What to Do on the Day of the USMLE Exam

Now we need to talk about scheduling meals and breaks and what to eat. Light breakfast in the morning preferably no meat but high energy carbohydrate. (High protein, high fat foods can make you sleepy, so no ham and eggs, sorry) Now coffee or tea to keep you awake, but limit to a cup since they increase urine formation.(increased heart rate, increased GFR = increased urine formation)

For the morning break, do not bring sandwich. It takes too long to finish eating it. Bring something sweet, high energy, high carbohydrate that can give you a sugar boost. (I ate a small high sugar cake that I finished in 4 to 5 bites.) You can opt to wash down with a cola (which can provide both sugar and caffeine boost) Do not skip the morning break. Remember your brain needs sugar to function properly.

For lunch break, do not eat full meal. A sandwich, preferably not high protein (egg sandwich or cheese sandwich comes to mind) is advisable. It’s actually basic physiology. A heavy meal will cause blood flow to be diverted to your GI tract longer therefore less blood flow to brain. Plus, proteins and fat will cause secretion of more HCl for digestion leading to Metabolic alkalosis. This leads to hypoventilation (to increase CO2) and therefore less oxygen to the brain. Longer digestive time causes longer time for HCl to be reabsorbed. This is the main reason why you are sleepiest after lunch.

For the afternoon break, a high sugary drink whether cola or juice will suffice. Limit total water intake as that can increase need for bathroom breaks.(600 t0 800 ml will be enough, max 2 breaks)

Now for the meds, you need the following.

1. Pain reliever – paracetamol, in case of headache or any other ache.

2. Loperamide – in case of gastrointestinal emergency eg. diarrhea

3. Antacid – in case of hyperacidity (anxiety can cause it)

4. Beta blocker – in case anxiety and palpitation become too distracting.

Don’t forget to bring any other meds you may need ( anti-histamine if you have allergies, salbutamol inhaler if you are asthmatic, etc.)

Now one last word of advise. Once you finish a block, forget about it. Concentrate on the block you are currently answering. Worrying about a block you have finished will not raise your score. Concentrating on the current block will help raise your score. Not paying attention to your current block because you are busy worrying about the previous block will even lower your score.

After you finish the exam. Go home. Stop thinking about the exam. Have dinner with your family, whom you probably haven’t spoken to in months. J Then take on a week long vacation before even starting to worry about your score. In the meantime, prepare what you want to write on the exam experience page of your favorite forum.