These questions are combination of many different facts just thrown in the stem of the question, not in particular order of time, symptoms, vital signs, and physical exam.

What to do: organize the question in time chronological order. Start with a piece of paper first. Put in the middle of the paper the chief complain (usually the first sentence) and additional information about the chief complain. Than, they usually give you some more information about the past medical history. Put it before the chief complain. The rest of the question is usually info about VS, PE, Sx, and Dx procedures. Put them after the chief complain sentence.

Now you have nicely organize question.

When you improve you can stop using the paper and try to do it automatically while you reading the question.

Cheers!

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.

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:

19.Salmon patch=Nevus simplex=Stork bite=Angel’s kiss
20.Human Placental Lactogen(hPL)=Human Chorionic Somato-mammo-tropin
21.Celiac disease=Celiac sprue=Gluten-Sensitive Enteropathy
22.Blind loop syndrome=Stagnant loop syndrome=Bacterial Overgrowth Syndrome
23.Zenker’s diverticulum=Pharyngoesophageal diverticulum
24.Barrium enema=Esophagogram
25.Guillain-Barre syndrome(GBS)=acute idiopathic polyneuropathy
26.Dyspepsia=Indigestion
27.Hypoxemic episodes=Tet spells(tetralogy of Fallot)
28.Hereditary nonpolyposis colorectal cancer=Lynch syndromes
29.Shy-Drager syndrome=Dysautonomia-orthostatic hypotension syndrome
30.Boerhaave syndrome=Esophageal perforation
31.Kayexalate=sodium polystyrne sulfonate
32.Percutaneous Umbilical Blood Sampling (PUBS)=cordocentesis
33.Glio-Blastoma-Multiforma(the common name)=Astrocytoma grade IV
34.Glioma=Astrocytoma low grade(the common name)
35.Dactylitis=hand-foot syndrome
36.Metoclopromide=Reglan
37.Nothing by mouth=nil per os=NPO
38.TMP-SMX=Bactrim
39.Kayexalate=Sodium polystyrene sulfonate
40.initial VZV infection=chicken pox
reactivation VZV infection=shingles
41.Autistic disorder=Pervasive developmental disorder
42.Bruton’s agammaglobulinemia=X-linked agammaglobulinemia
43.Paget disease=Osteitis deformans
44.Diamond-Blackfan anemia(DBA=Congenital pure red cell aplasia
45.Vascular dementia=Multi-infarct dementia
46.Myotonic Muscular Distrophy type I=Steinert disease
Myotonic Muscular Distrophy type II=Proximal myotonic myopathy (PROMM)
47.Schistocytes=Fragmented RBCs
48.DNA repair defect=Chromosomal breaks
49.HSV retinitis=Acute retinal necrosis syndrome
50.PCOS=Stein-Leventhal syndrome
51.PPD=Mantoux test
52.Scleroderma=Systemic sclerosis
53.Wegener granulomatosis=Granulomatous vasculitis
54.Yolk sac tumor=Endodermal sinus tumor
55.Bacteril superinfection=Secondary bacterial pneumonia

UPDATE:

56.Contraction stress test=Oxytocin challenge test
57.Oxytocin=Pitocin
58.Cephalopelvic=Fetopelvic disproportion
59.Button battery=Disk shaped battery–>Tx:endoscopic removal
60.Non stress test=Fetal activity determination
61.Multiple hamartoma syndrome=Cowden syndrome
62.Erythema multiforme major=Stevens Johnsons syndrome
63.Amyotrophic lateral sclerosis=Lou Gherig’s disease
64.Hepatoma=Hepatocellular carcinoma
65.Anazarka=generalized edema
66.IBS=spastic colon–>Tx with dicyclomine(anticholinergic) and other meds
67.SBO=small bowel obstruction
68.Myenteric=Auerbach’s plexus
69.Ballon dilation=Pneumatic dilation
70.Sour taste=water brash
71.sliding=axial hiatal hernia
72.paraoesophageal=rolling hiatus hernia

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.

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.

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 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.

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.

I did 5 cases today.

Finished with the short version of the PE.