How to Get the Most out of UWorld Questions for the USMLE

  • /Reviewed by: Amy Rontal, MD
  • Why should you bother studying all of these UWorld questions for your respective Step exams? I mean there are literally thousands of them; multiple iterations on the same list of topics that you need to master! What’s the point?

    After all, these are literally thousands of questions you will NOT see on your own respective Step exam. That’s scary!

    Also, it seems like there are an infinite number of topics that need to be memorized and categorized into arbitrary lists and tables.

    So how do you take something that seems endless and use a learning tool like UWorld to make sense of it all?

    UWorld is essentially core content that you WILL be tested on during your test day, but in the context of clinically relevant cases that focus on the need to know high yield concepts. Each question is designed to test a different aspect of some clinical topic.

    For example, the topic of sickle cell anemia can be cloaked in hundreds of different ways leading to many iterations of questions. Consider the vignette that starts with a 9 year old male with sickle cell anemia who presents with chest pain, a new lung infiltrate on chest x-ray, and pulse oximetry of 91%, concerning for acute chest syndrome. What is the main take away concept here? Is it the acute chest syndrome or the sickle cell anemia; well it is actually both but really the umbrella topic to know here is sickle cell anemia and HOW it is tested.

    Imagine how multi-step questions can be constructed just from this simple case scenario (not so simple though for the real life patient).

    Questions like:

    • What is the most likely diagnosis?
    • What is the best next step?
    • Which focus more on the acute chest syndrome component?
    • Or more basic science questions focusing more on the pathophysiology of sickle cell anemia, the inheritance patterns, etc.

    The point is that each time you do a question in UWorld, you should be identifying the REAL topic that is being tested and anticipating how that specific question you are sweating through can be altered to cover the different aspects of that topic. (You also want to avoid these 5 mistakes.)

    So if you are working on a sickle cell anemia question that sounds like the most likely diagnosis of acute chest syndrome and your best next step is admission with empiric antibiotics, do not forget to review as many other sickle cell anemia topics as you can WHILE you are doing the question.

    What is the benefit of this?

    The main benefit is that now YOU are the test writer; you start thinking like a test writer, and therefore you will be less surprised come test day when you encounter a whole new batch of test questions. This allows you to integrate across multiple questions and disciplines which will ultimately prep you very well for test day. So spend more time on each question; don’t just read the explanation and move on to the next, pause and think a bit more about the question you just completed.

    Think about several questions back in your block and how that prior question was similar and/or different to the current question.
    This may take longer, so start early! The time you invest now in each question will serve you well on your test day.

    Let’s apply this to a question and break it down:

    65 year old male with past medical history of hypertension, diabetes mellitus II, and coronary artery disease presents to the emergency department with chest pain acute in onset. It is crushing, substernal and radiates to the left shoulder. The medications he normally takes are aspirin daily, atorvastatin, metoprolol, and glipizide. His vital signs are notable for blood pressure of 100/60, heart rate of 104, respiratory rate of 24, saturation of 93% on room air, and he is afebrile. The cardiopulmonary exam is notable for bilateral rales 1/3 up the posterior lung fields. He has a harsh holosystolic murmur that is best appreciated in the apex and radiates to the left axilla. Which of the following is the best next step in management?

    A. ECG
    B. CXR
    C. D-Dimer
    D. Comprehensive metabolic panel
    E. Troponin
    F. Chest CT with contrast

    Question Breakdown:

    The answer to this question is A. ECG. This patient is a 65 year old male with multiple medical comorbidities; he has diabetes, high blood pressure, coronary artery disease and he is presenting with chest pain that is typical of an acute coronary syndrome. The best next step would be to obtain an ECG to see if he has ST segment elevations on the ECG which would determine if goes emergently to the cath lab or if he is initially managed medically. The other options are important tests to get for someone with chest pain, but not all of these tests are required for someone with chest pain. The cardiac troponin can be negative initially with someone having an acute myocardial infarction even if the ECG is positive and that is why the best initial test is the ECG.

    This question is also a great branch-point to review other topics related to this vignette (as is our previous question breakdown post). For example, while our main focus in this question is to arrive at the best answer in this scenario, and to correctly reason why this is the answer and why the other options are not, we can also take this opportunity to review other high yield topics mentioned in this vignette.

    Hypertension = review of basic science, physiology and pathophysiology of blood pressure. Corollary and integrative questions relating to the topic of blood pressure, high blood pressure, the different causes of blood pressure, its management.

    Diabetes = review basic science, physiology and pathophysiology of diabetes, its complications, and its management.

    Do this with each disease mentioned in the medical history.

    The medications listed in the case are also an opportunity to review their mechanisms of action, uses, side effects, and relevant diagrams that are frequently asked of them.

    By doing the above, you will not only constantly reinforce the content of the question at hand, but also integrate the topics inherent in it and in other questions you are doing. Good luck!