By now you know that I wrote, and also sell, a book called The Final Step – a collection of about 1,200 short, key-term-type questions.
Every once in a while, I get an email from someone that goes kinda like this:
“Brian, don’t you know that they don’t use key terms on the exam anymore?”
Or…
“I went through all of your material and I didn’t see any questions like yours on the test.
On the other hand, I also get emails things like this…
“Brian I just took my EOR and had questions RIGHT out of your book. Thank you!”
“I could hear you in my head throughout my entire exam, Thank you so much!”
“Your book was a major reason I passed my exam.”
A complete 180 from the first 2 emails. ????
Here’s how it’s possible. Some people don’t “see” the key terms. They are often hidden.
Here are a few questions stems to illustrate the point:
– A tall thin 19-year-old male comes into the ER with trouble breathing and chest pain. No history of trauma…
– A 17-year-old basketball player presents to the ER with trouble breathing and chest pain. There is no history of trauma…
– A college basketball player presents to the ER with trouble breathing and chest pain. There is no history of trauma…
Do you see it? These are exactly the SAME question. With the same exact patient presentation just said in a few different ways. At this point, if you know your key terms, you should be thinking about a spontaneous collapsed lung.
So, if the key term is “tall, thin young man with breathing issues,” think collapsed lung (until something in the stem makes you think otherwise).
They could go another way and say…
– A young male basketball player presents to the ER with trouble breathing and chest pain. There is no history of trauma. Because of his chest pain you order an ECG and it shows left ventricular hypertrophy.
So, as I’m reading this question, I’m thinking, “Okay, it’s a collapsed lung. Oh wait. LVH in a young male athlete causing an issue… might be hypertrophic cardiomyopathy???” I continue through the stem looking for clues (AKA your key terms). Then, I use the answer choices as clues as well.
Why don’t some people see the key terms?
Because the test MAKERS try to “hide” them. They don’t want it to be a key-term test, but, despite their best efforts, it has to be key-term driven.
These “clues” are unavoidable.
This question is dramatically different if I write…
– A 45-year-old overweight male comes in with shortness of breath and chest pain.
Or…
– A tall thin female presents c/o shortness of breath and chest pain.
Or…
– A person comes in c/o of shortness of breath and chest pain, with no previous trauma.
Do you see the difference? They have to give you clues. They have to give you something to go on. Something so that you can start building your differential diagnosis. Those things are your key terms or clues.
You can miss them because they might be disguised, but the key ideas MUST be there.
A tall, thin, clear skinned woman probably won’t be in the question stem for PCOS.
Knowing these clues and these key terms is the easiest way to pass your exams. It’s the easiest way to feel confident and like you know what’s going during an exam.
To know your key terms so well that you pass on the first try, get The Final Step.
Brian Wallace
P.S. One of my favorite examples to work with to demonstrate this stuff is a slipped capital femoral epiphysis, something commonly found in a large, 12-year-old boy. I operated on someone recently who had one as a kid. It was cool to see his x-ray. Not for him, but for me.