Read the question slowly and make sure you know what is being discussed. Do not look at the answers at this time.
Decide what information is superfluous. Knowing what is important and what is not can help you make a better choice. These exams were designed to try to mislead the student. Since it can be difficult to diagnose a patient correctly, the USMLE tries to mimic such cases to test the student. Eliminating irrelevant symptoms and other problems presented can lead to the right decision.
Try to come up with an answer before looking over the list of choices. If your answer matches one on the choices, chances are that it is correct.
Eliminate as many of the choices as possible, until only a few remain, in the event that your answer does not match any listed. When eliminating options, be sure that they are obviously incorrect and in no way could be the correct answer. This will help narrow your choices.
Decide which of the remaining answers is the best choice. If the best choice cannot be determined, then pick one, even though you are unsure. The question will be marked incorrect even if it is not answered. Choosing any of the best answers can only help.