Frustrated with test questions...

[DrAK18]

Hi all,

So I study my butt off, I know all the material, and then when I get into my school's weekly tests, there's inevitably some questions that I just cannot figure out. I'm trying to figure out wherein lies the problem: is it in how I'm being taught, in a lack of me seeking external resources, am I just stupid? ...Whatever it may be, I'd like to figure it out.

Here's an example: We are studying H2O/Na balance and the kidneys right now. We learned all about clearance rates (using the formula C = ([X]urine/[X]plasma) x V), but we were never taught about free water clearance by the kidneys. We were never taught what "free water clearance" means, but apparently if the urine is isosmotic to the plasma, free water clearance is 0. Thus, if someone has a free water clearance of 10 ml/min, it means is their urine is hyposmotic to their plasma and free water is being extracted from their body.

On the test, we were asked what it means if an individual has a free water clearance of 10 ml/min. Apparently, we were expected to deduce that it means he just drank 1L of pure water. I could easily do this if I had the aforementioned definition of what "free water clearance" means and that it is 0 if the urine is isosmotic to the plasma. However, all I had to work with is the formula I gave above for clearance and some basic knowledge of kidney function. I didn't know if the kidneys had a "set" free water clearance that I just wasn't aware of, I didn't know exactly what "free water" meant, etc.; it was just never taught to us.

Anyways, this happens pretty often, I feel like I'm being tested on concepts I was not taught. So I'm asking if you smarties out there have any insight on how you can make logical leaps on questions like this without full knowledge of what is going on, or if this sort of thing is just not a nice question to ask someone without giving them more background knowledge. Thanks!

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[AcademicNeurosurgery]

Much of this has to do with test-taking strategy and your ability to think clearly and not panic when you see something unfamiliar. In this specific example, you can break down the term "free water clearance" logically during the exam without fully understanding the concept. Presumably, you know what clearance means and you know what free water means (solute-free water). If someone has a positive free water clearance, that means they are secreting free water into the urine. Using your fundamental knowledge of concentration gradients, you can deduce that the urine must be hypertonic in comparison to the plasma for the free water to flow from plasma -> urine. Thus, the plasma must have more free water than the urine. Based on the answer choices, you may be able to narrow down to 1-2 choices that involve the patient having hypotonic plasma (e.g. drinking 1L of pure water).

Of course, my explanation isn't 100% accurate and the concept of "free water clearance" is more complex but this is the type of deduction you will need to do on Step 1. Use your in-house exams as a learning opportunity on how to tackle these questions. There is simply too much information in medicine for you to know every single concept/fact/biological process. On exams, you need to be able to use process of elimination and a "leap of logic/faith" to arrive at the best answer. This can be learned through practice (i.e. questions before your exams). Also realize that if your school is anything like mine, some professors are terrible, lazy test-writers who simply write poor questions. Just part of the process and not something to get frustrated with.

Don't give up!

 

[DrAK18]

Much of this has to do with test-taking strategy and your ability to think clearly and not panic when you see something unfamiliar. In this specific example, you can break down the term "free water clearance" logically during the exam without fully understanding the concept. Presumably, you know what clearance means and you know what free water means (solute-free water). If someone has a positive free water clearance, that means they are secreting free water into the urine. Using your fundamental knowledge of concentration gradients, you can deduce that the urine must be hypertonic in comparison to the plasma for the free water to flow from plasma -> urine. Thus, the plasma must have more free water than the urine. Based on the answer choices, you may be able to narrow down to 1-2 choices that involve the patient having hypotonic plasma (e.g. drinking 1L of pure water).

Of course, my explanation isn't 100% accurate and the concept of "free water clearance" is more complex but this is the type of deduction you will need to do on Step 1. Use your in-house exams as a learning opportunity on how to tackle these questions. There is simply too much information in medicine for you to know every single concept/fact/biological process. On exams, you need to be able to use process of elimination and a "leap of logic/faith" to arrive at the best answer. This can be learned through practice (i.e. questions before your exams). Also realize that if your school is anything like mine, some professors are terrible, lazy test-writers who simply write poor questions. Just part of the process and not something to get frustrated with.

Don't give up!

Thank you kindly, this was very helpful!

 

[feather421]

I would also suggest:

-Studying with friends. They focus on different things and may pick out details or think about things in different ways.

-Using outside practice questions. This one is a little more tricky, because you have to make sure that you aren't learning stuff that's unnecessary and won't be tested. But they force you to think about concepts in ways that you haven't been taught and examples that you haven't seen before.

 

[coldcase331]

Since we're talking about physio. Costanzo will become your bible for everything


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