Emergency Medicine Clinical Rotation Exams
Introducing two new 200 Question Interactive Emergency Medicine Rotation Exams with audio explanations now available to PA students and all members of Smarty PANCE. Not yet a member? You can Join Now and Save.
These exams follow the format of the PAEA Emergency Medicine End of Rotation Exam™ Blueprint and are perfect as preparation for your after rotation exams and the boards. Smarty PANCE is not sponsored or endorsed by, or affiliated with, the Physician Assistant Education Association. All trademarks are the property of their respective owners.
The Smarty PANCE Rotation Exam for Emergency Medicine follows the PAEA published ED content blueprint:
- Cardiovascular (20%)
- Orthopedics/Rheumatology (15%)
- Gastrointestinal and Nutritional (10%)
- Pulmonology (10%)
- Neurology (8%)
- ENOT and Ophthalmology (7%)
- Urology and Renal (6%)
- Dermatology (5%)
- Endocrinology (5% )
- Obstetrics and Gynecology (5%)
- Psychiatry and Behavioral Medicine (5%)
- Hematology (4%)
Here is a five-question sample from the Smarty PANCE emergency medicine rotation exam one (members only) with audio explanations:
Emergency Medicine Rotation Sample Exam
Question 1 |
A 65-year-old patient with steroid-dependent chronic obstructive lung disease presents with a headache that has been increasing in severity over the past week, accompanied by nausea and vomiting. He denies fever but has had photophobia and a stiff neck. Which of the following is the most likely diagnosis?
Transient ischemic attack Hint: Transient ischemic attacks present with focal neurological findings rather than headaches. | |
Bacterial meningitis Hint: Bacterial meningitis is typically acute in onset and causes fever, but immunocompromised patients may have a slower onset and no fever. | |
Migraine headache Hint: Migraines generally do not begin in this age group and are not accompanied by nuchal rigidity. | |
Cryptococcosis |
Question 1 Explanation:
Cryptococcus is an opportunistic fungal infection that affects immunocompromised patients, including those with HIV, chronic steroid use, organ transplants, diabetes mellitus, and chronic renal or liver disease. The most common clinical presentation is that of meningitis; fever is present in only about half of patients.
Review Topic: Cryptococcosis
Question 2 |
A 23-year-old female with a history of asthma for the past 5 years presents with complaints of increasing shortness of breath for 2 days. Her asthma has been well-controlled until 2 days ago. Since yesterday, she has been using her albuterol inhaler every 4 to 6 hours. She is normally very active, however yesterday she did not complete her 30-minute exercise routine due to increasing dyspnea. She denies any cough, fever, recent surgeries, or use of oral contraceptives. On examination, you note the presence of prolonged expiration and diffuse wheezing. The remainder of the exam is unremarkable. Which of the following is the most appropriate initial diagnostic evaluation prior to initiation of treatment?
Chest x-ray Hint: A chest x-ray should be ordered in an asthmatic patient only if you are concerned about the presence of pneumonia or pneumothorax, neither of which is supported by the H&P findings noted above. | |
Sputum gram stain Hint: A sputum gram stain is performed in patients who you suspect have an infectious process, such as pneumonia | |
Peak flow | |
Ventilation-perfusion scan Hint: A ventilation-perfusion scan (V/Q scan) is indicated in cases of suspected pulmonary embolism. The patient above does not have any risk factors that would lead you to suspect such a diagnosis |
Question 2 Explanation:
A peak flow reading will help you to gauge her current extent of airflow obstruction and is helpful in monitoring the effectiveness of any treatment interventions.
Review Topic: Asthma (ReelDx)
Question 3 |
A 3-year-old boy is seen in the office with a 5-day history of fever, erythema, edema of the hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and erythema of the lips, and cervical adenopathy. Antistreptolysin O (ASO) titer and throat culture are negative. The most serious systemic complication associated with this disorder is
Renal Hint: The patient most likely has Kawasaki syndrome. The major complication with this disorder is coronary artery | |
Cardiac | |
Pulmonary Hint: The patient most likely has Kawasaki syndrome. The major complication with this disorder is coronary artery
| |
Hepatic Hint: Children with Kawasaki syndrome may have associated hydrops of the gallbladder, but liver involvement is not part of this disorder. |
Question 3 Explanation:
The patient most likely has Kawasaki syndrome. The major complication with this disorder is coronary artery aneurysms, which are reported in up to 20% of affected children. The etiology of this disorder is uncertain, although a bacterial toxin with super antigen properties may be involved.
Question 4 |
A 53-year-old female status post abdominal hysterectomy 3 days ago suddenly develops pleuritic chest pain and dyspnea. On exam, she is tachycardic and tachypneic with rales in the left lower lobe. A chest x-ray is unremarkable and an EKG reveals sinus tachycardia. Which of the following is the most likely diagnosis?
Atelectasis Hint: Small atelectasis is commonly asymptomatic, while large atelectasis may produce signs of dyspnea and cough. Exam reveals absence of breath sounds in the area involved and dullness to percussion. A chest x-ray would reveal various findings dependent on the location of the atelectasis, but would not be normal. | |
Pneumothorax Hint: While a pneumothorax commonly presents with pleuritic chest pain and dyspnea, the exam would reveal the presence of diminished breath sounds and hyperresonance on the involved side. A chest x-ray would reveal the presence of a pleural line on the expiratory chest x-ray. | |
Pulmonary embolism | |
Myocardial infarction Hint: While a myocardial infarction usually presents with dyspnea, the chest pain is not usually pleuritic in nature. An EKG would commonly reveal ST segment changes which would be consistent with ischemia or infarct. |
Question 4 Explanation:
This patient's risk factors for pulmonary embolism include advanced age, surgery, and prolonged bed rest. While the diagnosis of pulmonary embolism is difficult to make due to nonspecific clinical findings, the most common symptoms include pleuritic chest pain and dyspnea associated with tachypnea. Chest x-ray and EKG are usually normal.
Review Topic: Pulmonary embolism
Question 5 |
A 19-year-old female presents with a sore throat for nearly two weeks. She complains of fatigue and a low-grade fever. On physical examination, there is cervical, axillary, and inguinal lymphadenopathy, and mild splenomegaly. On review of the blood smear, which of the following would be expected?
Atypical lymphocytes | |
Hypersegmented neutrophils Hint: Hypersegmented neutrophils are seen in vitamin B12 deficiency. | |
Hypochromic red blood cells Hint: Anemia, if seen in mononucleosis, is normocytic and normochromic. | |
Schistocytes Hint: Schistocytes are noted in hemolytic anemias. |
Question 5 Explanation:
The hallmark of infectious mononucleosis is the presence of lymphocytosis with atypical large lymphocytes seen in the blood smear. These are larger than normal mature lymphocytes, stain more darkly, and frequently show vacuolated, foamy cytoplasm, and dark chromatin in the nucleus.
Review Topic: Epstein-Barr virus infections (ReelDx)
There are 5 questions to complete.
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Smarty PANCE Rotation Exams
We're excited to add these two emergency medicine rotation exams to a growing list of clinical rotation exams available exclusively to Smarty PANCE members. You must be a member to access the exams.
Other exams include 13 Topic Specific Practice Exams, two full-length PANCE/PANRE Mock Practice Exams, five 250 Question Comprehensive Exams, and many, many more!
May the boards be with you!
Stephen Pasquini PA-C
