Level of thinking??

[NRAI2001]

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How do you know what level of though you should approach Step 1 questions? I feel like overall the step 1 questions (based on NBME) are not that difficult but I m not scoring that well on the NBMEs either (215 on my last one). I still have about 10 days till my exam and there are things I need to go over again that I havent gone over in a while now.

BUT while taking NBME exams I m always 2nd guessing myself.. it seems like none of the questions are overally difficult but I am always asking myself:

A) "am I over thinking the question" and should I go with the more OBVIOUS answer

B) "most of these questions seem pretty easy.. am I falling for the tricks/traps the test makers put out"??

What level of thinking do you guys approach the questions (especially those that seem relatively straight forward)? How do you know when you re missing questions bc your over thinking the questions? BC you re falling for questions that may appear easy at first, but are trick questions.

 

[NRAI2001]

Ok like an easy question l got wrong: NBME 6

A 15 year old girl sustains a minor burn on the arm. Within several minutes a red (hyperemic) area developes on the skin surrounding the burn. What mediators are responsible for the hyperemia:

A) Histamine (most obvious answer to me)
B) IL-1
C) LTB4
D) TXA2
E) C3b
F) 5-HETE

I chose IL-1 (the wrong answer) mainly bc histamine seemed like too obvious of an answer and also bc I thought histamine is tied to IgE interactions??

How do you know when you re over-thinking questions? or under-thinking them?

 

[NRAI2001]

Sorry another "easy" appearing question to me: NBME 6

A 55 year old man comes to the physician bc he has a had a 8lb weight loss in the past 3 months. He is a construction worker. He smoked 2 packs of cigarettes daily for 35 years. He has no history of medical illness. Vitals are normal. Physical exam shows supra-pubic tenderness. Urinalysis shows 3 RBC/hpf, 0 WBC/hpf, and no bacteria. Urine cytology shows malignant cells. Which of the following is the strongest predisposing risk factor for this patients condition?

A) age
B) smoking
C) gender
D) hereditary
E) occupation

I chose E (incorrect)... the obvious answer from the stem would immediately seem to be "smoking". How do you approach these questions that seem to be "too easy" or "too obvious", I m always 2nd guessing myself (as in this case).

What type of cancer is this by the way?

 

[aagupta2]

I would go with the answer of smoking as a risk factor for transitional cell carcinoma of the bladder.

The questions on this exam are designed for you to answer them correctly. I know how it is tempting to see a bunch of possible answers and just flail since you might not no every detail of everyone, but usually your first impulse is the right answer.

I know it helps me to first come up with the answer i would like in my head before i read the answer choices. That way you have a strong base before you get tempted by the distractors. I know this is a big exam for everyone with high stakes, but sometimes all you need to do is to take a deep breath and collect yourself before you select and answer.

As far as your first specific cited examples, i would try (if possible) to be able to reason to yourself why the answer you are choosing is the right one. When I hear IL-1 i think fever. I think it would be too time consuming to think of all the associations for all the answer choices, so i would definetly try and have an answer in your head before reading the choices. And again they really do want you to answer the questions right.

For the 2nd example you gave the answer of occupation could be the right answer if he worked in a dye factory, as aniline dyes are also a cause of TCC. I guess the main idea is that you should have a rock solid case for whatever answer it is the you choose. If you say occupation, think of what exactly is the occupational exposure that would give the symptom. Quite often the simple answer is right and we should have no problem picking it if we can have some solid rational behind it.

As i am sure you are aware these NBME test are the standard for seeing where you stand, but it is good too to utilize a good qbank. Im still toiling through kaplan's qbank but the general sentiment here is to go through all of uworld before you take the test.

Best of luck on your studies and on the exam.

 

[kryptik]

as students we become used to our professors trying to "trick" us all through college and medical school, for the most part the nbme doesnt try to trick you, so you have to constantly remind yourself that, for all the "easy" questions you will be right 8 out of 10 times if you go with the obvious answer

 

[knuckles]

Completely agree with what was posted above. When you read a question, you should have some idea of what the answer is before you glance at the choices. For the first one, you should be thinking acute inflammation. Rubor/Dolor/Calor/etc. You probably had some idea that histamine vasodilates, and causes increased permeability leading to redness, but then you see all these other high yield mediators. Sometimes, it's best to just rule them out by one and use the cross outs (aren't available on the NBME online assessments, unfortunately.) You know LTB4 and C3b are both chemotactics, and so they both can't be right, therefore neither is. IL-1 is an acute phase/pyrogenic cytokine, and the others just don't make sense. You should stick with your gut feeling because it's usually right.

I think the questions where the answer choices are single words, usually aren't trying to trick you. It's the phrased answers that are usually tricky, when a word or two can completely change the meaning of the question.

With regards to risk factors, SMOKING SMOKING SMOKING. They love to use it. I thought learned my lesson on a practice test a few weeks ago, with that bladder cancer question. However, I took UWSA2 yesterday and a dude was presented with the entire Robbin's Pathology textbook of problems. He was obese, diabetic, angina-prone, hypertensive, smoked, drank, and generally didn't give a f*** about his health. It said, what is the biggest risk factor for heart disease. I went with hypertension over smoking and of course, it was smoking. So until proven otherwise, go with smoking.
oh yeah, the biggest risk factor for pancreatic adenocarcinoma is also smoking. Alcohol is not one (but it is for acute and chronic pancreatitis...which can lead to adenocarcinoma...so whatever.)

Anyway, if you've gone through USMLEWorld, you definitely have the level of thinking required and knowledge base required. You just need to do more practice tests to work on your IQ under pressure. We're going to rock this thing. PS, I'm SGU 2012 too. Here's to hoping Dr. B's ****ty test's made us all smarter.

 

[vr123]

PS, I'm SGU 2012 too. Here's to hoping Dr. B's ****ty test's made us all smarter.

Hey did you do Kaplan this summer? There were a LOT of people from SGU 2012, so I was just wondering if maybe I met you there.

 

[knuckles]

Nope, but like half our class did. I'm $5000 less in debt, and I think I'll be alright 😛

 

[2012mdc]

Ok like an easy question l got wrong: NBME 6

A 15 year old girl sustains a minor burn on the arm. Within several minutes a red (hyperemic) area developes on the skin surrounding the burn. What mediators are responsible for the hyperemia:

A) Histamine (most obvious answer to me)
B) IL-1
C) LTB4
D) TXA2
E) C3b
F) 5-HETE

I chose IL-1 (the wrong answer) mainly bc histamine seemed like too obvious of an answer and also bc I thought histamine is tied to IgE interactions??

How do you know when you re over-thinking questions? or under-thinking them?

When a question is short and the answers are short they are probably not trying to trick you. But a good way to make sure you are not getting tricked is to go through with each answer and eliminate it - this is difficult on harder questions but on straight knowledge questions like this one it is doable.

In this instance you didn't offer a reason why IL-1 would be a better answer than histamine. Histamine was your gut answer and you didn't have a strong reason to change it. Remember that when you know something well then these short questions can seem very obvious to you. Just think of it as a reward for knowing your stuff.

The stuff you have to watch out for is the questions that are a little longer and try to hid stuff in the stem. I had a question where the pt had a rash and it mentioned he had pulled a tick out of his arm - right away I'm thinking lyme ds and skip ahead to choose the answer that relates to that. But I remember to slow down and see they had hidden the organism was gram + smack dab in the middle of the stem and caused me to re-read the whole thing and figure out it was anthrax. The tick was just a distractor

 

[NRAI2001]

After reviewing the questions I missed it seems as though I m not rely missing many of the "harder" questions ( I seem to be getting hose corrrect) I missing more of the easier more straight forward questions. Like I mentioned earlier when I get to some of these questions I feel like they re too easy and I missing some underlying trick and to pick the obvious answer would be to fall for the traps put by the test makers.

I don't feel like it's a lack of knowledge that is keeping me from scoring higher bc i was scoring in the upper 60s on uworld(finished only 40%) I ve read goljan, hy neuro, brs physio/biochem/path, rr micro, lippincotts pharm and of course FA. I just have trouble approaching the questions I guess... I think it's because I m always thinking that there must be some kind of a trick?

Is the stepreally for the most part straight forward? Should you for the most part go with what seems like the obvious answer most of the time?

 

[2012mdc]

After reviewing the questions I missed it seems as though I m not rely missing many of the "harder" questions ( I seem to be getting hose corrrect) I missing more of the easier more straight forward questions. Like I mentioned earlier when I get to some of these questions I feel like they re too easy and I missing some underlying trick and to pick the obvious answer would be to fall for the traps put by the test makers.

I don't feel like it's a lack of knowledge that is keeping me from scoring higher bc i was scoring in the upper 60s on uworld(finished only 40%) I ve read goljan, hy neuro, brs physio/biochem/path, rr micro, lippincotts pharm and of course FA. I just have trouble approaching the questions I guess... I think it's because I m always thinking that there must be some kind of a trick?

Is the stepreally for the most part straight forward? Should you for the most part go with what seems like the obvious answer most of the time?

If you know the material well then a lot of the questions can seem "easy" or obvious. It really depends on what your knowledge base is. I felt that I knew FA, UW, and RR really well and on my test the large majority of my questions were straightforward and very similar to the nbme practice tests.

My score was 2-4 pts lower than my practice tests so I believe that was due to random chance. In other words I think the strategy of "don't doubt yourself when it seems obvious, just re-read" worked out b/c when doing the nbme's I didn't miss too many "easy" questions either.

On the real thing I made sure to re-read any question that I felt was too obvious to see if I missed anything in the stem or read the question incorrectly.

Not choosing an answer because it seems too obvious is not a good test taking strategy. (even UW has questions with obvious answers) Remember that what seems obvious to you might not seem obvious to someone else. It's only easy/obvious if you know it and not everyone has the same level of prep/knowledge