xvSecond, when you cannot anticipate the answer, use the following guidelines
to help you make your choice:
- Opposites attract. If two of the answers are the opposites of each other,
one of them is usually the right answer.- Similars attract. If two answers are similar, one of them is usually the right
answer. Test writers don’t usually create two similar wrong answers.- Grammar is a guide.Sometimes wrong answers can be identified through
minor grammatical inconsistencies between the question and the answer
choice. The right answer should link to the question without grammatical
errors, as if it is part of a sentence that was cut neatly in half.- Avoid “always” and “never.”Answers that include alwaysandneverare
almost never correct. This fact has become so well known that you will
probably not see these words on the test. If you do, be wary.- Worst-case answers are often right.One of the goals of emergency medi-
cine training is to teach you to consider life-threatening illnesses first. Be
always on the look out for the pulmonary embolus or the ectopic pregnancy,
and anticipate the need for immediate surgical consultation and early intu-
bation. The diagnoses of GERD, gastroenteritis, or musculoskeletal low-
back pain should be made only after you have ruled out more serious
diseases with similar presentations.Third, don’t be flustered if you have difficulty interpreting a figure on the test.
Like diagnostic tests in the emergency department, images on the written exam
should be used to confirm or refute a clinical suspicion. The question will often
guide you to the answer without the image. Use the picture to strengthen your
confidence in your answer choice. For example, a 72-year-old male presents
with hip pain and difficulty walking after a ground-level fall at home. What is
his diagnosis? If you were seeing this patient in the emergency department, you
would put hip fracture at the top of the differential. The purpose of the radio-
graph would be to exclude a hip dislocation (although your exam will usually
do this) and to identify the location of the fracture. If the radiograph is negative
and the patient really cannot walk without a lot of pain, you will probably pro-
ceed to a CT or an MRI to find the fracture that you cannot see on radiograph.
Take the same approach to this patient on the test as you would in the emer-
gency department. Determine the answer from the story, and look to the image
to confirm your diagnosis. If you can’t interpret the image, answer the question
without it.
Fourth, read the question carefully. As in the emergency department, there is a
danger in being overly confident in a diagnosis. It is good to anticipate an answer
as you read, but be sure to read the entire question. Don’t be so certain about
your diagnosis of glaucoma that you miss the sulfa allergy, the history of sickle
cell disease, or COPD. Paying attention to such details can mean the difference
between choosing the right answer and a wrong one.
Fifth, be aware that test writers like to mislead test takers. It has been said that
writing good test questions is easy—it is writing good test answers that is diffi-
cult. A good test answer choice captures the imagination of unprepared test