a-B unsaturated carbonyls (non-technical question)

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Do you mean aldol reactions and such? I don't think any organic chemistry topic is important for the MCAT outside of general properties and maybe nucleophilic substitution. Officially, you do have to know it, but you also have to know rather obscure things like Hofmann rearrangement and you're unlikely to encounter that in the MCAT.
 
What about it confuses you? All ketones and aldehydes with an alpha carbon can exist in both the keto form with C=O and the enol form with C=C. An equilibrium exists between the keto and the enol forms, and usually the keto heavily predominates. This equilibrium reaction can be acid or base catalyzed.
 
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