TESTING HIGHER SKILLS

Raja C Bandaranayake

DOMAINS OF LEARNING

Cognitive (Knowledge)

Psychomotor (Motor skills)

Affective (Attitudes)

THE COGNITIVE DOMAIN

Recall and recognition

Comprehension or Understanding

Application

Problem-solving analysis

synthesis

evaluation

TYPES OF QUESTIONS

Multiple choice questions (MCQ)

Short answer questions (SAQ)

Modified essay questions (MEQ)

Long essay questions

OSPE / OSCE Stations

Clinicals (Long cases / Short cases)

Orals

LONG ESSAY

Describe the structural changes associated with the assumption of the erect posture by an infant.

List the advantages and disadvantages of each change.

SAQ

Name two sites in the body where an intimate relationship between the nervous and endocrine systems is of functional significance.

Explain the functional significance of such a relationship at each site, relating function to the histological structure of the site.

MEQ FLOWCHART – ACUTE APPENDICITIS

TRIGGERS SEQUENCE QUESTIONS Male 25 yr Circum-umbilical Embryology

PGH Surg.Wd colicky pain Histology Pain localised to RIF Why changed? Abd. Palpation Tenderness Parietal perit. Pt of max tenderness rigidity, rebound tend. McBurney’s Pt

Temp Pulse Complications Pathogenesis Generalized Generalized peritonitis Why? Pain, phy.signs Laparotomy Ant abd wall,

Positions Gangrene, Perforation Bacteriology, Antibiotics Culture/ABS

TRIGGER 1

You are a medical officer in a Surgical Ward of PGH. Mr M., a 25-year-old male patient, was admitted with pain in the right lower abdomen. Careful history revealed that the pain started 48 hours prior to admission as regular, intermittent attacks of gradually increasing severity around the navel. The pain is now felt only in the right lower abdomen, and it is continuous. A provisional diagnosis of acute appendicitis was made by

you.

Qn. 1A Explain how the pain was initially felt in the umbilical region in this patient?

Qn. 1B Describe the manner in which intermittent pain was produced in this patient, relating your description to the histological structure of the appendix.

Qn. 1C Name three structures in the abdomen, other than the intestine, in which such pain may originate.

Qn. 1D State precisely the pathological changes that are responsible for (a) the subsequent location of the pain in the right lower abdomen; and (b) its change from a colic to a continuous pain.

Qn. 1E List three physical signs you may elicit in this patient on abdominal palpation, which would have helped you to make a provisional diagnosis of acute appendicitis.

Qn. 1F Explain how each of these signs has been brought about in this patient.

Summary: Circum-umbilical colicky pain in a 25-year-old male, subsequently localized to RIF. Diagnosis of acute appendicitis made.

TRIGGER 2 Physical examination revealed tenderness , guarding and rebound tenderness in the right iliac fossa. Maximum point of tenderness was McBurney’s point. Pulse was 100/min; temperature 100.2ºF.

Qn. 2A Draw a diagram to illustrate McBurney’s point.

Qn. 2B List three (3) complications that may occur if this patient is not properly managed.

Qn. 2C Describe briefly the pathological changes that may occur in the inflamed appendix, which result in each of the complications mentioned.

MEQ GRID

QN. ANA PHY PAT MIC BIO PHA CLIN

1A X

1B X X

1C X X

1D X

1E X

1F X

2A X

2B X

2C X X

3A X X X

3B X

4A X X

4B X X

4C X X

5A X

5B X

6A X

6B X X

MCQ - TYPE A

The best evidence for the neuroectodermal origin of the adrenal medulla is that

A. it has a direct arterial supply from the

abdominal aorta B. its venous drainage is into a persisting part

of the subcardinal vein C. it lies near the sympathetic trunk D. its secretory cells are innervated by

preganglionic fibres E. its cells show a well developed granular

endoplasmic reticulum

MCQ – TYPE A

The anatomical feature which is least likely to contribute to middle ear infection is:

A. presence of lymphatic tissue in the

pharyngeal end of the auditory tube B. presence of mastoid air cells C. a horizontally directed auditory tube in

children D. a longer cartilaginous part of the auditory

tube in relation to the bony part E. presence of the pars flaccida in the

tympanic membrane

MCQ – TYPE E

The ductus arteriosus closes at birth by muscular contraction

because

Oxygen tension in the blood perfusing the ductus arteriosus rises when the pulmonary circulation opens up

EXTENDED MATCHING QUESTIONS (EMQ or MCQ TYPE R)

Theme: Cardiovascular drugs Options: A. Alpha agonists B. Alpha blockers C. ACE inhibitors D. Beta agonists……. K. Vasoconstrictors Lead-in: For each patient, select the most appropriate drug

class Item stems: 1. A 40-year-old man with sudden onset of severe headache,

dizziness and vomiting, BP 260/130 mmHg; encephalopathy and grade IV retinopathy

2. A 55-year-old man with mild, chronic hypertension,

tachycardia and other symptoms of mild congestive cardiac failure. Previous history of asthma and gout.

3. ………

INTEGRATED OSPE / OSCE Based on a pathological specimen

Examine the macroscopic specimen provided. 1. Pick up the ‘phone. At the other end of the

line is a senior colleague more experienced in Pathology than you. Give him a macroscopic description of the specimen, pointing out particularly its abnormal features.

2. Give him your diagnostic conclusion from the specimen.

3. Tell him the findings on which you base your diagnosis.

INTEGRATED OSPE / OSCE Based on a pathological specimen

4. Write the main clinical symptoms and signs you would expect this patient to have shown before his death.

5. Examine the histo-pathological slide

provided. 6. Write the histological features seen which

either support or do not support your diagnosis.

SKIN: THEMES FOR INTEGRATED QUESTIONS

THEME ANAT PHYS MICRO PHARM MED DERM

Protective function

Sensory function

Structural damage

Immune mechanisms

Infection