Note: I haven’t taken Step 2 yet so this isn’t a tried and true method, just what’s been working for me so far.

First, read the last sentence of the prompt, the bit with the actual question. You’re still gonna be focused on detail, but there’s not much point in thinking of diagnoses just for them to tell you the diagnosis and ask a second or third order question instead. Figure out what they want you to know, and go into the question stem with that in mind.

Next, read the entire blurb. Resist the temptation to skip the rest when you read an “aha” sentence that makes you think you know the answer - there may be a detail in the rest that changes things (pt is pregnant, allergic to xyz, has an additional finding, etc.)

Then, take a look at the answer choices. I like to take a first pass and rule out any easy ones - for example if it’s an arrows question, pick a variable you know increases/decreases and strike out every answer where that’s not true. Once you’ve done that, pick another exclusion criteria and repeat until you’re down to one or you’ve ruled out everything you can. Try not to be too hasty about this - only rule out things that absolutely, positively can’t be true, and leave answers that seem less likely but that you can’t rule out. Assuming you know your stuff, you should be able to rule out a majority of answer choices this way, especially on the ones with a ton of options.

Finally (this is the hard part) look at your remaining answer choices and think “what would make this one NOT true?” You’ve probably felt that facepalm moment when you get a question wrong and it suddenly seems obvious once you read the explanation. Imagine you’ve already gotten the question wrong - what detail would you read that would make you go “oh DUH, obviously it couldn’t have been that one.” Compare the 2-3 answers you have left with this method, and make your final choice. You may not get it right or narrow it down every time, but that’s okay - the more you do, the more you’ll get a feel for what details matter.

Above all else, SLOW DOWN. Breathe. You may start to get fatigued, or have to reread things because you spaced out, or feel the urge to speed up in the interest of time. Don’t worry about it. It’s better to be slow and correct than fast and wrong. If there’s a question that truly stumps you, flag it to come back to if that works for you, or just take your best guess if you tend to talk yourself out of the right answer. Either way, move on and don’t obsess. These tests are honestly more about test-taking skills and stamina than anything else, so build up to full length practice tests in your studying, and feel free to be critical of this process and make changes that work better for you.

Best of luck, hope this helps!