Today what I want do is give you a couple of tips to really help you get through your exams, to really pick apart the question, and to see exactly what they’re asking.
A lot of people think that the boards or your professors, when they write the exam questions, are really out to trick you. They feel like they’re writing questions that have two correct answers, when in fact there aren’t to correct answers. There’s always a best answer choice.
Now what’s going to make something a best answer is going to depend on the vignette that they give you. So a lot of times you’re going to look for something that’s going to be the contraindication as to why one answer is going to be incorrect. So let’s go over a couple of situations, a couple scenarios, as to how this is going to help you really pick apart that question.
So we’ll give a scenario here right? We have a pregnant woman, who comes in with a diagnosis of chlamydia. Now in order to treat chlamydia, you have two correct answers. You can either give Azithromycin or you can give doxycycline. Now, when they present the vignette with the clinical scenario of a pregnant patient, they will ask for the the treatment of choice. This is going to be Azithromycin, but they might give you doxycycline or they might give you Bactrim, which is trimethoprim/sulfamethoxazole. Which is going to be the treatment of choice?
Well now, instinctively you’re going to say Azithromycin and Doxycycline are both correct treatment choices, right? The problem is there is a contraindication there; you don’t want to give doxycycline to somebody who is pregnant. Doxycycline is contraindicated during pregnancy. So by realizing this, you notice that in reality, there’s only one correct answer choice and Azithromycin is a better answer choice than doxycycline, because of the adverse reactions that could happen to the fetus.
So this is one example as to where you might think the boards are trying to trick you or your professors are trying to trick you, but you should know this contraindication. There’s always going to be a contraindication as to why one answer is incorrect and why another answer is correct. So you have to look for that.
Let’s give another scenario, you have a 15 year old child, or let’s make it easier, you have a five year old child that’s presenting with right lower quadrant pain, you notice a positive Rovsins, a positive obturator, so your first initial thought is going to be appendicitis. Now they’re going to ask what the next step is or what is the best initial diagnostic test to rule in or rule out appendicitis.
They’re going to give CT scan with IV contrast, they’re going to give X-Ray, and they’re going to give ultrasound. Now you might think in your head, well CT-Scan is the preferred initial modality and ultrasound is also acceptable. X-Ray, you know, you’re not even thinking about that, it’s more of a distractor. But CT-Scan and ultrasound are both correct in the evaluation of appendicitis.
So which one are you going to choose? Well although they’re both correct, and although CT scan is the best as far as the most accurate diagnostic test to diagnose appendicitis, the best initial test is going to be ultrasound because you have a child in which you do not want to expose radiation to. You have a child, that if exposed to enough radiation at this age, has an increased risk of malignancy down the road.
So, in order to spare this child from radiation, the first initial test is going to be an ultrasound. Now the first initial test doesn’t mean the best test, right? You have to look at the wording there. Initial test will be ultrasound to diagnose appendicitis. If the ultrasound is unequivequal, if the appendix can’t be adequately visualized through ultrasound, then yes, you’re going to go to CT Scan. But initially to spare the child from radiation, you’re going to do ultrasound.
So that’s another example of as to where you really need to pick the question apart and realize what they are asking. They’re not asking me the best; they’re asking me the initial. And the same thing goes with the medication. What is the best treatment choice option here. Well there’s a contraindication to doxycycline, so it’s very important to look at these questions and pick apart what they’re really asking you.
Now this isn’t meant to trick you, because you’re going to have real life clinical scenarios where you’re going to have a pregnant woman coming in with chlamydia, you’re going to have a child presenting with possible appendicitis, you have to know how to manage these patients and this is the only real way to test your knowledge as to which study you’re going to choose. In real life, you’re going to have every option available to you, it’s not going to be a multiple choice test. You’re going to actually have to create that solution on your own.
Sure, you’re going to be able to ask your attending, your supervising physician, you’re fellow PA’s, but you don’t want to rely on asking these people for everything. You need to know what you need to do. So, for that reason I wanted to give you this tip. Really pick apart that vignette. Really find out what they’re asking for.
If you notice as you’re going down the multiple choice answers that there’s a couple of correct choices, go back and read the vignette. Go back. there’s going to be a contraindication, there’s going to be some kind of reasoning in that clinical story that’s going to pull you in another direction. So really, really make sure that you’re reading the question correctly.
Alright, so that’s what I wanted to do today. I wanted to give you guys a tip. I wanted to give you guys something useful that you can use when studying for your exams, when actually reading the clinical vignette in the exam.