A single secret to improving your “test-taking skills” and acing Shelf exams and USMLE.

Secret: Focus on LEARNING to “get-the-right diagnosis”.

But how you may ask. Let me break this down even further for you.

Most students come to me for help, saying my “Test-taking skills” are poor and I need to improve them. What it means specifically is that the student hasn’t learned the art of making the diagnosis because most shelf exams and USMLE step 2 questions require you to make the diagnosis first.

Then only you can answer the following common questions based on your diagnosis.

Most common risk factor/s of that diagnosis

Basic pathophysiology (e.g., temporal lobe atrophy in Alzheimer’s disease)

How to treat the condition? E.g., for Alzheimer’s patients, the 1st line DRuG is Donepezil, Rivastigmine, or Galantamine, not memantine or vitamin E.

Complications of the diseases or the side-effects of its treatment

To master the art of making the right diagnosis, learn by clustering different conditions with similar features and then recognize the features that set them apart.

Example 1:

A cluster of proximal muscle weakness

• Proximal muscle weakness + hoarse voice + weight gain + hyporeflexia in all extremities = Hypothyroidism
• Proximal muscle weakness + hirsutism + easy bruising = Cushing syndrome
• Proximal muscle weakness+ rash around eyesor on top of knuckles= Dermatomyositis

Example 2:

The cluster of seronegative arthritis and their common features:

It is a group of inflammatory joint conditions in which the rheumatoid factor is negative and is associated with HLA-B27.

Example 3: How to approach an immunodeficiency board question?

Click on the following links to practice this method more:

• Practice 1
• Practice 2

Remember, no matter how prepared you are, you will always feel uncertain about some questions, and that’s okay. Just use your best judgment, flag it, and move on. Chances are that you might have a fresh perspective on the question when you come back to it later.

Common TRAPS

TRAP 1: Some students tend to fall into the trap of reading the question stem and then trying to reason through each of the answers before committing to a diagnosis, which is inefficient, as it leads to many back-and-Forths.

The most efficient way to answer the majority of questions is to follow these steps:

• Read the question stem and highlight the pertinent findings.
• Focus on your highlighted portions of the question stem. Those are the puzzle pieces that you need to connect to figure out the diagnosis.
• Choose the answer based on your diagnosis.

There might be an infinite number of ways to go from point A to point B, but there is only one shortest path.

Finding the shortest path frees up some time to do other activities in our limited number of hours in a given day. So, try to maximize efficiency.

TRAP2: Some students tend to think through each diagnostic possibility in each pertinent positive of a question (e.g., hmm, the patient had a recent travel trip, meaning it could be TB, infection, etc.). This will result in time loss. Just highlight the pertinent positives as you are reading the question, and only at the end, connect the highlighted dots to make the diagnosis (! Don’t create a differential diagnosis out of each dot).

Trap 3: The Red Herring

Exam question schema: — In some USMLE questions, the question creators add a detail that tries to derail you through a red herring. Examples: “A family history of a neurological disorder in a case that sounds like chronic tuberculous meningitis,” “a recent camping trip history in a case that appears to be Neisseria meningitis,” “ a malignant head tumor that was noticed after head trauma” etc.

So in most USMLE questions, — you need the following schematic understanding:

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