Stage 02 · Board preparation · free

Board preparation: how the exam thinks

The exam does not test recall — it tests the order of your reasoning. This stage covers how items are built, how to attack ventilator and emergency scenarios, and how to pace yourself across 185 questions.

3 lessons44 min·8-question assessment
  • Identify what an item is actually asking before reading the choices
  • Work ventilator scenarios by target rather than by memory
  • Pace a 185-question exam without running out of time or focus
Lesson 2.1 · 14 min

How a board item is built

By the end you can

  • Find the stem's actual question before the distractors influence you
  • Recognize the four standard distractor families
  • Answer 'what should the therapist do first' correctly

The last line is the question

Every scenario item ends with the actual ask: recommend, evaluate, obtain, initiate, or discontinue. Read that line first, then read the scenario knowing what you are hunting for. The clinical detail is there to make you slow down.

'What should the therapist do first' almost never means the most advanced intervention. It means the fastest safe action that either fixes the problem or tells you what the problem is.

The four distractor families

Right action, wrong time — a correct intervention placed before the assessment that justifies it. Right idea, wrong magnitude — the correct change taken too far. Plausible but unsafe — something a busy therapist might do that violates a standard. And the physician-only answer, which shifts a decision you are credentialed to make.

Where people lose the point

  • Reading the choices before the final line of the stem
  • Picking the most aggressive intervention because the patient sounds sick
  • Calling the physician when the item is testing whether you know the protocol
Lesson 2.2 · 20 min

Ventilator scenarios: change one thing, for one reason

By the end you can

  • Separate oxygenation controls from ventilation controls
  • Adjust toward a stated target rather than a remembered setting
  • Justify every change with the value it is meant to move

Two dials, two problems

Oxygenation is FiO2 and PEEP — mean airway pressure and alveolar recruitment. Ventilation is rate and tidal volume — minute ventilation and CO2 clearance. Exam items reward candidates who never confuse the two, and punish the candidate who raises FiO2 for a rising PaCO2.

Work from the target backwards

Given a PaCO2 and a desired PaCO2, minute ventilation scales inversely: desired VE equals current VE times current PaCO2 divided by desired PaCO2. Once you have the new minute ventilation, decide whether rate or tidal volume is the safer place to find it — in lung-protective ventilation it is nearly always rate.

Lung-protective volumes are 4–8 mL/kg of predicted body weight, driven by height and sex, never by what the patient weighs today.

Numbers to know cold

Lung-protective VT
4–8 mL/kg PBW
Plateau pressure goal
< 30 cmH2O
Typical starting PEEP
5 cmH2O

Where people lose the point

  • Raising FiO2 for a ventilation problem
  • Increasing tidal volume when the plateau pressure is already near 30
  • Making two changes at once so neither can be evaluated
Go deeper in the full module
Lesson 2.3 · 10 min

Pacing 185 questions

By the end you can

  • Budget time per question and per review pass
  • Use flagging as a decision, not a delay
  • Protect accuracy in the final hour

The arithmetic

Four hours across 185 items is roughly 78 seconds each, and calculation items will take three minutes. That is affordable only if the recall items take twenty seconds. Answer what you know quickly so the hard items inherit the surplus.

Never leave an item blank when you flag it. Commit to your current best answer, flag it, and move — a flagged item with an answer is insurance; a flagged blank is a gamble on the clock.

The review pass

Reserve the last twenty-five minutes for flags only. On review, change an answer only when you can name the specific fact that makes your first choice wrong. 'It feels wrong' is the most expensive sentence on exam day.

Numbers to know cold

Average per item
~78 seconds
Review reserve
Last 25 minutes
Passing standard used here
70%
Study guide

The whole stage on one page.

Review this the morning of a shift or the night before the assessment. Print it or save it as a PDF.

2.1

How a board item is built

  • Find the stem's actual question before the distractors influence you
  • Recognize the four standard distractor families
  • Answer 'what should the therapist do first' correctly
2.2

Ventilator scenarios: change one thing, for one reason

  • Separate oxygenation controls from ventilation controls
  • Adjust toward a stated target rather than a remembered setting
  • Justify every change with the value it is meant to move
2.3

Pacing 185 questions

  • Budget time per question and per review pass
  • Use flagging as a decision, not a delay
  • Protect accuracy in the final hour

Every number in this stage

Lung-protective VT
4–8 mL/kg PBW
Plateau pressure goal
< 30 cmH2O
Typical starting PEEP
5 cmH2O
Average per item
~78 seconds
Review reserve
Last 25 minutes
Passing standard used here
70%

Traps to avoid

  • Reading the choices before the final line of the stem
  • Picking the most aggressive intervention because the patient sounds sick
  • Calling the physician when the item is testing whether you know the protocol
  • Raising FiO2 for a ventilation problem
  • Increasing tidal volume when the plateau pressure is already near 30
  • Making two changes at once so neither can be evaluated
Flashcards

Drill the recall before the assessment.

12 cards for this stage. Tap a card to flip it, mark the ones you know, then take the assessment.

1 / 12 · 0 known
Take the assessment
Finish the stage

Now prove it on the assessment.

Eight scored questions drawn from this stage. Score 70% or better and the stage is marked passed on your path.

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Back to the syllabus ABG interpretation Mechanical ventilation Emergency care & ACLS