They are tough, no doubt. Its funny because when Goljan lectures to us, and discusses USMLE "buzzwords" and clinical presentations, I can go home and read BSS and find the exact same presentation of a viral illness or other pathology. So, I know the correlations are there. The things like "cave explorer develops respiratory complications" or "bridge painter presents with labored breathing". Things that at first seem daunting, but when you recognize the material, it just seems like another question. THats why I think BSS is good, it really hits hard the classic stuff.