The difficulty level of many of the Pretest questions is appropriate; however, the content is off the mark with reference to what shows up on the NBME shelf exam. I found the pretest questions to be more challenging than those in the Appleton and Lange book (see my review), but too much attention is given to details of lyte management, chemotherapy etc. in pretest. The surgery shelf actually contains a fair amount of basic internal medicine type questions. I found surgical recall to be most helpful in preparation for this aspect of the shelf. I recommend doing the pretest questions, but advise caution. Use something to review basic medicine (again I relied on Recall and it worked).
