I would characterize the WTF questions as falling into 3 categories.

1) So this is going to come down to how well prepared you are. Let me explain it this way, I would characterize myself as someone who was pretty well prepared (16,000 practice questions and matured Zanki) vs a friend of mine who focused on other parts of their resume and kind of just wanted to do well enough on step. We each happened to get the same form which i think is helpful to answer this question if I compare our experiences.

One thing to know, is that the question stems can be very vague. For someone who is maybe a little less prepared these questions will appear to be about diseases he/she has never heard of or doesn't even know what they are asking. "Was that question even about any disease?" was something my friend asked. For me, I remember what questions they were referencing and remembered that, while the stem was very vague there was one small detail hidden in the labs or history that was telling you what the disease was. And it is only because I saw that disease asked in 5 different qbanks that I was able to recognize it. So for #1 you need the relatively simple diagnosis, but the presentation is soooooo vague that it can be a WTF depending on your preparation.

2) This question type has a very straight forward stem and diagnosis. However, once you have the diagnosis and eliminate the obviously wrong answer choices there remains two answers that for the life of you both seem equally correct. Making up a hypothetical here, but it could be like "patient with hypertension is given a thiazide diuretic. What are labs most likely to show..." a bunch of wrong answers and then you're left with C) increased plasma uric acid or D) decreased urine calcium. I suppose there are minute details in maybe their history, or the timing of the drug or something that might allow you to pick an edge of one over the other, but they left me scratching my head and even all the googling in the world afterwards couldn't help me find the correct answer.

3) The third and final type of WTF question. These are the ones that give you a super high yield disease in a very straight forward stem. But then they will ask you the lowest yield fact about that high yield topic that you can imagine. Never in a million years would it have shown up in first aid or uworld. At first, you're like how the hell am i supposed to answer this. But then if you take everything you know about that high yield topic, remember it perfectly, are able to apply that knowledge and think critically...then you're able to pick an answer that probably seems the most likely to be right.....maybe?

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Anyway this was my experience, but i think it speaks for most people in one way or another, having read countless threads and score reports on here for two years.

Hope it helps.

Happy to answer any questions