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Step 2 CK exam: The Time issue and small tips…

October 2, 2008

Editor’s note: This is a guest post from hcm11 originally posted on prep4usmle.

Hello, I said I would post this before taking my exam and here I am.

Now, before I start I would like to say that I was managing to finish UW tests with 8-10 min, I often even took some 30 seconds after q23 to relax. When I started repeating questions my time left at the end of each block went up to 15 min, a couple of times even 20!!

I want to clarify, that it WAS NOT like that on the real test. I barely finished my blocks at the first blocks, and I got some 3-4 min only for the last half of the exam. I think the reason is because you know it’s the real test. I have thought, it’s something like gambling with chips or real money. When you play black jack with chips, you will more easily risk more and decide faster, since you are in fact not risking anything. Same idea for UW vs exam!

Now this are my suggestions for time and a couple other useful ones:

1. Read the question first! (last line) Sometimes, even during the real exam, there are a couple of questions you can directly answer without reading the whole case. I know it’s risky, but in the end, this is not a real patient, so what do you care about the whole stem if you already know the question and answer?? This can give you an additional whole minute to distribute among other questions or to use on a single difficult one. For example:

Question goes on and on and on… and after some 10 lines it says, which of the following treatments will most likely prolong the survival AMI patients? And you see B-blockers there… why would you have to read the whole thing? Just see if the other options do not prolong survival, hit and run!!

2. Even if you don’t want to, or can’t answer (like most questions) only from that line, it will give you an idea of what they want… so you are not breaking your head trying to decide if the dyspnea is respiratory or cardiac while reading through the whole stem just to find out they tell you in the end the patient has a CHF… and have to read it all over again to focus now on other details that will give you a hint to the best treatment for that patient, for example.

3.. Learn how to switch your brain on and off at appropriate parts of the question’s stem.For example if there is a question that says:

Mary, a 23-year old college student, who is 28 weeks pregnant and has been known by you for the whole of her pregnancy, is brought to the emergency department by her husband, who found her not responsive on her bed on a pool of blood…. question goes on.

Now, I used to highlight the parts where my brain should be on:

23 years old, 28 weeks, unconscious, pool of blood.

This is half a line from the original three, so you can learn how to quickly scan for this important info and turn your brain on!

4. You can also use this technique for long stems that include a lot of illnesses and treatments… many times, (I said many) you don’t even need this info for the next step or tx, and if you do, there will be a part of your brains that retained that info, trust me! For example, if you get a case with three or four comorbidities you just quickly scanned and in the end they ask you what’s the best tx for his hypertension, you will know that in this case if the patient had a prostate hyperplasia for example will in fact matter, since you could start with a-blockers instead of thiazides, you can always quickly go back to the comorbidities that are listed together. Of course, if you had read the question first, you would have known it is a questino were you most likely will need to turn your brain on for the comorbities part, so you won’t have to go back! wink

5. Pick a choice quickly!!! Once you have read a question, you already know or don’t know if you know what they are talking about!!! Why would you discover some magical word that will bring the knowledge back to your brain with a second read? Questions are composed of many different hints that guide you to the correct answer, not one single word… so by the end of the question you should have a feel of the disease… if you don’t, I could bet you don’t know what the hell they are talking about!! So get over it, and pick the one that sounds the most likely to you.

6. “Run away Simba, run away and never return.” What I mean is, once you have answered the question… never return to it, not physically, nor mentally!! Clean your slate!!! Forget about the patient, it’s done, cured, out of the hospital, not there anymore, chart got stolen, patient left the country… doesn’t matter!!! Just don’t keep thinking of the question while you are reading the next stem!!! NEVER!!! You are most probably never going to find out what the answer is, less so while reading another question, and you will most likely, again, don’t know what the hell they are talking about on this new question, so you will have to read it again. If you do the math, you have now spent time for four questions in answering a single question, most probably wrongly on top of all!!!! If you have some spare time in the end, you might go back to it… altough from what I have read in this forum and personal experience, you will most likely change it to a wrong answer… either from right to wrong, or wrong to wrong… so why bother?

7. Don’t assume the patient might have something it doesn’t say on the question he has!!! I often got wrong answers, knowing the right answser, because I thought: “Well, if this patient had AIDS, for example, well this whole thing could be this other possibility…” No! If it doesn’t say on the question an HIV patient, HE IS NOT!!!! That’s what I have learned!! Take the info as presented, the patient is what’s written on those lines, don’t assume!!!

8. Don’t let the distractors play games on your brains!!! If you have a strong feel of what this question is about, and you even thought about the answer and saw it there… pick it!!!! I also sometimes got trapped into thinking… welll, if it’s listed it’s possible… if it’s listed as an answer it must be close enough… so it could be… I think, you will be wrong oftentimes! We are trained Dr.’s! We are trained to recognize patterns… don’t try to fit a square into a circular hole just because it’s listed and in theory, if you got rid of the extra material all around the square in equilinear distances from it’s center, it could actually fit… or with a little pressure… no, no… you are deviating from your first instinct and training!! I think!!

9. Learn to eliminate distractors. Sometimes it’s so easy!! For example, a patient with pneumothorax or cardiac tamponade CAN’T have flat veins on the neck!! He just can’t!!!! Can he?? NO!!!! Not on the exam!!! So you my friend, just succesfully eliminated two distractors at one shot!!!

10. READ ALL THE ANSWERS!!!! Sometimes there’s a slightly better answer than A, which of course is correct, but F is even more correct!!!! For example, what would you do about this patient’s trichomoniasis?

A) Treat the patient with metronidazol.

F)Treat the patient and partner with metronidazol. See??

11. Don’t answer a whooooooooole question because of one single word!!!!! And the best example that comes to my mind is “TICKS!!” Not every single patient with a tick bite has Lyme’s!!!! There’s even one question on UW where the patient actually has babeiosis!!!

12. This has reminded me to tell you guys, not to let be guided by JUST THE LAST SX!!!!! Sometimes it happened to me!!! Having it fresh on your mind, sometimes it makes you forget about the rest of the stem, and you give that single sx more weight, which of course is wrong, because in the end it would be the same as answering the whole q, by one word!

13. Please read correctly!!! I answered a couple of questions wrongly because of ptosis/proptosis, nephropathy/neuropathy!!!! And the answers were appropriate to that misreading!!!!

14. I am not sure about this one, but I would say, if you are running out of time, keep your pace… it’s better to leave 3 q’s without answer, than to answer 6 questions incorrectly because of reading way too fast!

15. Don’t spend too much time thinking about the rightness of the question you just answered before moving on to the next one. I think you are just giving yourself peace of mind, you are just convincing yourself that you indeed picked the most appropriate question. When you really know the answer, you don’t have to debate so long with your subconscious about what you just answered… so if you didn’t know, and made an educated guess… I think there’ll be no difference in convincing you of one or the other options left, you will never know!!

This is what I can think of for answering questions, good luck!

[credit hcm11]

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3 Comments leave one →
  1. Deepak permalink
    July 28, 2009 10:19 am

    thanks a lot. gr8 help.

  2. S.M. permalink
    October 7, 2009 12:30 pm

    Easy for you to say…
    By the way, check your grammar (or at least re-read once!) before writing something that you’d like people to take seriously.

  3. October 7, 2009 12:54 pm

    Thanks S.M. for letting us know about the grammar issues. You might be right that some corrections can be done here and there. Probably you didn’t read carefully, but this post was taken from a forum with the permission of the author. On forums people don’t usually pay much attention to their grammar. Hopefully the readers will get the message despite some small errors. This post will stay in its original version. If you want to help and make the corrections, go ahead and please do so in another comment to the same post. Thank you!

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