USMLE Step 2 Clinical Knowledge
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Introduction to USMLE Step 2
Step 2 assesses whether you can apply medical knowledge and understanding of clinical science essential for the provision of patient care under supervision, and includes emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences that undergird the safe and competent practice of medicine.
Step 2 consists of multiple-choice questions prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada. Test questions focus on the principles of clinical science that are deemed important for the practice of medicine under supervision in postgraduate training. The examination is constructed from an integrated content outline that organizes clinical science material along two dimensions.
Normal Conditions and Disease Categories (Dimension 1) form the main axis for organizing the outline. The first section deals with normal growth and development, basic concepts, and general principles. The remaining sections deal with individual disorders.
Sections focusing on individual disorders are subdivided according to Physician Task (Dimension 2). The first set of physician tasks, Promoting Preventive Medicine and Health Maintenance, encompasses the assessment of risk factors, appreciation of epidemiologic data, and the application of primary and secondary preventive measures.
The second set of tasks, Understanding Mechanisms of Disease, encompasses etiology, pathophysiology, and effects of treatment modalities in the broadest sense.
The third set of tasks, Establishing a Diagnosis, pertains to interpretation of history and physical findings and the results of laboratory, imaging, and other studies to determine the most likely diagnosis or the most appropriate next step in diagnosis.
The fourth set of tasks, Applying Principles of Management, concerns the approach to care of patients with chronic and acute conditions in ambulatory and inpatient settings. Questions in this category will focus on the same topics covered in the diagnosis sections.
The diseases noted in the outline do not represent an all-inclusive registry of disorders about which questions may be asked. They reflect the development of a “High-Impact Disease List” that includes common problems, less common problems where early detection or treatability are important considerations, and noteworthy exemplars of pathophysiology. Questions are generally, but not exclusively, focused on the listed disorders. In addition, not all listed topics are included on each examination.
Study Techniques for USMLE Step 2:
When the test starts:
- Start your exam with a topic you are familiar with. This will tend to have you feeling good about the exam. This will build up your confidence to be able to answer those questions that you really find it easy. This builds confidence on your part.
- Make time for Matching. Knock this one out first if you see it. Often, there are many easy questions in there that people often run out of time to capitalize on.
When answering LONG question stems:
- Read the last sentence first. When you see a lengthy question that looks like a paragraph or half-page, the best thing to do is to read the last sentence of every question to find out what they are looking for. Then, read the question and you will be more focused. That is incredibly important.
- Look for hints. Questions may contain 5-7 hints so look for it and circle keywords as you read through. When you read those long questions you don’t know the answer, don’t read it again because you still won’t know the answer. Remember it’s a time constraint test and you don’t have the luxury of 5 minutes looking at one question. So that you can get an educated guess on and KEEP MOVING.
Should you ever guess on a test?
- Yes, but not in the setting that you may think. Here are some techniques that might help you navigate shelf exams:
- Only guess when you really don’t have any idea. When you read questions you have no idea about and you simply don’t know a thing, and then guess.
- When guessing, let it be an educated guess. First look at answer choices that are remotely familiar answer, take it. This is probably the answer. Certainly don’t randomly choose one favorite, pre-determined letter B or C and stick with it – this is a bad idea! You’ll hear all kinds of advice similar to this, but test writers hear the rumor mill too.
Patient management decisions:
- For the USMLE Step 2, think cheap and use your common sense. When dealing with management, find the cheapest “next step”. Often, the gold standard is not the first step on the USMLE, or in real life.
Single One Best Answer Questions
This is the traditional, most frequently used multiple-choice format. These items consist of a statement or question followed by three to twenty-six response options in alphabetical or logical order. The response options in this format are lettered (eg, A, B, C, D, E). Examinees are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.
Read each question carefully. It is important to understand what is being asked.
Try to generate an answer and then look for it in the option list.
Alternatively, read each option carefully, eliminating those that are clearly incorrect.
Of the remaining options, select the one that is most correct.
If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
Example Question 1
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She is not yet on dialysis. Examination shows no abnormalities. Her hemoglobin level is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 µm3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?
A. Acute blood loss
B. Chronic lymphocytic leukemia
C. Erythrocyte enzyme deficiency
D. Erythropoietin deficiency
E. Immunohemolysis
F. Microangiopathic hemolysis
G. Polycythemia vera
H. Sickle cell disease
I. Sideroblastic anemia
J. b-Thalassemia trait
(Answer D)
Matching Sets
This format consists of a series of questions related to a common topic. All matching sets contain set-specific instructions, a list of lettered response options, and at least two questions. There will be between four and twenty-six response options. Each set is preceded by a box that indicates the number of questions in the set associated with the response options that follow. Examinees are directed to select one answer for each question in the set. Questions will be presented one at a time, with set-specific instructions and response options repeated for each subsequent question (see examples below).
Strategies for Answering Matching Sets
Begin each set by reading through the option list to become familiar with the available responses.
Read each question carefully.
Within a set, some options may be used several times, while other options may not be used at all. Respond to each question independently.
For matching sets with large numbers of options, try to generate an answer to the question and then locate the answer in the option list. This is more efficient than considering each option individually.
Example Question 2 (Screen 1 of Set)
The response options for the next two items are the same. You will be required to select one answer for each item in the set.
For each patient with lymphadenopathy, select the most likely diagnosis.
A. Chronic lymphocytic leukemia
B. Drug reaction
C. Hodgkin’s disease
D. Infectious mononucleosis
E. Metastatic carcinoma
F. Sarcoidosis
G. Systemic lupus erythematosus
H. Toxoplasmosis
I. Tuberculosis
J. Tularemia
A previously healthy 30-year-old man has had fever, night sweats, pruritus, and an enlarging lump above his left clavicle for 3 weeks. Examination shows a 3-cm, nontender, rubbery, supraclavicular lymph node. An x-ray film of the chest shows mediastinal lymphadenopathy.
(Answer C)
Example Question 3
For each patient with lymphadenopathy, select the most likely diagnosis.
A. Chronic lymphocytic leukemia
B. Drug reaction
C. Hodgkin’s disease
D. Infectious mononucleosis
E. Metastatic carcinoma
F. Sarcoidosis
G. Systemic lupus erythematosus
H. Toxoplasmosis
I. Tuberculosis
J. Tularemia
A 41-year-old woman comes to the physician for a follow-up examination. She has taken aspirin for chronic headaches and phenytoin for a seizure disorder for 2 years. Examination shows mild epigastric tenderness and bilateral, 3-cm, nontender axillary lymph nodes. A lymph node biopsy shows hyperplasia.
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