How do you deal with "Step III questions?"

[The Angriest Bird]

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I define a "Step III question" as something that you will only know after several years of practice or residency. I've seen a good number of them in UW and Kaplan Qbank. One example being "Sigmoid colon is involved in Merkel Diverticulum 75% times, but rectum is always involved." I was like "wow, good to know."

See, I hate to sound like a person who whines a lot or blames the system. But Step I is Step ONE for a reason. There are Step TWO and THREE, which means we don't have to know everything right now. I really hope questions like these are the small minority on the real exam, because they are definitely not in First Aid, and I doubt they are even in other review books (for the example above, it's not in HY Embryology).

 

[medstu2006]

I define a "Step III question" as something that you will only know after several years of practice or residency. I've seen a good number of them in UW and Kaplan Qbank. One example being "Sigmoid colon is involved in Merkel Diverticulum 75% times, but rectum is always involved." I was like "wow, good to know."

See, I hate to sound like a person who whines a lot or blames the system. But Step I is Step ONE for a reason. There are Step TWO and THREE, which means we don't have to know everything right now. I really hope questions like these are the small minority on the real exam, because they are definitely not in First Aid, and I doubt they are even in other review books (for the example above, it's not in HY Embryology).

I didn't know that either. But remember that this test is curved. So a lot of students will get a question wrong if it wasn't mentioned in FA or other q-banks. It could also be an experimental question.Trust yourself and realize that if you think a question is a "Step III question" then it's highly likely that others will think the same.

 

[DOCTORSAIB]

I define a "Step III question" as something that you will only know after several years of practice or residency. I've seen a good number of them in UW and Kaplan Qbank. One example being "Sigmoid colon is involved in Merkel Diverticulum 75% times, but rectum is always involved." I was like "wow, good to know."

See, I hate to sound like a person who whines a lot or blames the system. But Step I is Step ONE for a reason. There are Step TWO and THREE, which means we don't have to know everything right now. I really hope questions like these are the small minority on the real exam, because they are definitely not in First Aid, and I doubt they are even in other review books (for the example above, it's not in HY Embryology).

That's more Step 1 minutiae than Step 3 (which is more on management of disease).

And it's Meckels diverticulum, not MERKEL..😉

 

[R_C_Hutchinson]

I define a "Step III question" as something that you will only know after several years of practice or residency. I've seen a good number of them in UW and Kaplan Qbank. One example being "Sigmoid colon is involved in Merkel Diverticulum 75% times, but rectum is always involved." I was like "wow, good to know."

See, I hate to sound like a person who whines a lot or blames the system. But Step I is Step ONE for a reason. There are Step TWO and THREE, which means we don't have to know everything right now. I really hope questions like these are the small minority on the real exam, because they are definitely not in First Aid, and I doubt they are even in other review books (for the example above, it's not in HY Embryology).

Wow, I must be really out of the loop. I thought Meckel's was the "rule of 2's" one and found in the ileum. Would you mind explaining?

The only thing that comes to mind when you say rectum always and sigmoid 75% is UC; is there some kind of correlation?

 

[agranulocytosis]

Wow, I must be really out of the loop. I thought Meckel's was the "rule of 2's" one and found in the ileum. Would you mind explaining?

The only thing that comes to mind when you say rectum always and sigmoid 75% is UC; is there some kind of correlation?

I think that's what the OP meant. I'm sure it was a typo. Even still, this is something that is totally fair game because every single review book and Qbank I have read and done so far try to make this point clear.

 

[mudphudwannabe]

Yep, you should expect to see some questions like this on Step 1. They are "weed out" type questions to separate the good from the really really good. They are somewhat overrepresented on USMLE World (I can't speak for Kaplan), but it's important to get used to seeing them and giving them your best shot because you can't let them freak you out on the exam.

Think of them as a good opportunity for learning -- if you can remember some of these miniscule details, you are probably more likely to remember the big stuff that's really important too.

 

[ASDIC]

I define a "Step III question" as something that you will only know after several years of practice or residency. I've seen a good number of them in UW and Kaplan Qbank. One example being "Sigmoid colon is involved in Merkel Diverticulum 75% times, but rectum is always involved." I was like "wow, good to know."

See, I hate to sound like a person who whines a lot or blames the system. But Step I is Step ONE for a reason. There are Step TWO and THREE, which means we don't have to know everything right now. I really hope questions like these are the small minority on the real exam, because they are definitely not in First Aid, and I doubt they are even in other review books (for the example above, it's not in HY Embryology).

I think you are confusing Meckel's Diverticulum with Hirschprungs Disease. In the latter, sigmoid colon is involved in Hirschprungs 75% times, but rectum is always involved. Meckels is always 2 feet away from the ileum.

 

[peter90036]

thats more like step 2

step 3 is like pain in the rectum was given 20mg morphine and a hemorrhoidectomy now has bloody diarrhea and chills what do you do next

 

[BabyPsychDoc]

I think you are confusing Meckel's Diverticulum with Hirschprungs Disease. In the latter, sigmoid colon is involved in Hirschprungs 75% times, but rectum is always involved. Meckels is always 2 feet away from the ileum.

I think this is right.

 

[osli]

Glad to know I'm not the only one to read the OP and think "wtf? crap, never heard of that." Hirschprung's... now that's something I knew about.

 

[eur]

which review book is that factoid in about the percentages? i dont see it in FA.

 

[agranulocytosis]

which review book is that factoid in about the percentages? i dont see it in FA.

It's not actually stated, but it can be inferred: p. 308 FA: UC - Location: continuous colonic lesions, ALWAYS with rectal involvment.

 

[InternationlDoc]

In the spirit of the thread, I wanted to see if people feel frustrated by these "step III" questions and the abberant scores on Uworld? on some question sets I hit 90% then a couple where its 60% where there are a string of questinos that <20% of people got correct. Also, some management questions (step II?). oh and why is Uworld hell bent on asking obscure pharmacology questions?

honestly, I took shelf exams, and one NBME so far, and uworld is just so much more difficult. Is the level of difficulty really the step 1 difficulty? because NBME 3 wasn't as hard as some of these Uworld questions. I mean some are just ridiculously detail oriented. I guess kudos to those who get them right, but really, all I can do at this point is to just learn from it than freak out thinking there is a concept gap in my knowledge.

😡 at tough uworld question