USMLE Step 1 Question Types: Bait and Switch Questions

Another type of question USMLE Step 1 test makers use is bait and switch questions. These questions occur when what you first think the question is about is not what the question is really asking. Have you ever begun reading a question thinking that the core focus is physiology and discover at the end of the question that the real issue is pharmacology? Have you ever read a clinical case collecting evidence for a diagnosis and discover that at the end of the question they give you the diagnosis, but want to know something about treatment options? If you have had these experiences, then you have run into bait and switch questions.

Bait and Switch Questions on the USMLE

Bait and switch questions begin by presenting material that may lead you to think about content in one direction, but then shift you to another line of thought at the end; a sort of mental sleight of hand. The key question is always given in the last line of the question stem. Everything else before the last line is simply a setup. You cannot tell for certain what information is useful and what information in unnecessary until you get to the end of the stem and encounter the actual question.
Because of this, some students make a habit of reading the last line of the question stem, and then scan the rest of the presented information looking for pertinent material. This strategy may have worked on other tests, but has some pitfalls on the USMLE Step 1. If you have the discipline to read the question line and then return to read the rest of the stem in detail, this is not a bad strategy for this type of question. However, experience suggests that this is not the best strategy for most students.
The best advice is to read the last line of the question first only if you then read through the rest of the question. Read the last line before reading the rest of the question, not in place of reading the rest of the question. Reading the last line first to avoid reading the entire question is a low- yield strategy and results in an increased error rate.

Kaplan Expert Tip

There are two problems with reading the last line of the stem first:
• You do not know that you are faced with a bait and switch question until you read through the whole question. In other words, you often can’t tell that this strategy will work until you have already read the question.
• Many people do not have the discipline to read the last line and then return to read through the rest of the question stem. Once they read the question line, many students move directly to the options without adequately evaluating the information presented in the question stem. Alternatively, students scan the question stem looking for one single piece of information to help them answer the question. Looking only for one key fact often means you will miss another key detail and, therefore, end up with a wrong answer.



USMLE Practice Questions: Bait and Switch

A generally healthy, 65-year-old man was in a car accident and broke several ribs on his left side. His medical record shows a history of mild diabetes and treatment in the past year for gonorrhea. Approximately 12 days after the car accident, the patient developed a painful, well-circumscribed vesicular rash over his left rib cage. The rash persisted for several weeks. What is the rash due to?
(A) Primary infection with herpes B virus
(B) Primary infection with herpes simplex virus type 1
(C) Primary infection with herpes simplex virus type 2
(D) Reactivation of latent Epstein-Barr virus
(E) Reactivation of latent varicella-zoster virus

The correct answer is E, reactivation of latent varicella-zoster virus.

A 59-year-old man with a history of hypertension and cigarette smoking survived a myocardial infarction two years ago. He has been reluctant to follow the diet prescribed by his physician, but as part of his recovery program, he has taken up running. Following an early morning run, he consumes a breakfast consisting of cereal, eggs, bacon, sausage, pancakes with maple syrup, doughnuts, and coffee with cream and sugar. Which of the following proteins will most likely be activated in his liver after breakfast?
A. Glycogen phosphorylase
B. PEP carboxykinase
C. Hydroxymethylglutaryl-CoA reductase
D. Glycogen synthase
E. Carnitine acyltransferase

The correct answer is D, glycogen synthase.

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