TEST TAKING STRATEGIESCognitive Skills ProgramJennifer Meka, DirectorEmail: jmeka@hmc.psu.eduPhone: 717-531-0003 ext.287646

General Recommendations for MC Questions

• assemble key clues into a mental "snapshot" of the patient• understand precisely what is being asked• allow a few moments to think, recall, and to anticipate possible answers• compare the given choices to your anticipated answer•mark choices that match best• rule out choices that don't account for all findings•mark the best answer

Errors to Avoid• Answering a question that is not being asked• Focusing on an irrelevant fragment of the question•Not identifying important sections of the question• Focusing on the answer choices/options

MC Question ApproachSteps 1 & 2: Read and Paraphrase

1. Read the last sentence or two of the question vignette (the actual question) first. This will help you know what to look for in the vignette to answer the question.

2. Read the rest of the question (vignette). Before you look at the answer options, stop to paraphrase the case and question.

Try it out: Read and Paraphrase

A 75-year-old smoker and alcohol abuser is hospitalized for evaluation of a squamous cell carcinoma of the larynx. On his second hospital day, he complains of sweating, tremors, and vague gastrointestinal distress. On physical examination, he is anxious and has a temperature of 101°F, heart rate of 104/min, BP of 150/100 mm Hg, and a respiratory rate of 22 breaths per minute. Later that day, he has three generalized tonic-clonic seizures. Which of the following is the most likely cause of his seizures?

Remember: Read & Paraphrase

1. Read the last sentence or two of the question vignette (the actual question) first.

*Share: What do you need to look for?2. Read the rest of the question (vignette). Stop to paraphrase the case and question.

*Share: What are the key aspects of this case?

MC Question ApproachStep 3: Predict1. Read the last sentence or two of the

question vignette (the actual question) first. This will help you know what to look for in the vignette to answer the question.

2. Read the rest of the question (vignette). Before you look at the answer options, stop to paraphrase the case and question.

3. Predict the answer.

A 75-year-old smoker and alcohol abuser is hospitalized for evaluation of a squamous cell carcinoma of the larynx. On his second hospital day, he complains of sweating, tremors, and vague gastrointestinal distress. On physical examination, he is anxious and has a temperature of 101°F, heart rate of 104/min, BP of 150/100 mm Hg, and a respiratory rate of 22 breaths per minute. Later that day, he has three generalized tonic-clonic seizures. Which of the following is the most likely cause of his seizures?

Turn to your neighbor and share your prediction.

Try it out: Predict

MC Question ApproachStep 4: Consider Options

1. Read the last sentence or two of the question vignette (the actual question) first. This will help you know what to look for in the vignette to answer the question.

2. Read the rest of the question (or vignette). Stop to paraphrase the case and question.

3. Predict the answer.

4. Look through the options. If you see your answer, pick it.

A 75-year-old smoker and alcohol abuser is hospitalized for evaluation of a squamous cell carcinoma of the larynx. On his second hospital day, he complains of sweating, tremors, and vague gastrointestinal distress. On physical examination, he is anxious and has a temperature of 101°F, heart rate of 104/min, BP of 150/100 mm Hg, and a respiratory rate of 22 breaths per minute. Later that day, he has three generalized tonic-clonic seizures. Which of the following is the most likely cause of his seizures?A. Brain metastasisB. Febrile seizureC. HypocalcemiaD. Alcohol withdrawal E. Subdural hematoma

Try it out: Consider Options

MC Question ApproachStep 5: Eliminate Incorrect Responses1. Read the last sentence or two of the question

vignette (the actual question) first. This will help you know what to look for in the vignette to answer the question.

2. Read the rest of the question (or vignette). Stop to paraphrase the case and question.

3. Predict the answer. 4. Look through the options. If you see your answer,

pick it.

5. If you don’t see your answer, begin eliminating those you know are incorrect.

When eliminating responses:

•Think about the data presented in the question. Use the evidence to make your selection. •Avoid adding assumptions or reading more into the question/case than what is presented.

A 75-year-old smoker and alcohol abuser is hospitalized for evaluation of a squamous cell carcinoma of the larynx. On his second hospital day, he complains of sweating, tremors, and vague gastrointestinal distress. On physical examination, he is anxious and has a temperature of 101°F, heart rate of 104/min, BP of 150/100 mm Hg, and a respiratory rate of 22 breaths per minute. Later that day, he has three generalized tonic-clonic seizures. Which of the following is the most likely cause of his seizures?A. Brain metastasisB. Febrile seizureC. HypocalcemiaD. Alcohol withdrawal E. Subdural hematoma

Try it out: Eliminate Incorrect Responses

A. Brain metastasisB. Febrile seizureC. HypocalcemiaD. Alcohol withdrawal E. Subdural

hematoma

MC Question ApproachStep 6: Choose your answer

A 4-year-old boy is brought to the local emergency department by his mother because he is “not acting right.” His mother reports that he seemed well last night, but this morning he was uncharacteristically groggy and appeared “flushed.” He fell over twice while walking around the house and “passed out” for 20 seconds while eating breakfast. Although he did not hit his head, he did complain of a headache. On the way to the hospital he vomited once; it was nonbloody and nonbillious. There are no sick contacts in the household, but his father awoke with a severe headache this morning. The family is vacationing at a nearby mountain resort noted for its “rustic log cabins with wood-burning fireplaces.” The boy’s temperature is 37°C (98.6°F), blood pressure is 90/50 mm Hg, pulse is 130/min, and respiratory rate is 26/min. The patient is minimally cooperative; he refuses to walk, preferring to nap in his mother’s arms. There is no evidence of head trauma and his physical examination is otherwise unremarkable. Further testing would most likely reveal which of the following abnormalities?

A 4-year-old boy is brought to the local emergency department by his mother because he is “not acting right.” His mother reports that he seemed well last night, but this morning he was uncharacteristically groggy and appeared “flushed.” He fell over twice while walking around the house and “passed out” for 20 seconds while eating breakfast. Although he did not hit his head, he did complain of a headache. On the way to the hospital he vomited once; it was nonbloody and nonbillious. There are no sick contacts in the household, but his father awoke with a severe headache this morning. The family is vacationing at a nearby mountain resort noted for its “rustic log cabins with wood-burning fireplaces.” The boy’s temperature is 37°C (98.6°F), blood pressure is 90/50 mm Hg, pulse is 130/min, and respiratory rate is 26/min. The patient is minimally cooperative; he refuses to walk, preferring to nap in his mother’s arms. There is no evidence of head trauma and his physical examination is otherwise unremarkable. Further testing would most likely reveal which of the following abnormalities?

A. Blood glucose level of 60 mg/dLB. Low partial pressure of arterial oxygen measured on arterial

blood gas testingC. Metabolic acidosis with increased anion gapD. Pulmonary effusion on x-ray of the chestE. Pulse oximetry reading of 89%

• After completing practice questions, complete a test error analysis form: what are your areas of strength? What are your areas of weakness?• For content issues, identify the topics that you need to review and re-learn. Complete a targeted review of these topics.

Effective Study Strategies

•Ask yourself questions as you review material.•Create charts, tables, and graphs to summarize and synthesize information.• Identify key information.•Create summary notes – what are the 3 or 4 key things you need to remember about this disease?•Practice, practice, practice.

USMLE Step 2 CK

•approximately 350 multiple-choice questions•divided into eight 60-minute blocks•the number of questions per block on a given examination form will vary, but will not exceed 44

Question Types• Single Item • Sequential Items - one patient/case vignette with 2 or 3 questions• Matching Items - series of questions related to a common topic; you will be presented with each question one at a time

Question Types• Pharmaceutical Advertisement (Drug Ad) Format

The drug ad item format includes a rich stimulus presented in a manner commonly encountered by a physician, e.g., as a printed advertisement in a medical journal. Examinees must interpret the presented material in order to answer questions on various topics, including • Decisions about care of an individual patient• Biostatistics/epidemiology• Pharmacology/therapeutics• Development and approval of drugs and dietary supplements• Medical ethics

• Abstract FormatThe abstract item format includes a summary of an experiment or clinical investigation presented in a manner commonly encountered by a physician, e.g., as an abstract that accompanies a research report in a medical journal. Examinees must interpret the abstract in order to answer questions on various topics, including • Decisions about care of an individual patient• Biostatistics/epidemiology• Pharmacology/therapeutics• Use of diagnostic studies