How to read a Part II case
The fastest Part II candidates are not the fastest readers. They read each case once, carefully, and let it carry them through every item.
Part II is 350 items hung on patient cases, and NBEO puts particular weight on diagnosis and treatment. The fastest candidates are not the fastest readers: they read each case once, carefully, and let it carry them through every item.
Read the case in order
- Demographics and chief complaint. Age, sex and the complaint frame the differential. A 70-year-old with sudden vision loss and a 25-year-old contact lens wearer with pain are different exams.
- History. Systemic disease, medications and family history often point straight at the answer, or at the drug you cannot prescribe.
- Findings. Acuity, pupils, pressures, slit lamp, fundus, fields and images. Name the finding that does not fit a benign explanation.
Commit before you look
Form a working diagnosis before you read the choices, then use the choices to confirm or challenge it rather than to generate it. Tempting wrong answers are built from what a hurried reader would assume.
Answer the question that is asked
One case can ask for the most likely diagnosis, the next test, the best treatment, the follow-up interval and what to tell the patient. These are different questions. A correct diagnosis does not answer the treatment item, so reread the stem of every item.
Know when the answer is urgent
Some presentations turn every answer into now: central retinal artery occlusion, suspected giant cell arteritis, a pupil-involving third nerve palsy, acute angle closure, a chemical injury and presumed bacterial keratitis in a lens wearer. When one appears, a routine recheck is almost never right.
Pace with the case, not the item
At 175 items in 3.5 hours you average 72 seconds an item, but the time is not spent evenly. The first item of a case absorbs the reading; the rest should go faster. If an item stalls, mark it and move on, because a later item in the same case may jog your memory.