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PLAB 2 History Taking Secrets

PLAB 2 Exam secret methods of history taking   
            

When you have come thus far, I can well guess that you are a doctor from overseas United Kingdom and already cleared the first hurdle of PLAB 1. Now you are entering into the second round of the exam, i.e. PLAB 2, which is also known as OSCE (Objective Structured Clinical Examination). Passing PLAB 2 is not so easy my friend, and yet it is not so difficult either! You must be thinking I am cutting you a joke. No my friend, I am here to help you in passing this test. Being a successful candidate a PLAB 1 and PLAB 2, I felt the urge to help my fellow doctors across the world in clearing the examination with flying colours. There are some secrets which need to be addressed to get a pass mark in PLAB 2. I shall discuss my secrets here.

In PLAB 2, you will have to face the real patients. You will be examined in a way to assess that whether you are capable in eliciting important clinical aspects from the patients. You should be familiar with the common diseases occurring in the UK and have general idea about the epidemiological aspect of the diseases also. It will also be evaluated how you communicate with the patients.

The minimum criterion to pass PLAB 2 is at least 10 ‘C’ with not more than 1 ‘E’ in the entire examination process where C is regarded as marginal pass and E is marked as severe fail.

My first secret will be not to lose your cool in the entire process of the PLAB 2 exam. To pass the exam in a better way, you need to remember the negative aspects of the exam also. This should come in your mind that even if you fail in 4 different stations, there is still a fair chance to pass in the aggregate score. If you consider that your performance was not good in a station, there is another 13 chances to make it brighter. Thinking positive is the only way in passing the PLAB 2. If you continue pondering it over and over again about the dreadful station, there is high chance that you may do more mistakes in the subsequent stations as well. Maintain your focus and you will definitely win.

Let me give you an idea what is considered as ‘Fail’ in PLAB 2.

  • Generally scoring D is considered as fail in any station. But don’t worry; you can still conquer the PLAB 2 even if you score D in up to 4 stations.
  • The poorest performance you can have is an E. It is considered as severe fail. Again there is grading in E. 1 E is considered as pass. Any score less than 1 E is a fail in PLAB 2.

See, it is very difficult to fail in PLAB 2. I mean, to get 4 Ds and 1 E (i.e. any score less than 4 Ds) and 5 Ds or 4Ds with 1 E or 2 Es (you are marked E in a station if you make any gross mistake) is really hard. If you get this petite score, you were never prepared well to sit for PLAB 2 my dear friend.

Let me share my secrets as to how you should take history in PLAB 2. Just go though the lines and you will find the useful ways to take history nicely in a shortest period of time.

I am sure you all know how to take history. You must have also noticed that there is a specific outline to take history. Let me tell you the essential items that you should not miss during history taking –

  • First things first, rule out the life threatening diseases.
  • Ask leading questions about the diseases that are common in the UK. This will help you in making the differential diagnosis. I know, asking leading questions in history taking is not strictly by the books; but you are taking an exam my friend. You can go by the books later when you pass the exam with flying colours.
  • You must proceed in a specific pattern –

Ask about GRIPS

The chief complaints

The duration of the disease

Any other associated complaints

Significant past history (do not bother about single attack of flu 5 years back)

Personal history including history of allergy (never forget to note down this, your examiner will eagerly await whether you miss this)

Any relevant Family history

Any known side effects of medication

Memorise this pattern. This will help you to recap all the points even if you miss any point by any means.

Let me give you a clinical example. This will help you better in memorising the facts.

Case Study:

A 25 years old young lady presented herself to you with headache. Take the history and note down the differential diagnoses.

Again I would like you to refer the pattern I have just furnished. According to the list, the first thing is to be done is to rule out the diseases that may be life threatening. You can well guess the probable differential diagnoses – SOL (Space Occupying Lesion) or SAH (Sub Arachnoid Haemorrhage). Then you should think about the common diseases like diminished vision, migraine, Glaucoma, tension headache and depression. You must take proper history and can ask leading question to elicit the diagnosis.

By asking questions about the life threatening diseases, you can prove yourself to be a safe doctor before the examiner and that will help you in building your impression.

I am giving you what I faced in my exam. One of my patients was an elderly lady having painful menstruation. She was in early menopause and my provisional diagnosis was Menorrhagia. I made my diagnosis with few questions and oh boy, I was relieved. But I had to think about other differential diagnoses also. You know, there is a long list for the causes of menorrhagia. I gave her an open question, whether she wants to tell any other information. She told me – “Doctor, one of my relative has cancer Uterus. Is there any chance I may suffer from this?” Bells was ringing in my head and I asked a few questions related to CA Uterus and CA Cervix (CA Cervix is very common in the UK). I gladly noticed that my examiner was nodding in affirmation and putting a tick mark as I was clarifying the patients to rule out CA.

2. I was supposed to clear out the common d/ds next. By taking epidemiological history you can catch the disease better. I asked about family history of migraine as it is common in the UK than sinusitis. You have only 5 minutes out there for history taking. So better to prioritising the questions and asking only the relevant ones is the better idea. Noting down the duration and severity of complaints will also help you a lot. It will give you an insight to important d/ds. If any patient says the headache he is suffering is the worst in his lifetime, you can easily think of SAH.

3. Next you should ask about any associated symptoms as well. Vomiting is associated with migraine and history of hypertension or injury to the skull is the clue for SAH. Patient suffering from glaucoma will have visual disturbances.

4. The important of past history should not be emphasised much. It gives you vital information to reach a diagnosis. A case of Herpes Zoster will definitely have an episode of Chicken Pox in his childhood. If any patient gives you similar history of headaches in the past, the probability of migraine is high as it is episodic in nature.

5. Personal history like smoking, drinking and drug abuse has to be taken according to the relevance of the disease. The current status of hypertension and Diabetes may be asked. If any person is suffering from long standing unstable hypertension, he be a case of SAH is there is severe headache.

Always ask about any allergy including drug allergy. Allergy is quite common in the UK. You will make an impression before your examiner that not only you practice safe medicine, but you know the subject also.

6. Most of the people are on a medication. Therefore, it is imperative to take history of medication. Please do not ask “Do you take drugs?” as this means whether he is a narcotic abuser. Ask him/ her “Do you take any regular medicines?” If the patient is taking Contraceptive pills for a long time, there is chance of headache. If you miss it, you are missing an important triggering agent of headache.

7. Keep all the psychiatric aspects of the diseases in mind. Let me give you examples – depression can precipitate insomnia, stress can precipitate headache and anorexia may precipitate weight loss.

As you can see from the example mentioned here that following a specific pattern will help you to keep in mind all the important aspects of history taking. It also carries good impression to the examiner and help you in scoring higher grade in exam.

Let us recapitulate the important points of history taking once more. Do not forget three vital points as per given order while calculating the important differential diagnosis as you are offered a station –

  1. First, exclude the life threatening diseases.
  2. Rule out the common differential diagnosis
  3. Proceed in a specific pattern and never forget to inquire about history of allergy and medicinal history.

Lastly, complete your history taking by asking “Is there any other thing you wish to tell me?”

Remember my fellow aspirants, passing history stations with flying colors is not a game of a child. You may get 2-3 such stations in PLAB 2. It may become a nightmare if you don’t know exactly how to proceed methodically. Also remember that history taking is such a station you cannot concoct anything if you have no idea about proper clinical methods. I have seen a few well prepared candidates are getting mental blocks and roam about the relevant questions to be asked.

At the end of this discussion, let me wish you all the best in your PLAB 2. There is nothing better than a hard work and success is not achieved if you don’t have the guts for hard work.

 

 

USMLE STEP 1 GUIDE

usmle step 1

 

I just got through my United States Medical Licensing Examination (USMLE) Step 1 and here are the experiences and the lessons I learnt for whatever it worth to you.

1. Covered the FA from cover to cover and jotted down lots and lots of notes from it. In those subjects that I was weak in I spent more time reviewing matter from other sources.

2. In spite of the fact that my main source of study was the FA, I read and studied several other books also. If u can get it and go through it, Lippincott’s Biochemistry is worth its weight in gold. I could complete it in about 5 to 6 weeks and it was worth every second. If you really studied that book, there’s nothing that they can ask you about biochemistry that you cannot answer. Additionally, it gives you mechanisms. This makes the learning a lot more easier. At least it did for me. The heavier Robbins will do you a whole lot of good as a reference book for pathology. It is quite impractical to go through the book.

3. Physiology was one subject that I went through in depth. As I was weak in Renal and Pulmonary physiology, I started from the basics and then applied what I had learnt to the disease process. ICU books are extremely helpful in that they lay thread bare the basics of physiology in relation to disease.

4. Answered some twenty plus practice questions daily for the first three weeks of my study. During the last 2½ weeks I was doing 200+ questions daily, randomly. I also reviewed in detail each and every question, whether I had got it right or wrong. This reinforced the material that I had already studied. The source of my questions was the Kaplan QBank.

5. I did have some doubts about the Kaplan QBank. You see, the exam questions aren’t as detailed as they are in QBank. But if you study them in depth you’ll really learn the subject. I went through practically 95% of the questions and I was scoring a decent 74% overall and that too in the random timed mode; not just the review mode. Doing it in the tutor mode might have got some people some good scores, but that isn’t like the real examination.

6. Review, Review and Review again. You should reserve at least one day per week for reviewing what you had studied previously. It did it at the end of each study day, one FA section per day. This helped me go through my annotated version of the FA foe more than a couple of times before I went for the examination. When reviewing, don’t skip anything. If you really take a closer look, you’ll find that there is more than what you thought there was and some more. You learn something more and you also get a deeper understanding of the subject.

7. Did one of the NBME examinations just a day prior to the examination and then rested the rest of the day. I got my predicted score of 251. I gave a sigh of relief and I gained more confidence to go to the real examination.

8. Studied for a total of six plus weeks. Sat for the examination in the middle of February. The scores came up three weeks later. Scored 258/99. Patted myself on the back!

I’d highly recommend getting First Aid (FA) and reading it in the first and early second years. Take notes and annotate it so that when you come to the time for reviewing you have everything pat and ready for you. Makes life easier.

see also

USMLE Step 1 Tips

10 steps to USMLE Step 1

7 reasons make you fail in usmle step 1

how to study for usmle step 1 exam

USMLE Step 1 exam misconceptions

USMLE Step 2 ck guide

It is absolutely possible to score 99 in Step 2 Ck, and you should aim for it. If your aim is 95, your score will be around 90. So it’s always better to have a higher aim. We can assure you that you can succeed in achieving this high score.

Since you have just begun your career avoid frustration and take one step at a time. No doubt you have acquired high IQ after passing Step 1. You are assured of excellent education and life in the United States. Just think how many students in your own country can contemplate of such a possibility.

 

I shall explain what I did to succeed in Step 2 Ck. I had to sit down for nearly two hours to honestly answer some questions. I switched off my cellphone lest should I be disturbed. I took out my notepad and started writing the answers.

Question no.1 was what my requirement was. Obviously the answer was a score 99 in USMLE Step 2 Ck. Any aberration from this correct answer would entail deviation from your aim. The next question was about the experience that you would get when the goal is achieved. Surely you would celebrate with your pals when you have scored 99 in USMLE Step 2 Ck.

The other usual questions that require your answers are:

What are the hindrances that can cause difficulties in reaching your goal?

What is the timeframe for achieving the target?

What resources are at hand to help achieve your goal?

Who was successful in accomplishment of the goal and can be emulated by you as a role model?

 

Prepare the timetable and plan for achieving your goal on your notepad and write down on it your honest and detailed answers to the above questions. Whatever is your native language, go on writing for above ½ hour. At the end, read aloud what you have written. Or you can go to the seashore and read the answers aloud there. Make sure to read them first thing in the morning and last thing in the night. Being obsessed with your aim will help you to achieve it with ease. You will be comfortable with no problems in studying hard.

Take the Kaplan Q book and begin with memorization of the first fifty pages. There you will find the ideal ways to how to be organized for the exam and how to respond to various questions. The best method to study medicine as well as other subjects is to ask yourself these questions before you begin reading the book:

Why do I read this book?

For whose purpose do I read this book?

 

Your answers would elaborate about your patients. Main points from a single of line from the text can help in saving the patient’s life. Subsequently you will be induced to read more and gather the meanings of every line in the Kaplan textbook.

 

You should read medicine and then pediatrics for twelve days each during the revision, beginning with the CVS chapter in each subject. This will help you save time and energy. For the first five days the O&G is to be read, followed by Surgery for three days and Psychiatry/Behavioral Sciences for four days. You can complete a set of revisions in twenty-four days in this manner.

During this period you should access the website www.usmleworld.com and begin to answer all the questions listed therein. Don’t leave out any one question. Continue your studies with USMLE sample CD (can be obtained from ECFMG), Kaplan Q book (10-12 blocks), and Question bank (10-12 blocks). Once again don’t leave out any question.

So, all these materials are required for a 99 score in USMLE Step 2 CK:

Kaplan Q book and Q bank of usmleworld.com
USMLE sample CD
Harrison’s Text Book of Internal Medicine with hematology/dermatology slides
Photos from First Aid book

During the last ten to twelve days don’t try to first answer the questions; you should devote your time on reading the texts several times. Regular intake of Vitamin B-complex will guard against Wernicke’s encephalopathy. Then you can find answers for the USMLE CD and the Kaplan simulated. After this you can devote two to three days for each subject. You need not read some textbook other than Kaplan and resist the impulse to read other books. Surely you will get to know all the correct answers. It is better to make a note of the points in Kaplan that you can’t recall from memory, such as pediatric guidelines, leukemia, AIDS infection, etc. Don’t read new text in the last three days. Just go through what you have taken down in your notepad earlier. You may need memorization of some topics in CNS, hematology and Renal system, and a quick revision of these topics is advised. Find answers for the USMLE CD once more in the two days before the exam and also view the pictures in Harrison.

One day before the test, you can have some entertainment or fun. You can go for a movie, a body massage, or a haircut, and have some relaxation. Don’t sleep in the afternoon or you will lose sleep in the night before the test. It’s better do some exercise like walking, etc. In the morning you should read the fifty pages at the start of the Kaplan Q book where you will find how the USMLE questions should be answered. Don’t read any text on the day before the test; check your id and orange card.

The night before the test, before going to the bed, imagine yourself to be at the exam hall and answering the papers. Think that you will do well as you know the right answers. Read something that can motivate you so that get up with a positive attitude in the morning, refreshed and all ready to face your exam.

Take some bottles of energy drinks with you to provide quick energy. You can also take along a few jam sandwiches or some sweet items to provide you with sugar sufficient to supply your brain with energy. Let your breakfast contain some apples, as these are a source of stimulation, and better than coffee or tea. Also two Vitamin B-complex capsules need to be taken. If you are a coffee or tea drinker, take it along too. Once again check your id and orange card. Now you may invoke the blessings of the Almighty, your elders and your well wishers. When you’re at the exam venue, breathe deeply and relax before the commencement of the exam. Wash your face with water at the toilet so that you’re fresh.

When you.ve entered the exam hall, don’t rush to answer the questions. Insert the earplugs in your ears and write on your pad that you will be doing your very best. Now you’ve gained confidence and you can start with the tutorial of the test. You can’t skip it, but continue to press the NEXT button. When it’s over you can type your CIN number in the required field and the exam will begin.

Read very carefully and proceed with the test. Have patience and take the test as if you’re playing a game. Remember, it’s important that you should be enjoying the test.

As each of the blocks is passed over note it on your pad. When you’re through with 4 or 5 blocks, you can have a light meal. Now you have done almost 70% of your exam. As you complete each block, try to write some good points about yourself on the pad. This is one of my secrets which I actually did in my test.

Should you need any help feel free to contact me. I’m sure you all will do your best at the test and anyone can reach a 99 score just because all of us are doctors. I wish good luck to all of you.

USMLE STEP 3 GUIDE

Hello there! I just finished writing USMLE Step 3 and felt like sharing my experiences with you. I’ll try to do it to the beat of my ability. You see, I took the exam between residency interviews and so you might find it a bit rusty.

The Actual Exam : The exam, you know, runs for two days. Initially it is pure Multiple Choice Questions (MCQs) and then on the second day it is MCQs and cases.

Content : What knowledge you have gained during your internship is what is tested in Step 3. There is nothing to beat your clinical experience. I found that out at the very first set of questions that I got to do. The questions on neonatology were difficult; at least they were for me. That was when I found that I was woefully inadequate in clinical experience.

During my interviews I had the chance to talk to a PGY-3 IM resident who had only a couple of months back (actually prior to me) had completed his exams. Has had done exceedingly well in the exams. He told me one thing about his preparation. It was minimal but what stood him in good was his clinical experience.

As far as I am concerned, typically most of the questions relate to diseases and their management. Questions in relation to prognosis were also asked. Medications, the treatment preferred and the side effects of these medication could also be asked.

Some of the questions that I came across were ..

1. What are the methods for monitoring RA?
2. Anemia n infants. I got a lot of questions in this field of study. And variations of the same question in the same set.

Multiple Choice Questions (MCQs) : The books and material that I used were

1. Kaplan QBank,
2. UWorld Qbank and
3. Kaplan Step 3 and some videos.

I finished studying all to the Kaplan books and the videos. I couldn’t finish either the Kaplan QBank or the UWorld QBank. If you intend to do the questions, do it with the intention of learning and not just for the exams. All the materials were helpful. I can’t, for the life of me, tell which one was the better one.

Summary of MCQs : Suppose I had to do it all over again, God forbid; I’d do more questions – more Kaplan Qbank and the UWorld Qbank.

Clinical Cases : Most of them were quite straightforward. The books I used were

1. UWorld Cases,
2. USMLE Steps 1, 2 & 3 (I got them off the Internet) and
3. First Aid Step 3 Cases.

I couldn’t finish all the cases. Just about 25% of all the material I had. Here’s my opinion of the material I used.

UWorld Cases : More than enough.
First Aid : Exactly what is needed. At least what I needed.
USMLE Steps 1, 2 & 3 : Decent. With the software for practice.

Summary Of Cases : That depends on your confidence on the management of real time cases. U can use either UWorld or First Aid. Get yourself acquainted with the software a week or two before the exam. Depending upon your knowledge of computers, the time to get used to the software varies.

 

see also

Complete Physical Examination : PART ONE

Thyroid examination video

Neurological Exam Part 1

Neurological Exam PART 2

Abdominal Examination

RESPIRATORY SYSTEM EXAMINATION

 

 

USMLE Step 1 Tips

USMLE Step 1 – Preparation and My Experience

Hello, everyone! I have taken my USMLE Step-1 and I had a very good experience in the preparation stage, which I am sure is going to help you for achieving a better score in your exams. I haven’t received the result of my scores yet, but I’m sure it would be a nice idea to share my experience with all of you who have their exams coming up shortly. For your convenience, I’m giving a step-by-step explanation of the entire process.

Ideal Time For Preparation 


It took me almost 6 months in preparation, which completely depends on your initial reading and also on the number of MCQs you are willing to solve later. Majority of students complete their preparation in 4 to 8 months. But of course, if you have exceptional reading skills and a sharp memory, you can do it in less than 8 months.

Books and Resources That Will Help You 

In my opinion, Kaplan is the best source for carrying out your preparation in an efficient manner. There are several other books including ‘High Yields’, but Kaplan has answers to all those question that one encounters in exams. It also has answers to subjects like behavioral science, for which majority goes for BRS.

However, you can also revise pathology with the help of Goljan or BRS.
I used following resources for myself:
Kaplan for all subjects
Goljan 500 pages for pathology
Kap videos for micro/immunology, Anatomy /physio / behavioral science/Biochemistry
First aid

 

how to prepare for usmle step 1

What Actually is USMLE Exam?
USMLE is not an easy test at all. It requires you to be present for continuously 8 hours in an ongoing exam with a minimum break of 45 minutes. It goes smooth in the beginning; but in the end, you are extremely tired and stressed out that you feel like ticking whatever sounds like a best possible answer, without giving it a second thought – all you have in your mind is getting it done as quickly as possible. So, it requires a lot of patience and stability to efficiently perform this test.

Besides examination, there are several points which make it quite difficult for most of the people. Everything is totally uncertain at all the steps of USMLE, which as an American medical residency involves several other problems that can be stressful. One has to think about expenses and exceptional performance in all the steps that are parts of this long procedure. In addition, you also have the risk of not getting a residency after clearing all of the required steps. It can turn out to be a total loss any minute. So, you have to make your way to the top along with fighting with severe uncertainty that anything could happen either in step 1, step 2 Ck / CS, in Step 3 or your interview, which also plays a very important role.

But it does not mean that only exceptionally smart students are eligible for USMLE; even if you are an average student, you should still go for it and give at least 6 months to it with your heart and soul. After first 6 months, you would know that whether it is for you or not.

How to Prepare for USMLE Exam?
Preparation for usmle step 1 can be mastered if you have a perfect plan in your mind regarding the availability of your time and doing your Qbook as well as Qbank. Moreover, you also need to decide in first place that when would you be able to take Step1 Exams because you need to apply in Sep – Oct period. It is better to start with the subject you were most comfortable with in your graduation period. It makes it easier to initiate your process and you are able to complete that particular subject easily without wasting a lot of time in thinking how to best start your preparation.

In my case, it was Physiology, and I think it is best for everyone to start with because it is entirely theoretical and you do not need to hunt for facts, which ultimately saves your time and helps you in making a solid start. However, you can select any subject that best suits you. What matters is your own comfort and understanding of the subject.

It is better to complete your first reading as quickly as possible. Spending a lot of time on first reading is not really going to do any favors; you won’t be able to save a lot in your memory even if you pay all your attention and time to your first reading.

Consider a fixed number of books and sources for your preparation, as they promise to provide you with all the required concepts. Mostly, only vital concepts are tested in USMLE, which you can find in a few defined books.

Besides, preparation requires a lot of patience. If one day does not go well enough, you still need to keep your spirits high and continue with your preparation. Next day might be the best one to help you for several upcoming days. Your self-belief is your only power here and you need to empower it as much as you can. And it is not always possible that only those students excel in USMLE test who have spent all of their time studying and preparing for the test. Common sense and calmness brings better result here than one’s brain.

Additionally, you also need to have a good sleep the night before because it will keep you calm and steady, helping you complete your blocks easily. Otherwise, you will get tired in a very short time and instead of thinking about succeeding at the test, you would be thinking about leaving the test.

My Preparation
I was done with the first reading, in which I never used the Qbook, in 3 months. Then, I did my second reading with the Qbook in 1 month. MCQs and final reading of theory, however, took just 15 days each.

My Scores

Q book…..75 % (Two months before exams)
Q bank……75% (I only completed half of the blocks and random mixed questions one month before the exams)
350 question…..73% (It was five days before USMLE exams)
USMLE FRED practice exam……40/50,46/50,37/50 (2 days before USMLE exam)

The Exam Day Experience

If there is someone else who is going with you, you should first confirm the routes which lead to your centre so you would be able to reach on time with ease. You won’t have any problems once you have reached your exam’s center because the staff at parametric center is very professional. They will immediately tell you about the DOs and DON’Ts.

The exam is really tough and takes a lot of time before it is finally over. It is divided into different blocks of which some are really tough, and some consists of average questions. Moreover, there would also be some blocks being the easiest ones.

However, unlike other practice tests, you will be short of time, which requires you to make quick final decisions so you could be able solve each block before it’s time is over. Doing so, you will succeed in saving a little time to give a second glance to all of the doubtful questions.
Besides, you also need to use your breaks efficiently. Ideally, you should relax for five minutes after each block to get your breath back as well as to gather all of your ideas and thoughts. Doing so will also give you a 15 minute break after you doing block 4 along with a ten minute break which can be taken later.

Another thing that possesses a vital importance is your passport and orange card. Make sure that you have both of these. Otherwise, everything will go in vain.

My Mistakes
I took a lot of time for doing my first reading, which can easily be done in 1.5 to 2 months.
I couldn’t meet up with my weekly / subject- wise goals and wasted a lot of time.
I also failed to finish reading first aid in the last two days of exams along with Goljan 500 in the initial 2-3 days. I could only complete reading half of first aid and even less than half of Goljan.
I focused more on doing Qback and missed numerous MCQs.
Most of my time in the last month I spent on the internet and TV, and it was extremely disadvantageous for me.

What I Did Right

I did not delay my exam more than 5-7 days. Because spending more time won’t bring any better results. You will still be having almost the same amount of preparation, and you might feel that you do not know anything at all when your exams start to near.
I never gave up. I always kept myself motivated and strengthened my beliefs with optimism.
I stopped wasting my time on the internet and TV, and gave my full attention to preparation in the last week.

I know this experience and knowledge that I shared is very scarce as compared to the amount of information and guidance required, but I hope my little contribution would bring better results for your test and help you in several possible ways

 

First Aid for the USMLE Step 1 2013 (First Aid USMLE)

Clinical Microbiology Made Ridiculously Simple

USMLE Step 1 Secrets, 3e

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