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How to Ace Multiple Choice Exams (Like a Boss)

How to Ace Multiple Choice Exams (Like a Boss)

Ahhh multiple choice tests...


I've written about these little devils before. 

I've spoken with a lot of students (and colleagues) about developing test taking strategies. Not just learning the material...but actually analyzing the make-up and limitations of a multiple choice test. Getting under the hood to look at the anatomy and the nuts and bolts of the thing.

How do you narrow down your answer choices?

What types of questions are there?

Is there a trend?

Is there a way to improve your odds as a test taker (similar to how counting cards will give you an advantage on a black jack table)?

Anyway, the surprise for me comes when I'm met with resistance (or border line offense) for discussing test taking strategy. Many see it as "gaming the system."

The counter argument I'm most frequently met with (which tends to come from the professor crowd) is that by teaching students how to "hack" the test, they will not really learn the material. Or worse, they won't be able to apply it to real situations after the test. Likewise, some of the students I've discussed strategy with consider themselves "purists" and would rather grind it out than Money Ball their way to an A.

And, to be honest, there's merit to these arguments.

Real life is not a multiple choice test. A patient’s medical chart doesn’t come with instructions. Evaluating a medication profile places you in an ocean of potential interventions to make (or not make). There is no handy device to narrow your choices to 4 options. 

What do you do? Where do you even start?

Seriously, am I the only one who thought this entire franchise was AWESOME?! ( Image )

Seriously, am I the only one who thought this entire franchise was AWESOME?! (Image)

If you've ever played the computer game Myst, it's exactly like that. 

It requires a different mode of thinking and preparation than the multiple choice exams you’re used to taking.

But here’s the thing...

Every single milestone that stands between you and becoming a pharmacist requires passing a multiple choice test.

The NAPLEX, MPJE, and CPJE are all multiple choice. Advanced certifications such as BCPS are also multiple choice.

Is a multiple choice exam the best way to assess your understanding of the material? Does your performance on these exams predict your ability as a pharmacist? Will pharmacist licensing exams ever not be multiple choice?

I'm not sure.

But I do know that until the above exams go through a massive format change, you owe it to yourself to become outstanding at taking multiple choice tests.

Here's an all too common scenario...

After a few bad exams, a student falls into the trap of defeatist self-talk. She'll say "I'm just not a good test taker." Or she'll trumpet the refrain of "C's get degrees!" Or even worse: "Maybe I'm just not cut out for this pharmacy stuff."

I don't buy talk like that.

Sure, some people are naturally good at taking tests. These are the types that finish every exam in 30 minutes and still get good grades. If you ask them to explain their secret, they aren't able to tell you. It's always been effortless to them. They've never had to think about it. They're like that friend of yours who is totally ripped but eats pizza from the hospital cafeteria every day and never exercises.

This is a very small minority of people. And while I respect their gifts, they're annoying AF.

The reality is, you don't need a special gift to ace your exams in pharmacy school. You just need a little refinement in your approach to studying and test taking.

Test taking is a skill (no matter what your defeatist self-talk will tell you). Like any other skill, it can be improved with practice.

You can get better at taking tests.

You can reduce the dry mouthed, armpit sweating anxiety you feel before, during, and after your exam.

You can stop over-analyzing every question and talking yourself out of the right answer (again).  

This article will review 3 of my best "high-level" test taking strategies for pharmacy school. Note that none of them are "easy." This is not a click-bait "Top 7 Test Taking Secrets your Professors Don't Want You to Know!" article. There are no shortcuts in pharmacy school. While I advocate getting better at taking tests, I don't know a way to do that without actually learning the material.

If that's the article you were looking for, I'm sorry. You won't find it here. You can click your browser's back button (or just move on to your next distraction by looking at this video of cats acting like people). 

Pharmacy Test Strategy # 1: Learn Brand/Generic Names

I cannot stress this point enough. There's an entire chapter of Pharmacy School: The Missing Manual dedicated to taking tests, and learning brand/generic is a large part of it. I wrote an article on How to Study for the NAPLEX and as part of the research process I reached out to recent graduates to ask them what worked.

Here's a list one of your fellow tl;dr readers sent me: 

I wonder if he's trying to emphasize something...

I wonder if he's trying to emphasize something...

So, yes. Learn your brand/generics.

We have a tendency to sweep brand/generic under the rug so we can focus on the more fun "clinical stuff." But this is a costly mistake. The tests you need to get through to become a pharmacist use brand names. And when you get into your practice career, that's what the majority of your patients (and other health care providers) will be using. 

This seems like a good point to go off on a quick tangent (read: mini rant).

There is a group within our profession (they often work in academic medical centers) who believe that as pharmacists, we should only use generic names. They often draw a line in the sand as if it's our professional duty, claiming that using generics educates other health care professionals about drug classes.

I don't buy into this "all or nothing" mentality. And I have several rebuttals. First, what about drugs with multiple formulations? Bupropion has an IR, an SR, and an XR formulation (plus another SR formulation under a different brand name used for smoking cessation). The same goes for valproic acid, carbamazepine, digoxin, diltiazem, itraconazole, paclitaxel, and basically any drug used for ADHD. Using the generic name with these drugs only adds confusion, whereas saying "Equetro" denotes a specific and unique formulation of carbamazepine.

Secondly (and this is more about aesthetics), you sound kind of like a pretentious ass when the RN is saying "Keppra" and you're saying "levetiracetam." You sound like Ted pronouncing encyclopedia on "How I Met Your Mother." I'm not saying it's not important to know how to pronounce difficult drugs like levetiracetam and fosaprepitant. Just that you're not going to make a lot of friends if you go around correcting everyone all the time.

The ultimate goal of our profession is to communicate drug information to people that (presumably) know less about drugs than we do.

This is true whether it's a doctor, patient, nurse, PA, or your grandmother. The general rule of thumb here is to talk at whatever level the person you are speaking with is.

Consider it similar to being bilingual. You need to be able to speak both "generic" and "brand" languages fluently. If you're speaking with a critical care attending who is using generic names, then use generic names (I think they secretly like saying "dexmedetomidine"). But if it's a patient and you're counseling them on their new heart failure drug, please (for the love of Pete!) just say "Entresto."


My thoughts on missing a test question because I didn't know the brand name.

My thoughts on missing a test question because I didn't know the brand name.

Anyway, back to why you need to know brand/generic. You might know every clinical detail about a drug. But if you can't identify it on a test, you'll miss the question anyway. This is the most frustrating thing in the world. I remember missing a simple mechanism of action question on a test because I didn't know what Brilinta was. 

There are plenty of tools to help you with brand/generic. Just do a Google search for "Top 200 drugs" and you'll be inundated with cheat sheets, drug cards, and quizlets.

tl;dr pharmacy may even create our own Top 200 (or 300) drug list one day (if you'd be interested in that sort of thing, let us know at mail@tldrpharmacy.com).

Also, when you are studying for a test in school, keep a running list of every drug that you come across (and its brand name). You can use note cards, quiz apps, scratch paper...whatever works for you. Just keep them around and don't throw them away. Review them periodically and they'll very quickly become second nature for you. 


Pharmacy Test Strategy #2: Time Management

There is nothing worse (or more frustrating) than running out of time on an exam. Leaving a question blank gets you a whopping zero points (and on some tests, negative points). But blindly guessing so that you have "any" answer isn’t much better. You're basically just throwing darts at that point. Why leave your grade to chance when you probably know the answer to many questions living at the end of the test? 

You've gotta be efficient when taking an exam. And guess what? It just so happens that you can shave minutes off of many questions by applying a simple technique.

Don't read the entire question (at first).

Instead, the first thing you should do is identify the actual question (hint: Look for the question mark). A lot of times, the actual question has nothing to do with the paragraph of background information.

Many test questions (especially patient cases and calculations) are designed to see if you can filter through unnecessary information. It’s part of their purpose. It's to help prepare you for the real world of not having an instruction manual. Can you go through these several paragraphs of patient information and suss out the information that you need to answer the question?

You may come across a patient case with a complete medical, family, and social history, a medication list, a set of labs, and a chief complaint. Then you get to the actual question and it asks “Which of the following home medications could be contributing to this patient's increased blood pressure?”

You could save a lot of time (not to mention brain power) by reading the question first, then skimming through the medication list. And don't underestimate the importance of brain power on an exam. With the NAPLEX now weighing in at 250 questions, your attention span is more important than ever. Don't drain your limited resources thinking about and processing information that you don't need. 

Even if you actually end up needing all of the background information to answer the question, your reading process will be much more efficient by knowing what exactly the question is asking of you. Your brain will naturally sift through the case study with a filter designed to pick up the relevant info that it needs. 

Again, this is most useful on patient cases and calculation questions. But it can be used on just about any question to get you out of the exam room faster. 

Pharmacy Test Strategy #3: Identify "Red Flag" Drugs

Look! It's a rifampin question! ( Image )

Look! It's a rifampin question! (Image)

There are certain drugs that should act as a signal flare when they show up on your exam.

When you come across one of these drugs, you pretty much have to assume that there is a drug interaction (with resulting drug toxicity and/or treatment failure) somewhere in the question.

Here are 3 red flag drugs that should immediately alert you to look out for a drug interaction in the question: 

  • Rifampin - It’s one of the most powerful CYP inducers known to man. And its actual clinical use is somewhat limited (it's almost exclusively used for tuberculosis and as an adjunct to certain bone or hardware infections).

  • Grapefruit Juice - It has no real therapeutic use that I'm aware of. But it's a powerful CYP and Pgp inhibitor.

  • St. Johns Wort - A powerful CYP inducer that likes to show up on tests during your Psych module or the herbal medicine elective.

This is far from exhaustive, of course. There are literally thousands of potential drug interactions. But if you find rifampin, grapefruit juice, or St. Johns Wort on a test you can almost guarantee it's a drug interaction question. You can't do that with most other drugs.

Closely related are drug toxicity questions. If a drug requires therapeutic monitoring, you will encounter it as a toxicity question sooner or later. Questions on drug toxicity are often woven into a drug interaction question (where a drug interaction is leading to a toxic level of the toxic drug). 

These are the sorts of drugs (and interactions) that keep pharmacists employed, so it's imperative that you have these down. I can guarantee you they will be emphasized on your exams.

Know as much as you can about the following drugs. And when you see them on an exam, determine if you're dealing with a drug interaction or toxicity question. 

  1. Amiodarone

  2. Warfarin

  3. Digoxin

  4. Carbamazepine

  5. Phenytoin

  6. Valproic Acid

  7. Vancomycin

  8. Aminoglycosides

  9. Lithium

  10. Tacrolimus

  11. Cyclosporine

Final Tips on How to Pass Pharmacy Exams

Try hard not to put your own thoughts and feelings into the question. It’s easy to second-guess yourself and read more into the question than necessary. This is a recipe for failure (and it wastes a lot of time and brain power to boot).

Multiple choice questions are usually black and white. Decipher exactly what you’re being asked, and answer accordingly.

If all else fails and you’re completely lost...remember that one of the primary concerns of the NAPLEX is ensuring that you can practice pharmacy safely. Knowing the 4th line of therapy (and its renal adjustment) for a given disease is important...but many test questions are looking to make sure that you don't harm the patient. 

During your studying, give extra weight to learning black box warnings, contraindications, and adverse effects. This will help keep your perspective centered within "First, do no harm."

Practice these strategies diligently, and you will notice your grades start to improve. You'll be able to throw down (like a boss) any exam that comes your way.

Want to dig a little further?

We wrote a book on surviving and thriving in pharmacy school. It's got an entire chapter dedicated to dissecting multiple choice test questions (with lots of examples). If you are a pharmacy student, this book is the white flower that lets you spit balls of fire. 

Check it out here.

Tired of Being a Pharmacist? Read This...

Tired of Being a Pharmacist? Read This...

New FDA Approval: Bevyxxa

New FDA Approval: Bevyxxa