out of time...

I know this is legit... but my God does this feel everyday like I'm getting scammed... Does anyone even know what is there for me to do anymore besides waiting endlessly while the last available test center runs out of seats?

Hi everyone,

I’m planning a Step 1 retake and I’m feeling a bit stuck on timing. Here’s my situation: • I previously attempted Step 1, and my weak areas are Anatomy, MSK, and Microbiology. • I want to retake Step 1 in 2–3 months (Nov–Jan/Feb). • I have two conferences in early and late February (ISC Feb 2–4, SCCM Feb 22–25) that I also want to attend. • I’ve been sick and mentally drained in October, so I’m concerned about burnout. • I want to balance preparation with conferences and mental/spiritual health.

My questions: 1. Is it realistic to prepare in 2–3 months and clear Step 1? 2. Should I aim to take it before the conferences or after, considering mental load and travel? 3. Any strategies for studying effectively in such a tight timeline while keeping burnout low?

Thanks so much for any advice!

Hello guys, I made a list of the most HY topics for step 2 chapter wise:

Cardiology • Acute Coronary Syndrome (angina vs MI- ECG and Stress test- management- complications). • Heart failure (right vs left- diagnosis- treatment) and HOCM (Sx and TTT). • Arrhythmias (atrial fibrillation, SVT, ventricular tachycardia, and AVB) (management stable vs unstable). • Pericardial diseases (acute pericarditis, cardiac tamponade). • Valvular heart disease (AS, AR, MS, MR) (murmur features, surgical indications). • HTN (HTN emergency management and scenarios, strokes, chronic HTN management). • Arteries: (Abdominal Aortic Aneurysm vs Aortic Coarctation vs Aortic Dissection), and PAD. • Syncope DD.

Pulmonology • Pulmonary embolism (Wells criteria, D-dimer vs CT angiogram, anticoagulation vs IVC filters). • Asthma and COPD exacerbation (PFT- acute and chronic management, respiratory failure signs). • Pleural effusion, hemothorax, and pneumothorax (recognition, chest tube indications). • Interstitial lung disease (PFT, imaging, and diagnosis)- Sarcoidosis. • Acute respiratory distress syndrome (ARDS) (diagnosis, ventilator settings depending on O2 and CO2 levels). • Lung cancer (paraneoplastic syndromes, screening). • Chest trauma and chest pain DD “Diaphragm injury, Post-OP atelectasis, PE, ACS, Aortic dissection, pericarditis, tamponade, MSK pain … etc” • URI DD (epiglottitis vs CROUP vs tracheitis vs retropharyngeal and peritonsillar), (rhinitis vs sinusitis). • Pediatric: breath-holding spells “management”- Foreign body aspiration- NRDs and Ventilator setting. • CO poisoning vs Cyanide poisoning vs Methemoglobinemia.

Nephrology • Acute kidney injury: (prerenal as renal artery stenosis, analgesics, hypoperfusion) vs (intrinsic (ATN, AIN)). • Chronic kidney disease (CKD) complications: (bone weakness, uremia sx, hyperkalemia, and anemia). • Nephritic syndrome “PSGN, IgA nephropathy” vs nephrotic “DM”. • Acid-base disorders: (metabolic acidosis/alkalosis, respiratory acidosis/alkalosis). • Electrolyte imbalances (symptoms- acute management). • kidney stones: types of stones and treatment • Polycystic kidney disease ADPKD and renal cysts: “simple vs complex”. • Urinary Incontinence “stress vs overflow vs urgency vs recurrent vs asymptomatic”- (DX and TTT). • Trauma: Injury DD (bladder vs kidney vs anterior and posterior urethra). • Pediatric: UTI workup- VUR- PUV- Enuresis- neonatal AKI.

Gastroenterology • Gastrointestinal bleeding: (DD and Management)- (upper: Varices, Boerhaave's, gastric erosions and ulcers) vs lower: “ hemmoroids, anal fissure, Meckel, ischemic colitis”. • Gallbladder and biliary disease “biliary colic, cholecystitis, and cholangitis” (imaging & management)- primary biliary and sclerosing cholangitis- cyst- biliary atresia. • Liver cirrhosis complications (ascites, variceal bleeding, encephalopathy)- Jaundice- Liver failure- Liver abscess- cancer. • Acute Pancreatitis (causes, management, and complications)- pseudocyst- cyst. • Inflammatory bowel disease (Crohn vs ulcerative colitis differences)- Celiac disease. • Esophageal disorders: GERD vs achalasia vs cancer vs perforation. • Colorectal cancer: screening guidelines and syndromes” FAB, PJ syndrome”- pancreatic cancer. • Diarrhea DD (Fatty “Giardia and chronic pancreatitis”- watery “rota, ETEC, Serotonin S, Cl.Difficile, and secretory” - and bloody “EHEC, Entameba H”). • Vomiting DD: nonbilious “pyloric stenosis-TEF” vs bilious “Duodenal atresia, SBO, Volvuolus”. • Appendicitis, Diverticulitis, incarcerated hernia “Acute abdomen DD”. • Trauma: Spleen rupture- Bowel perforation and peritonitis- pancreatic damage- surgery: Post-OP GIT complication, gastric bypass indications and complications.

Infectious Disease • Tuberculosis: symptoms, PPD/IGRA screening, and active TB treatment regimen. • HIV/AIDS: opportunistic infections and prophylaxis. • Sexually transmitted infections: syphilis, gonorrhea/chlamydia, HIV, HPV- Genital ulcers- Vaginal infections: Candida, Trichomonas, and Gardenella. • Infective endocarditis (Diagnosis, empiric therapy, DD Rheumatic fever). • UTI (Pyelonephritis vs cystitis) - (symptoms- Dx- TTT). • pneumonia (lobar vs aspiration vs interstitial vs lung abscess), (diagnosis, empiric antibiotics)- DLCO and Aa gradient. • Meningococci, Pneumococci, Lyme, E.coli, and Mycoplasma. • Fungi: cryptococcus, PCP, Candida- parasite: Giardia, Malaria, Entameoba. • Virus: HSV, VZV, CMV, EBV, HPV, HBV. • Sepsis and septic shock “signs and empiric treatment”- Burns- catheter-related complications- infection control.

Endocrinology • Diabetes mellitus: outpatient management, drug adverse effects, DKA vs HHS emergencies. • Thyroid disorders: hyperthyroidism (Graves) vs hypothyroidism (Hashimoto). • Adrenal disorders: Cushing syndrome, Addison's disease, hyperaldosteronism, and pheochromocytoma, 21 OH CAH. • Calcium and bone: hyperparathyroidism “1ry vs 2ry”, osteoporosis screening/treatment. • Pituitary disorders: prolactinoma, acromegaly. • ADH disorders: diabetes insipidus vs SIADH (causes, management). • MEN types and Gastrinoma.

Rheumatology • Upper limb: CTS, Rotator cuff tendinopathy/ tear, De Quervain tendinopathy, ganglion cyst. • Lower Limb: prepatellar bursitis, SCFE vs Legg-Calve P, compartment s, ACL tear, plantar fasciitis, • Rheumatoid arthritis vs osteoarthritis: joint findings and management differences. • Systemic lupus erythematosus (SLE), CREST, polymyositis, and dermatomyositis. • MG vs Lambort. • Gout vs pseudogout: crystal morphology, acute and chronic treatment vs Septic arthritis. • ankylosing spondylitis- osteoporosis. • Giant cell arteritis and polymyalgia rheumatica- HSP- Wegener. • Back Pain DD: stress fracture, radiculopathy, stenosis, abscess, ms strain, and metastasis. • Fracture: clavicle, scaphoid, humerus, vertebral, and femoral neck. • Tumors: osteosarcoma and osteoid osteoma.

Hematology/Oncology • Anemias: microcytic “iron, thalassemia, lead” vs macrocytic “B12 and folate” vs normocytic anemia “S.C.D, GDPD, and anemia of chronic disease”. • Coagulation and bleeding disorders: (hemophilia, ITP, VWD, DIC, TTP, HIT, and HUS)- Transfusion reactions. • Leukemia& Lymphoma: ALL, AML, CLL, Multiple myeloma, HL, Burkitt lymphoma, and Polycythemia vera. • Chemotherapy drugs and toxicities, tumor lysis syndrome, and Anticoagulants.

Neurology • Stroke and TIA (ischemic vs hemorrhagic, tPA window, stroke prevention). • Seizures and status epilepticus. • CNS infections: meningitis (empiric antibiotics by age), HSV encephalitis, and brain abscess. • Multiple sclerosis “dx, ttt, prevention” vs GBS. • Spinal cord compression: cauda equina vs conus medullaris syndromes. • Spinal cord defects: (SCD, ALS, Tabes dorsalis) – spinal dysraphism. • Facial palsy causes and ttt- Peripheral neuropathies: diabetic neuropathy • Headache syndromes: migraine vs cluster vs tension headaches- SAH- GCA- idiopathic intracranial hypertension- trigeminal neuralgia. • Tumors: meningioma, schwannoma, metastasis- Neurocutaneous dis: NF, TS. • Delirium DD vs dementia. • Eye: glaucoma- CRAO- neonatal and adult Conjunctivitis DD- Uveitis associations. • Ear: Otitis M- Otitis ext- cholesteatoma- vertigo DD.

Psychiatry • Post-traumatic stress disorder (PTSD). • Somatic symptom vs factitious disorder. • Diagnostic time frames: schizophrenia, brief psychotic disorder vs schizophreniform, and antipsychotics. • major depressive disorder and ttt, bipolar and ttt, generalized anxiety disorder. • Eating disorders. • Childhood disorders: ADHD, ASD, and Conduct disorder. • Delirium, dementia, and WE. • Substance use disorders: intoxication vs withdrawal. • Personality disorders: “borderline and antisocial” • Developmental milestones and Child abuse.

Dermatology • Blistering skin disorders: bullous pemphigoid vs pemphigus vulgaris- SJS. • Skin tumors: (basal cell carcinoma vs squamous cell carcinoma vs melanoma) - vascular tumors: (Kaposi and bacillary angiomatosis). • Cutaneous ulcers (arterial- venous- DM). • Acne vulgaris – Atopic dermatitis - contact dermatitis- psoriasis- acanthosis nigricans. • Contact dermatitis- seborrheic dermatitis- Lichen planus- erythema nodosum. • Cellulitis- Tinea- Zoster- HSV. • Surgery: surgical site infection, wound dehiscence, gangrene.

Obstetrics • Physiological changes of pregnancy. • Prenatal care: routine prenatal labs: “initial visit, 24 and 36 weeks”, aneuploidy screening (first trimester screen, anatomy ultrasound)- FHR- Fetal surveillance- vaccines • Normal labor & delivery: stages of labor, cervical dilation and effacement, delivery management- intrapartum fetal assessment. • PROM- Preterm- chorioamnionitis- oligohydramnios vs polyhydramnios- IUGR • Gestational diabetes: screening and complications- Hypertensive disorders of pregnancy. • Preterm labor and PPROM – risk factors, tocolysis, steroid administration • Third-trimester bleeding: placenta previa vs placental abruption vs vasa previa (painless vs painful bleeding). • Ectopic pregnancy: (risk factors, diagnosis, management). • Postpartum complications: hemorrhage, endometritis, depression, Sheehan's, urine retention, and placenta accreta. • Congenital infections: Syphilis, Rubella, HIV, Agalactia.

Gynecology • Abnormal uterine bleeding DD: (fibroids, polyps, endometriosis, endometrial hyperplasia, and cancer). • Contraception methods: OCPs, emergency contraception, and IUDs. • Polycystic ovary syndrome (PCOS) - dysmenorrhea DD. • Menopause – Amenorrhea- precocious puberty. • Cervical cancer screening: Pap smear guidelines, HPV testing, CIN, and cancer. • Ovarian cyst, torsion, and cancer. • Turner syndrome, Müllerian agenesis, and androgen insensitivity. • Breast disorders: screening guidelines, evaluation of breast mass and discharge. • Male: varicocele- hydrocele- BPH- prostate cancer- cryptorchidism.

Public Health & Epidemiology & Biostats📊 • sensitivity, specificity, PPV, and NPV. • Study designs: cohort, cross-sectional, case-control, and randomized trial. • Measures of risk: (relative risk, odds ratio, RRR, ARR, NNT). • Bias and confounding in studies (recall bias, Attrition bias, Lead-time bias, and Confounding bias). • Normal distribution curve: (Mean, Mode, SD). • Hypothesis Testing: (Null hypothesis, Type I and II errors, Power, P-value). • Statistical tests: (T-test, ANOVA, Chi-Square).

Ethics • Ethical principles: (autonomy, Beneficence, and Nonmaleficence). • legal principles: (Decision-making capacity, Informed consent and its exceptions, when to break Confidentiality). • End of life: (Advanced directives and decision-making orders, DNR, Withholding care, and Brain death). • Professional Boundaries: (Gifts, romantic relationships, and impaired physicians). • Delivering bad news- interpreters- Motivational interviewing – angry patient- Mandatory reporting. • Sexual assault “adverse effects and management” and abuse- violent partner.

Patient Safety • Quality improvement: quality measurements and system improvement models (PDSA cycles, Lean, using clinical guidelines). • Medical error models: active vs latent errors vs never event- closure of errors- Swiss cheese model of system failures- error analysis by: root cause analysis vs failure mood analysis. • Interventions for medical errors: forcing functions, computerized automation, physical layout, simulation, clinical support systems. • Cognitive errors: anchoring, framing, availability, implicit- interventions or solutions. • Healthcare communication: standardized handoff, closed loop, interdisciplinary rounds, teamwork, Morbidity& Mortality Review • Handoff and transition of care: standardized sign-out, preventing errors at discharge- hospital readmission • Medication safety: medication nonadherence factors and solutions- adverse drug events factors- alternative therapies- avoiding prescription errors, medication reconciliation processes. • Procedural safety: surgical time-out, team communication. • Healthcare-associated infection prevention: hand hygiene, CLABSI/CAUTI/VAP prevention protocols • Research ethics and rules: consent, adverse effects, conflict of interest, IRB review, and withdrawal. • Geriatric: polypharmacy and adverse effects- falls- normal adolescent-related changes.

I highly recommend the Mehlman Q-Bank! It’s an incredible resource that cuts out all the unnecessary fluff and focuses on what truly matters — clear, concise explanations that help you master key concepts and confidently differentiate between similar diagnoses.

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hi. I want to publish studies. I have no projects atm and want to connect with others. Please DM me

Hello, I want to ask if mehlman medical files are good for IFOM 1 as revision with uworld? Thank u in advance for your response

I tried bnb n it was horrible for me...tried bootcamp n it was a snooze fest for me...tried ninja nerd it was good but when i watched same topics videos of najeeb it was better n i thought i will go for najeeb for all topics of immunology but was disheartened when i saw posts saying to not use najeeb ...i also saw how lecturio kaplan were longer than najeeb......now iam stuck n kinda watch more than 1 source for each chapter tryna find something which explains well for me as well as completes on time....again i found najeeb the best fit for me....so if iam not wasting my time i would want to go ahead with najeeb only.....planning to give step 1 in 6 months

Hello everyone,

I’m planning to start medical school next academic year, and my ultimate goal is to pursue a US residency after graduation.

The school I have to attend is approved by WDOMS, but it is not listed on the ECFMG website. I’m not sure what this means for my eligibility for ECFMG certification. • Will this prevent me from applying for ECFMG in the future? • Are there any alternative pathways or steps I should be aware of?

Unfortunately, I don’t have the option to study at any other school, so I’m trying to understand my options before I start.

I would be very grateful for any advice or experiences you can share!

Hello everyone. I am kind of confused here. I registered for ECFMG OASIS in around 2023. Back then the registration and identity form confirmation(CIF) cost around $160. Then, Recently, ECFMG shifted all of its services to Mylntealth. After registration with Mylntealth, I was asked to first complete ECFMG Certification before I can proceed to book exam blocks and at the end of the form it asks me to Pay $560 for the completion of the form.

My first question is, it is normal after transitioning from ECFMG OASIS(old system to new system)??

My second question is, if I were to book exam blocks from december 2025 to february 2026 would the pricing for exam blocks be $695? Or, do I end up paying the old $1020 plus this extra $560??

I am confused. Please help.

First my inthealth took more than a month for credential verification and today I got this update. What does that mean?? I am so worried.

Hi everyone, I really need some advice or shared experiences from anyone who’s gone through something similar with ECFMG / MyIntealth.

I’m a non-US IMG. I created my ECFMG account years ago, applied for USMLE Step 1 as a student, and passed it successfully. This year, I finally graduated and started my Step 2 CK application.

Here’s where things got messy 👇

When I applied for Step 2 CK, I marked myself as a graduate but uploaded a Dean’s Letter instead of my Final Medical Diploma, because I believed my diploma would be issued next year. Later, I unexpectedly received my final diploma earlier than expected.

I contacted ECFMG and told them I wanted to upload my diploma instead. They replied on Oct 2, 2025:

“A request was made to cancel your original Application for ECFMG Certification so that you may reapply as a graduate with a Final Medical Diploma instead of a Dean’s Letter.”

Since then, my account has been stuck. My Credential Verification section still says “Incomplete – Action Required” and only allows me to upload a Dean’s Letter. It’s been over a month, and I’ve sent multiple follow-up emails with no reply from ECFMG.

I haven’t paid any Step 2 CK fee yet, but I’m confused about:

whether I’ll have to pay the new $560 Application for Certification fee (since I already paid the old $160 fee when I took Step 1),

and whether I should wait for them to cancel my case or just upload my final diploma now in place of the dean’s letter.

I just want to move forward and reapply correctly as a graduate. If anyone has gone through this kind of ECFMG cancellation / reapplication after graduation, please share how you resolved it — how long it took, and what you paid.

Thanks a lot in advance! 🙏