Struggling with scenario type questions on exams

[Limes]

I've noticed that I struggle the most when it comes to scenario type questions, especially the ones that ask for the best answer (you know, the "they're all right, but which one is the best answer").

But when it comes to more "straight forward" questions, I'm fine (and usually if I don't get the question right it's because of something I didn't review). I guess you can say the more complicated the question gets, the more I struggle.

Are there any tips you guys can give me for these types of questions? Generally speaking, I've always struggled with questions that always ask for the best answer.

 

[Chewy20]

Know patient assessment.

 

[Ewok Jerky]

A before B, B before C

 

[Aprz]

You'll hopefully get a feel for it as you do more scenario questions.

Like Ewok and Chew said, know your patient assessment and ABC. If it is asking about treatment or what to assess for, it is whatever comes FIRST in the patient assessment in the answer list. For example, if it had a question like

You respond to an 86 years old female complaining of chest pain. You should...

A) Check that the scene is safe.
B) Assist with administration of the patient's own nitroglycerin.
C) Administer high flow oxygen.
D) Transport

They are all right, but scene safety is the first one on the patient assessment algorithm so that would be the answer. This is usually the easiest for me to figure out. just go down the list. Whatever come FIRST on the list is the answer. List being the NREMT skill sheet for patient assessment.

In regard to CAB vs ABC, I am not 100% sure how it works still. I think for NREMT, their questions are ABC unless the patient is unresponsive, then the AHA CAB route is the way they want you to go. Worked for me on the NREMT (fake) paramedic test.

Other scenario questions that were simply right or wrong answers were actually a little bit more difficult. Like I said, you'll get a feel for it. At one company I applied for it, it had a scenario that mentioned the patient having JVD, muffled heart tones, and a narrowing pulse pressure (systolic decreasing and diastolic increasing). Since I knew Beck's triad for pericardial tamponade, I knew the answer was pericardial tamponade. It had other answers that could be tempting like a patient with congestive heart failure and tension pneumothorax (they know the noobies are really only going to be familiar with the JVD part, lol). You're going to know it when you see it (hopefully).

Another way I deal with scenario questions is I don't really spend too much time on them. Usually the first answer I came up with is what I stuck with. You are going to be taught to think of stuff quickly and you are probably already going think of the right answer without thinking about it much. You might not know 100% why that is the answer, but your book and instructor have already had intercourse with your mind and you're thinking of it. You're not going to think about it much in real life. Don't think about it too much on the test.

Sometimes it seems like the writer of the questions or literature are obsessed with very specific things. I mean they are important, but I feel like they are "obsessed" with these association. Another example is that anytime I saw a question with altered mental status and an answer with blood sugar, I would just pick blood sugar. I actually got really lazy at my fake paramedic school and just always picked blood sugar without even reading the full question and answer. Not a good habit to pick up, but it worked out well for me since I'm a certified fake paramedic now. Word association I guess? Like more examples from earlier with the tension pneumothorax vs CHF vs pericardial tamponade is

tension penumothorax - unilateral breath sounds with neck veins
tension hemothorax - no neck veins
CHF - pedal edema, sitting/legs lower, pulmonary edema or cardiac wheezes, pink frothy sputum
pericardial tamponade - the JVD from increase venous pressure, narrow pulse pressure (increase diastolic, decrease systolic), muffled heart tones,

Like I just start picking out words and I immediately have an idea what the answer is without reading the whole thing. They are usually going to pick something everyone knows like JVD, but then add stuff that not everyone knows that will help distinguish which is the correct answer.

If all else fails, I always remember @JPINFV's signature with the holy trinity of EMS: spinal immobilization, high flow oxygen, and rapid transport. EMS seems to be moving away from that stuff, but it doesn't look like the literature, instructors, and tests have moved away from them yet.

 

[OnceAnEMT]

Patient assessment, both trauma and medical, involves a pretty straight-forward algorithm that the NREMT loves to test. There are probably multiple flowcharts in your book depicting it from General Impression to Primary Assessment to Secondary Assessment (broken down to vital signs, SAMPLE Hx, and the various types of physical assessments). Some great points about that above.

The key that really helped me was when reading those scenario questions where there are multiple "right answers", just pop a "...first" at the end of the question. It's not "Here's a patient, what do you do?", but instead read it as "Here's a patient, what do you do first?". That little trick alone is the key to those questions. I've never seen a question basing its answer on importance. For instance, you don't choose Airway from ABC because it is most important, you choose it because it is first in the algorithm.

 

[Limes]

Thanks for the responses everyone. I have been doing more scenario type questions like you guys have suggested so I can get the feel of it.

I've never thought about it in an "algorithm" aspect, but that's a great way to put it.