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What if I'm completely stumped by a question?

Activity Forums USMLE Step 1 Forum What if I'm completely stumped by a question?

This topic contains 3 replies, has 4 voices, and was last updated by Dr. David Delnegro MST USMLE Tutor Dr. David Delnegro MST USMLE Tutor 1 year, 10 months ago.

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    We should try our best to learn as much as we can for Step 1. But what if we find a question we have no idea about? What strategies of test-taking might come in handy? This is very difficult to answer, and I think that I’d say in general, it’s difficult to come up with a general, succinct strategy for approaching such questions. One of my focuses with students that I tutor is breaking down the vignette, question stem, and answer choices, and trying to see what direction they are steering you in- I would do this, if at all possible. For instance, if all of the answer choices are lung diseases, and then cue-in to the details in the vignette that help you differentiate one lung disease from another. Or if the vignette gives you an extensive family history, then maybe the right answer is the genetic disease.

    Also, pay very close attention to what exactly the actual question is asking you. A common mistake I have seen is students diagnosing an old medical problem that is unrelated to the current issue the question wants you to address.

    Other general test-taking strategies include paying attention to incorrect relationships in the answer choice.

    For instance, if an answer choice includes a “because” linker, or implies another relationship, but the causal relationship it suggests is invalid, even if the hypothetical cause and effect are both related to something in the vignette/question, then you can be sure that’s the wrong answer choice. As an example, if the vignette describes someone in heart failure, and the question asks how the best long-term treatment for heart failure reduces mortality, and the answer choice is “Beta blockers effectively reduce blood pressure,” but we know that beta blockers are not first line blood pressure meds, we can guess with good confidence that this is not the correct answer.
    And when you really have no idea, I go with the longest answer choice. Particularly if that answer choice is “2 large bore peripheral IVs, crystalloid bolus, PPIs, antibiotics, etc..”

    Dan S., MST USMLE Tutor
    Reputation: 30
    USMLE ExpertMD or DOContributor

    One thing I found to be helpful was recognizing that, generally, each answer choice corresponds to a particular disease. Therefore, if you recognize that an answer choice is referring to some disease, and that disease doesn’t fit with the question stem, knock that answer off. For instance, if the question is asking about complications of a lung disease that you have identified as obstructive based on the PFTs they give you, and you see one of the answers referring to hypercalcemia, which, among lung diseases, you associate with sarcoidosis (or other granulomatous diseases), you can knock that answer option off. So you don’t necessarily need to know that the answer isn’t true for the disease in question to eliminate it; if you know that it is true of another disease of that organ system that doesn’t fit with the data in the question, you’re almost always safe crossing it out.


    Another slightly different perspective I will add — sometimes, its worth it to just skip it! On the real exam, you will definitely get some more nit-picky questions asking about the specific mechanism of a certain protein in this one different environment of the body… and while you could maybe spend time logic-ing your way through the question and using your principles of biochemistry to work through it, it’s often not worth the time you are wasting at the expense of other clinical questions. Each question is worth the same amount!

    With extra time at the end, by all means, go for it! But on first pass through a question set, just keep on moving to get through and not miss easier points down the line.


    Here to echo a little bit of Sana’s thinking. STEP 1 is a longgg exam, with 280 or so questions. Don’t let yourself die on the hill for one question you are likely to not get right in any universe.

    For example, a friend once got a question on how to treat a jellyfish sting. Nowhere in class nor a book did he know that answer. Was it saline? Cold tap water? Hot tap water? Urine?

    He simply tried to narrow it down to the ones he knew it wasn’t (the old wives tail of peeing on a sting is certainly not the right answer and tried to improve his odds from 20% to 33%. Over an exam with 280 questions, saving your time for others while trying to at least improve your odds with a quick ‘process of elimination’ pass can help you pick up a couple of points here and there. More importantly, it will prevent you from falling into a quicksand for a question you just don’t know.

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