Getting the right answer to many questions relies on knowledge of definitions and descriptions, rather than facts and buzzwords as we are lead to believe. There are less buzzwords than there are descriptions of buzzwords or alternate and little used words for these buzzwords. Knowing these, along with a good fund of knowledge allows the reader to recognize patterns of diseases and syndromes. This is more of the ‘integrating’ process when reading through a question, that is, after translating phrases or descriptions to concrete terms or buzzwords, integrate them in to a disease or syndrome that triggers memories. Obviously everyone does this to some extent or they wouldn’t be passing, but I recommend going a step further and literally saying it in your head and fully translating the question into a simplified form.
A second key to this method is identify what the actual question being asked is (which surprisingly can be very hard to get to), and furthermore what the concept being tested is.
I will use a question from the NBME free 150 to illustrate this:
A sexually active 23-year-old man with multiple sex partners has dysuria and a yellow urethral exudate. Gram stain of the exudate shows numerous neutrophils, many that contain intracellular gram negative diplococci. He has had three similar episodes of urethritis over the past 2 years. Which of the following properties of the infecting organism best explains the reinfection?
Here is how I would read this question and the thoughts in my head:
A sexually active 23-year-old man with multiple sex partners has dysuria and a yellow urethral exudate.[Ok so young guy with STD]. Gram stain of the exudate shows numerous neutrophils, many that contain intracellular gram negative diplococci [So, young guy with gonorrhea]. He has had three similar episodes of urethritis over the past 2 years. Which of the following properties of the infecting organism best explains the reinfection? [What property of gonorrhea allows repeat infection?]
This is a very simple example but it illustrates how the thought process simplifies a second order scenario to a very discrete question that is much easier to approach.
A second example from the free 150 shows how this method can be used in eliminating answers as well as clarifying the question:
A 22-year-old man develops delusions, flattening of affect, catatonic behavior, hallucinations, and aphasia [Ok, so young guy has schizophrenia].Which of the following symptoms would be more likely to improve if this patient were treated with clozapine rather than haloperidol? [Which symptoms of schizophrenia are treated differently by clozapine (2nd generation antipsychotic) vs. haloperidol (1st gen?)]
I briefly look over all the answer choices and realize they are examples of positive vs. negative symptoms so the question becomes: Do 2nd generation antipsychotics better treat positive or negative symptoms of schizophrenia? I know the answer to this question is negative symptoms.
(A) Affective flattening and aphasia [Ok these are both negative symptoms so probably the answer]
(B) Affective flattening and hallucinations [one of these is positive and one negative so can’t be]
(C) Aphasia and delusions [one of these is positive and one negative so can’t be]
(D) Catatonia and delusions [one of these is positive and one negative so can’t be]
(E) Hallucinations and delusions [both of these are positive, so a possible answer, but not correct]
In this example, even if I didn’t know the concept being tested (efficacy of 1st vs 2nd gen antipsychotics), I could recognize the pattern of symptoms in the answer choices and get a 50/50 shot.
Again, I don’t think this method is new or groundbreaking and I believe it is done to some extent by everyone, but making a concerted effort to think this way and to practice this way with question banks I think would increase scores, especially for people having a solid knowledge base but struggling with more difficult questions. Have you ever been stuck on a question after you read it and think… what is this thing talking about? That’s where I feel this method shines.
We know that the more practice questions a student does the more likely they are to have a good score, I think that is in part due to naturally (perhaps subconsciously) developing the skills I’ve listed here. This method provides clarity to the question being asked and allows for multiple ‘checkpoints’ where you can assure the answer you choose is correct.
There is an obvious downside, and that is if any translation or integration of phrases in a question is done incorrectly, it throws it all off. In my experience the vast majority of the time being incorrect in my integration made all of the answer choices seem very odd, which lead me to go back and reassess my thoughts, usually leading to the correct answer.