USMLE Step 2 CK QbookPreface ‘Section One: TestTaking and Study Stateges Guide “Chapter One. Inside the USMILE Step 2 O Exam Chapter Two. Stuy Tecriques ‘Chopter Tvee Tackling the Exam ‘Chapter Foue Physical and Mental Preparation Caprese. Surmany Pointers Section wo: Qbook Practice Tests Invernal Medicine Test One sete Test One Answers and Explorations Test Tro . “est Two Answers and Cxplanations Test Thee “Test Tree Anewers and Explanations ‘est Four coe “Test Four Answers end Cxplenations Test Fie soe “Test Fe Answers and Explanations “est Su “est Sic Anewers and Explanations Test Seven Test Seven Answers and Epanaions Test Een “est Eight Answers and Bplanations 7 a 55 35 101 7 133 147 2185 179 195 208 2 22a 259 as ContentsObserics/Gynecalogy Test One “est One Annes ad Explanations TES THO sesso Test To Assners and Explanations Pediaics Tet One Test One Answers one sparations Test Two co Test Tuo Ansuess and Explosions Test Tree . Test Tree Answers and Explanations Paychiaty Test One “Test One Anwar end Explanations Test wo “Test Two Answers end Explorations Surgery Test One “Test One Animes and Emanatons Test Tao Test he Answers and Explanations 289 308 321 335 351 358 3m 301 495, sor 23 335| SECTION ONE | Test-Taking and Study Strategies GuideSection One: Test-Taking and Study Stategies Guide | 5 Chapter One: Inside the USMLE Step 2 CK Exam ABOUT THE USMLE The United States Medical Licensing Examination (USMLE) consists of three steps designed to assess physicians ability to apply abroad spectrum of knowledge, concepts, and principles and to evaluate the physician's basic patient-centered sil ‘Step 1 (multiple-choice exam)—This exam is designed to test how well the examinee understands and applies concepts integral to the basic and clinical sciences. ‘Step 2 (two separate exams)—The Step 2 Clinical Knowledge (CK) ita multiple-choice ‘exam designed to determine whether the examince posesss the medical knowledge and ‘understanding of clinical science considered essential for the provision of patient care under supervision. The Step 2 Clinical Skil (CS) i a separate, “hands-on” exam that tests the examinee’ clinical and communication skills through hier ability to gather information from standardized patients, perform a physical examination, communicate the findings to the patient, and write a patient note ‘Step 3 (multiple-choice exams)—This exam asses the examinees ability to apply medical [knowledge and the understanding of biomedical and clinical scence essential for the ‘unsupervised practice of medicine, with emphasis on patient management in ambulatory setting. “The results ofthe USMLE are reported to medical licensing authorities inthe United States and its territories (state boars") for use in granting the inital licens to practice medicine. The ‘examination serves to provide a common basis for evaluation ofall candidates for licensure ‘The USMLE i sponsored by the Federation of State Medical Boards (FSMB) and the National ‘Board of Medical Examiners (NBME). DESCRIPTION OF THE STEP 2 CK EXAM USMLE Step 2 CK is nine-hour, computerized examination that serves as the clinical science ‘exam ofthe licensing pathway, Is purpose sto determine whether an examinee possesses the ‘medical knowledge and understanding of clinical science considered exeential fr the provision ‘of patient care under supervision. As the complemen tothe Clinical kills Step 2 CS exam, Step 2.CK consists of multiple-choice questions that will test you on the principles of clinieal science that are important to the practice of medicine in postgraduate traningChapter One ‘Strategy Tip View the computer tutorial at home 0 the USMLE demo dik and skip the computer {uta on est dy for an ‘adefional 15 minates of break time Seaton One: Test Taking and Study Suatgies Guide What Is Tested on the Step 2 CK Exam Step 2K tert primary cae maine. Subjects covered on the USMLE Step 2 CK inloe bt are oot limited + Internal medicine + Obwttics and gynecology + Preventive medicine and public heath + pacar + Emergency medicine + Dermatology + Neatlogy + Gerais * Sugsy For a dete decipton of examination content ares sete USMLE website, Not that he dines ited inthe orline do at represent anal nce ist. Question ae generally, bt rot ext, faut on the lise ores neon nat al sted tpi aria on Cath examination. Remember la tht etegoiatons and content coverage ate Sbj hans Examination Structure ‘The nine-hour Step 2 CK exam consists of approximately 370 questions, divided into eight “blocks of one hour each: Fach ofthe eight blocks contains appronimately 50 questions from ‘he fll range of topics covered on the exam You wll be able to skip back and forth among test ‘questions, but only within ablock of questions. Once the hori up, you wil be unable o return to that block of questions. When you start the testing session, Your session clock will ein ‘counting down from nine hours, When the nine hours are up, the test wil shutoff completely. Within your nine-hour session ime, you will have to complete eight, one-hour section Step 2 CK at Glance Examination Length: Gg cornu "lod" aninered in one hour tesing session compute tra 15 minutes; breaks: 45 mines, sel scheduled Number of Questions: Apprcimail 370; 1-47 questions per I-Hour black Question Types: To types of muktplechoice question: single best answer and matching set ‘The additonal hour can be used to view the tutorial (up to 15 minutes) and to tke breaks, including lunch, Ifyou skip the tutorial (which you should because you can review it on the USMLE' demo dish), you will havea full hour of break time. ‘Whenever you begin a new block, the section clock will countdown from 60 minutes (the ses sion clock will continue te count down fom the orginal nine hours). When you complete # section (block, youl get information about how many sections you have lef, a well s your remaining session time. Ifyou completa section early, you can add those mites to your rest ‘time. You can never add minutes o your tet imeScion One: Test aking and Study Stateies Guide |g Inside the USMILE Step 2 CK Exam Question Order “The questions on the Step 2 CK exam are presented ina random, interdscplinary sequence— there are no “conteat-specifi” sections. This makes the exam quite challenging, a you are required to possess the mental agility to jump back and forth among many topic ares. Test, ‘questions focus on topics that are relevant tothe practice of medicine, All the questions are presented in multiple-choice format. Question Length ‘The exon sens on the Step 2 CK exam tend to be considerably longer than those o Step [rast amas inuding ie history an laboratory dt. nerpretason of physic igs td symptoms, nia at personal histories, bls, aging sae, andthe resus of other ingot stoke te equi rere. MULTIPLE-CHOICE QUESTION FORMATS ‘There are two basic question formate on the Step 2 CK eam: one single best answer and extended matching. You will encounter both types throughout the USMLE Step 2 CK Qbook, whichis designed to simulate actual exam questions. Approximately 75-80 percent of the questions on the exam are in the one-bes-answer format. ‘These questions will be the frst one in each black. You wil be presented with a statement or ‘question followed by alist of 3 to 26 options from which you are requied to eelect the one best answer (Five choice is by fr the most common.) “The final questions (20-256) in each block ae in the extended matching set format. Fach of these sets consists of alist of letered choices urvally related to 2 common subject (@g renal tliseases or neurologic disorders). You mast choose the single answer that best corresponds to tach numbered question, There canbe upto 26 answer choices (although 10 most common) ‘There are usualy about two oF thre questions corzsponding to each matching st. A small ‘numberof matching questions in each block wil require you to pick more than ene correctSocton One: Test Taking and Study States Guide Chapter One. One Single Best Answer Questions ‘This isthe traditional, most frequently used multiple-choice format. It consists ofa statement ‘or question followed by 3 t026 options that are in alphabetical o logical order. The response ‘options in this format are etered. Examines ate required to select the best answer to the ques tion. Other options may be partially correc, but there is only one best answer. ‘ATS year-old man presets wth ce complaint fhe episodes offaining (er the past month. He ao relates several episodes of lesde chest pin that ocr with xeon and ese on esing. Furtesmoe he hs noted increasing leg edema and orthopnea. He has no pro aria hisory and is nt on any mecieaions. is lod pressure 130/70 mm He ands pulses min, Ping edema is present in both lower exrenies. The caratd upstokeis dele Cardiac examination irematale fo a nomal Si anda sot, singe S2. harsh te peang sso ejection murmur is ead atthe Fight upper sera border An ECG shows signs of let verricularhypertopty ‘Wc ofthe followings the mast ely agnosis? (A) Aarti insuciency @) Aatic stenosis (Q) Mita insufcency (0) Mita stenosis © Ticuspid insuiciency (answer 8)Section One: Test aking and Study Staregies Cue Inside the USMLE Step 2 CK Exam ‘Oceasionaly single vignette is wsed to introduce two questions. These are known as “linked “questions” An example js shown below. Mems 1-2 ‘A 26yearsld man comes to medial atenton because of sustained hypertension for the past year During the same period, he ao hed parongsma episodes characterized by profuse seating, headache, and a ‘sensation of increased heart ate. At hs time, hs blood pressure 160/95. mig, with pulse of 86min in the supine poston, On standing, is blood presse i 120/70 mm Hg, and hs pulse i 10m. A cpstick test eves fucose in the urine. |. Which ofthe folowing s the most appropiate next step in diagnosis) (8) Urinary 2557 for tee catecholamines and veiymandeli ci (6) Measurement ofevinephrne and norepinephrine in the blood (©. Measurement of esting glucose lvls in plasma or serum ©) Pharmacologic provocative tess (© CT andor MRI tutes ofthe abdomen (Ansver A) 2. Aer perorming the appropiate diagnostic stuties, the patent scheduled for surgery. Which ofthe following i the most appropriate pharmaccterapy? @ Insulin (@) Labetalol © Niedpine (0) Nivoprsside © _Phenonpewamine (Propranolol (Answer B) Strategies for Answering One Single Best Answer Questions, + Read each question carefully Is essential to understand wht is being asked. + Try to generate an answer first and ther look frit in the option lis + Ifyou cat come up with an answer, read each option carefully and eliminate those that are clearly incorrect. + Of the remaining options, select the one thats most correct. + Ifyou are unsure about an answer, guess. Unanswered questions are automaticaly ‘counted as wrong answers. ‘Strategy Tip ‘ou ae nt onking fora good answer, you at lokg for ‘he one best rane,Seaton One: Test Taking and Study Sbatgis Guide (Chapter One Matching Sets ‘This format consists ofa series of questions related toa common topic, All matching sets contain st-speific instructions, alist of letered response options, and a est two question. There will be between 4 and 26 response options. Each sti preceded by a box tat indicates the number of questions in the set asiociated with the response options that follow. You wil select one answer for each question inthe st. Questions wil be presented one at time, with instruction and response options repeated foreach subsequent question. The response opos res -2arethe same You wil be requied to select nears foreach tem inthe set (A) Aortic dissection (B) Nerosertic disease (© Cure Svaus syniome (0) Cryoglbutineicvacus (©) Giant cell arteritis. (F) Henoch-Schonlein purpura (@) Kawesaki syndrome (H) Microscopic polyangitis (0 Palyartests nodosa G) Syphiltic aortits (1) aay tenis (0) Thromboangits obitears (0 Wegener genlomatosis For each patent wth ins and symptoms of perpheral asia ease, select the most ely diagnos 1A 25yearolé women presenis with a 2-month history of recurent transient episodes of visual bising, dizziness, and focal neurologic defi, suchas lib weakness and paresthesias. She aso reports numbress and cles of her fiigers. Physical examination discloses marked weakening of the pulses in the upper extremities. An aoc angiogam reves Proximel narrowing ofthe brachiocephalic, fet common carotid, and lt subclavian arteries, The aortic ach appears normal (Answer K) 2. A Sé-yearold woman presents witha month history of sinsis ae ois media unresponsive to common antbioic and antrinlammatary treaimens. She ecenty developed increasing malise and 2 perssent Cough product of Bod inged spt, Her emperatures 38.2 C (1008 9), blood pressure fs 126/81 mmm Hg, pulse min, and respirations are 1W)min. Laboratory studies show mild anemia and levkoytoss, an erytracte sedimentation rate (ESR) of 87/min, and the presence of| Crulting artnet cytoplasmic atbodies of ANCA type. Urinalysis shows more than 5 red blood celishigh poner id and red cell casts (Answers)‘Section One: Test aking nd Study Statgies Guide| Inside the USMLE Step 2 CK Exam ‘small narber of matching questions in cach block wll quite you to pick more than one | correct answer. Questions that require more than one answer often refer to patients wo need vitamin supplements or vacines oto stations in which ordering e series of laboratory oF ‘ther diagno tet i retin the workup ofthe patent. ‘The response options forthe items 1-2 are the samme. Each item wil state the ‘number of options to select. Choose exactly this number. (A) Antinuclear antibodies titer | (8) Blood cultures (© Bone abserpiometry t (D) Complete blood count i (&} Radionudide scanning: (P) Rectal examination (©) Rheumatoid facto iter | (9) Serum protein elerophoresis | Urinalysis: i 0) Keay fs For each patient with musculoskeletal pain, select the most appropriate dagostc tudes, |. A Gt-year-od man comes to medical attention because of pain inthe ‘wer back, weight los, and two episodes of bronchopneumenia in the past 6 months. He doesnot smoke. Examination reveals bone tenderness ‘n compression onthe lumbar spinous processes an pallor of skin and sucosee (SELECT 5 STUDIES) (nsiers:D, B Hy) 2. A 2I-yearold man wit a history of sickle ca disease presents wih the acute onset of pain and sweling ofthe right ower temperatures up to 40 C (14 F, and profound male fr 3 days. Bone tendemess on pressutis led onthe dial tia, SELECT 3 STUDIES) ‘Answers: BD.) Strategies for Answering Matching Sets Begin ac st by eating through the option ist to Bcome faa wth he vale response. + Read each question carefully. + Within st some options may be used several ties, whereas oer options may nat ‘be used at all. Respond to each question independently. + For matching ste wth age numbers of options try o generate an answer othe {oeton and thence the anower inthe oon It + yo cat come up wih answer, read ech option ctf an climinete those that ae dey incre. + Ofte remaining options seket the one thats most core + Ifyou a unsure about an answer, guess. Unanevered questions re automaticaly {ound as wrong answers Strategy Tip ‘A ananesed questions are courted as wrong ans, to your advantage to guess when you dnt know iitticalSection One: Testking and Stuy Soategies Guide Chapter One UNDERSTANDING STEP 2 CK QUESTION TYPES ‘Within the basic multiple-choice formats presented on the USMLE Step 2 CK exam, there are tinct types of questions If you understand how Step 2 CK questions are written, you wil ind ieasirto understand what the intended answer shouldbe. A good USMLE tem testo se not only you know the requisite knowedge, but if you alo can think with that knowledge the way «physician needs to think. Can you use che information presented to solve the presented clini cal probleme Different types question structures tes diferent types of clinical reasoning sil Stimulus-Response Questions “This yp ofitem ask seightforerd question nde ansvered by imple simul eponie paling Gene ean"Xin the stem you have to pick the right sascaton fo th anon Thistye of question incayto wnt and yo have the owe iy ery snow Noe ‘hat othe roche wed foc mot USMLE questions and that thi spe of Hem nt what you hou be preparing enenx || Stem ‘Answer Figure 1-1.014 Style tem (One ofthe goals of your exam preparation must be to become a good consumer of questions so that you know what is and what is nota good question. Tht way you can train yourself for ‘the particulars of this exam, Double-Jump Questions ‘This question requires you to make nt one, but a series of corect decisions in order to elect the proper anser from the presented alternatives. The qoeston gives yu some information, “X,"and you must reason "IEX is true, then point umber one must be tue If point mimber ‘one struc then pot amber wo must be tre. pot number twos tr, then the answer fot tobe choice D® ‘This ain of esoning is sometimes called internal medicine log because internal medicine physica seem particulary adept a this thought process om | = ve Figure 1-2."Double jump” tem ‘The frustrating part about this type of question is that you can know some, but just not al, of the steps and stl get the question wrong.{ Secion One: Testakng and Study Stategies Guide | 4 | Inside the USMLE Step 2 CK Exam Clinical Case Questions “The second common type of Step 2 CK question is the long clinical case. Clinical case questions ‘are more than just alot of words. They are made up of words selected ina particular way, with prticular information at particular places. You have to understand how they ate put together {E you want tobe clear on how to answer the {Long clinical case questions begin as texthook examples of some disease or medical situation Allof the base features youd expec forthe disease will be included inthe descriptive material ‘ofthe question. All he crucial signs and symptoms are there. Next, the question write lays out ‘isto option that include the correct answer, bu alo common diagnoses that are often com fused with the disease that is presented. The goal ofthese dstactorsis to mislead stadents way from the correct answer In clinical case questions, the frst ine i critical. The Fist ne sets up the question and gives key ‘demographic information such as sex, race, socioeconomic status, oF vocation. The lst ine of ‘the queion i also critical becase it gives the actual question to be answered. Everything that ‘ame befor it is merely information. To be correct, your answer mst entrespond to what is asked in the lst ine So now wehave a classic case with asetup, a question, and options that inclode the right answer sand some distractor, Forts item writer, fo conver this question into a good USMLE ques- ‘on, further modification i quired. The fst hing to dois go back into the case and add “ed ‘ervings thats, facts that donot change the answer, butby themselves, in isolation, might tend tolead you to one of the distractors for an answer Asa simple example, a patient is presented, As we read through the case it provides a textbook ‘example of Alrheimer dementia. However, the patent’ history also mentions a history of Ibypertension. Then you are asked for the patient's mos likely diagnosis. I you tke the case as ‘whole, the corect answer of Alzheimer dementia should be obvious. Bu if you fisate on the fact of the hypertension, you might well select the answer of vascular dementia and get the {question wrong, The examiners know what key words you are looking for. A simple way to write 2 more dificult question isto include these “buewords" that led to the wrong answer But we're not done constructing our clinical case question, yet. Remember al the casi signs and symproms we included in our case? Le’ go back and remove some of them from the ques- tion. Not enough to change the answer, but just enotgh to remove some key signs that cvery student knows. For example, if presenting 2 case of schizophrenia, we may not include the ‘pmuptoms of auditory hallucinations The examiners expect you to arrive at the correct diag ‘nosis from the athe information provide. ‘The intent her isnot merely to be dificult but to present the student with real world scenae fos. In real life, patients often lave out important information, or include information that’s cxtrancous Will you beable to figure out what is going on in these less than perfect situations? ‘That's what the clinica cae questions are intended to asses.12 | Chapter One Note The Sep 2 K exam does at feature negate phrased uesions (ie, quesion wth the words NOT, EXCEPT, of LEAS nthe stem) Section One: Tes Taking and Sty Suategis Guide UNDERSTANDING DISTRACTORS Getting 4 question correct means selecting the best answer, Incorrect options are called “distractora” Their purpose isto distract, tha is, to get you to pick them rather than the best answer. Each distractor wil be selected by some examinees oF it would not be included as an ‘option, Every option fool somebody. Your job sw not be misled, In general, dstractors will seem plausible and few will stand out a¢ obviously incoret. Distractors may be partially right answers but not the best answer. Common misconceptions, incomplete knowiedge, and faulty easoning wll cause you to select distractor The question writers are told that their distactors mus fellow thes ive ules: + They mast be homogeneous. For example, they will be all laboratory tess or all thera pies, nota mix ofthe two. + They mus be incorrect or defintely inferior tothe correct answer Thee wl be enough ofa difference between the right awer and the datactrs to allow a distine- tion. For example, if extimating the percentage ofa population with a disease, the options wil differ by more than five peren They must not contain any hints to the right answer, Disteactors are meant to induce ot to an incorrect choice, not give you ces to the correct one. + They must seem plausible and attractive tothe uninformed. Ifyou are not sucieny familiar with atopic, you may wel find that all of the options look good. + ‘They must be similar to the correct answer in construction and length. Thus, trying to “psy out” the question by looking fr laws in its construction i not a useful strategy. “Answer choices that do not adhere to these rules are not used on the exam. All options ate ‘meant to distract you, but often one ofthe distractor wil soem better than the thers, the s0- ‘alled "preferred distractor” This isthe wrong answer chosen most often. Preferred distractors sre why you can often get yourself down to two choices: the correct answer versus the preferred distractor, Selecting the correct answer isnot a matter of splitting ais. The correct answer wil be clearly correct Ifyou think two answers are so close that you cannot reasonably choose between them then the odds are that nether one is correct you need to look carefully at a different option, Reading the Question ‘The examiners kno thatthe thing you lest want to do ona Tong cna cse question i read the qurston. However question ae constructed that if you do net etd them, youre ely together wrong ‘A sophisticated question writer can take advantage ofthis tendency. Istudens ae likely to stop reading the question part way down, the question writer an inclade key information in the lat ‘part ofthe question, knowing that many students wil never get thee, If you stop reading halfway down through the question, you wil offen mis important, if not crucial, information. So how should students approach long clinical case questionst Start withthe notion that you fre going to read the question. Stop tzying to Sind away around reading the question and jst ‘dit. Time spent reading the question is time well spent.Secon One: Test aking and Study Soategies Guide Inside the USMLE Step 2 Ck Exam 6 you find yourself confused by the question oi you are short on time, ty these strategies Think as You Read ‘Many students read the question and then try to figure out what is going on. By then it's 1 Int. You should be figuring out the question as you read it initially. This means stop at every period and tel yours whats going on. Summarize the question to tht point and decie what Jssues seem mest important. Create an ongoing hypothesis that you can confirm or disconficaa as you move dow through the question Read the Last Line to Set Up Reading the Question Te you do this it this cam be very etective strategy But be cael f you read the question fist and then read through the enti eas, that's great approach, However, many people read the question instead of reading the case and then go skim through the case looking for one crucial piece of information to answer the querson. Inver, they come across aed hein. and they choose the wrong answer, lf You Find Yourself Short on Time, Use the “Rule of Three” Here's the rule: Never piclean answer on the bass of one piece of information, You must have thee pices of supporting information to be sure that you are on target If you do find three Pieces of information tling you the same thing, then you can fel very confident that you now “understand what's going on. THE COMPUTER-BASED TEST Although you'l receiv a tutorial on using the eomputer on test day; sure yuite comfortable ‘with this format by running the tutoril and sample materials onthe USMLE website to become Familiar with it prior to your test date. Experiment with taking the test in blocks and know the screen and all the test features well. A normal laboratory values table including Standard Tnternational conversions, wil be available as an online reference when you take the examina- tion. Other computer interface features inelide clickable icons for marking questions to be reviewed, automated review of marked and incomplete questions clock indicating the time remaining, and help application, During the defined tine to complete the tem in cach block, you may answer the items in any order, review your responses, and change answers, After you exit the block, or when time expires, you can no Tonger review test items or change answers ‘SCORE REPORTING The USMLE program recommends a miniawum passing sore for each Sep. Curtently, the pass ing score as set by tne USMLE program is 182 for Step 2 CK. This corresponds to answering 60 {070 percent ofthe items correctly. The mean sore for first-time examinees from accredited ‘medical schools inthe United States isin the range of 200 220, andthe standard deviation is approximately 20. Your sere rport will include the mean and standard deviation for recent administrations ofthe exam, ‘There will also be a two-digit score on your score report. This two-digit sore is derived from the three-digit score and is used to meet requirements of some medial licensing authorities that the passing score be reported a8 75, ‘The graphical profiles which appear on the back of your individual Step 2 CK sore report are provided as an asessment tol for your benefit and will not be reported or verified to any thi4 | chapter One iStiical ‘Section One: Test ating and Study Strategies Cuide party. The profiles summarize relative areas of strength and weakness to ad in self-assessment. Percentiles are not provided in connection with USMLE scores. ELIGIBILITY ‘To be cig to take the Step 2 CK, you mut be in one ofthe following categories tthe time of application and on test day: + A medical student officially enrolled in o a graduate of, a US. or Canadian me school program leading to the M.D. degree that is accredited by the Liison ‘Committee on Medical Education (LCME) + A medical student offically enrolled in, ora graduate of a U.S. medal school pros tram, leading tothe D.O. degree tat i accredited by the American Osteopathic ‘Association (AOA) + A medical student ofcilly enrolled in, ora graduate of, a medical school outside the U.S. and Canada an eligible for examination by the Educational Commision for Foreign Medial Graduates for its certificate USMLE EXAM SEQUENCING Students and graduates of LOME- and AOA-accredited medical schools may ake Step 1, Step 2CK, and Step 25 in any sequence. Students and graduates of medial schools ouside the U.S.and Canada rms pass Step ! before registering for Step 2CS, REGISTRATION FOR THE STEP 2 CK EXAM Students and graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medicel Education or the American Osteopathic Astcition may regis ter forthe Step 2CK throug: NBME Examinee Support Services 3750 Market tret Philadelphia, PA 19108-3190 Website: htpstwwenbme.org “Telephone: (215) 590-9700 Fax (215) 590-9457 E-mail webmailnbmecorg ‘You may use one application to apply foe Step 2 CK, Step 2.CS,and Step 1 a the same time. ‘Students and graduates of medical schools outside the United States and Canada may register for the Step 2 CK through: ECEMG 5624 Market St Philaelpia, PA 19108-2685 Applicaton materials: Website: hips /ww.ecing org ‘Telephone: (215) 386-5900 Pax: (218) 386-9196 E-mail: infosectng orgSection One: FstTaing and Study Stategies Cuide Inside the USMLE Step 2.CK Exam Intemational students may also complete a paper application (Form 1068). You can download, Form 106S from the ECEMG website or request a photocopy from ECEMG. ELIGIBILITY PERIODS ‘When applying for Step 2 CK, you mus sect a thre-month period during which you would like to take the exam. A Schedaling Permit with instruction for making an appointment a Prometric Tet Center willbe sent to you after you registration entity processes your applica- tion and determines your digibiliy. The Scheduling Permit species the three-month eighility period during which you mast complete the examination. ‘The Steps to Take Step 2 CK ‘Obtain application mater ram the appropiate registration en, Complete your aplication materia sabi them to the reqszation ety. Receivea Scheduling Peri veriying your eit and authoring you to schedule the Follow the isrucons on your Seedling Permit to schedule your test date at 2 rome conte Cente cation are avaiable at wunspremeticom, Bing your Scheduling Perit and ierifcation as described on yout Sdeding ert tothe Pometic et ener on the scheduled date ad ime to tke the examination. TESTING REGIONS Step 2.CK is administered in the United States and Canada and in more than 50 other counties by Prometrie, You can contact Prometric’ central scheduling office known a8 the “Regional Registration Center” to schedule test dates st www.prometriccom. Use the Prometric Test Center Locitor for up-to-date information on the locations of Prometric Test Centers. ON EXAMINATION DAY rive atthe Prometric Test Center 30 minutes before your scheduled testing ime on your testing day f you arrive more than 30 minutes afer your scheduled testing time, you will not be admited. ‘When you arrive a the tet center, you must present your Scheduling Permit and the required identification described on your Scheduling Permit. Your identification must ‘contain both your signature and photograph. Acceptable forms of identification include the following forms of unexpired identiiation: = passport = drivers icense with photograph rational identity card ~ other form of unexpired, government issued identification IMG issued identification card + Your name a it appears on your Scheduling Permit mst match the name on your forms) of identification exactly.Section One: Testing and Stay Stategies Guide 16 | chapter one + Upon arrival at the text center, you must present the required identiiation, sgn a test ‘ante log, be photographed, and store your personal belongings in your assigned locker + You will ceive a marker and laminated writing surfaces for use during the text. If you fll he laminated writing surface provided, please inform the test center staf. Replae- ‘ment laminated writing surfaces wil be provide. You will not be provided with material {o erase the laminated writing surfaces; do not wipe them clean yourself, Center personnel wil exort you to your assigned testing station and provide brief instructions on use of the computer equipment. You may then tke a bie tutorial prior to starting the frst ws block. Fifteen minvtes is allotted to complet the tutorial and 45 mints for break time. The 45 minutes for breaks canbe divided in any manner, according to your preference. For example, you can tke a short break at you seat ater you complete a bock, or You can take longer break for a meal outside the test center afer you complete a few blocks. ‘Once you begin a block ofthe test, no breaks are provide during the block. Each block lasts approximately 60 minutes. During blocks, the clock continues to run even if you leave the testing room fora personal emergency, Each Block ends when is time expires or when you exit from it + Asyou progress through the blocks ofthe est, you shoul monitor how many blocks ae remaining and how much break time is remaining. Ifyou take too mvch break time and exceed the allocated or accumulated break time, our ime to complete the last lock(s) in the esting session willbe reduced, +The test session ends when you have started and exited all sections or the total time for the est expires. EXAMINEES WITH DISABILITIES Reasonable accommodations will be made for USMLE examinees with disabilities who are ‘covered under the Americans with Disabilities Act (ADA). Ifyou wish to apply for test accom ‘modations, you must send your afcal request and documentation a the same time that you apply forthe exam, Soe the USMLE website for more information. FOR MORE INFORMATION + See the USMLE Bullen of information andthe USMLE website at USMLE.org. ‘Changes can occur afte the Bulletin is released, so monitor the USMLE website for the most curcent formation about the test + Refer tothe website of your registration entity: BCFMG for students and graduates of international medial schools; the NBME for students ad graduates of US. and Canadian medical schools + Run the sample Step 2 CK tet materials and tora provided at the USMLE website, inedicalSection One: Test Taking and Study Strategies Guide | 17 Chapter Two: Study Techniques ACTIVE LEARNING Active tse of material increases retention and facilitates recall. Repetition makes memories Each instanceof recall produces a new memory race, inking it to another moment of fife and increasing the chance for recall in the future. Memory is dynamic. Recall actualy changes ‘neuronal structures. Tobe truly usful,a piece of information needs to be triangulated, con- nected to a number af otber concepts or better yt, experiences, For the USMLE Step 2 CK exam, ‘meaning, not mere information, s your gol Rereaing textbooks from cover to cover and underlining —yet again, in a different color— every line on every age fs nt an efcient way to learn You need to focus onthe material most They to be on the examination, Studying that material through active application i the bet Meese ofthe study ‘way to enhance your understanding and retention of the information. materia isthe key to success studin ‘The following study techniques will help you develop better ways to prepare for the exam, but remember, learning for retention and use requires active involement. CHOOSING WHAT TO STUDY (AND WHAT TO IGNORE) | | Hw can you possibly know what is likely to be on your examination? There area sumber of | 1. Talk to medical schoo! faculty. They often have sen past exams or have reviewed an item analysis and can tll you the topics most likely to appear on the examination. They should beable to direct you to what i essential knowledge in ther feld and what is ess imporcant. “Talk to students and colleagues who took the examination in past years. Do they remember some topics being particularly "hard hit” Was there a"avor”to the exam? For example, did there sem to bea lot of Pathology? 4, Students who took the eam i the pst cannot tl you what wil be on the exam that you will tke, but they can direct you to the high-yield content arcis that you must make sure to | master Is highly recommended to talk with people who have taken the exam. However, be | cautious. Candidates typically overestimate how much of their weakest area was on the | eam. They are most likely to recall ested content that they got wrong | 4, Take advantage of the CD-ROM. practice disk sent with your Step 2 CK application | confirmation. These questions can also be downloaded from the USMLP’s website (nwwstlecorg). These practice questions will help indicate dhe content structure ofthe ‘tam. Every year new topics are added to the content oulline, and some older nes are eim= inated, These changes ae likely to indicate new questions that you will not hear about fom any other source, so be sure to check out these soutes. The good news is that this USMLE book contains a general oulline of everyting that can be tested on the exam. The bad news ‘is that as you peruse the outline, you will son realize that there is more content indicated than any one person can possibly master in detail be18 | chapter two Remember You dort have to study eventing Use a numberof diferent sources of ifaton when deciding wha to tc Remember Yous beable to recgrize concep undersand tei importance, and apply them in presented sitions | Secion One: Test-aking and Study Stategies Guide 5. Certain topics are standards others appear as tends. Recent there have been many’ ques: sions on AIDS, infectious disease, genetic disorders, toxicology, pregnancy and prenatal are, ‘thice, autition, aging, and increasingly, molecular biology: Pay special attention so these topics when you plan your studying. In general, topics begin to appear on the exam two to three yeats afer they reach prominence inthe scientiieay community. Any interesting ‘medical topic that appeared in the literature atleast two years ago isa candidate for inch sion on the exam, 6, Beware ofthe trap of “studying forthe last exam”—exam content dilfers fom yest to yes. ‘This year’s exams will be ditferent from last years. And within any given year, you exam ill be diferent from that of other. Tiss especially true because the exam is computerized, CHOOSING HOW To STUDY ‘Mastering the material you must learn for this exam is a three-stage proces. These stages parallel the functional organization of memory. Basic Terms and Definitions You must learn basi terms and definitions This provides the core vocabulary to understand the content being tested. This stage ia mater of simple recognition and memorization, Terms and 4efntions are learned bythe wse of associational memory. Tiss the level where mnemonics can be useful Central Concepts ‘You must lear central concepts foreach ofthe seven subject ares, This is a mater of being able to explain the meaning of conceps, haw they re used, and how they connect with other concepts Understanding the ero-linkages within subjects and across subjects will serve you ‘well over the course ofthe exam ‘Your basic mental task here i that of reconstructive memory, learning to recall concepts in terms of how things ft togsther. At this sage, the practice of recaling one concep facilitates the recall of other elated ideas. Patterns begin te emerge. Thisis the evel at which diagrams, tables, and pictures can be most helpfl Application You most be able to apply the concepts in presented lca setings an recogni wha om Cepis ars most portant in micas presentations. This the hadet stage of pepaaion, tnd te one that met students neglect Acevng your best pou score deers om know” ingot nly what concepts mean but lo how ie are apple ina gien meal tation, ‘The tsk at this level is that of reasoning, understanding the implications of presented infor ‘ation, and being abe to choose the appropriate action from the avllable options. At this eve, study/discussion groups and doing practice questions can be most help. ‘Your method of study and your study schedule should be arranged to allow you to master each ‘ofthese tages in tur, Asyou make your decisions about how you wll sted, the following sug- sestons may be helpful:Section One: Test Taking and Std Statgies Guide + orga Sup an xu stay shee and adit The big ange wierrpar re cln pnd ws mane cron sonar gogo | SSRESESERR lithe sh tayo wl sug rh ag pe yor ie iniensei kbd purity | «Daiwa your nek ay ling ete doc asinine Uontoarcoueneor wegen tok ep ou pe ilu oa seal pr cr atest tebe + Denote nel ors aay but alec sinew em Tin be tia Rocco ato mes sae ya oy roe Shand irs ns toabjtha mae ncn ce ce ‘Sicpallicmosttineon cab tne out noc + fp ite by ering abe ery nye, witgeaty sé our pgeraton Sep Coch cps enero teiesdoues ths efor s ote ns pap its pe Cher moka eon ma ify hn youd ep oe yorperhe nd wenn «Recent nla css For eample keane and ever ow Sha poem bse penlgy ees wo itt he ein chro peso ch sg tt wou ‘Peston dap ht cv sera Se ey + Kept morn nou oan otra sh wi te 15mm aurea dingy ean or Sng tari ony inal xe oot eat esl he ‘ow cm memory ing ner + Donate boas Ueno ft on infomation 0 + inte mambo fran sue fom nih ou sta. Set oe main tees ea fre cyber bos woe ry tui ccs cape ay point se {uns oon anodes mp HIGHLY EFFECTIVE STUDY METHODS ach person has his or her own preferred way of staying, You will have to decide what will ‘work best for you. High yield study methods all have one feature in common: The more active ‘sou are withthe material the more content you will ultimately retain. Remember, your goal in studying i nt just to putin the mos time, but tobe efliient. Many ofthe hes stodents make use ofthe following techniques ‘Ask Yourself Questions ‘One ofthe best study techniques isto pose questions to yourself es you review material. Perhaps ‘youll want to jot them down on index cards to share with others and to practice later By ask- ing yourself questions, you ae framing the materi challenging yourself to focus on key areas, land preparing for questions you may well see on the examination, Your goal is not to lean ‘ovledge for general use, but tobe able to answer multiple-choice xm questions Study Techniques | ™® Note his eay to dsever your en areas by watching your cain reaction to each be Whatever subject or subject eas you te the eas are probably the onesin wich you are the wees. Remember Do nc entirely eget your sug aeas, but pay ks 2terson to them when studying lang he ater foc teview ‘Study Tip ‘The fey nt how long you spend suing, but geting ‘he most otf the te.20 | chapter two ‘Study Tip oul see los of tables, srs, and chats on the fram <0 pracice using these oo Study Tip Pasting content in your ‘own words wil make you beter test ake. Remember Ifyou can teach someone a top then you know wel enough forte xa, Section One: Test aking aed Study Strategies Guide This steategy will move you from thinking like a student answering questions to thinking ikea faculty member whois writing questions, ly this proces, you "get into" the head of the ques tion writers and begin to understand what makes a good question and the basi science issues likely to beat the core of presented questions Use Graphs and Charts Many common graphs and carts appear reps onthe exam, Practice reading graphs hart and ables Try abstracting the alent facts quick fom a graph or chart. This tay be txpedied by using a pain set of paper fo cover unneeded information and oft your Stenton on eeted information. Drawing the graph yourelfscems to hp you remember it more than just looking st it lt ple times, Drawing a graph from memory will give you the confidence that you've tuly mas tered the material Again, the more active you are with the material, the more kely you are to ‘oth remember it and understand important nuances. Paraphrase Practice paraphrasing material to highlight important information Paraphrasing means po Cen th neal out rn ling youre what portant a ant 2 ‘ead throgh ind summariing the Ky content in your wn wort. Pretend shat you ate the teacher who i in charge of presenting the content. What would you ‘choose to emphasize? What would you leave out if you were short on time? How would you ‘explain the concept to someone new to the field? Remember, if you can say it in your own ‘words then you realy know it ‘The at of paraphrasing wil allow you to answer questions with extensive information in the stem, such as ease histories, much more efficiently. Many students sy the mos dificult part of the exams is getting through the large volume of reading requited for each question. When you sare paraphrasing, do not treat every piece of information with the same emphasis, but decide ‘what is important and what is not. Developing this skill wil also be helpfl as you progress through your medical cacer. Summary Notes (Creating summary notes ia great sy technique and wil reinforce your parapirsing sk Samsmary ote are yout personal representation of ey pont inthe mater writen na way that makes sense to you, Summary notes should run parallel to yout primary sty mse nd ‘Boul serve to ainott usta aad amplify the hey points of that materi. The physical Seton of simply writing the notes nds to reinforce learning and al long-term retention, Once competed summary noes provide «ready guide for hoe ines when you review te materi Study Groups Sty with ends or colleagues in groups of our or five. The best groups comprise people with 2 range of experts. Ty to form «group where each perons weaknes is complemented by fomeone ees strengthsSecon One: Test Taking and Study Steg Guide ‘The goal of these study groups is not to show your colleagues how much you know. Rather, is to find the hoes in your knowledge while you sill have time to correct those gaps. Dont be afraid wo tackle the tough tics Wit the aid of your study group things will make sense much Sooner than they will on your on. Challenge eachother. Pose hypothetical situations and sek agreement as the best answers, Plan Your Study Time For moe cit studying. eo cramming and plant reteviw hey material on a regular bess Repeated exposure to mater ve ie lends to move thorough retention than one mas se concatrted pone Jn your inal eviews remember tha active earings est. This meas siding simply read ingthesame pge of nue ve and over Inn, wat ey words s ment ggereand tel our sefas much you can about the topic ou are studying. Fr example, don spread he cbs eye Rather tl yours about tas if you were expaning to someone ee and then Check your explanation spins! your nots Rereview it alo the ime to hein to mak inks among different sections of our materi ‘What dows your understanding of the physoogy of te tadioscaar ate el you about Common pablogy or pharmacologic inferventton? The threade of common dates wee throug ech of the bu sence ube them together and rove a famework ht ads intention Practice with Test-like Practice Questions Doing practice questions is exential in your preparation for taking a multiple-choice exam. Your goal here sto test yourself and also to learn good question-answering habits As you do questions, examine whether you got them right, but more importantly, look a why you got the «question right or wrong Did you not know the conten? Then that’s your cue that more study {sneded, Did you misread the question? Then evaluate how you mistead it and lean how the question writer wants you to read it Sources of Multiple-Choice Errors Problem Type Source of Errors Format problems Particular question subtypes Anxily problems Questions containing numbers or done ealy in the review session Fatigue probleme {Questions done lt in review session Reading errors ‘More common in Fong questions Directionalityerors _Quetions that ak prediction of consequences Group delineation errors. Questions that present material a unique context ‘When you do your practice questions, do them under a time limit similar tothe actual exam In general, your rule should be one minute per question. Tis is roughly the amount of ime (72 seconds) you will have during the real exam. Get used tothe time constraint. Iris one ofthe unchangeable realities of the USMLE, ‘When doing practice questions, avoid these common mistakes: 1. Do not do questions without preparatory studying, Review material fst until you fe you ‘know it, and then ase questions to text youre I you study by doing questions before you ae ready, you will erode your self-confidence and fail to develop key linkages within the ‘material. ‘Study Techniques | 7? Remember Pan your wok and wok the plan, Remember Your efeny athe ang process deaeases rapidly as the amount of study tne Remember "You do no ave pasa of the subsecins ofthe eam, butyou donot wat o be ‘weak otra rvery wean ‘wo or three oes22 | chapter two. Stady Tip Learing the arses to hated of questo tat you may pt see an the exam vil ot help you prepare Review materi unt you know hen do questions Remember ‘ein passive earig wl not increase your rteion of information; you rust work withthe meter itiedical Seaton One: Test Tong and Study Stargies Guide 2. Donnot get into the habit of lingering over « question. You do not have this luxury on the real exam, Remember that you have just over one minuce per question. You should spend ahout75 percent of that time reading and analyzing the question stem and the other 25 per Cent selecting an ansver. e honest when you do not knove an answer, move on, and look it up witen you are finshed, 5 So-called “retired questions” and many published questions in review books are not rep- resentative of questions featured om the current USMLE Step 2CK. They ae a reasonsble ‘way to review content, but often do not reflect the length or form ofthe questions on the 4, Donnot do questions individually. Do them in clusters under time pressure, with 5 to 10as a miniorn. This will gt you used to’ moving from question to question. Do not Took up answers after each question, Instead, check yourself after you have done te ful se of ques- 5, When you start working on questions do not panic if you do not get the correct answers. {earn from your mistakes. Questions are apart of the study process they help you sce what ‘dee you need ta learn You will et beter at questions as your studying continaes TRY THIS QUESTION-MASTERING EXERCISE ‘Coverup the options tothe question and read the question tem. Pause teach peviod and pars- ‘phrase what you have read. When you finish reading the question, cove the question and reveal ‘he options Select from the options without looking back at the question ste, With practice, you will get faster, and this strategy wll become a habit. This strategy frees you +o get the information out ofthe question as you read it and does not allow you to waste time by Boing back and re-reading. Remember, you only have tite to read each question once. Learn to make your reading time as efficent as possibleSection One: Test-Taking and Study Strategies Guide | 23 Chapter Three: Tackling the Exam STEP 2 CK TEST STRATEGIES ‘Some students have their own personal strategies for dealing with multiple-choice exams. Ifyou hhave & method that you are comfortable with, stick with it Hostever, many people find the Following set of recommendations bell. Our experience shows that your best strategy is (0 Follow this vice: + Start with the beginning ofthe question block and work your way tothe back of it. “This means tat withthe frst question and do each question, in onder, until you come tw the last question. The idea here iso get into a rhythm that will carry you through the exam, Tis rhythm wil help erate what one paychologist calls 3 "low" experience. ‘The low experience isa state of optimal concentration and maximal performance + Do not skip any questions. Ifyou don't know the answer when you come tot you ce not likely to know i ater, Skipping around wastes time and ean end up confusing ‘you.as to where you ae in the exam. Deal with each question as yo come tit ‘Answer itas best you can, and move on to the next question. + Limit your wse of the question-marking feature to no more than two questions in each block. The marking feature lets you return to review and reconsider questions ‘where you would ike more time. However, marking more than a couple of questions makes it hard to keep track of how many you want to revisit You simply may not have time to go back and look at questions you have marked, especially if you mark alo of them. Keep track of the questions you do mark by writing down the question number and any option you hae been considering on your whiteboard, Use the macking fea ture wo keep yourself feom geting bogged down, not to hold yourself back. + Remember that you can only return to questions within the current question block. (Once the time as expired on any given question bloc, you ean no anger access any ofthe questions within it. + Re cautious about changing answers. In geneva, your odds of changing a correct answer toa rang one are so much higher than the everett it is simply not worth ‘the risk Ifyou chenge an answer, you are mos likely making it wrong! You fst impulse i usually the correct one. Stay with it unless some clear insight occurs t you you are not sur, leave your Best answer + you finish a question block with time lft over, go back and “check” only those answers that you have previously marked, Checking almost away leads to changing and tends to reduce your score. Ifyou have « spare moment, make sure that you have fentered an anawer for every question inthe block and then relax. Stake a Break, and ‘mentally prepare yourself forthe next block of questions Focus on the questions to ‘come, not the ones that ae past Test Taking Tip Used comeaty, question making wil you double check quesions whe you have high proba of tinge ansver coer. Misused, making can cause yout nt give 2 question you ful tention heist, fee around24 | chapter Three Remember Eee te management is key to geting your best core, Remember Keep moving foward thoush the ean. There is ays anther question coming strategy Tip Rea think answer Seaton One: TestTaking and Study Stategies Guide Segment your time sothat you know how much you have left, and so that you do not find yourself rushed atthe end. You have just over one minute per question (72 seconds), Some questions will take more time and some less. Work on your pacing fom the beginning ofthe question block Check your watch every 10 questions 10 rmatke suze you are on the correct pace to finish. you pace yourself throughout the block, you should not be squeezed for time atthe end. + Do not spend alot of time on individual questions. Research has shown that st ents spend the mos time on questions that they get wrong, Ifyou find yourself spending fot of time on a question, this is your indication that you do not know the answer How will ou know you are spending too long on any one question? Ifyou {ind yourself thinking, “Maybe Tm taking oo long on this question” you are. As soon 1s you think this, stop, mark your best gues, and move on tothe nex. + During the breaks between question blocks, try to relax and not think back over the ‘exam. The desc to recall questions is strong but not helpful. Those questions ae in the past you will never se them again. Focus on relaxing and making the most of your break: Remember, you will always tend to remember those questions you got ‘wrong, Thinking back over these questions will hr you self-confidence and make the temainder of the exam more difcn. Be glad one set of questions is behind you, Forget about them, and think about something more pleasant A PROVEN ROUTINE FOR HANDLING EACH QUESTION “The Step 2 CK exam isnot just about regurgitating fics, but about applying those facts in 2 clinical content. Ta handle these types of questions, Your response pattern must nt simply be “read, answer” but instead “read, think, answer” ‘Take a Moment to Think ‘You must tran yourself to take this racial moment of thought on each question. Give youself time to reflect and cal to mind the key facts tat will help you answer the question. Many ques- tions require you to make multiple determinations to arrive ata correct answer. You must take ‘reflective moment on cach question to allow yoursl the time for this cognitive processing Read the question cll mind what you know and then proceed to select an answer. Approach ‘ach question with th assurnption shat you know the answer, and then muster your knowledge toattackit, ‘Make Your Choice in the Time Allotted “The mental task of sclectng an anower on « multiple-choice exam is different than the ask you face when you make decisions in clinical medicine. In the day-to-day practice of medicine, ‘when sclcting a Iaboratory tet, arriving at diagnosis, or finding the best reatment option, ‘you want to carefully consider all ofthe options and be sure about your choice. patient’ ‘health, and perhaps lie ia your bands, Before making choiee, most people report that they ‘want 19 fel 2s lose to one hundred percent certainty a they cn, For the USMLE exams you do not have the time to wait for ths level of certainty. You must ‘rain yourself to make your choice within the time allowed. This often means choosing an answer, even when you are not completly sure. If you wait for that absolute feeling of inner ‘certainty, you wil take to long. Make your choice as soon as you have identified a clear best ‘gues, Then move onto the next question, Remember, theres always another question coming.Secion One: Testaking and Study Strategies Guide ‘THE KAPLAN METHOD: THREE TRIES FOR AN ANSWER ‘You have thre chances to get each question right. you cannot get a clear answer sing these three attempts, you donot know the answer. Mark your favorit letter and move on tothe next ‘question, The hey to this strategy is that you always know what you ar going to-do next. This helps you fein contol and reduces anxiety Step 1: Read the Question. ‘This may seem civil, but studies have shown that most students look atthe answers fis. (Questions cause anxiety and answers provide te solution, so many people go right forthe sl ‘ion. However you cannat pick the correct answer untl you know what you are being asked, Superior students generally spend about 45 seconds reading the question and about 15 0 20 seconds choosing from the given options Poorer students tend to reverse this time allocation, spending ess time on the question and moze on the options, Time reading the question is ime ‘well spent. More time onthe question means moze time spent thinking. + Read the question and pick out key words. Key words are diagnestic information, albnormal values indications of gender of race, and any qualifying terms. + Read caeflly enough 0 that you only have to read the question once. Going back ‘over the question takes time. Read for comprehension the fst time Paraphrasing is the key to effective reading. Because the exam is administered on computer, you can no longer undertne key facts, circle abnormal findings, or make notes in the mains. “To compensite, superior test takers continuously summarize the key information in a brief {ashion while reading the question, This allows you tolook to the options with a sharp focus on the key elements and lessens the need to go back to reread it while examining the choices. Look at the following question to see how this is done A 7o.yearold smoker and alcohol abuser i hospitalized for evaluation of 2 squamous cell carcinoma of the am On his second hospital day, he complains of sweating, tremors, and vague gastrointestinal dress. On Piyscal examination, hes antious and has temperature of 101 Fear rate of 104/mi, BP of 1Sq/!00mm Hg, and a respztoy rate of 22 breaths pet minute. ater that da, he has three generalized tonicconic seizures. Which of the folloning isthe most ely cause of his seizures? (A) Aloholwithdcwal (©) Brain metastasis © Febrile seiawe (©) Mypoaleemia (© Subdurl hematoma Anower: A) ‘The mental paaphasing for this question might be as follows ‘An old man with laryngeal cancer who smokes and drinks too much hat sweat, tremor, a and some GI problems—he has three seizures afew days after admission, What's causing the seizures? Tracking the Exam | 25 Remember You cant give a coer answer toa quesion tat you havent redScion One: TestTeking and Stody Stateges Guide ‘Chapter Three Paraphrasing isthe mental equivalent of underlining. Ithelps you selec what's important and kecp thot key fats in mind while you are evaluating possible answer. Like mos test-taking Skills it also takes practice. If you practice paraphrasing material when you study, you wil ind that you have developed the basics to answer questions. Paryphrase each time you work with questions to gain skill and confidence. Step 2: The Prediction Pass. ‘After eating the question, stop Before looking atthe option, try to come up with an answer ‘We cll his the preiction pass because you are trying to think ike the question writer and pre- dict the correct answer. By the USMLE’s own rules, questions are written so that any expert in the field can come up withthe correct answer without having any options present. (With the correct answer in mind, you ar les likly tobe led astray by distractor, Remember, they are supposed to distract you and convince you to pick the wrong answer. Ifyou se the answer you thought of, scan the other answers to be sure that itis the best. Then pick it and ‘move on tothe next question. Step 3: The Selection Pass. ‘Air reading the question, look down through al ofthe distracts in order (A,B, CD, ,1,G, tc). you se a correc ase pckit. This the selection pas. Ifthe answer seems cbvious and {iret good, Do not rick yours into thinking the question must be ricky o* more diffu Most answers wil be clearly correct. Ifyou find yourself making up along story why ane option is better than another, stop yourself You are probably wrong, The correct answer should be leary correc, two aswers sem tobe almast the same, then neither one correct. Once you hhave identified what looks tke the best answer choose it and move on to the nest question Step 4: The Final Pass. 1, after reading through the opGons, you ae sil not sure ofthe answer, you have one final try the fina pass. At his tage, rater than trying for a correct answer, you ae eliminating those you ow tobe incorrect. Using this strategy, you can usualy eliminate all bu tw ofthe options. ‘When you have narrowed your choles down to only two options, you have now arrived atthe ‘most crucial moment of the exam. The enerect action at this pont isto pick one of the wo answers and move onto the next question, I'you are really unsure ofthe correct anser, which ‘one you pick does not mate, With two options to choose from, you have 250 percent chance ‘of getting the question correct, rather than the 20 percent chance you started with ‘Make a choice. Many people waste time at this point by not choosing. Some people, when they have eliminated all but two answers, go back and rereed the question in hopes of finding some information that wil help them choose between the two options, Time spent talking with sti- dents and watching their thought processes during the exam suggests tht this the wrong ‘strategy. When students read a question a this point, they tend to add tito pick out single ‘atures that help them fel better about choosing one of the answers. Howeve,it does not help them pick the right answer. BY adding assumptions tothe question, students may feel more ‘confident, but they ee rally mentally rewriting the question tobe one that they fel more com- fortable answering. The answer they picks then the right answer tothe question that they env sion, but not fr the actual question presente. fae these three passes (1, Predition Pas, 2. Selection Pas, 3. Final Pass) you sil ate not sure ‘ofthe answer, your best option isto guess. At this point, mark any eter and move on to the ‘next question. No answer counts the same asa wrong anne.‘Section One: TestTaking and Study Stategies Guide {Questions with large numberof options should be handle the same way asl ne-best-answer -Sestons, The only ciference stat you should not do a Final Pass because it would et up too ‘uc time. That means these questions usually take less ise to handle if dane correct emember: the key to doing well on this exam ito train yourself make choices. fyou donot ‘snow an answer, admit it make your best guess, and move on to the next question. TIPS FOR THE WEEK BEFORE THE EXAM Daring the last fev days before the exam, you should be tapering off your studying and geting v0 mental and physieal sbape - This is not the time for ramming in new material, but time to organize and integrate what you already now. Work on making what you know more accesible, Review keywords, phrases, and concepts. Look over your summary notes one more time. This i the time to dill yourself on esental information The key i to practice recall, not simply read over the material again. What you need to know is probably already in your head, Your tsk now isto train youself ro access the information when you need it. Doing practice questions ia good way to reinforce your recall skills. Remember, practice questions fre fen harder than the questions onthe ral exam, so do not panic yous do not gt them ‘ight Use them to clarify your understanding af ke details, 53. Have an honest conversation with yourself and decide what you do not know. No one can ‘know everything that i asked on this exam. Be honest with yourself about what you do and a not know Krawing that you do not knove somthing gives you more ofa sense of control fn the exam and makes you les likely to panic when you encounter the material and/or ‘este time on questions you ate not likly to get cornee. When you come to question that you know that you do not know, simply mark your favorite letter and move on! 4. Get youself onto the right time schedule. Wake up every day at the same time you will need to on the day ofthe exam. This will get your circadian Fhytam coordinated with the exam schedile. Do not nap between #00 41% and 5:00 Pm. Otherwise, you will accustom your body to shutting dowa during critical exam hours, 5. You shouldbe getting sufficient amount of slep, For most people that means atleast 6 10 7 hours night Sleep isan essential time for your brain fo consolidate what you have learned, You need sleeps it makes you a more efficient leaner when you are awake. 6. Take some time each day to relax. Have a good meal Take a walkin the fresh ai. Find time for exercise. The change of pace will refresh you and the physical activity will help you relax and sleep at night Consider the impact of your personal relationships on your preparation, Family responsi- Lilies and obligations can be very distracting. The week before the exam you should avoid family confrontations and any stressful relationships. Your focus should be on the exam and nothing ele. The other parte of your life can wait, 1. you vent done so already, visit the Prometric Center whece you willbe taking the exam. lt willbe indicated on your exam entry ticket. This will ensure you knw how to get thece and how much time you shoul allow forthe commute, You can see where you should park, and see what the computer set-up is ike 8. Ifyou have not yet done so, review the tuloral on the official USMLE CD-ROM, Recome {amiliae with the interface, the location of Key information on the screen, and how to navi- {ate between screens f you walk ito the exam familiar with the exam, you wil not have to _use any of your valuable break time to do this on test day. Tackling the Exam | 27 Remember Use te time before the eam for even, ot for tyng to Jean new materialSection One: Test aking and Study Stotegies Guide {Chapter Three ‘THE DAY BEFORE THE EXAM 1. Take the ayo om all tadying. Theis your day to relax and gather your stengh before themain eet, Gt ou of bd at the same ne you wil have to et up he net day and then trea! this aya a vcation day to reward youre fo all your hard work. If you mst ty, limit yourse to reviewing your own notes and fasard. 2. Have some fan. Go fora wal. Listen to your fvorite muri. Go sce» goo comedy or an action movie that will llw cathartic reese. Go shopping. Spend time with sigiicint other Do whatever you ike You have worked bard and deserve it 2. Make se tat you hav checked ou the bass forthe exam: + Have you worked through the USMLE CD-ROM roi? + Do you know where the exam is bing given and how to ge thee? + Do ou he atemative transportation if for example, your ar dost not art + Do you trast your alarm clock to wake you up in time? If not, make arrangements with frends a a backup. You want tobe sure to wakeup ested, reeeshed, ad on tine 4 Lay out what yu!ll need for your exis before you go t lep. This ncades your photo ‘denutcation,sehedlig permit and confirmation number aswell x any persona ems Tike eyes Whyte a ity dot forget to pack hncht 5 Call your frends and casmates and make some plas to celebrate after the eam is over. “ui need to blow off some seem anyhow, and aking with clleagus wil remind you tat yo are notin this by youre. 6 Bese to do some physi activity Just taking a walk for an hour will hp relax you. 1. Geta good nights sep. To lp you sep consider aot bath or wm milk, Avoid taking sleping medication a ay lve you grog nthe morning ‘THE DAY OF THE EXAM “This isnot the most important day of your carer, but just another hurdle on your way t0 ‘becoming a icesed physician. Keep it in perspective. Treat the exam lke what i i a routine ‘mechanical exerci. You ate not doctor for this da, but an assembly line worker. Rather than ‘making cats or toasters, you aze answering questions. Deal with each question as you come to ty make your choice, and then move on. "No mater how well prepare you are forthe USMLE Step 2CK exam, you will gt many questions ‘wrong. This satan exam were you should expect to know every answer. Remember, 70 percent ‘correct puts yo well over the mean! Knowing this, your test-taking strategy should be some- ‘what diferent than it may be when you take other exams. ‘Doing wll on this exam means spending your time on those questions you are most likely to get correct, and not wasting time on questions you ate likly to get wrong. Two minutes spent ‘om 2 question that you get wrong is two minutes wasted. Approach every question assuming ‘that you will be able to answer it correedy Ifyou discover that you can not arrive at a clear answer, admit i, make «choice, and move on to the nest question, The core idea isa simple ‘one You know you will gt some questions wrong. Therefore, admit which ones they are and spend your time on those questions for which your probability ofa orzect answer is higherSection One: Fest-aking and Stay Stotegies Guide TEST-TAKING TIPS “Try to arcive 30 minutes carly to the Prometric Cente 0 yu are aot rushed and have time to get ‘organized. You wil be given alocker to stove your personal items and then assigned «computer station, Remember that you have ¢ total of & hours to complete 350 questions in 50-question Docks You will have 1 hour for each block of questions, and total of I ou tobe used through: ut the day for breaks and lunch You will be equied to sign out when taking breaks, To cope with fatigue, you wil need to schedule breaks. Our recommended schedule forthe Question Block Break Time at End of Block Block 1 No break Block 2 S:minute break Block 3 S5-minute break Block ¢ 30-minute lanch break Block 5 No break Block 6 10-minute break Block 7 Done! This allows you 10 minutes extra to we a8 needed. You should also be aware that if you leave the exam room during bloc, it willbe marked as an ereglarity in your testing session. SO consider after each lock whether you want wo take a bathroom bresk during your break time. AFTER THE EXAM Take the day off and have some fun! You deer it! Forget about the exam and pay attention to ‘the rest of your lf that you have put on hold while preparing, You will have plenty of time to ‘hinleabout the exam agnin when your scores come in, For now, however, take a holiday! Tackling tre Exam | 79 iiédical