Mark Davis MD SPEX TUTOR AND MENTOR








Special Purpose Examination, commonly called SPEX, is a test unlike any you have taken before. Created by the minds at the Federation of State Medical Boards it attempts to test a physician on a wide range of subjects. Federation officials claim in their literature that every physician, regardless of specialty, should have knowledge of the subject matters contained within the structure of the SPEX. Their claim further notes that participants in this exam who stayed current with general medical literature should not find the questions on this test “totally unfamiliar.” Reading the Federation’s literature many candidates for the SPEX,  who took this exam, would contest the Federation’s description that common medical knowledge is sufficient to obtain a passing grade. The high rate of failure speaks for itself.


Medical Boards send their SPEX candidates into this exam literally blind. They provide no guidelines, literature or other information to enable a potential examinee to know what they will be confronting.  Most candidates I have come in contact with were given a phone number of a faceless bureaucrat at the Federation of State Medical Boards to call. The voice on the other end is more interested in collecting the enormous exam fee than guiding the examinee on how to study for this very broad based test. It is to the benefit of this Federation for you to fail because they can collect additional test fees. Obtaining an edge up on the questions and subject matters of this exam is extremely important. Why? Because it can make the difference between passing or failing. It will only take a few questions marked the wrong way to fail this extensive exam. Hence SPEX tutoring came into being.  As a tutor I come into contact with many who have moved through this exam. Their feedback is enormously helpful for future test takers. Reviewing books on the market, many of them antiquated for this test, have not been very helpful to the multitude of examinees who could not make it through this exam the first time. Physicians taking this exam two, three and even four times are not uncommon. Since there are no legitimate live courses available the tutor, Mark Davis MD, can provide help to overcome the hurdles of a test designed to fail. The content of this e-book provides a glimpse how a tutor can be of great assistance to a potential examinee.




Given by computer over a one day period this test is a challenge to fully complete in the allotted time. There is a total of 336 questions divided into 7 segments each containing 48 clinical presentations. Each segment is given 64 minutes to complete. This provides 1.3 minutes per question. Many of these presentations are a full page long with paragraphs that contain 8-10 sentences or more not including the multiple answers to evaluate. Being well versed in the content of this exam and its layout is extremely important. The Federation of State Boards’ description of this exam is illusive at best. Listed subject matters on their website concerning this exam are incomplete. Therefore tutors, such as this author, are indispensable to help a potential examinee through the maze of literature necessary to succeed.




Versatility in many subject areas is a must to conquer this expansive exam. There is an array of radiographs one must be able to assess quickly. These x-rays do not always have the clarity one would expect on an exam yet you are expected to know the answer to the problem presented. When x-rays are displayed the written clinical presentation may not always be clear exactly what the author of the question is looking for. There have been a number of x-rays which have been repeated over the years and a tutor can clue you in to those he or she has come across. Certain types of fractures, dislocations and injuries show up more often than others. In the pulmonary category there is a focus on certain disease states. Both pediatric and adult equivalents must be known by the test taker as well.




Reported that EKGs are not of the best quality is also a fact. The clinical presentation may request a treatment based on your diagnostic capability therefore analyzing the cardiogram appropriately is a must. SPEX designers may have purposely introduced artifact into their EKGs to confuse the test taker into thinking they are viewing a rhythm other than it really is. Certain patterns have shown up more frequently in recent years which your tutor would be able to reveal to you.




Though clinical genetics is a class we took in our medical school days it is ever present on current SPEX tests. The Federation’s foray into genetics encompasses inheritance, chromosomal anomalies and phenotypic expression. The test participant should be aware of both pediatric and adult presentations of genetic anomalies. Emphasized most recently is the percent of genetic expression for specific diseases. Your tutor can enlighten you on which diseases were most frequently represented on the test.




Orthopedics is showing up more frequently on current exams. Many of the presentations are purposely misleading which diminishes the amount of time you have for evaluation.  Fractures, dislocations and tumors in both the pediatric and adult age ranges have been displayed. Knowing which have shown up more frequently could save you much time. Many of these presentations are not common bone diseases therefore a tutor who has communicated with prior examinees is someone you should seek out. 




Vaccines have been included in recent exams. An odd presentation of a very common disease showed up more than once in the most recent circuit of exams. The wording was straight forward yet those who studied for this exam overlooked this disease. It is not enough to know vaccine schedules. One must understand when to apply them in emergency settings and or not use them as a specific case is referenced. A tutor could be instrumental here.




There are thousands of variations of cardiac disease. Yet the Federation of State Boards appears to want their physicians to know certain disease states. Knowing Cardiology is not sufficient. Odd presentations of symptomatology are examined on SPEX.  Also tested is the examinees ability to elicit certain symptoms to arrive at a diagnosis. Physical diagnosis is tested in a number of ways. When to test and when to withhold testing of a patient is paramount. Which cardiac drug to select when a patient presentation is given is of utmost importance to know. As a tutor for SPEX those who have taken this exam several times reported back the recurring themes the Federation of State Boards has utilized in cardiology.








A wide range of pulmonary presentations have confronted recent examinees. The examiners have introduced an international flavor to the test. Diseases normally not seen frequently in the United States have challenged test takers. Remember you have approximately 1.3 minutes to evaluate an x-ray, graph or chart. In addition you must read and evaluate the clinical presentation before moving onto the 4-5 answers to select. Preparation is key. With few exceptions the flash cards offered for study of SPEX and other books sold were not very helpful in this section as reported to me. Variants of common pulmonary disease states both in the pediatric and adult categories were also amongst the offerings.  Several deceptive presentations of lung cancer and uncommon bacterial/viral diseases made their mark on examinees. Knowing where to emphasize your studies in this medical subject is paramount.




Psychiatry had a wide presence on recent exams. A series of symptoms describing a patient’s personality was frequently seen. The examinee was required either to make the correct diagnosis or chose the medication for that diagnosis. Some of these presentations were a full page in length.  One clever presentation gave a description of an infection which required a psychiatric diagnosis. There are several methods to cut down the time for evaluation of these types of questions.


Check with your tutor for the best approach. Parsing your time is one of the keys to passing SPEX.




Numerous questions in gastroenterology, both in the pediatric age group and adults have been given on recent exams. These questions frequently but not always have x-rays along with their extensive description of diseases. Knowing which age groups these diseases appear more frequently would substantially cut down the time in finding the answer. Remember many of these clinical presentations appear the same except for a few distinguishing characteristics.  Questions related to the liver and the various toxic encounters it incurs should not be overlooked.  A large number of errors are made in this area of the anatomy. Your tutor can cue you in on what has been seen most recently.




A wide ranging knowledge of infectious disease is a must to move into the passing grade zone. This subject overlaps with every other category of disease on the exam. Odd presentations of common diseases have been seen. Both domestic and foreign vermin are presented to challenge the examinee. In some questions a specific symptom or set of symptoms may be given and you have to know the disease presented in order to answer which treatment modality is needed. This is called a second level question. This type of question is seen frequently. A patient presents to a physician with several symptoms of severe neurological disease. On first glance at the question the examinee may not consider this is an infectious disease problem, yet it is. The Federation test writers do an excellent job with  infectious disease questions literally misleading the test candidate by adding vacuous information to the introductory paragraph of a given question.  Your challenge is to get beyond the confusing verbiage to quickly delineate the answer.  Tutors are helpful here because they can clarify the fine differences in questions to get to an answer sooner.




There are numerous questions on Oncology and Hematology. Many of the books on the market have physicians studying various slide presentations of cells or other extraneous lab data. If that makes the examinee comfortable then by all means study this material. Recent tests did not have microscopic slides for these specific subjects. Questions are definitely recycled.  Additionally a clinical setting may be given requesting the examinee to answer several questions based on its contents. This type of presentation was given throughout the test. On the Oncology side pulmonary, bone and skin cancers have been frequently seen.  These questions either ask the diagnosis and or the most common treatment mode.  Few may request the cause of the cancer which may not be as obvious as one would think. A vast array of hematology questions have been seen from bio-chemical deficiencies to blood born cancers. Your tutor can be very helpful here directing the examinee to emphasize certain areas of study.




Neurology and Neurosurgery questions are part of the repertoire of presentations. Symptomatology is similar for many of these diseases. Therefore questions can be quite confusing. With limited time available the examinee must get into the “meat” of the question quickly. Knowing the physical findings specific for compressing lesions and or vascular anomalies would be very helpful to the test candidate. Within these fields your ophthalmological knowledge will also be tested. Knowing the layout of specific nerve roots could help answer some of these complex questions. Your tutor can enlighten you on some of the more broad based approaches examinees should take to get beyond these types of questions.




Nephrology is represented by many key questions from urinary crystals to cancers. Vascular anomalies have been presented in creative ways to throw the examinees’ thinking for the proverbial loop. A multi-prong study approach should help the test candidate through these difficult questions. Let your tutor guide you to the best approach in this subject.




Special Purpose Examination (SPEX) has shown itself to be incredibly difficult. Failing this exam two, three and even four times has occurred frequently by test candidates. The cost in time and money can be cut down substantially for examinees by proper preparation and study for this exam. A tutor who has a wide ranging knowledge of this exam and who has come in contact with a multitude test candidates is well suited to help the potential examinee.  Please contact Mark Davis MD at platomd@gmail.com to inquire concerning fees and study times available.




Mark Davis MD




SPEX Tutor and Mentor


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