Goals

The student or graduate PA will:

Test-Taking Tips
Jim Van Rhee, M.S., PA-C
Program Director; Associate
Professor Yale School of Medicine,
PA-Online
1. Identify proven techniques from the psychology of
learning and educational measurement which will
enhance test performance.
2. Identify information from testing theory which will help
avoid “careless” errors.
3. Practice using clues to help identify correct and
incorrect responses to exam questions.

Test-Taking… To achieve our goals, we will discuss:

• Measures two things: • How to prepare
– 1) Knowledge
– 2) Test-taking skills • How to do your best during the exam

• The mechanics of test-taking

• Is a skill, like any clinical skill
– …but good clinical skills do not always translate directly into • Managing stress and anxiety
good test-taking skills!
• Some test question examples
• Has evidence-based, scientific foundations
• Some DOs and DONʼTs for test-taking

Before the Test Standardized Testing

• Preparation • Norm-Referenced
– Know what to expect on the exam – All raw scores converted to a standard (norm) score
• Prepare mentally based on a reference group
– Stop worrying about how or what other students are
• Average PANCE score is 500
doing
• Know the testing site • SD is 100
– Allow time to drive to the site • Criteria-Referenced
– Dress accordingly – Standard for passing set by a group prior to the
• Supplies exam being given
– None allowed – PANCE is about 350
Itʼs 3 A.M. but I
still have 2 more
chapters to get
through.

1
 The Test: PANCE
• Pearson VUE testing centers
• 300 total questions
– ~20% surgical issues
• Five 60-question blocks each lasting 60 minutes
• No time stopping breaks after starting block
– Total break time 45 minutes
– Total exam time 5 hours 45 minutes
• Can register 90 days before graduation
– Take exam 7–90 days after graduation
The Test: PANRE
• Pearson VUE testing centers
• Must take exam every 10 years
• 4 hours plus breaks to complete
• 240 questions- multiple choice
– Four 60-question blocks each lasting 60 minutes
• Exam window period year around
• Exam Options
– 60% will be generalist exam
– 40% can be directed in one of 3 areas: adult medicine,
surgery, and primary care

Scoring PANCE Results- First Time Pass Rate

• One point for each correct answer • 2017
• NO penalty for incorrect answers – Pass rate 97%
• Tests then evaluated and questions removed if needed • 2016
and test re-scored – Pass rate 96%
• Passing score is predetermined • 2015
– Pass rate 96%
• 2014
– Pass rate 95%
Remember: Donʼt leave any answer blank.
• 2013
• Pass rate 94%

Testing Center Identification

• Arrive 30 minutes early to Pearson VUE testing center. Acceptable forms of ID:
• Computer clock • Primary ID must contain a • Secondary ID must
permanently-affixed photo, contain the candidateʼs
• No supplies allowed
along with candidate's name:
– Marker board or scrap paper is supplied. pre-printed name and
signature:
• No personal belongings allowed – Driverʼs License – Employee ID
– You will be assigned a locker – Passport – Social Security Card
– Military ID – Credit Card
• Once you begin a block, no clock-stopping breaks are – Student ID – Birth Certificate
permitted. – Naturalization Papers
– Government-issued
• Do not forget 2 forms of ID (at least one
International Driverʼs
with a photo). License

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 Exam Content General Test Strategies
• Dump Information
% of Exam Diseases/Disorders/Organ System These five areas make up – Calculations, formulas, flow charts
13 Cardiovascular System 50% of the exam.
• Develop a plan
10 Pulmonary System
% of Tasks and Objectives – Budget your time
9 Gastrointestinal System/Nutrition Exam
• If taking more than 2 minutes, answer and move on
8 Musculoskeletal System 18% Formulating most likely diagnosis
– Plan to use the entire exam time
7 Eyes, Ears, Nose & Throat 17% History taking and physical exam

7 Reproductive System
• Make educated guesses
14% Clinical therapeutics
7 Endocrine System
– Go back later to questions you donʼt know
14% Clinical intervention
6 Neurologic System – Donʼt waste time
12% Using lab and diagnostic studies
6 Psychiatry/Behavioral Science – Guess if you have to; donʼt leave it blank
10% Applying scientific concepts
5 Genitourinary System
10% Health maintenance
5 Renal System
5% Professional Practice
Note: Drug names: generic names for common names and
5 Dermatologic System
generic and trade for others; never just trade name
5 Hematologic System

6 Infectious Diseases

Question Options Multiple-Choice Tests

Multiple-Choice Formats • Work quickly.
• A-type Questions • Try to answer the question before looking at the
– Multiple-choice question: stem with 5 options choices.
– Negative (“All of the following EXCEPT”) questions • Pick the BEST answer.
are rare
– May have a scenario – If it appears that there are 2 correct answers, select
the most specific one.
• B-type Questions
– Matching questions • Eliminate unlikely answers.
– Very few questions in this format • Look for clue words and numbers.
– Typically organized around a theme (anemia, IBD) • Avoid reading into the question (assume nothing).
• No K-type questions
• When in doubt, guess.

Normal Ranges Sample Question

A 29-year-old female complains to her health care provider of headaches, fatigue,
and weakness over the past several months. Physical exam is significant for pallor,
tachycardia, dizziness on standing, and spooning of the nails. Laboratory studies
reveals the following:
Hemoglobin 10.2 g/dL (normal 12-16 g/dL)
Hematocrit 31% (normal 35-45%)
Serum iron 24 mg/dL (normal 50-170 mg/dL) Serum
ferritin 30 ng/mL (normal 10-120 ng/mL) TIBC
30 ng/ml (normal
250-450 mg/dL)
A peripheral blood smear would likely show which of the
following?

A) Macrocytosis with hypersegmented neutrophils

B) Microcytosis with basophilic stippling
C) Microcytosis with hypochromia
D) Numerous schistocytes

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Answer for Choosing
• Decide what the answer is to a question before looking
at the answer choices.
• Then pick the answer choice that most closely matches
your answer.
• Choose simple answers even if they seem obvious.
• Never pick an answer without first reading all the
choices.
Look for Clue Words and Numbers
• If 2 answers are opposites, one of them is probably
correct.
• Answers with the following words are usually
incorrect: always, never, all, none.
• Answers with the following words are usually
correct:
seldom, generally, most, tend to, probably,
usually.
• Look for grammatical clues.

Guess Three Phases of Question-Answering

• Even if you are randomly guessing, you • Phase 1
should get about 25% right. – Go through the exam and answer those items about
which you are confident.
• With educated guessing, that jumps up to
• Saves time and builds confidence
75%.
– Donʼt leave any questions blank.
• Random guessing tips • Phase 2
– The longest response is often correct. – Go back and focus on marked/skipped questions.
– Answer “C” is a good choice. – Eliminate incorrect answers.
• Phase 3
– If there is a range in numbers, choose
– Take your best guess.
one in the middle.
– Watch random guessing on
standardized tests.

Test Anxiety Mechanics of Test-Taking

• Keep a positive attitude. • Time allowance
• Concentrate on the test. • Maintain a positive attitude
– Be prepared for a long (but not
– Donʼt worry about the person next to you.
unbearable) day
• Pay close attention to one question at a time. • Answering by elimination
• Relax. • Always triage first
• Medications • Should you change your answer?
– Yes, if a good reason to change
– Not the time to start something new
– But don’t stop regular medications

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How to Pass the Exam… Types of Questions You Will Encounter and
Three conditions are generally necessary: Strategies for Dealing with Them
1. Know about or recognize medical information. 1. The Oversimplification
2. The Oversimplification that is Dangerous by Omission
• The best way to pass any exam is to know the
material. However, there are times when you will need 3. Clues from Logic
to guess between 2 or more choices. Donʼt guess 4. Clues from Related Areas
randomly, however; use educated guesses involving 5. Qualifying Words
known test-taking skills and strategies.
6. The Overqualified Choice
2. Use appropriate test-taking skills. 7. Strange Terms
3. Avoid situations leading to mistakes or impeding 8. “Apple Pie” Choices
performance. 9. Hints from Inconsistencies in Terminology
10. Rank Orders

Types of Questions You Will Encounter and The

Strategies for Dealing with Them questions appear tricky because you think, “No question
Oversimplification
Some
could be this simple!” If you really know the answer to a question,
Regardless of the question type, always triage first. Ask answer it without belaboring or looking for booby traps that are not
yourself the following: there.
A 24-year-old female presents with lower abdominal pain
• Is this a friendly question? and fever of 48 hours duration. During the pelvic exam,
– Simply asks for information she experiences exquisite pain when the cervix is moved.
Which of the following is the most likely diagnosis?
• Is this a trap?
A. Cervical carcinoma
– Attractive choices that can catch you off guard
B. Bacterial vaginitis
• Are choices potentially harmful? C. Leiomyoma
– Important pitfalls which must not be missed—probably just D. Peritonitis
the ones you would consider clinically important E. Cystitis

The Oversimplification The Oversimplification that is

A 24-year-old female presents with lower abdominal pain and fever of 48
hours duration. During the pelvic exam, she experiences exquisite pain Dangerous by Omission
when the cervix is moved. Which of the following is the most likely
diagnosis? As always, triage questions for traps. Here, the correct choice is an
oversimplification that is dangerous by omission.
A. Cervical carcinoma
B. Bacterial vaginitis A 19-year-old male presents with a painless testicular
C. Leiomyoma mass. Which of the following diagnoses should be
D. Peritonitis pursued?
E. Cystitis
A. Strangulation
The item least likely to cause pain, (A), is
eliminated. Any of the remaining 4 are possibilities, B. Carcinoma
but peritonitis C. Varicocele
(D) of any etiology is usually a safe D. Carbuncle
diagnostic consideration. E. Torsion
Do not get bogged down considering the
unlikely diagnostic possibilities when an
obvious choice is present.

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The Oversimplification that is Dangerous Clues from Logic
by Omission Sometimes a logical (and correct) answer is contained in
A 19-year-old male presents with a painless testicular mass. Which of the following the stem.
diagnoses should be pursued?

(A)Strangulation At what time is the diagnosis of congenital hip

(B)Carcinoma dislocation made?
(C)Varicocele
(D)Carbuncle
(E)Torsion A. In utero
(A), (D), B. At birth
and (E) are C. At 6 weeks of age
incorrect
because D. At 6 months of age
they are
usually E. At 1 year of age
painful. (B)
and
(C) are
usually
painless.
Because
of its
prognosis
if left
untreated,
a
testicular mass should be considered cancer until proven
otherwise. Not to do so would be considered a life-threatening
omission. (B) is correct.

Screen questions for dangerous or critical choices whether harmful by

Clues from Logic
omission or commission. A potentially harmful choice may present Clues from Related Areas
itself as an oversimplification.
At what time is the diagnosis of congenital hip dislocation Similar to clues from logic, knowledge about related
made? disciplines can provide additional hints.

A. In utero An obese 50-year-old woman presents with acute groin

B. At birth pain. Upon examination a 2–3 cm soft mass is noted in the
right labia majora. Which of the following is the most likely
C. At 6 weeks of age diagnosis?
D. At 6 months of age
E. At 1 year of age A. Lymphadenopathy
B. Inguinal hernia
The term congenital means “present at birth.” This is when C. Uterine prolapse
the diagnosis of congenital hip dislocation is made. The
correct choice is (B). D. Femoral aneurysm
E. Neurofibroma

Clues from Related Areas Qualifying Words

An obese 50-year-old woman presents with acute groin pain. Upon Test-item stems which contain qualifying words such as
examination a 2–3 cm soft mass is noted in the right labia majora. most, more, usually, often, less, seldom, or few can lead
Which of the following is the most likely diagnosis? you to the correct answer.
A. Lymphadenopathy
B. Inguinal hernia A 30-year-old presents to the clinic with what
C. Uterine prolapse is suspected to be alcohol withdrawal. Which
D. Femoral aneurysm of the following would be the most likely
E. Neurofibroma
finding?

You would probably not miss the common diagnosis of A. Visual hallucinations
inguinal hernia in a male patient. Remembering from B. Auditory hallucinations
developmental anatomy that the labia majora and scrotum C. Fine motor tremors
are corresponding tissues, (B) would be selected as
correct, even if you had minimal knowledge about surgical D. Motor seizures
emergencies. E. Autonomic hyperactivity

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Qualifying Words The Overqualified Choice
A 30-year-old presents to the clinic with what is suspected to be To make an answer acceptable, test-item writers sometimes
alcohol withdrawal. Which of the following would be the most likely
finding? must qualify a choice to the point at which the savvy test-
taker recognizes the ploy.
A. Visual hallucinations
B. Auditory hallucinations In the smoking patient, which of the following
C. Fine motor tremors most appropriately describes clubbing?
D. Motor seizures
E. Autonomic hyperactivity A. Discoloration of the nail bed
B. Flattened angle between the dorsal surface of
Any of the above may be seen with alcohol the distal phalanx and the proximal nail
withdrawal. However, fine motor tremors are by far
the C. Abnormal, outwardly curved nail
m ost likely
( most commo n. The stem
), suggesting contains
(C) qualifying
as the correct
“ ” D. Decreased eponychium
choice.
words

The Overqualified Choice Strange Terms

In the smoking patient, which of the following most Choices which contain completely unfamiliar words are likely to
appropriately describes clubbing? be distracters. If the choice appears completely bizarre, the test-
item writer was probably scraping the barrel for a distracter.
A. Discoloration of the nail bed
B.Flattened angle between the dorsal surface of the distal On a routine peripheral blood smear, a nucleated cell filled
phalanx and the proximal nail with bright red granules and approximately 3x the diameter
C.Abnormal, outwardly curved nail of a typical red blood cell is noted. What is this cell called?
D.Decreased eponychium
A. Reed-Sternberg cell
B. Myeloblast
The overqualified (lengthy) choice, (B), is likely to C. Eosinophil
correct, as we see here. However, recall the
be D. Lacunar cell
choice
“ odd ” described earlier. Sometimes, the short E. Kupffer cell
choice
“ odd ” is correct. You will recognize this
variation because it will be attractively precise
and succinct.

Strange Terms “Apple Pie” Choices

On a routine peripheral blood smear, a nucleated cell filled with bright red
granules and approximately 3x the diameter of a typical red blood cell is noted.
What is this cell called?
A. Reed-Sternberg cell There are some responses to which no one would object.
B. Myeloblast
C. Eosinophil When evaluating a 23-year-old woman with vaginal
D. Lacunar cell bleeding, the most important clinical information
E. Kupffer cell
is gained from which of the following?
(A), (D), and (E), while real cell types, are not typically A. Complete blood count
noted in primary care. (B) is familiar—remember basic
B. Prothrombin time
hematology. However, identifying a myeloblast on the
peripheral smear is not basic primary care, which the C. Bleeding time
PANCE/PANRE exams cover. Physician assistants should D. Physical exam
recognize the morphology and significance of an E. History
eosinophil; thus, the correct response is (C).

7
 “Apple Pie” Choices “Apple Pie” Choices—Watch Out
When evaluating a 23-year-old woman with vaginal bleeding, the most for Seductive Traps!
important clinical information is gained from which of the following?
An unconscious patient presents to the
A.Complete blood count emergency room. Which of the following is the
B.Prothrombin time most important physical exam component to
C.Bleeding time perform?
D.Physical exam
E.History
A. General inspection
A patient ʼs history provides a clinician ʼs best information and is B. Neurologic exam
almost never incorrect. (E) is an “apple pie” choice. C. Pulmonary exam
D. Vital signs
The ”apple pie” choice, however, can also be used by test-item
writers to set traps! E. Brain MRI

“Apple Pie” Choices Hints from Inconsistencies in Terminology

Watch out for seductive traps! Grammar inconsistencies between the stem and a choice (e.g., tense,
number, gender) are usually recognized by expert educational evaluators
An unconscious patient presents to the emergency room. Which of the who screen Board exam test questions. You will seldom encounter this type
following is the most important physical exam component to perform? of “hint” on Board exams.
A.General inspection A 19-year-old motorcycle accident victim with suspected multiple
B.Neurologic exam trauma is brought unconscious to the emergency room. The
C.Pulmonary exam
most significant physical findings will usually result from which
D.Vital signs
of the following?
E.Brain MRI

The initial triage here would identify this as a “trap” question A.Undressing the patient
because the critical nature of the scenario is combined with an B.Prompt neurologic exam
C.Interviewing the family
incorrect “apple pie” choice. Brain MRI (E) is promptly dismissed
because it is not a physical exam component. (B) appears D.Interviewing a witness to the accident
attractive because of its “apple pie” component. But recall the E.All the above
ABCs of emergency care. (D) is correct.

Hints from Inconsistencies in Terminology Rank Orders

A 19-year-old motorcycle accident victim with suspected multiple trauma is When given a list of numbers or other rank orders, the
brought unconscious to the emergency room. The most significant physical
findings will usually result from which of the following? correct response most often occurs somewhere between the
extremes.
A.Undressing the
patient B.Prompt
In the patient with chronic schizophrenia, how long must
neurologic exam
the disease be present to be termed chronic?
C.Interviewing the family
D.Interviewing a witness to the accident
E.All the above
A. ½ year
B. 1 year
(C) and (D) refer to historical findings, not physical. This also
excludes foil (E). Although indicated, at this point of presentation
C. 2 years
the neurologic exam is too focused. A more general, overall D. 3 years
assessment provides the best clinical information; thus, critical,
E. 4 years
life-saving information across organ systems may be gained
from observing the patient. (A) is correct.

8
Rank Orders
Most test-item writers try to bury the correct answer
somewhere in the middle. (C) is the correct answer
in each example.
As with hints from inconsistencies in terminology,
this clue does not often work on Board exams.
Educational evaluators try to randomize the
position
of correct responses as much as possible. However,
when in doubt, it is better to avoid the extremes.
DOs and DONʼTs
DOs
• DO reread instructions provided by the testing agency the night
before, to ensure you arrive on time, at the right place, and with
the right materials.
• DO review in detail the information on the PANCE or
PANRE content, instructions and format found at
www.nccpa.net.
• DO remember to bring admissions materials (such as your
government-issued identification).
• DO examine the computer station you are assigned. Be alert
for glare or other lighting problems, and potential traffic flow
as others arrive and leave throughout the day.
• DO consider the proctor is there to support you. Ask for any
reasonable support or change of computer location that will
help you do your best.
Q-Bank
DOs
• DO practice what you will be doing during the exam; that is,
answering multiple-choice questions on a computer. This is
imperative for the clinician who has not taken a written or
computer-based exam recently.
• DO direct your studying to the primary care areas with
which you are least familiar.
• DO get adequate sleep and rest before the exam.
• DO dress comfortably in layers that prepare you for
temperature extremes. Coats or jackets will not be
allowed.
• DO arrive alert, calm, and well-rested.
• DO bring beverages, food for lunch, and between-test-block
snacks.
DOs
• DO pace yourself, allowing a calculated amount of time per
question. Allow for some extra time at the end to return to items
you have marked as unsure.
• DO avoid situations that might put you in an unfavorable mindset
before the exam. Let nothing interfere with your best possible
performance.
• DO relate test questions to your own practice and experience.
Test-item writers are people who have derived many of the test
questions from their own clinical experience. What would you
expect a primary care physician assistant to know?
• DO change your answer if you have a good reason to do so. You
are twice as likely to change from an incorrect response to a
correct one.
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DOs
• DO triage each and every question before selecting your
answer. Evaluate it as a question designed to
– test knowledge in a “friendly” way
– trap by including common pitfalls
– evaluate your knowledge about potentially dangerous choices
• DO use the process of elimination. As with a patientʼs differential
diagnosis, this usually is done by elimination. Avoid choosing an
answer until after you have considered all of the choices.
• DO eliminate choices containing completely unfamiliar words as
distracters. If the choice appears completely unfamiliar, it is
probably incorrect.
DOs
• DO mark items if you are not sure of the answer. Return to
these items when you finish the question block (but donʼt
leave them blank the first time through the exam).
• DO consider “apple pie” choices as probably correct.
However, beware that they may also be used to trap.
• DO consider choices that are different from the others—the
“odd choice.” These may include a choice having an “odd”
meaning or “odd” length—long or short. The overqualified
choice often is correct.
• DO select choice (C) when purely guessing; it is most
frequently the correct response on many one-choice-only
multiple-choice questions. If you eliminate (C) as a
possibility, (B) is the next most likely choice. This is a “last-
ditch” strategy that works more often on classroom tests than
on Board exams.

DONʼTs
• DONʼT cram at the last minute; the exam covers mostly primary care
breadth rather than depth.
• DONʼT eat a large meal within 2 hours of the exam.
• DONʼT leave any items blank. Unanswered items will be counted as
wrong.
• DONʼT discuss the exam with others during the test administration,
breaks or even afterward; this adds to anxiety and may result in
Sample Questions
disqualification or revocation of your certification.
• DONʼT become irate over seemingly absurd questions.
Answer them to the best of your ability, realizing that they are
probably experimental questions that will not affect your score.
• DONʼT guess randomly. Even if you are completely unsure of an answer,
use the hints suggested today to increase the probability of guessing the
correct response. Make educated, not random, guesses.
• DONʼT think of anything except the exam in front of you.

A 15-year-old male presents to the office with jaundice. Vital

signs are normal except for a low-grade fever. A CBC is
Which of the following is the most common cause of non-
gonococcal urethritis in men under the age of 35? performed and results noted below:
Hematocrit 46% Hemoglobin 15.4 g/dl MCV 86
Platelets 150,000/mm3 fL WBC 14,500/mm
A. Pseudomonas aeruginosa Diff: Neutrophils 20%, Bands 2%, Lymphocytes 70% (22% atypical with
B. Escherichia coli vacuoles), Monocytes 6%, Eosinophils 2%
C. Chlamydia trachomatis Which of the following is the most likely diagnosis?
D. Trichomonas vaginalis A. Viral hepatitis
E. Ureaplasma urealyticum B. Pertussis infection
C. Infectious mononucleosis
D. Acetaminophen overdose
E. Acute lymphocytic leukemia

10
After This Program Ends
• Rank-order NCCPA organ systems from weakest to
strongest based on recent testing, and study them in
that order.
• During the remaining study time, devote more time to
weaker subjects and less time to stronger ones.
– This will help even out your knowledge base so that on the actual
exam, you wonʼt lose a lot of points in any one area.
Effective Reviewing
• Make a plan and stick to it.
• Transform, apply, and extract key aspects into briefer
form.
• Practice testing should be cumulative, not single
subject.
• Analyze patterns in your test errors and adjust study to
strengthen habitual problem areas.
• Reward yourself for goals achieved.
• Gradually switch focus from reviewing to “performing.”
• Simulate exam-pacing plus item mix before test day.
• Let self-testing results dictate when you are test ready.

The End
• Donʼt worry.
• You will receive your scores in 10-14 days.
• Donʼt discuss the exam with others; it will just create
more anxiety plus it is unethical.
• Check policies and procedures at: Questions
– http://www.nccpa.net/PoliciesProcedures?mID=101
• GOOD LUCK!

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