Scores

NBME 9 - 265 5.5 weeks out (~30 wrongs)

~1500 Amboss question in between - 82% average

NBME 10 - 265 3.5 weeks out (~30 wrongs)

NBME 11 - 258 3 weeks out (~30 wrongs)

Basically my scores are the same or even declining. I review the exam very closely and sometimes topics are easy (I missed some biostats on NBME 9 so I perfected those on all NBMEs after that)

But many questions I am struggling and I feel there is no knowledge or resource I can learn. Amboss or UWorld do not even have this detail in their questions and it doesn’t show up on prior CMS either!

For example NBME 11:
has a question on Mono asking what is best step to prevent transmission. Pt lives college dorm. Options I narrowed it were “isolation until symptoms resolve” vs. "no specific measures." The answer is no specific measures but how did I know that, no resource mentions that and technically Isolation will prevent transmission.

Similar question is Crohn disease patient started on infliximab, question asks what to check at 1 month follow up. I put CXR for reactivation TB but the answer is CBC because apparently TNFa inhibitors cause granulocytopenia?? I know that the CXR is before starting but it was the only association I knew and the stem did not say he had CXR before starting infliximab.
Another one, 70 year old woman with BMI 17 admitted for PE, asking what is the biggest risk factor. I put BMI 17 but it is age? But the age was not so high and basically deciding between all these is the same, there is no question or teaching like this in AMBOSS or UWorld to explain.
Woman has ankle sprain, what prevents morbidity? Answer is PT not ankle tape or boot but again where is this? All UWorld and Amboss tests is Ottawa Ankle rule not so detailed like this.
Another patient has diagnosis of heat stroke which I ruled out because of cold clammy skin, but no question bank presents heat stroke like this. Skin should be flushed and warm. So I chose sepsis with the fever, but it was heat stroke. Somehow patient has fever but also cool skin from external heat.

I feel like I have no way to improve in remaining 3 weeks these questions are impossible. I see people saying "trust your gut" "don't overthink" but seeing my NBME I cannot tell what detail is important and what detail does not matter, unlike Qbank where my average is high.