Test Taking Strategies for the
Boards
Franklin A. Michota, MD, FACP, FHM
Associate Professor of Medicine
Cleveland Clinic Lerner College of Medicine
at Case Western Reserve University
Director of Academic Affairs
Department of Hospital Medicine
Cleveland Clinic
1
Getting Ready
• The ABIM exam is designed to test
breadth and depth of knowledge
– Not just the ability to recite facts and
figures
• You cannot CRAM
for it!
• However, the test is
for the GUMP:)
2
Getting Ready
• Assess yourself
– Review courses and practice examinations
can help
– Know your strengths and weaknesses
• Rely on study guides, not
textbooks
• Review sample questions
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Join a Study Group
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Understand the Test
• Comprehensive computer-based
examination that focuses on all major
areas of internal medicine
– 14% cardiovascular disease
– 10% GI, pulmonary, ID, renal disease,
endocrinology
– 5% Heme/onc, rheumatology, geriatrics, women’s
health, neurology, psychiatry, dermatology
– 2% Palliative care, ethical issues, ophtho
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Understand the Test
• All questions are case-based
• Will ask you to pick the single best
answer
• For many questions you will need to
both make a diagnosis and suggest the
best treatment
– Pick the right diagnostic test, choose the right
treatment, identify risk factors
– Questions can be short or long (3 paragraphs)
• Xrays, photos, and other images are
common and important
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Understand the Test
• Late-breaking clinical studies will not
show up on the test
– Question are created at least a year before they
are “made live”
• Not all questions count towards your
score
– Discriminating questions are not easy to create
• 20% of questions are repeated year
after year
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Question Anatomy
• Clinical vignette is
called the stem
– Contains the critical
clues
– Not all the information
is needed
• The actual question
is the last sentence
– Called the “Lead-in”
• One correct answer
with 4-5
distractors
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Test Taking Strategies
• Work questions systematically
– Look at all pictures and images first
– Next, read the “Lead-in” carefully
– Now go and read the stem and noting
key points or facts
• Abnormal findings or labs
• Age and gender
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Sample Question
• A 73 year old man is brought to the ER
by his daughter for confusion and
vomiting. She states he was fine earlier
today, but that in the last hour he has
become confused with an episode of
emesis. He has a past medical history of
hypertension and tobacco use. He
drinks four gin and tonics nightly. He is
widowed and lives in an apartment
alone with his daughter across the hall.
His medications include HCTZ and
amlodapine.
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Sample Question
• On examination his vital signs are:
T=36.5, P=94, RR=20, BP=90/60. He is
disoriented, lethargic, and diaphoretic.
Lungs have bibasilar rales. Heart tones
are normal with a positive S4 gallop.
Abdomen is normal. There is no
peripheral edema, and no focal
neurologic deficits. CXR shows vascular
redistribution. EKG is shown
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Sample Question
• What is the most appropriate
next step in this patient’s
management?
A.
B.
C.
D.
E.
Administer intravenous antibiotics
Obtain cardiac biomarkers
Order a CT scan of the chest
Give the patient a baby aspirin
Send the urine for a toxicology screen
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Test Taking Strategies
• Look for “Magic”
words
– Ethnicity
– Geography
– Occupation
– Special
descriptors
• Tearing
• Plop
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Test Taking Strategies
• If the answer seems obvious, IT IS!
– There are no “trick” questions on the exam
• Absolutes such as always, never and only
are usually wrong
• Only spend 1-2 minutes on each question
and move on
– Take your best shot, don’t get stuck on one
question
– Stick with your first answer unless you
realize you misread the question
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Test Taking Strategies
• Focus on the “most likely” answer
– ABIM emphasizes general knowledge over
trivia or exceptions
– Many distractors will be plausible, perhaps
even partially correct
• Make sure there is an
“epidemiologic” fit
• There is no penalty for
guessing
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Zebras
• Look for target
words and
associations
• Anosmia = Kallmann’s
syndrome
• Paroxysmal HTN =
pheochromocytoma
• Rabbit exposure =
tularemia
• Ohio river valley =
histoplasmosis
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Sample Question
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Sample Question
•
Which of the following medications is
most likely responsible for this
patient’s findings?
A. Warfarin
B.
C.
D.
E.
Unfractionated heparin
Enalapril
HCTZ
Ciprofloxacin
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Sample Question
•
•
•
•
•
•
•
•
Laboratory studies:
WBC=6.7, Hgb=9.1, Plts=98,000
Na=136, K=3.9
BUN=26, Cr=1.5
INR=1.6, PTT=89sec
D-Dimers >1000
Fibrinogen is normal
AST/ALT = 45/52
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Sample Question
• A 65 year old woman with a past
medical history of HTN is post-operative
day #9 following a right THR. Her postoperative course was complicated by a
UTI and a proximal DVT and she is on
her 6th day of intravenous UFH
overlapping with warfarin. Current
medications include the UFH, warfarin,
ciprofloxacin, enalapril, and lasix. Over
the last 24 hours she has developed
pain and discoloration of her left hand
and foot.
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Sample Question
•
Which of the following medications is
most likely responsible for this
patient’s findings?
A. Warfarin
B.
C.
D.
E.
Unfractionated heparin
Enalapril
HCTZ
Ciprofloxacin
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Examination Day
• Computer-based examination
• Administered by Pearson VUE with
over 200 testing sites
• 8 testing sites in Ohio
• Take the ABIM tutorial prior to
exam day
www.pearsonvue.com/abim/tutorial
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Examination Day
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Examination Day
• Initial certification day = 10 hours
– Registration, optional tutorial, instructions,
exam, optional breaks, and survey
• 4 modules that are 2 hours each
• Optional breaks
– AM (20min), Lunch (60min),
PM (20min)
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Examination Day
• Registration
– Must show two forms of ID
– Electronic fingerprint, signature,
and picture taken
• Exam room
– Given a notepad, optional earplugs
– No phones, watches, pens, food, water,
gum – NOTHING IS ALLOWED IN EXAM
ROOM!
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Examination Day
• Wear layered clothing
• Don’t study the day before
– Take a 2-3 days off from studying before
the examination
• Don’t study during breaks
– Do not look up questions or discuss
answers with other examinees
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Pace Yourself
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Get Plenty of Rest
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Stay Calm
Overall, 75% of the
questions are
answered correctly
8 out 10 first time
Takers pass the exam
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Good Luck!
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