PNA (Internato Médico) common mistakes
PNA (Internato Médico) · Understand the traps and how to avoid them.
On multiple-choice items with five options, selecting the first plausible answer and moving on without reading the remaining options to the end.
Time pressure in a long exam and the habit from medical school tests where the first correct-looking option is usually right; distractors in this exam are often designed to be attractive to a partial-knowledge reader.
What to do instead
Adopt a fixed routine per item: read the stem, formulate your own answer before looking at the options, then read all five options and eliminate explicitly before choosing. Practice with timed blocks so the routine survives under pressure.
Answering the question you expected rather than the one written, e.g. missing a negation ('except', 'not', 'least likely') or a qualifier ('initial', 'most appropriate next step').
Pattern recognition: the clinical vignette resembles a familiar case, so the brain completes the question from memory instead of reading the actual wording.
What to do instead
Underline or circle the operative word in the stem (except/next/most likely) before evaluating options; on any item where you feel instant recognition, re-read the last sentence of the stem once more before answering.
Treating 'most appropriate next step' items as diagnostic-recall items and choosing the test that confirms the diagnosis rather than the step that should be taken first (including resuscitation, stabilisation, or referral).
Medical training rewards naming the diagnosis; management sequencing and urgency are practised less and are easy to conflate with diagnosis confirmation.
What to do instead
For every management item, first classify the scenario as emergency, urgent, or elective, and ask whether the patient is stable. Only then choose among options; eliminate any option that delays necessary stabilisation.
Choosing a management option that is contraindicated or less safe in a specific host (pregnancy, renal or hepatic impairment, elderly, breastfeeding, allergy) because it is the usual first-line drug in a healthy adult.
First-line treatment is memorised as a single default, and special populations are studied as separate chapters that are not integrated into prescribing decisions.
What to do instead
Before committing to a drug option, run a rapid three-point check: pregnancy/lactation, renal and hepatic function, and allergy/interaction. If any is present, re-evaluate all options rather than only the one you first liked.
Confusing screening, diagnostic confirmation, and staging or follow-up tests, and selecting a screening test as the answer in a symptomatic patient (or vice versa).
The same test appears in several contexts and the purpose of the test is not explicitly stated in the stem, so the candidate matches on the test name rather than on the clinical question being asked.
What to do instead
Label each option by purpose (screen / diagnose / stage / monitor) before choosing, and match it to the patient's status: asymptomatic average risk, symptomatic, or known diagnosis.
Spending disproportionate time on a small number of difficult items and leaving later, easier items unanswered or rushed.
Loss aversion and the feeling that the current item is almost solved; without a hard stop rule, candidates over-invest in low-yield questions.
What to do instead
Set a per-item time budget from the total item count, mark and move on after the budget is exceeded, and reserve the final minutes for marked items and for checking that no answer is blank.
Changing correct first answers on review based on vague doubt rather than a concrete new fact from the stem.
Anxiety during review and the belief that a second look is always more accurate; answer-changing feels like diligence but often erodes correct responses.
What to do instead
Only change an answer if you can state the specific stem detail or fact that makes the original choice wrong. Otherwise keep the first answer and move on.
Mixing up absolute versus relative measures when interpreting a study or trial result, or choosing an option that overstates the strength of the evidence (e.g. equating association with causation, or a surrogate endpoint with clinical benefit).
Epidemiology and biostatistics are studied early and rarely revisited, and the numeric distractors are designed to look interchangeable.
What to do instead
For any data-interpretation item, write down the measure named (relative risk, odds ratio, absolute risk reduction, number needed to treat) and what it can and cannot support before reading the options; reject options that claim causality or clinical benefit beyond the design.
Defaulting to the most severe diagnosis or the most aggressive treatment when the vignette describes a mild or self-limiting presentation, or the reverse.
Exam preparation emphasises classic severe presentations and red flags, creating a bias toward the dramatic answer; conversely, over-familiarity with benign cases can lead to missing red flags.
What to do instead
Explicitly grade severity from the vitals, mental status, and functional impact given in the stem, then choose the option calibrated to that grade. Practise paired vignettes (same disease, mild versus severe) to build calibration.
Ignoring the legal and ethical framework (informed consent, confidentiality and its limits, capacity assessment, mandatory reporting, documentation, end-of-life decisions) and answering purely on clinical grounds.
These topics are perceived as peripheral to clinical knowledge and are often skimmed, yet they appear as standalone items with unambiguous correct answers.
What to do instead
Build a short, memorised checklist for capacity (understand, retain, weigh, communicate), consent (voluntariness, information, capacity), and confidentiality exceptions (risk to others, legal duty, public health). Apply the checklist to every ethics item before reading options.