USMLE Step 1: Conjunction Questions

/in /by

In the same manner as two-step questions, USMLE Step 1 conjunction questions require two correct choices to arrive at the best answer. Options are presented as sets of terms or facts linked by a conjunction (usually the word “and”). The best answer is the one in which both parts of the option are correct.
By using this type of question, the examiners are able to move beyond asking for a single piece of information, asking instead which two pieces of information satisfy the question criterion. Most commonly, students are asked to detect two overlapping disease states, or which are the two best interventions to be performed next.
 

Conjunction Practice Question


A 66-year-old man has been brought to his physician’s office by his wife who expresses concern that “something is just not right.” During neurologic examination, both recent and long-term memory appear unimpaired. However, the patient seems to have difficulty concentrating. He asks repeatedly where he is and what he is doing there. He has difficulty with simple arithmetic and in writing simple sentences. He has no difficulty outlining or reproducing presented figures, but on a discrimination task, he confuses his right and left hands. This patient is most likely suffering from lesions affecting which of the following?
(A) Dominant parietal and frontal lobes
(B) Dominant parietal and dominant temporal lobes
(C) Dominant temporal and frontal lobes
(D) Nondominant parietal and dominant temporal lobes
(E) Nondominant parietal and nondominant temporal lobes


The correct answer is A, dominant parietal and frontal lobes.



Strategy for Conjunction Questions


The best method for handling a conjunction question is to treat it as two separate questions. Answer the question twice, once for each part of the response option. Cognitively, it is difficult to hold the two parts of the option in mind at the same time. By splitting the task into two simpler choices, you are less likely to become confused or make mental mistakes. For example, in the previous question, first notice that some of the symptoms are suggestive of a frontal lobe lesion; then as a second step, focus on those that suggest a dominant parietal lobe dysfunction.
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