| System | Approx. % of Exam | |--------|------------------| | Cardiovascular | 11% | | Pulmonary | 9% | | Musculoskeletal | 8% | | GI / Nutrition | 8% | | Genitourinary | 6% | | Reproductive | 7% | | Endocrine | 6% | | Neurologic | 6% | | Psychiatric/Behavioral | 7% | | Eyes, Ears, Nose, Throat | 6% | | Dermatology | 5% | | Hematology/Oncology | 5% | | Infectious Disease | 6% | | Renal | 4% | | Multisystem / Emergency | 6% |
A 58-year-old man with HTN, DM type 2 presents with acute-onset sharp chest pain radiating to the back. BP 160/90 in R arm, 100/60 in L arm. CXR shows widened mediastinum. What is the most appropriate next step? | System | Approx
| Challenge | Impact | |-----------|--------| | Fatigue by Block 3 | Reduced concentration → increased missed “easy” questions | | Time pressure (60 sec/question average) | Inability to review all flagged items | | Pilot questions (20 per block, unmarked) | Wasted effort on experimental items | | Break mismanagement | Taking too long → late return → automatic exam termination | | Changing answers | Data shows first answer is correct 70% of the time unless misread | CXR shows widened mediastinum