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There is a tremendous amount of information on the USMLE and it can be overwhelming to think about what we actually need to know. The following are a few ways to think about what is actually going to appear on your test.

1. Is this something easily testable in a clinical vignette?

The majority of concepts are tested in clinical vignettes. Thus, something that cannot be made into a clinical vignette is unlikely to be tested. A good example of this is epidemiology. Knowing the most common cancers are important because common things are common, even on exams. On the other hand, knowing that that testicular cancer accounts for 2% of tumors in men is too esoteric for an exam, and there is no way to test that through a clinical vignette.

2. Is this actually clinically relevant?

Often times, we are inundated with significant details about pathophysiology that don’t really affect diagnosis, treatment, or management. You could memorize every single aspect of glycolysis, but the only important enzymes are the ones that are relevant to disease. You’ll be tested on phosphofructokinase because insulin and glucagon act on them. You’ll be tested on pyruvate kinase because people can be born deficient of it. But you won’t be tested on many, many other enzymes because there simply aren’t clinically relevant diseases that aren’t super rare that make them worth knowing.

3. Is this unique or fascinating in some way?

Tests like to pick out specific, unique things to test you on rather than generic things that might be common to a thousand different things. Take chemotherapy drugs, for example. Nobody will test you on the fact that cyclophosphamide causes nausea, vomiting, and bone marrow suppression like every other chemotherapy agent out there. But cyclophosphamide does do one thing: it makes your bladder bleed, and nothing else does this. And you can actually give patients Mesna and fluids to prevent this. This means that this will probably show up on your boards at some point.

4. Is there a buzz word or connection that I can make?

Just like cyclophosphamide can be associated with hemorrhagic cystitis, a ton of associations can be made on the test that are often going to be the only thing they are really testing in a long, 10-line clinical vignette. Starry-sky appearance is Burkitt’s lymphoma. Apple core is colon cancer. Bull’s eye rash is Lyme disease. The USMLE is all about buzzwords, and hidden in that means finding the one thing that stands out most about a disease. Lyme disease gives you joint pain and tons of other findings, but it’s the one of the only things (if not the only) that gives you a bulls eye rash that moves around!

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