Insights into COMLEX & USMLE: 6 Hidden Truths They Don't Disclose

Secret 1: “COMLEX is a Poorly Written Test”

Comlex is a poorly written test. Simple as that. Throughout your exam there will be many questions which will leave you guessing what the question was even asking as the question stem is either too concise (one sentence) or overly wordy (two paragraphs). This format makes it difficult to answer questions as there is no way to definitively diagnose a condition off of one sentence of information, especially when all of the answer choices technically could be possible diagnoses. So, how do we approach these types of questions?

First, pick the answer choice which you first thought was correct as it usually is right as we will mention below.

Second, if no answer jumped out at you as being the best one, then go with the answer that is the most common cause for whatever condition they describe, especially if the stem includes specific buzzwords. For example…

A man recently went on a cruise and now presents to your office for complaints of malaise, diarrhea and vomiting. What is the cause of this patient’s symptoms?

 Now there is no way you could definitively diagnose this patient without some labs tests or at the very least a more detailed history. It could be ETEC, shigella, norovirus, or one of the other thousands of causes of diarrhea. However, since they gave you nothing else to work with, and a common cause of diarrhea and malaise related to cruise ships in norovirus you just need to assume this is the answer and move on.

Secret 2: “There is More Than One Correct Answer”

While taking your test you will notice multiple times that there are more than one possible correct answer for the question. Test writers do this to see if you can identify the “most correct” answer given the specifics of the question stem. When you encounter these types of questions you need to pit the answer choices against themselves and make an argument for why one is better or worse than the other. Some specific items that should be evaluate include:

Time: While both answer choices may be correct, is there one that should be performed first?

Question specifics: Is there a reason this specific patient should not receive this drug, have this treatment, etc.

Risks: Does one test have less risk (Ultrasound vs CT), or is one test less invasive than another?

These are some of the questions that you should be routinely thinking about when deciding between two similar answer choices.

Secret 3: “Answer the Question You are Asked, Not the One You Think You Were Asked”

One huge downfall for many test takers is that they know the information well but are careless when taking the test. A common tactic used by examination writers is how they word the question. You must be sure that the question you are answering is the one they actually asked, and not the one you think they may be asking. For example…

A man presents for right sided weakness and tingling in addition to slurred speech and difficulty with finding the right words to say. He has a past medical history significant for diabetes, a 30 pack year smoking history and uncontrolled hypertension.

Which of the following is most sensitive test for diagnosis of this patient’s condition?

Which of the following is the best next test?

Here the answer to the first question would be MRI, as it is the most sensitive imaging modality for stroke. However the answer to the second question should be CT scan. Unfortunately many students will read through these questions quickly, get excited that they know the diagnosis and immediately jump at the answer that would be the next diagnostic step, however, as we see with the first question this is not always what the question is asking and therefore not always the right answer.

Secret 4: “Recall Questions Tend to Have Many Answers”

If there are many answer choices, such as A-H, then the question is more likely to be related to cold recall rather than application. If you do not immediately know the answer to a question in this format it is likely better than you flag the question, pick an answer and move on as it is unlikely you will be able to reason through the question stem.

Secret 5: “Answer Choices are Meant to Mislead You”

Don’t let the answer choices lure you into the wrong answer. Some suggest that you look at the answer choices before reading the question stem, however this can sometimes be misleading as it already skews your interpretation of the patient’s presentation.

We suggest reading the question first, followed by reading the rest of the stem.

When reading each question stem you should be forming what you think the diagnosis or answer is. This gives you an unbiased approach for when you look at the possible answer choices. If you look at the answer choices without already having an idea as to what the correct answer is in mind, then it is likely that you will be tempted into picked a distraction answer choice.

Secret 6: “The Less Options, the Better Your Odds”

You need to narrow down the answer choices. There are typically 5 answer choices for each question, labeled A-E. Of the 5 answers, one can usually be ruled as incorrect immediately. Of the remaining 4, it is usually easy to determine that 1-2 answer choices are simply less likely to be the answer rather than another answer choice listed. Now you are choosing between 2-3 options rather than 5, which gives you significantly better odds than when you started.