In my last post, I gave my first four secrets on what to look for to solve any Step 2 CK or Step 3 question stem. Now, with rotations finishing up for many students and Step 2 CK looming on the horizon, I can’t think of a better time to share the rest!
The Most Important Things to Look for in Almost Every USMLE Step 2 or Step 3 Question – Part Two:
1. Medical History:
Let’s use secondary hypertension as an example: A smoker with history of previous myocardial infarction and intermittent claudication is much more likely to have renal artery stenosis than a pheochromocytoma. Patients with a history of atrial fibrillation and a sudden onset of severe abdominal pain with an unimpressive physical exam should raise a red flag for mesenteric ischemia. (These are not questions that I just thought of now. These are questions that I’ve personally seen students get wrong because they were not paying attention to the medical history.)
This is important because, first of all, medications sometimes help fill in medical history. Patients who are on daily hydroxychloroquine and use prednisone are likely to have systemic lupus erythematosus. Medications are also important because there are many questions on Step 2/3 that are specifically asking about medication side effects or interactions. You should always be looking at these carefully and making a mental note.
3. Abnormal Labs and Vital Signs:
The keyword here is abnormal. Normal labs and vital signs are generally not clues, except for what they rule out. In other words, they don’t generally point towards possible diagnoses, but away from them. As an example, completely normal vital signs point away from things like septic shock. However, they do not give you any clue as to what the problem could be. For this reason I believe that normal labs and vital signs should be scanned over quickly. Remember that you’re reading actively here. You’re actively looking for abnormals, and you will use those to help you figure out what the problem might be.
4. “Everything Else:”
In other words, miscellanea that are important when they are given in the question stem, but that don’t need to be looked for in every question. Things like travel history, pets, allergies, family history, etc. (Family history is actually extremely important in real life, but it doesn't play as large a role on exams.)
When it Comes to Breaking Down USMLE Question Stems, Practice Makes Perfect
When I teach this method for breaking down question stems to students, I often get the following reaction: “who has time for that?” Believe it or not, I used this method for all of my board exams and it actually helped me go faster. I’ve finished exams 1-2 hours early using this method (note: I’m not suggesting that you finish early). This was possible because I practiced this method thousands of times. Thousands.
Honestly, whatever method you use will require thousands of repetitions before you master it. I also use the highlighter function to help me focus. I read the question actively as I highlight the above information, and by the time I get to the end of the question stem, more often than not I already have a likely answer in mind.
This method doesn’t work for everybody, and initially, it is likely to slow you down. But with time and practice, it has worked for most of my students. Hopefully it will work for you too!