USMLE purpose: Build a strategy for difficult biostats questions: classify the stem, ignore distractors, and solve the requested metric.
Hard biostats questions are usually easy questions wrapped in extra words; strip the stem down to the requested metric.
| If the stem contains... | Think | First action |
|---|---|---|
| Diagnostic test language | Sensitivity/specificity/PPV/NPV | Draw 2×2 table |
| Exposure and future outcome | Cohort / RR | Compare risks |
| Disease and past exposure | Case-control / OR | Use odds ratio |
| Confidence interval | Significance | Check if CI crosses 1 or 0 |
| Bell curve | Standard deviations | Use 68–95–99.7 |
| Survival curve | Kaplan-Meier | Read time/survival axes |
A stem gives extensive background but ends with “Which measure is most appropriate for a case-control study?” What is the answer?