TESTING HIGHER SKILLS

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TESTING HIGHER SKILLS

• Raja C Bandaranayake

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DOMAINS OF LEARNING

• Cognitive (Knowledge)
• Psychomotor (Motor skills)
• Affective (Attitudes)

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THE COGNITIVE DOMAIN

• Recall and recognition
• Comprehension or Understanding
• Application
• Problem-solving
• analysis
• synthesis
• evaluation

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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

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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.

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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.

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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. McBurneys
Pt Temp Pulse Complications Pathogenesis Ge
neralized Generalized peritonitis Why? Pain,
phy.signs Laparotomy Ant abd wall,
Positions Gangrene, Perforation
Bacteriology, Antibiotics Culture/ABS
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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.
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Qn. 1A Explain how the pain was initially felt
in the umbilical region in this patient? Qn.
1BDescribe the manner in which intermittent pain
was produced in this patient, relating your
description to the histological structure of the
appendix.Qn. 1CName three structures in the
abdomen, other than the intestine, in which such
pain may originate.
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Qn. 1DState 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. 1EList 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. 1FExplain
how each of these signs has been brought about in
this patient.
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SummaryAcute appendicitis in a 25-year-old male.
Physical exam. revealed tenderness , guarding
and rebound tenderness in the right iliac fossa.
Maximum point of tenderness was McBurneys point.
Pulse was 100/min temperature 100.2ºF.Qn.
2ADraw a diagram to illustrate McBurneys
point.Qn. 2BList three (3) complications that
may occur if this patient is not properly
managed.Qn. 2CDescribe briefly the
pathological changes that may occur in the
inflamed appendix, which result in each of the
complications mentioned.
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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
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MCQ - TYPE A

• The best evidence for the neuroectodermal origin
  of the adrenal medulla is that
• it has a direct arterial supply from the
  abdominal aorta
• its venous drainage is into a persisting part of
  the subcardinal vein
• it lies near the sympathetic trunk
• its secretory cells are innervated by
  preganglionic fibres
• its cells show a well developed granular
  endoplasmic reticulum

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MCQ TYPE A

• The anatomical feature which is least likely to
  contribute to middle ear infection is
• presence of lymphatic tissue in the pharyngeal
  end of the auditory tube
• presence of mastoid air cells
• a horizontally directed auditory tube in children
• a longer cartilaginous part of the auditory tube
  in relation to the bony part
• presence of the pars flaccida in the tympanic
  membrane

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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

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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.

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INTEGRATED OSPE / OSCEBased on a pathological
specimen

• Examine the macroscopic specimen provided.
• 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.
• Give him your diagnostic conclusion from the
  specimen.
• Tell him the findings on which you base your
  diagnosis.
• Write the main clinical symptoms and signs you
  would expect this patient to have shown before
  his death.
• Examine the histo-pathological slide provided.
• 5. Write the histological features seen which
  either support or do not support your diagnosis.

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SKIN THEMES FOR INTEGRATED QUESTIONS

• THEME ANAT PHYS MICRO PHARM MED DERM
• Protective function
• Sensory function
• Structural damage
• Immune mechanisms
• Infection