NP/PA ER · emergency department ramp

ER practice cases for NPs and PAs.

Don’t-miss ED cases, bread-and-butter foundations and verbal procedure stations — each one ending with a crisp presentation to your attending.

Start your free 7-day trial
Free 7-day trial · practice as much as you want · 17 don’t-miss cases, 33 foundations cases and 8 procedure stations · physician-reviewed
The exam

What an NP/PA ER case is like

This track is not an oral board. It is a floor ramp for NPs and PAs working in the emergency department: don’t-miss ED traps with a present-to-attending close.

Same examiner loop as DOME’s Emergency Medicine cases, aimed at catching high-liability misses and delivering a crisp plan to the attending.

  • Don’t-miss airway, ACS, ENT deep infection, SCAPE, and subtle PE paths
  • Present-to-attending closing beat
  • Bread-and-butter foundations: chest pain, pneumonia, DVT, pregnancy bleeding, pediatric fever and more
  • Verbal procedure stations: shoulder reduction, digital block, I&D, laceration repair, US-guided IV
How to prepare

Practice the way you’ll be examined.

01

Practice the present-to-attending close

What you found, what has resulted, and what you are asking for — said out loud, in that order, every case.

02

Talk procedures through step by step

Indications, consent, analgesia, technique, complications and aftercare. The examiner credits what you say.

03

Order what you need

Results appear only when you order them, so the workup you build is the workup you get.

04

Read the debrief every time

Every case ends with a debrief of what you caught and what you missed.

Sample walkthroughs

Three free sample cases.

Short excerpts from physician-reviewed DOME cases: the opening stem, a few of the examiner’s questions, and the teaching points from the debrief. In the full version you run it live, out loud, and the examiner only reveals what you ask for.

Sample 1 · Clinical case

The stem

You are an NP/PA in a community emergency department with an observation unit and treadmill capability in the morning. Carla Mendoza, a 58-year-old woman, walks in with chest pressure. Vitals are on the monitor. She looks comfortable now. How would you like to proceed?

The examiner asks

  • Walk me through how you scored this patient and what disposition that score usually drives in your shop.
  • Her first troponin is only barely above the URL a couple of hours after onset. What does that tell you about ruling out myocardial injury tonight?

Key teaching points

  • Non-ischemic ECG ≠ zero risk when the story and risk factors are intermediate.
  • Document the score, the shared decision if she refuses obs, and return precautions either way.
  • Present to attending: name the HEART band, what is already resulted, and the obs/admit ask.

Excerpt only. The full clinical case runs live with the AI examiner and ends with a full debrief.

Sample 2 · Clinical case

The stem

You are an NP/PA in a community emergency department with ultrasound available. Alicia Gomez, a 27-year-old woman, walks in with vaginal spotting and mild cramping. Vitals are on the monitor. She looks well. How would you like to proceed?

The examiner asks

  • Her ultrasound shows no IUP. What do you tell her tonight and what follow-up do you arrange?

Key teaching points

  • Why it matters: Ectopic pregnancy ruptures into the peritoneum and kills by hemorrhage — any first-trimester bleed without a documented IUP is a PUL until proven otherwise, so a clear plan and close follow-up are non-negotiable.
  • Return precautions must name syncope, heavy bleeding, and severe pain.

Excerpt only. The full clinical case runs live with the AI examiner and ends with a full debrief.

Sample 3 · Procedure station

The stem

You are an NP/PA in a community emergency department. A 19-year-old has an anterior shoulder dislocation after a basketball collision. Pre-reduction films confirm it. Talk me through reduction: indications, contraindications, consent, analgesia, technique steps, complications, post-reduction films, and aftercare.

The examiner asks

  • How do you test the axillary nerve before and after reduction?
  • First technique fails and spasm is worse. What do you do next?

Key teaching points

  • Post-reduction radiographs are mandatory.
  • Failed attempt → more relaxation or new technique, not more force.
  • Two failed low-force attempts is the signal to escalate: bring your attending to the bedside for procedural sedation and a fresh attempt, and involve orthopedics if it still will not go.

Excerpt only. The full procedure station runs live with the AI examiner and ends with a full debrief.

Pricing

Start practicing tonight.

Free 7-day trial — every case and station, as many reps as you want.

Each exam is its own subscription. Founding price: $49/month, locked for as long as you stay subscribed. The list price will be $99/month later.

Start your free 7-day trial