PANCE PANRE Question Breakdown: Newsletter 101
Free tips to pass your National Commission on Certifying Physician Assistants exam
PANCE PANRE Question Breakdown: Issue:101
In this issue, we are exploring the importance of words in the stem of a question. Often one word will be the defining factor in leading you to the correct answer. Many times one word can make the answer very apparent while ignoring that word can make the answer illusive. Let’s look at the question below and find the most important word in the stem of the question.
An 88 year-old male suddenly faints while sitting on the sofa. The syncopal episode lasted approximately 10 seconds. There are no associated symptoms. He is brought to the emergency department where your exam reveals an alert, asymptomatic man with no significant exam findings. BP = 140/76 mmHg (right arm supine), pulse – 78 bpm (regular), respirations = 16 breaths/min (non-labored), temp – 97.8o F (oral), SaO2 = 97% on room air. Which of the following test should be performed first?
A: 12 lead EKG
B: PA and lateral chest X-ray
C: Arterial blood gas
D: Non-contrast CT of the brain
E: Electroencephalogram
Which word is the most important is defining the correct answer?
This question can be tricky as more than one of the potential answers could and would likely be performed in the ER evaluation of this patient. The most important word is “first”. Answers A-D would all may be considered in the ER work up of this patient. If when reading this question, the test taker does not give “first” much thought, differentiating the answer becomes very difficult. The 12 lead EKG should be done first to rule out acute coronary syndrome (ACS) as elderly may present with asymptomatic AMI. Acute coronary syndrome requires timely diagnosis and treatment and therefore must be done “first”. Chest X-ray may reveal underlying pathologies (e.g. pneumonia), however this would not be as urgent as ACS. ABG may be considered, however is not an urgent need in a patient who is asymptomatic and has a SaO2 = 97% on room air. Non-contrast CT would be considered, however not first as the patient is now alert and has no signs of acute neurological sequelae.
In this issue, we are exploring the importance of words in the stem of a question. Often one word will be the defining factor in leading you to the correct answer. Many times one word can make the answer very apparent while ignoring that word can make the answer illusive. Let’s look at the question below and find the most important word in the stem of the question.
An 88 year-old male suddenly faints while sitting on the sofa. The syncopal episode lasted approximately 10 seconds. There are no associated symptoms. He is brought to the emergency department where your exam reveals an alert, asymptomatic man with no significant exam findings. BP = 140/76 mmHg (right arm supine), pulse – 78 bpm (regular), respirations = 16 breaths/min (non-labored), temp – 97.8o F (oral), SaO2 = 97% on room air. Which of the following test should be performed first?
A: 12 lead EKG
B: PA and lateral chest X-ray
C: Arterial blood gas
D: Non-contrast CT of the brain
E: Electroencephalogram
Which word is the most important is defining the correct answer?
This question can be tricky as more than one of the potential answers could and would likely be performed in the ER evaluation of this patient. The most important word is “first”. Answers A-D would all may be considered in the ER work up of this patient. If when reading this question, the test taker does not give “first” much thought, differentiating the answer becomes very difficult. The 12 lead EKG should be done first to rule out acute coronary syndrome (ACS) as elderly may present with asymptomatic AMI. Acute coronary syndrome requires timely diagnosis and treatment and therefore must be done “first”. Chest X-ray may reveal underlying pathologies (e.g. pneumonia), however this would not be as urgent as ACS. ABG may be considered, however is not an urgent need in a patient who is asymptomatic and has a SaO2 = 97% on room air. Non-contrast CT would be considered, however not first as the patient is now alert and has no signs of acute neurological sequelae.