Getting ready to recertify - dealing with the PANRE
Knowing what you are up against as you take your PA recertification exam is a good place to start
PANRE Review
So you haven't take the PANRE in a really long time. NCCPA changes the rules and stops the take home exam and know you have to take the regular exam...
Many PA's today have gotten into this situation where they now need to make a game plan on how to approach this general medicine exam, on information that have not seen in 12 years. There is little information on a PANRE study guide or review for those in the specialist position. So what do you do????
Unfortunately there is no magic pill or spell that fixes this problem. Some with the ability to memorize massive amounts of info will pass the PANRE with a quick study review course. There are many out there Kaplan, Duke, Emery, FA Davis books, Chicago course and of course my recommendation the Help-campus site. However if you are not that type of person or really want to put the information back in your brain, i suggest a 4 month plan or some modified version.
4 months to prepare for the PANRE. So why so long you ask.. Let me show you
The adult medicine and surgery exams, 60% of the exam will cover general content, 40% will be focused in either adult medicine or surgery but will still follow content blueprint, pediatric questions may be included this means its all fair game and you need to study.
First you need to reread and reteach your self, this means taking/making notes and working with a partner if possible. There are 13 topics by organ system in the NCCPA Blueprint. Most have 40 to 60 topics in each section. ID however as a section falls into most of the other sections except for a few exceptions like HIV. That leaves 12 sections or one per week for 3 months (12 weeks). One section per week would be 20 topics a day for 3 of the days or 10 a day for 6 days on the high side, some weeks would be less topics to cover. The plan would be to read in a book like Current medical diagnosis and treatment and/or the "up to date" website and/or other references you prefer and make notes and review all the material. This is best done with a partner (fellow PA) where you both research all the topics and then meet and compare notes and discuss the sections for improved learning and recall. Do not split up the objectives, you will only remember your half. The goal is to set up a good knowledge base again and get things refocused in your brain.
After the three months you then hit a review course and get a power version of all the work you just did. The review courses are to focus your attention to key words, phrases and topics that are most likely tested. The reason you need to study before this is because the PANRE will not always use the same clues or descriptions and a base knowledge will give you a better chance to select a correct answer.
During that 4th month you will also be doing questions over and over. Do them often and repeat ones you already did, it is possible to write a question about most topics in only a few ways so questions can train you to see certain patterns like in medicine when we look for patterns in our diagnosis of patient conditions.
Alternatives are to do a review course that you can buy and use online or as a cd/dvd at the same time you study with books and references. This will allow you to study and then listen or interact with a topic in the review course for highlights. The reason a review course is not as effective alone is because the 240 question exam only covers 50% of 500 topics and you don't know which topics they will ask and they don't always ask the most common information, so you have to know as much of the 100% of the topics as you can. It is why understanding the topic not just memorizing some facts is necessary to ensure passing. It seems insurmountable but a good steady study plan with a partner will grind down the topics and have you passing in no time. The questions almost always have two good answers and memorizing some facts doesn't help distinguish between two close answers with similar signs and symptoms. Let me show you why I feel you need to study first.
My example is syncope in an elderly male. The question reads a 76 year old male passes out during a heated argument with a bill collector, he is brought to the hospital and evaluated. Work up reveals an unremarkable physical exam, no past medical history, Ekg shows normal sinus rhythm and a stat echo reveals no valvular abnormalities with an ejection fraction of 25%. What is the most likely cause of his syncope?
A. Acute myocardial infarction
B. Aortic stenosis
C. Atrial fibrillation
D. Ventricular tachycardia
E. Orthostatic hypotension
So with a few facts memorized it seems all these answers could be true. However with reading and good question dissection we can reveal the true answer. First atrial fibrillation while possible is mostly ruled out due to the normal EKG and lack of exam findings like palpitations or irregularly irregular rhythm. Orthostatic hypotension while possible is not at all described in the presentation (dry mucous membranes or recent illness with vomiting or diarrhea) nor is there mention of orthostatic blood pressures. So now the last three, the most common cause of syncope in the elderly is acute myocardial infarction, but the exam shows no S4 (stiff ventricle due to ischemia) or other findings and the ekg shows NSR. Aortic stenosis is ruled out due to the normal valvular function seen on the echocardiogram. However we do note that the EF (ejection fraction - a measure by percentage of how well the left ventricle pumps blood. normal is 55 - 65%) is low. Low EF means arrhythmia specifically VT (syncope due to VT - low cardiac output) and in this case is the most likely cause of his syncopal event.
They could ask this same question but at the end instead of asking what caused the syncope they would ask what would the best treatment for this patient be to prevent or protect the patient from reoccurance of the syncope?
A. Cardiac catheterization to look for blockages
B. Diltiazem (calcium channel blocker)
C. AICD (defibrillator)
D. Valvular replacement of the Aortic valve
E. Replace fluids with NS IV x 2 liters
Again same as above however they are making a two step question of having you discover the cause and then appropriate treatment. Cant figure out the cause you wont get the answer here. FYI the answer for low EF (below 40%) is an AICD to prevent the VT leading to sudden death by shocking the heart back to normal sinus rhythm.
Or they could just ask what is the event he just have called? (Stokes adams)
The point is that memorizing word associations does really help but so does knowing information and most would have likely memorized the most common cause of syncope in elderly is heart attack but would have missed this question or locked on to another answer without working your way through the question.
Another reason to read is to familiarize your self with the terms and lingo associated with the sections. If you have no idea what an EF or Pro Bnp is then not much chance of answering the question. EF = Ejection fraction and Pro Bnp is a lab test used to determine if a patient is in CHF.
Anyways i have taken a bit of your time and hope it helps, you have to study or get lucky, i prefer to increase my odds by studying and not relying on the fickleness of luck.
The over all goal is to pass the PANRE and that target is about 55% correct answers. The PANRE is a 240 question exam according to the NCCPA website.
4 blocks of 60 questions and 45 minutes of breaks if needed. The break down is found at the following link or at the NCCPA website.
http://www.help-campus.com/faqhelp/panrereview/
http://www.nccpa.net/ExamsContentBPOrgans.aspx
The next question is can i avoid some sections and still pass. Yes, not the best idea but yes you can. I will cover that in another page in a few weeks. Today is Sept 8 2012.
Who am I, just a fellow PA that recognizes that the ideal world and reality meet at the point where we live and work and hope to make my colleagues lives a little easier. I have taken the exam three times and have helped others study and prepare for the last 10 years.
Good luck.
Many PA's today have gotten into this situation where they now need to make a game plan on how to approach this general medicine exam, on information that have not seen in 12 years. There is little information on a PANRE study guide or review for those in the specialist position. So what do you do????
Unfortunately there is no magic pill or spell that fixes this problem. Some with the ability to memorize massive amounts of info will pass the PANRE with a quick study review course. There are many out there Kaplan, Duke, Emery, FA Davis books, Chicago course and of course my recommendation the Help-campus site. However if you are not that type of person or really want to put the information back in your brain, i suggest a 4 month plan or some modified version.
4 months to prepare for the PANRE. So why so long you ask.. Let me show you
The adult medicine and surgery exams, 60% of the exam will cover general content, 40% will be focused in either adult medicine or surgery but will still follow content blueprint, pediatric questions may be included this means its all fair game and you need to study.
First you need to reread and reteach your self, this means taking/making notes and working with a partner if possible. There are 13 topics by organ system in the NCCPA Blueprint. Most have 40 to 60 topics in each section. ID however as a section falls into most of the other sections except for a few exceptions like HIV. That leaves 12 sections or one per week for 3 months (12 weeks). One section per week would be 20 topics a day for 3 of the days or 10 a day for 6 days on the high side, some weeks would be less topics to cover. The plan would be to read in a book like Current medical diagnosis and treatment and/or the "up to date" website and/or other references you prefer and make notes and review all the material. This is best done with a partner (fellow PA) where you both research all the topics and then meet and compare notes and discuss the sections for improved learning and recall. Do not split up the objectives, you will only remember your half. The goal is to set up a good knowledge base again and get things refocused in your brain.
After the three months you then hit a review course and get a power version of all the work you just did. The review courses are to focus your attention to key words, phrases and topics that are most likely tested. The reason you need to study before this is because the PANRE will not always use the same clues or descriptions and a base knowledge will give you a better chance to select a correct answer.
During that 4th month you will also be doing questions over and over. Do them often and repeat ones you already did, it is possible to write a question about most topics in only a few ways so questions can train you to see certain patterns like in medicine when we look for patterns in our diagnosis of patient conditions.
Alternatives are to do a review course that you can buy and use online or as a cd/dvd at the same time you study with books and references. This will allow you to study and then listen or interact with a topic in the review course for highlights. The reason a review course is not as effective alone is because the 240 question exam only covers 50% of 500 topics and you don't know which topics they will ask and they don't always ask the most common information, so you have to know as much of the 100% of the topics as you can. It is why understanding the topic not just memorizing some facts is necessary to ensure passing. It seems insurmountable but a good steady study plan with a partner will grind down the topics and have you passing in no time. The questions almost always have two good answers and memorizing some facts doesn't help distinguish between two close answers with similar signs and symptoms. Let me show you why I feel you need to study first.
My example is syncope in an elderly male. The question reads a 76 year old male passes out during a heated argument with a bill collector, he is brought to the hospital and evaluated. Work up reveals an unremarkable physical exam, no past medical history, Ekg shows normal sinus rhythm and a stat echo reveals no valvular abnormalities with an ejection fraction of 25%. What is the most likely cause of his syncope?
A. Acute myocardial infarction
B. Aortic stenosis
C. Atrial fibrillation
D. Ventricular tachycardia
E. Orthostatic hypotension
So with a few facts memorized it seems all these answers could be true. However with reading and good question dissection we can reveal the true answer. First atrial fibrillation while possible is mostly ruled out due to the normal EKG and lack of exam findings like palpitations or irregularly irregular rhythm. Orthostatic hypotension while possible is not at all described in the presentation (dry mucous membranes or recent illness with vomiting or diarrhea) nor is there mention of orthostatic blood pressures. So now the last three, the most common cause of syncope in the elderly is acute myocardial infarction, but the exam shows no S4 (stiff ventricle due to ischemia) or other findings and the ekg shows NSR. Aortic stenosis is ruled out due to the normal valvular function seen on the echocardiogram. However we do note that the EF (ejection fraction - a measure by percentage of how well the left ventricle pumps blood. normal is 55 - 65%) is low. Low EF means arrhythmia specifically VT (syncope due to VT - low cardiac output) and in this case is the most likely cause of his syncopal event.
They could ask this same question but at the end instead of asking what caused the syncope they would ask what would the best treatment for this patient be to prevent or protect the patient from reoccurance of the syncope?
A. Cardiac catheterization to look for blockages
B. Diltiazem (calcium channel blocker)
C. AICD (defibrillator)
D. Valvular replacement of the Aortic valve
E. Replace fluids with NS IV x 2 liters
Again same as above however they are making a two step question of having you discover the cause and then appropriate treatment. Cant figure out the cause you wont get the answer here. FYI the answer for low EF (below 40%) is an AICD to prevent the VT leading to sudden death by shocking the heart back to normal sinus rhythm.
Or they could just ask what is the event he just have called? (Stokes adams)
The point is that memorizing word associations does really help but so does knowing information and most would have likely memorized the most common cause of syncope in elderly is heart attack but would have missed this question or locked on to another answer without working your way through the question.
Another reason to read is to familiarize your self with the terms and lingo associated with the sections. If you have no idea what an EF or Pro Bnp is then not much chance of answering the question. EF = Ejection fraction and Pro Bnp is a lab test used to determine if a patient is in CHF.
Anyways i have taken a bit of your time and hope it helps, you have to study or get lucky, i prefer to increase my odds by studying and not relying on the fickleness of luck.
The over all goal is to pass the PANRE and that target is about 55% correct answers. The PANRE is a 240 question exam according to the NCCPA website.
4 blocks of 60 questions and 45 minutes of breaks if needed. The break down is found at the following link or at the NCCPA website.
http://www.help-campus.com/faqhelp/panrereview/
http://www.nccpa.net/ExamsContentBPOrgans.aspx
The next question is can i avoid some sections and still pass. Yes, not the best idea but yes you can. I will cover that in another page in a few weeks. Today is Sept 8 2012.
Who am I, just a fellow PA that recognizes that the ideal world and reality meet at the point where we live and work and hope to make my colleagues lives a little easier. I have taken the exam three times and have helped others study and prepare for the last 10 years.
Good luck.