UW and USMLE:They Usually Tell You Which Ones are the Wrong Answers in The Stem of the Question. Rule them out!

Very well known strategy for approaching usmle questions is first to look for the right answer, if you can’t get it, start ruling out the wrong answers. It is easy to say but difficult to do for few reasons:

1. Limited information showing you why the corresponding answer is the erroneous one. For the right answer they usually give you on average at least 3 clues/key words explained in 2-3 sentences. That makes the biggest part of the question. This is you first goal. Find the biggest and obvious hints.

For the incorrect answers they give you only one sentence or sometimes only one word, which can help you in the elimination. So, if you weren’t able to figure out the right answer based on that much information, imagine how difficult is to eliminate the incorrect answers leaning on only few words. Not easy, indeed, but it’s not impossible. Some of the wrong answers are very obviously incorrect and you can get to the point to make a pick between only 2 answers. From now on, you know what to do. The ratio is 50:50. Make your educated guess and continue.

2. Time factor. You spend one minute to find out which is the correct answer. If this one minute wasn’t enough, how much longer you will tose out the incorrect answers. Another 4 minutes? Nooo, this is too much. 20-30 seconds is the maximum time you can afford. If you still hesitate, make your educated guess and continue with the next question.

One of the UW tricks

This wasn’t fare, but they did it. There is a question pointing towards Kawasaki disease, but this name wasn’t in the answers. What do they want you to know? They want you to know that Kawasaki disease is also known as Mucocutaneus Lymph Node Syndrome. This is the answer.

What I want to say is, that using alternative names and synonyms in the UW questions is not uncommon, but they usually do it for very common diseases and their synonyms. The problem is when they ask synonyms that are not very popular.

This is a short list with  some of the Most Common “also known as” for diseases,drugs, symptoms and others AKA:

1.perineal diaphragm=urogenital diaphragm
2.infundibulo pelvic ligament=suspensory ligament
3.cardinal ligament=parametrium
4.internal iliac art. and vein=hypograstric art. and vein
5.nervous bladder=unstable bladder=detrusor disinergia
6.endometriomas=chocolate cyst
7.Medroxy-Progesterone Acetate(MPA)=Provera
8.Danocrine=Danazol(testosterone derivate)
9.Leu-prolide=Lupron
10.Culdocentesis=colpotomy
11.Sexual desire=libido
12.Cystic Teratoma=Dermoid cyst(the dominant layer of the teratoma is Ectoderm, hence Dermoid)
13.BCP(birth control pills)=OCP(oral contraceptive pills)
14.Kawasaki disease=Mucocutaneus Lymph Node Syndrome
15.Measles=Morbilli=Rubeola
16.Rubella=German measles=3 day measles
17.Koplik spots–>bluish white lesions=table salt crystals
18.Human Herpes Virus 6=Roseola infantum=Sixth disease=Exanthem subitum

UPDATE:

UW Q-bank and how to solve 2 of the problems

I started doing questions from UW Q-bank 20 day ago . Not that much difference compare to step 1. Same good style of questions, some of them very difficult.

The new thing is that they increased the length of the questions and added some additional information just to make you confused. Now, it takes more time to read between the lines and find the relevant information and toss out the information you don’t need.

In some of the questions they give a long list of lab values and if you read them one by one, you will spend 5 minutes per question.

OK, lets try now to figure out how to solve these 2 problems:

Problem number 1: Lengthy questions with “garbage information” to make you confused.

Solution: Read the last sentence and the answers first. Sometimes(may be less than 10%) the last sentence is a direct question and that will be enough to get the right answer. Don’t forget just in case to scan the whole question after you picked the answer.

If the last sentence don’t tell you anything, start reading the question thoroughly from the beginning, but scan/skip the not relevant information like BP 130/80, HR 65, RR 16(this is all normal), skip information like patient drinks one glass of wine on weekends, and used to smoke 1/2 pack a day 30 years ago(that much alcohol and ex-smoker, common…these are not risk factors). In other words be very selective and try to make the question short…of course be very careful not to miss important clues.

Problem number2: a long list with lab values.

Solution: look only at the values you need for the case. For example if the patient has RUQ pain, jaundice, fatigue, nausea, no appetite, etc., look at the lab values related to the liver, gallbladder and pancreas such as: ALT, AST, bilirubin, Amylase, Lipase. If the patient has cardiac problem you won’t be able to get that much information by looking at ALT/AST…you need CK-MB and Troponin.

I Passed Step 2 CS, One of the Toughest Exams I’ve Had

When I opened my score report I coulnd’t believe when I saw PASS.

Thanks for the support of everybody, especially my wife and baby, my nephew, the rest of my family, Babak, Nikolai, Y.S. from prep4md (sorry I still don’t know your full name), Alberto from medicalpills, Bioguy, and the great prep4usmle forum.

Cheers!

After the exam

Mistakes I made:

1. I was very nervous before the exam and slept only 1 hour.

2. I wanted to know more and was studying thinks that are not important for the exam. Didn’t had to go into details that much. I had to learn the symptoms and the DD for these symptoms, instead of following FA and UW case by case and trying to memorize the way they present the cases, DD, and the workup. Even csprotocol blog is full with too much information to remember. Big time mistakes. I had to make general strategy with very simple questions and to follow this pattern.

3. Despite the fact that I practice on my communication skills, I made some mistakes because of the crazy speed on the exam. I had to practice more on this instead of figuring out ways to remember how to ask all the questions for specific case.

4. The exam is 90% general performance and 10% medical knowledge. I did it the other way around. Stupid, but fact.

5. Some of the Pts had really weird roles and there were 2 cases I couldn’t figured out where the catch is. I had to spent more time on working to find out what they want to tell me, and to try anything to make them feel better.

6. I seems like there is no better way to know more about the CS exam than go and try how the exam works.

There will be more.

Few days before the exam

I don’t feel that well prepared as I was for step 1, but I will try to do my best. These are my 3 important things to follow.

1. Mantra for the exam: do your best, be confident, and look at the eye. I will keep repeating this until the exam comes.

2. If the case starts going in the wrong direction, don’t panic, just return the case to the previous stable level. Think about the tennis players. I have seen so many games when one of the players is so close to loose the game but he gets his act together, and finally wins the game.

3. Nobody will judge you if you fail. Many people screw up in front of the whole nation, but they don’t care. They keep doing what they like and don’t think in a negative way about themself.

4. The patient needs help, so help him. You have to believe that you are helping the patient and he will feel better.

5 days

5 more days only. I am looking forward to finish with this exam and to continue with the rest of the exams.

I talked to George from Ottawa and he gave me some good information about observerships aka elections.

Information to remember: selection comity, Dr. Chernovski, 2wks observership, but 1 month is the best.

6 days

I finished with FA, and started reading some of the cases from UW like heel pain, insomnia. For tomorrow I have to do terminal cancer Pt counseling, palpitations, spells, vomiting.

7 days

I did 5 cases today.

Finished with the short version of the PE.

8 days

I practiced 5 cases from FA. The exam is very close now. I am going to start practicing on concentration and confidence.