PANCE (Physician Assistant National Certifying Exam) — All Questions

An uninsured man arrives at a hospital emergency department with chest pain. The registration clerk wants to confirm how he will pay before he is seen. Under the federal EMTALA regulation, what is correct?

• a.Payment information must be verified before any examination
• b.Only Medicare beneficiaries are covered
• c.The screening exam may not be delayed to ask about payment✓
• d.He must be transferred to a public hospital first

Under EMTALA (42 CFR 489.24), a Medicare-participating hospital with an emergency department must provide an appropriate medical screening examination to anyone who comes to the ED, regardless of ability to pay, and may not delay screening or stabilizing treatment to inquire about payment or insurance status. Transfer before screening and stabilization is not permitted, and the rule applies whether or not the person is a Medicare beneficiary.

A PA in a clinic phones a consulting cardiologist at another practice to discuss a mutual patient's echocardiogram and medication list for treatment planning. How does the HIPAA minimum necessary standard apply to this disclosure?

• a.The disclosure is prohibited without a court order
• b.It does not apply to treatment disclosures✓
• c.Written patient authorization is required first
• d.Only a one-line summary of the record may be shared

Under 45 CFR 164.502(b)(2)(i), the minimum necessary standard does not apply to disclosures to or requests by a health care provider for treatment, and treatment disclosures are permitted without the patient's written authorization. There is no rule limiting such communication to a brief summary, and a court order is not required.

A 45-year-old patient with decision-making capacity declines a recommended colonoscopy after the PA explains the risks, benefits and alternatives. The PA believes the refusal is unwise. What is the most appropriate action?

• a.Respect the refusal and document the discussion✓
• b.Ask a family member to consent instead
• c.Schedule the procedure anyway and obtain consent later
• d.Request a psychiatric evaluation because of the refusal

Patients with capacity have the right to refuse treatment, and a refusal by itself is not evidence of diminished capacity; the clinician should make sure the patient understands, respect the decision, keep the door open, and document the informed refusal. Referring for psychiatric evaluation or asking relatives to override a capable adult violates autonomy, and proceeding without consent is battery.

An unconscious adult with a ruptured spleen arrives after a car crash. There is no advance directive and no family can be reached. Emergency surgery is needed to save his life. Which principle allows the team to proceed?

• a.Therapeutic privilege
• b.Presumed (implied) consent in an emergency✓
• c.Waiver signed by the hospital attorney
• d.Substituted judgment by the surgeon

In an emergency when a patient cannot consent and no surrogate is available, consent to life-saving treatment is presumed. Therapeutic privilege refers to withholding information that would harm a patient, not treating without consent. Substituted judgment is exercised by a surrogate who knows the patient's values, not by the treating surgeon, and a hospital attorney cannot consent for a patient.

A PA notices that a colleague has repeatedly arrived for shifts smelling of alcohol and has made two recent dosing errors. According to the AAPA Guidelines for Ethical Conduct, what is the PA's responsibility?

• a.Identify and assist the impaired colleague✓
• b.Wait for the colleague to self-report
• c.Discuss it only with the colleague's patients
• d.Ignore it unless a patient is harmed

The AAPA Guidelines for Ethical Conduct state that PAs have an ethical responsibility to protect patients and the public by identifying and assisting impaired colleagues, which may include reporting through appropriate channels. Waiting for harm or for self-report leaves patients at risk, and discussing a colleague's impairment with patients is inappropriate.

A PA is asked out on a date by a current patient whom she has treated for several months. Which statement reflects the AAPA Guidelines for Ethical Conduct?

• a.Sexual involvement with a current patient is unethical✓
• b.It is acceptable if the patient initiates the relationship
• c.It is acceptable once the current course of care has ended
• d.It is acceptable if both are single adults

The AAPA Guidelines for Ethical Conduct state that it is unethical for PAs to become sexually involved with patients, and that it may also be unethical with former patients or key third parties. Who initiates the relationship, the timing of the next visit, and the marital status of either party do not change this, because of the power imbalance and trust inherent in the clinical relationship.

After explaining a new insulin regimen, a PA asks the patient: "To make sure I explained it clearly, can you tell me in your own words how you will take this at home?" What is this technique called?

• a.Teach-back✓
• b.Closed-loop referral
• c.Motivational interviewing
• d.Reflective listening

Teach-back checks understanding by asking patients to state in their own words what they need to know or do, framed as a test of the clinician's explanation rather than of the patient; AHRQ recommends it as a universal health literacy precaution. Motivational interviewing explores ambivalence about change, reflective listening restates the patient's feelings, and closed-loop referral tracks whether a referral was completed.

In a randomized trial, a new drug reduces the 5-year stroke rate from 10% in the placebo group to 6% in the treatment group. What is the number needed to treat to prevent one stroke over 5 years?

• a.4
• b.25✓
• c.17
• d.40

The absolute risk reduction is 10% - 6% = 4%, or 0.04, and the number needed to treat is 1 / 0.04 = 25 patients over 5 years. A value of 4 confuses the absolute difference in percentage points with the NNT. Forty is the relative risk reduction expressed as a percent (4/10), and 17 corresponds to the inverse of the treated-group event rate (1/0.06), not the difference between groups.