How understanding the structure of how a USMLE question is written can help optimize your performance on NBMEs & UW blocks...
In general, here are the building blocks of a USMLE style vignette.
Chief complaint:
β Generally broad
β The focal point of the patient presentation
π― Pay attention to tempo & setting:
β ED = acute pathology vs. office setting = indolent process
β < 2 wks = acute
β 2-4 wks = subacute
β >4 wks = chronic
π― Create a mini differential
β Generally broad
β The focal point of the patient presentation
π― Pay attention to tempo & setting:
β ED = acute pathology vs. office setting = indolent process
β < 2 wks = acute
β 2-4 wks = subacute
β >4 wks = chronic
π― Create a mini differential
HPI:
β Elaboration of CC
β Think of this part as a way to understand more of pt symptoms and progression of disease
π― Relate symptoms to pathophysiology
β ex: SOB on laying flat = transudative fluid in alveoli
π― Hone in on pertinent β & β
β Elaboration of CC
β Think of this part as a way to understand more of pt symptoms and progression of disease
π― Relate symptoms to pathophysiology
β ex: SOB on laying flat = transudative fluid in alveoli
π― Hone in on pertinent β & β
Past Medical History (PMH):
β Gives an idea of what pathophysiologies the patient is predisposed towards.
π― Relate past medical history back to chief complaint
ex: PMH of DM, Htn, Dyslipidemia = atherosclerosis so now chest pain may be more π«
β Gives an idea of what pathophysiologies the patient is predisposed towards.
π― Relate past medical history back to chief complaint
ex: PMH of DM, Htn, Dyslipidemia = atherosclerosis so now chest pain may be more π«
Medications:
β Relate to PMH
β 3+ meds in a question could mean that the pt's chief complaint is due to a side effect or interaction of the medications
π― Active recall of MOA of meds helps you:
1οΈβ£ Understand how they modulate pathophys
2οΈβ£ Recall HY side effects
β Relate to PMH
β 3+ meds in a question could mean that the pt's chief complaint is due to a side effect or interaction of the medications
π― Active recall of MOA of meds helps you:
1οΈβ£ Understand how they modulate pathophys
2οΈβ£ Recall HY side effects
Social History:
β Stratifies patient as high risk vs. low risk based on lifestyle risk factors
π― Social history is important in understanding:
1. STI risk
2. Cancer risk
3. Pneumoconiosis
4. Atherosclerosis risk (i.e. from π¬)
5. Immune status
β Stratifies patient as high risk vs. low risk based on lifestyle risk factors
π― Social history is important in understanding:
1. STI risk
2. Cancer risk
3. Pneumoconiosis
4. Atherosclerosis risk (i.e. from π¬)
5. Immune status
Family History (FMH):
β Helps to identify genetic diseases or atopic states that the patient may be predisposed towards!
β Helps to identify genetic diseases or atopic states that the patient may be predisposed towards!
π Now comes an important transition point in a vignette.
The building blocks thus far were from patient perspective.
Now, we look at the (same) pathophysiologic mechanism from more of an objective/physician lens.
The building blocks thus far were from patient perspective.
Now, we look at the (same) pathophysiologic mechanism from more of an objective/physician lens.
Vital Signs:
β Quantitative data to help assess stability & systemic manifestations of disease
π― Fever = infectious or inflammatory
π― When vitals are unstable think SHOCK!
β Quantitative data to help assess stability & systemic manifestations of disease
π― Fever = infectious or inflammatory
π― When vitals are unstable think SHOCK!
Physical Exam (PE):
β Focused, hands on assessment of the pathophysiology
β Relate to the HPI (ex: paroxysmal nocturnal dyspnea in HPI = crackles on PE)
π― Understand the physics behind the PE
ex: dullness to percussion of chest = consolidation/fluid in that area!
β Focused, hands on assessment of the pathophysiology
β Relate to the HPI (ex: paroxysmal nocturnal dyspnea in HPI = crackles on PE)
π― Understand the physics behind the PE
ex: dullness to percussion of chest = consolidation/fluid in that area!
Labs/Imaging:
β Extension of PE
β It's a Kodak moment of the pathophysiology πΈ
π― Know 'why' behind the lab tests
ex: BNP = stretching of atria due to volume overload
β Extension of PE
β It's a Kodak moment of the pathophysiology πΈ
π― Know 'why' behind the lab tests
ex: BNP = stretching of atria due to volume overload
Stem π
1οΈβ£ Step 1 stems like to test more mechanisms & diagnoses.
2οΈβ£Step 2 stems like to test diagnoses, next best step, and risk factors.
1οΈβ£ Step 1 stems like to test more mechanisms & diagnoses.
2οΈβ£Step 2 stems like to test diagnoses, next best step, and risk factors.
Tl;dr:
1. Each line of vignette is a building block that serves as a pertinent β or β to an underlying diagnosis or mechanism of disease.
2. The vignette can be divided into two 'perspectives': patient (i.e. subjective) & physician (i.e. objective).
3. Interrelate the blocks
1. Each line of vignette is a building block that serves as a pertinent β or β to an underlying diagnosis or mechanism of disease.
2. The vignette can be divided into two 'perspectives': patient (i.e. subjective) & physician (i.e. objective).
3. Interrelate the blocks
Hope this helps you clinically reason & think like the test maker as you approach vignettes for USMLE/NBME exams!
Slowing down & analyzing the vignette line by line will help you understand various patterns in USMLE style questions! π
Best wishes!
Slowing down & analyzing the vignette line by line will help you understand various patterns in USMLE style questions! π
Best wishes!
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