First, what is the anatomy of a multiple-choice question?
Stem - this is the clinical vignette
For example: A 34-year-old man presents to the ED with complaints of fatigue. The patient states that over the previous week he was camping at a near-by National Park. On exam you note motor weakness in his lower extremities.
Lead-in - this is the question
For example: Which of the following conditions is associated with ascending weakness?
Options - your answer choices
Well-written questions have one answer choice that is correct, but it is surrounded by distractors. Think about the answer choices on a continuum that looks something like this:
Are there tricks to help tip you off to which of the answer choices are incorrect?
Or even better, which of the answer choices is most likely the correct one...without even reading the question.
While preparing for the board exam, you should utilize these simple techniques to guarantee the best chance of passing the exam.
Grammatical cues - one or more answer choices (distractors) don’t follow grammatically from the stem
Q: A 60-year-old man is brought to the ED by the police who found him lying unconscious on the sidewalk. On exam, he is breathing spontaneously and has clear, bilateral breath sounds. He is diaphoretic. The first step in management should be intravenous administration of?
Question writers tend to pay more attention to the correct answer than to the distractors, grammatical errors are more likely to occur in the distractors. In the example above, It is clear that answer choices A and C can be ruled out because they do not grammatically fit with the question stem.
Logical cues - a subset of the options are collectively exhaustive
Q: Which of the following is true regarding febrile seizures?
Options A, B, and C include all possibilities. Therefore, one of these options has to be the correct answer. Choices D and E, therefore, can be eliminated.
Absolute terms - such as “always”, “never”, or “all”
Q: An 88-year-old man is found lying on the floor of his apartment. He states that he fell 3 days ago and was not able to stand up. Lab results reveal a CPK of 15,000. Which of the following is true regarding his condition?
Options A and D contain terms that are less absolute (frequently) than options B and C (always). Therefore, options B and C can be eliminated because they are less likely to be true than something stated less absolutely (choices A and D).
Longer option is the correct answer - often the answer choice that is longest, more specific, or more complete than the other options is the correct choice
Q: Which of the following is correct regarding aortic dissection?
Option B is longer and more specific than the other answer choices. Question writers tend to pay greater attention to the correct answer rather than the distractors and write longer correct answers that are more in-depth.
Word repeats - a word or phrase is included in the stem and in the correct answer
Q: A 49-year-old man with a history of schizophrenia and bipolar disorder presents to the ED confused and agitated. He states that he is hearing voices and that the world he is living in is not real. Which of the following best describes his condition?
The question contains the word “not real” and the correct answer is option A, derealization.
Opposites - two answer choices that are opposites of each other, one of them is usually the correct answer
Q: A 45-year-old man presents to the ED after a syncopal event. On exam, you note a loud crecendo-decrecendo systolic murmur at the left lower sternal boarder. Which of the following maneuvers will accentuate the murmur?
Options B and C are opposites and the correct answer is likely one of them...in this case option C is correct
Similar answer choices - when two choices are very similar in detail it is likely that one of them is correct. Question writers rarely create two similar distractors.
Q: A 42-year-old woman with HIV presents with dyspnea, cough, and fever. Her CD4 count is unknown. You note oral thrush on exam. The chest x-ray reveals bilateral hilar infiltrates. Her pulse ox reads 98% on room air. Which of the following best describes the next step in management?
Options C and D are similar in detail and only differ by which antibiotic is recommended. One of these similar options is likely to be the correct answer...in this case option C is correct.
Test-Taking Hacks