Writing Effective Test Questions for the Basic and Clinical Sciences - PowerPoint PPT Presentation

Loading...

PPT – Writing Effective Test Questions for the Basic and Clinical Sciences PowerPoint presentation | free to download - id: 5fe056-NDJkM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Writing Effective Test Questions for the Basic and Clinical Sciences

Description:

Writing Effective Test Questions for the Basic and Clinical Sciences Carolyn L. Cambor, M.D. Department of Pathology Jennifer R. Kogan, M.D. Department of Medicine – PowerPoint PPT presentation

Number of Views:241
Avg rating:3.0/5.0
Slides: 91
Provided by: Theres112
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Writing Effective Test Questions for the Basic and Clinical Sciences


1
Writing Effective Test Questions for the Basic
and Clinical Sciences
  • Carolyn L. Cambor, M.D.
  • Department of Pathology
  • Jennifer R. Kogan, M.D.
  • Department of Medicine
  • FAPD Series
  • September 29, 2010

Materials adapted from the National Board of
Medical Examiners
2
Objectives
  • Describe the item types currently used by the
    NBME the rationale for their use
  • Describe the steps in writing A-type items
  • Basic Sciences
  • Clinical Sciences
  • Identify technical flaws in test items
    understand the importance of avoiding them
  • Advance your skills in writing A-type test items
  • If time permits, describe and practice writing
  • R-type test items

3
Steps in Test Development
  • Test purpose
  • Testing time and method of administration
  • Test standardization
  • Test content
  • Number of items
  • Item format
  • Develop items
  • Item selection and evaluation

4
Why learn how to write test items?
  • Ensure that your items are
  • Clear understandable
  • Test what you want to test
  • Fair
  • Provide reproducible results
  • Avoid technical flaws
  • Create confusion
  • Add unnecessary difficulty
  • May aid the testwise student

5
Alphabet Soup of Item Types
  • True-false
  • X (simple true/false)
  • K (complex true/false) 1,2,3, 1,3, 2,4
    all
  • C (A/B/Both/Neither)
  • In general, not recommended not used in Mod1,2
  • If used, must be clear, unambiguous with options
    that are
  • 100 T or 100 F
  • One-best answer
  • A (4 or more options)
  • B (4 or 5 option matching sets in sets of 25
    items)
  • R (extended matching items in sets of 2-20 items)

6
A-Type Item Components
  • Stem Longest part of the item
  • Sufficient information to
    answer the lead-in question.
  • Lead-in The question being asked
  • Options The correct answer and 3-4 distractors

7
A-type Item
  • Stem A 65-year-old man has difficulty rising
    from a seated position and straightening
    his trunk, but he has no difficulty flexing
    his leg.
  • Lead-in Which of the following muscles is most
    likely to have been injured?
  • Options A. Gluteus maximus Answer
  • B. Gluteus minimus
  • C. Hamstrings
  • D. Iliopsoas
  • E. Obturator internus

Distractors
8
Good, A-Type Items Have a Distinctive Shape
Stem Lead In
Option A (distractor)
Option B (answer)
Option C (distractor)
Option D (distractor)
Option E (distractor)
9
Poorly shaped A-type item
  • Short stem lead-in
  • Long option
  • Long option
  • Long option
  • Long option

10
6 Rules for Writing A-type Items Basic Sciences
  • 1) Focus on important topics.
  • Ideally based on your objectives.
  • 2) Pose problems, or clinical decision-making
    tasks that are within the education/experience of
    examinees.
  • 3) Assess application of knowledge, not recall.
  • 4) Provide sufficient information in the stem and
    pose a clear question in the lead-in. Cover the
    options rule
  • 5) Use homogeneous distractors
  • 6) Avoid technical flaws and unnecessary
    difficulty

11
6 Rules for Writing A-type Items Basic Sciences
  • 1) Focus on important topics.
  • Ideally based on your objectives.
  • 2) Pose problems, or clinical decision-making
    tasks that are within the education/experience of
    examinees.
  • 3) Assess application of knowledge, not recall.
  • 4) Provide sufficient information in the stem and
    pose a clear question in the lead-in. Cover the
    options rule
  • 5) Use homogeneous distractors
  • 6) Avoid technical flaws and unnecessary
    difficulty

12
6 Rules for Writing A-type Items Basic Sciences
  • 1) Focus on important topics.
  • Ideally based on your objectives.
  • 2) Pose problems, or clinical decision-making
    tasks that are within the education/experience of
    examinees.
  • 3) Assess application of knowledge, not recall.
  • 4) Provide sufficient information in the stem and
    pose a clear question in the lead-in. Cover the
    options rule
  • 5) Use homogeneous distractors
  • 6) Avoid technical flaws and unnecessary
    difficulty

13
Example Recall or Application?
  • What area of the brain is supplied by blood from
    the posterior inferior cerebellar artery?
  • A) Location 1
  • B) Location 2
  • C) Location 3
  • D) Location 4
  • Recall item rote memory of isolated fact

14
Example Recall or Application?
  • A 62-year-old man develops left sided limb
    ataxia,
  • Horners syndrome, nystagmus, and loss of
  • appreciation of facial pain and temperature
  • sensations.
  • Which artery is most likely to be occluded?
  • A) Artery A
  • B) Artery B
  • C) Artery C
  • D) Artery D
  • Application of knowledge
  • Reach a conclusion, make a prediction,
    select a course of action

15
6 Rules for Writing A-type Items Basic Sciences
  • 1) Focus on important topics.
  • Ideally based on your objectives.
  • 2) Pose problems, or clinical decision-making
    tasks that are within the education/experience of
    examinees.
  • 3) Assess application of knowledge, not recall.
  • 4) Provide sufficient information in the stem and
    pose a clear question in the lead-in. Cover the
    options rule
  • 5) Use homogeneous distractors
  • 6) Avoid technical flaws and unnecessary
    difficulty

16
Cover the Options Rule
Stem Lead in
Options a-e
17
Example Cover the Options
  • A 62-year-old man develops left sided limb
    ataxia,
  • Horners syndrome, nystagmus, and loss of
  • appreciation of facial pain and temperature
  • sensations.
  • Which artery is most likely to be occluded?
  • A) Artery A
  • B) Artery B
  • C) Artery C
  • D) Artery D

18
Example Cover the Options
  • A 62-year-old man develops left sided limb
    ataxia,
  • Horners syndrome, nystagmus, and loss of
  • appreciation of facial pain and temperature
  • sensations.
  • Which artery is most likely to be occluded?
  • A) Artery A
  • B) Artery B
  • C) Artery C
  • D) Artery D

19
Writing the Stem
  • Avoid
  • Which of the following statements is correct?
  • Each of the following statements is correct
  • EXCEPT
  • Because
  • Unfocused stems
  • Dont follow cover the options rule
  • Heterogeneous options
  • mix of epidemiology, genetics, mechanisms etc

20
Poorly worded stem
  • True statements about cystic fibrosis (CF)
    include
  • 1. The incidence of CF is 12000
  • 2. Children with CF usually die in their teens.
  • 3. Males with CF are sterile
  • 4. CF is an autosomal recessive disease

21
Patient vignettes are good for stems
  • Patient vignettes (stem)
  • brief for basic sciences
  • should not require patient care expertise
  • age
  • gender
  • site of care
  • presenting complaint
  • duration
  • /- family history
  • /- results of diagnostic tests initial
    treatment, etc
  • material needs to be taught with clinical
    relevance
  • Lead in
  • Clearly focused question

22
Patient Vignette Templates Basic Sciences
  • A (patient description) has a (type of injury,
    location). Which of the following structures is
    most likely to be affected?
  • A (patient description) has (signs symptoms).
    These observations suggest that the disease is a
    result of the (absence or presence) of which of
    the following (enzymes, mechanisms)?
  • A (patient description) dies of (disease). Which
    of the following is the most likely finding on
    autopsy?

23
Patient Vignette Templates Basic Sciences
  • Which of the following is the most likely
    mechanism of the therapeutic effect of this (drug
    class) in patients with (disease)?
  • (time period) after a (event, such as a trip or
    meal w/ certain foods) a (patient or group
    description) became ill with (symptoms and
    signs).
  • Which of the following (organisms, agents) is
    most likely to be found on analysis of (food)?

24
During an operation, the arterial PCO2, and pH
of an anesthetized patient are monitored. The
patient is being ventilated by a mechanical
respirator, and the initial values are normal
(PCO240 mm Hg pH7.42). If the ventilation
is decreased, which of the following is most
likely to occur?
Physiology Patient Vignette
  • pH
  • A. decrease
  • B. increase
  • C. no change
  • D. decrease
  • E. increase
  • F. no change
  • Arterial pCO2
  • A. decrease
  • B. decrease
  • C. decrease
  • D. increase
  • E. increase
  • F. increase

25
At a banquet, the menu included fried chicken,
homefried potatoes, peas, chocolate eclairs and
coffee. Within 2 hours most of the diners became
violently ill, with nausea, vomiting and
abdominal pain. Analysis of the contaminated
food is most likely to yield large numbers of
which of the following organisms? A. Escherechia
coli B. Proteus mirabilis C. Salmonella
typhimurium D. Staphylococcus aureus E. Strepto
coccus faecalis
Microbiology Patient Vignette

26
Lab Vignettes are good for Basic Sciences
  • Lab-vignettes
  • laboratory examples
  • research examples
  • biochemical pathways
  • drug metabolism

27
Biochemistry Lab Vignette
A
B
C
D
II
III
IV
I
V
E
IV
In the branched metabolic pathway, a different
single enzyme catalyzes each of the individual
steps. The enzyme that would be expected to be
most severely inhibited by compound V is
enzyme A. A B. B C. C D.
D E. E
28
Pharmacology Lab Vignette
  • Drug Y has a volume of distribution of 75 L in
    both younger
  • and older adult men. In younger adults, it has a
    clearance rate of
  • 15L / h, 50 of which is via the liver and 50
    via the kidneys. For
  • younger men, the maintenance regimen is 100 mg
    every 6 hours.
  • Which of the following regimens will produce
    essentially the same
  • steady-state concentration in an older man, whose
    creatinine clearance
  • is half that of younger men, but whose hepatic
    function is unimpaired?
  • A. 75 mg every 3 hrs
  • B. 75 mg every 6 hrs
  • C. 75 mg every 9 hours
  • D. 100 mg every 3 hours
  • E. 100 mg every 6 hours
  • F. 100 mg every 12 hours

29
Basic Sciences Integrated Items
  • Physiology / Pharmacology
  • Microbiology / Pharmacology
  • Pathology / Pharmacology
  • Pathology / Pathophysiology
  • Stem describes one component, options ask about
    another
  • 1 stem is used for 2 questions, on different
    topics
  • Guidelines
  • Team preparation
  • Avoid cueing
  • Avoid hinging

30
Integrated Items - Example
  • An unresponsive 58 year old woman is brought to
    the ED after
  • collapsing at a local shopping center.
  • More history. Physical signs describe a
    neurologic deficit.
  • 1. The dilated, unreactive left pupil is most
    consistent with injury to the left
  • List of anatomic structures
  • 2. The extensor posturing on the right is most
    consistent with injury to the left
  • List of anatomic structures
  • 3. Which of the following herniation syndromes is
    most consistent with her clinical presentation?
  • List of herniation syndromes

31
Patient Vignettes Clinical Sciences
  • Include
  • age, gender
  • site of care
  • presenting complaint
  • duration
  • patient history
  • physical findings
  • /- diagnostic studies
  • /- initial treatment
  • Stems should
  • not be completely based on real patients
  • include reference material when it would be
    realistic in practice
  • not use the patients or doctors own words
  • not include patients who lie

32
Non-vignettes in the Clinical Sciences
  • The most likely renal abnormality
  • in children with nephrotic
  • syndrome and normal renal
  • function is
  • A. Acute poststreptococcal glomerulonephritis
  • B. Hemolytic-uremic syndrome
  • C. Minimal change disease
  • D. Focal and segmental glomerulosclerosis
  • E. Schonlein-Henoch purpura

A B C D E
Hi 1 0 99 0 0
Lo 8 1 90 1 0
33
Short Vignette
  • A 2 year old boy has a 1
  • week history of edema. His
  • blood pressure is 100/60
  • mmHg and there is
  • generalized edema and
  • ascites. Labs show Cr 0.4
  • mg/dL, albumin 1.4 g/dL and
  • cholesterol of 569 mg/dL.
  • UA shows 4 protein and no
  • blood. The most likely
  • diagnosis is

A B C D E
Hi 0 0 98 2 0
Lo 5 2 82 8 1
34
Long Vignette
  • A 2 year old black child developed
  • swelling of his eyes and ankles
  • over the past week. Blood pressure
  • is 100/60 mmHg, pulse 110/min
  • respirations 28/min. Exam shows
  • swelling of eyes, abdominal
  • distention and a positive fluid wave.
  • Labs show Cr 0.4 mg/dL, albumin
  • 1.4 g/dL and cholesterol of 569
  • mg/dL.UA shows 4 protein and no
  • blood. The most likely diagnosis is

A B C D E
Hi 0 1 98 1 0
Lo 10 9 66 10 5
35
Writing the Lead-In Clinical Sciences
  • Diagnosis
  • Which of the following is the most likely
    diagnosis?
  • Which of the following is the most appropriate
    next step in diagnosis?
  • Management
  • Which of the following is the most appropriate
    next step in patient care?
  • Mechanisms of disease
  • Which of the following is the most likely
    pathogen?
  • Which of the following is the most likely
    explanation for the findings?

36
6 Rules for Writing A-type Questions
  • Focus on important topics.
  • Ideally based on course / activity objectives.
  • 2) Pose problems, or clinical decision-making
    tasks that are within the education/experience of
    examinees.
  • Assess application of knowledge, not recall.
  • Provide sufficient information in the stem and
    pose a clear question in the lead-in. Cover the
    options rule
  • 5) Use homogeneous distractors
  • 6) Avoid technical flaws and unnecessary
    difficulty

37
Writing the Options
  • Homogeneous in content
  • Grammatically consistent with stem
  • Similar in construction and length
  • Alphabetized or logically ordered
  • Incorrect/inferior to the correct answer
  • choice affects question difficulty
  • Plausible/attractive to uninformed
  • no distracter should be obviously incorrect
  • Each should be chosen by some

38
Easy Distractors
  • Who was the primary author of the
  • Declaration of Independence?
  • A. Abraham Lincoln
  • B. Thomas Jefferson
  • C. Franklin Roosevelt
  • D. King George II
  • E. Catherine the Great

39
More Difficult Distractors
  • Who was the primary author of the
  • Declaration of Independence?
  • A. George Washington
  • B. Thomas Jefferson
  • C. Alexander Hamilton
  • D. Benjamin Franklin
  • E. James Madison

40
6 Rules for Writing A-type Questions
  • 1) Focus on important topics.
  • Ideally based on course / activity objectives.
  • 2) Pose problems, or clinical decision-making
    tasks that are within the education/experience of
    examinees.
  • 3) Assess application of knowledge, not recall.
  • 4) Provide sufficient information in the stem and
    pose a clear question in the lead-in. Cover the
    options rule
  • 5) Use homogeneous distractors
  • 6) Avoid technical flaws and unnecessary
    difficulty

41
Technical Item Flaws
Issues related to Irrelevant Difficulty
Issues Related to Testwiseness
42
Assess Your Testwiseness
43
Testwise Analysis
  • The primary purpose of the stam is to remove the
  • carm
  • denton
  • menace
  • stam bar

44
Testwise Analysis
  • The primary purpose of the stam is to remove the
  • carm
  • denton
  • menace
  • stam bar

Word repeats in stem and answer
45
Testwise Analysis
  • Which of the following pairs has won the greatest
    number of Abby awards?
  • Jones and Smith
  • Smith and Taylor
  • Smith and White
  • White and Allen

46
Testwise Analysis
  • Which of the following pairs has won the greatest
    number of Abby awards?
  • Jones and Smith
  • Smith and Taylor
  • Smith and White
  • White and Allen

Convergence correct answer has the most in
common with other choices
47
Testwise Analysis
  • How many pounds of pressure are exerted by a
    callam?
  • 2.6
  • 150
  • 260
  • 2600

48
Testwise Analysis
  • How many pounds of pressure are exerted by a
    callam?
  • 2.6
  • 150
  • 260
  • 2600

Convergence Correct answer has the most in
common with other choices
49
Testwise Analysis
  • The stanon is aided by a
  • instel
  • immon
  • octal
  • port

50
Testwise Analysis
  • The stanon is aided by a
  • instel
  • immon
  • octal
  • port

Grammatical cues only port follows
grammatically from the stem
51
Testwise Analysis
  • The stanon frequently overheats because
  • all grestels are bilious
  • no immon are directly fectitious
  • octals are usually casable
  • ports are always critical

52
Testwise Analysis
  • The stanon frequently overheats because
  • all grestels are bilious
  • no immon are directly fectitious
  • octals are usually casable
  • ports are always critical

Absolute terms never found in the correct answer
53
Testwise Analysis
  • Stammation normally occurs when the
  • anstels rupture
  • immon falls and the denton is in place
  • octal rotates easily
  • ports pass over the carm

54
Testwise Analysis
  • Stammation normally occurs when the
  • anstels rupture
  • immon falls and the denton is in place
  • octal rotates easily
  • ports pass over the carm

Longest answer is usually the correct answer
55
Testwiseness Grammatical Cues
  • The option(s) does not flow from the stem
  • Example
  • The minor differences among organisms of the
  • same kind are known as
  • A. Heredity
  • B. Variations
  • C. Adaptation
  • D. Natural selection

56
Testwiseness Logical Cues
  • A subset of options are collectively exhaustive
  • Example
  • Crime is
  • A. Equally distributed among the social classes
  • B. Overrepresented among the poor
  • C. Overrepresented among the middle class and
    rich
  • D. Primarily an indication of psychosexual
    maladjustment
  • E. Reaching a plateau of tolerability for the
    nation

57
Testwiseness Absolute Terms
  • Terms such as always or never are used in
    options
  • Example
  • In patients with advanced dementia, Alzheimers
    type, the
  • memory defect
  • A. Can be treated adequately with lecithin
  • B. Could be a sequela of early parkinsonism
  • C. Is never seen in patients with
    neurofibrillary tangles
  • C. Is never severe
  • D. Possibly involves the cholinergic system

58
Testwiseness Long Correct Answer
  • The correct answer is longer, more specific, or
    more
  • complete than the other options.
  • Example
  • Secondary gain is
  • A. Synonymous with malingering
  • B. A frequent problem in obsessive-compulsive
    disorder
  • C. A complication of a variety of illnesses and
    tends to prolong many of them
  • D. Never seen in organic brain damage

59
Testwiseness Word Repeats
  • A word or phrase is included in the stem and
  • correct answer.
  • Example
  • A 58-year-old man with a history of heavy alcohol
    use and
  • previous psychiatric hospitalization is confused
    and agitated.
  • He speaks of experiencing the world as unreal.
    This
  • symptom is called
  • A. Depersonalization
  • B. Derailment
  • C. Derealization
  • D. Focal memory defect

60
Testwiseness Convergence
  • The correct answer includes the most elements in
  • common with the other options
  • Example
  • Local anesthetics are most effective in the
  • A. Anionic form, acting from inside the nerve
    membrane
  • B. Cationic form, acting from inside the nerve
    membrane
  • C. Cationic form, acting from outside the nerve
    membrane
  • D. Uncharged form, acting from inside the nerve
    membrane
  • E. Uncharged form, acting from outside the nerve
    membrane

61
Technical Item Flaws
Issues related to Irrelevant Difficulty
Issues Related to Testwiseness
62
Irrelevant Difficulty Options are long,
complicated or doubled
  • Systematic geography differs from regional
    geography in
  • that
  • A. Systematic geography deals, in the main, with
    physical geography, while regional geography
    concerns itself essentially with the field of
    human geography
  • B. Systematic geography studies a region
    systematically while regional geography is
    concerned only with descriptive account of a
    region
  • C. Systematic geography studies a single
    phenomenon in its distribution over the earth in
    order to supply generalizations for regional
    geography, which studies the arrangement of
    phenomena in one given area

63
Irrelevant Difficulty Numeric data are not
stated consistently
  • Following a second episode of infection, what is
    the
  • likelihood that a woman is infertile?
  • A. Less than 20
  • B. 20 to 30
  • C. Greater than 50
  • D. 90
  • E. 75

64
Irrelevant Difficulty Frequency terms in options
are vague
  • Severe obesity in early adolescence
  • Usually responds dramatically to dietary regimens
  • Often is related to endocrine disorders
  • Has a 75 change of clearing spontaneously
  • Shows a poor prognosis
  • Usually responds to pharmacotherapy and intensive
    psychotherapy

65
Irrelevant Difficulty Language in options not
parallel
  • In a vaccine trial, 200 2-year-old boys were
    given a vaccine
  • against a certain disease and then monitored for
    five years for
  • occurrence of disease. Of this group, 85 never
    contracted the
  • disease.
  • Which of the following statements concerning
    these results is correct?
  • No conclusions can be drawn since no follow-up
    was made of non-vaccinated children
  • The number of cases (I.e. 30 cases over five
    years) is too small for statistically meaningful
    conclusions
  • No conclusions can be drawn because the trial
    involved only boys
  • Vaccine efficacy () is calculated as 85-15/100

66
Irrelevant Difficulty Options in an non-logical
order
  • The population of Denmark is
  • A. 2 million
  • B. 15 million
  • C. 4 million
  • D. 7 million

67
Irrelevant Difficulty None of the Above used
as option
  • Which city is closest to New York City?
  • A. Boston
  • B. Chicago
  • C. Dallas
  • D. Los Angeles
  • E. None of the above

68
Irrelevant Difficulty Complicated Stems and
Options
  • Arrange the parents of the following children
    with Downs
  • syndrome in order of highest to lowest risk of
    recurrence.
  • Assume that the maternal age in all cases is 22
    years and
  • that a subsequent pregnancy occurs within 5
    years.
  • The karyotypes of the daughters are (see next
    slide)

69
Complicated Stems and Answers
  • I. 46, XX, -14, T (14q21q)pat
  • II. 46, XX, -14, T(14q21q) de novo
  • III. 46, XX, -14, T (14q21q) mat
  • IV. 46, XX, -21, T (14q21q)pat
  • V. 47, XX, -21, T (21q21q) parents not typed
  • A. III, IV, I, V, II
  • B. IV, III, V, I, II
  • C. III, I, IV, V, II
  • D. IV, III, I, V, II
  • E. III, IV, I II, V

70
Window Dressing Red Herrings
Irrelevant Difficulty
71
Basic Science Examples for Discussion
72
  • Which one of the following sets of laboratory
  • studies is most consistent with a diagnosis of
  • anemia of chronic inflammation?
  • (Inc means increased level, Dec means decreased
    level)
  • Ferritin TIBC Serum Iron Soluble
    Transferrin Receptor
  • A. Inc Inc Dec
    Dec
  • B. Dec Inc Dec
    Inc
  • C. Inc Dec Dec
    Inc
  • D. Inc Dec Dec
    Normal

73
  • A 16 year old girl presents with a sore throat of
    4 months
  • duration. She describes feeling a lump in her
    throat.
  • Physical exam reveals a 1 cm cystic lesion at the
    base of
  • the tongue.
  • This developmental lesion most likely arises as a
    remnant of which of the following anatomic
    structures?
  • A. Auditory tube
  • B. Branchial arches
  • C. Facial fusion lines
  • D. Rudimentary thymus
  • E. Thyroglossal duct

74
  • All of the carbons in cholesterol are derived
  • from
  • A.        choline
  • B.        sphingosine
  • C.        acetyl CoA
  • D.        HMG-CoA reductase
  • E.        CO2

75
  • What is the most likely inheritance pattern
  • of the following pedigree?
  • A. Autosomal recessive
  • B. Autosomal dominant
  • C. X-linked recessive
  • D. X-linked dominant
  • E. Mitochondrial

76
Clinical Science Examples
77
  • A 64 year old male is admitted to the hospital
    with 3 days of
  • progressive shortness of breath. He has a medical
    history of poorly
  • controlled hypertension. He denies tobacco or
    alcohol use. On physical
  • examination he is afebrile, pulse 100,
    respiratory rate 26, blood
  • pressure 180/110 mmHg and room air oxygen
    saturation 91.
  • Examination of the lungs reveals bilateral
    crackles and his cardiac
  • exam reveals a diffuse, laterally displaced point
    of maximal impulse, a
  • soft S3 and loud S4. Abdominal exam and extremity
    exams are normal.
  • A chest Xray reveals bilateral alveolar
    infiltrates and an
  • electrocardiogram is remarkable for left
    ventricular hypertrophy. Which
  • of the following is the next best step in
    management?
  • A. Administer intravenous furosemide for diuresis
  • B. Administer oral morphine
  • C. Start oral beta blocker
  • D. Administer chewable aspirin
  • E. None of the above

78
  • A 72 year old female presents to her physician
    with progressive bilateral knee pain for 3
    months. The pain is worse with ambulation and
    increases in severity during the day. She denies
    trauma or pain in other joints. On physical
    examination she is afebrile. Her body mass index
    is 31. Her knees are warm bilaterally but without
    effusion. There is bilateral crepitus. There is
    no instability. The remainder of her examination
    is normal. Plain xrays of the knees demonstrates
    narrowing of the joint space, marginal
    osteophytes and subcondral sclerosis. Which of
    the following is the most likely diagnosis?
  • A. Osteoporosis
  • B. Osteoarthritis
  • C. Osteogenesis imperfecta
  • D. Rheumatoid arthritis
  • E. Pseudogout

79
  • A 42 year old female presents to her physician
    for a routine medical examination. She has no
    specific concerns. Her blood pressure is noted to
    be 170/80 mm Hg. Which of the following sounds
    auscultatory findings corresponds to the systolic
    and diastolic readings?
  • The systolic reading is the first appearance of
    the Korotkoff sounds and the diastolic reading is
    the disappearance of the Korotkoff sounds
  • The systolic reading is the regular appearance of
    the Korotkoff sounds and the diastolic reading is
    the muffling of the Korotkoff sounds.
  • The systolic reading is the regular appearance of
    the Korotkoff sounds and the diastolic reading is
    the disappearance of the Korotkoff sounds
  • The systolic reading is the first appearance of
    the Korotkoff sounds and the diastolic reading is
    the muffling of the Korotkoff sounds.

80
  • A 42 year old female presents to her physician
    for a routine medical
  • examination. She has no specific concerns. Her
    blood pressure is
  • noted to be 170/80 mm Hg.
  • Which of the following sounds best corresponds to
    the
  • blood pressure reading?
  • 170 80
  • A. First Korotkoff sound Disappearance of
    Korotkoff sounds
  • B. Regular Korotkoff sounds Muffling of
    Korotkoff sounds
  • C. Regular Korotkoff sounds Disappearance of
    Korotkoff sounds
  • D. First Korotkoff sounds Muffling of Korotkoff
    sounds.

81
Practice Time!
82
R-Type Items Extended Matching
83
Extended Matching R-type Items
  • Four components
  • A theme
  • An option list
  • A lead-in statement
  • At least 2 item stems

84
R-type item-Theme Cerebrovascular anatomy
  • A. Left anterior cerebral artery E. Left
    posterior cerebral artery
  • B. Right anterior cerebral artery F. Right
    posterior cerebral artery
  • C. Left middle cerebral artery G. Left
    lenticulostriate arteries
  • D. Right middle cerebral artery H. Right
    lenticulostriate arteries
  • For each patient with neurological abnormalities
    presented below, select the artery that is most
    likely to be involved from the list above.
  • 1. A 72-year-old right-handed man has weakness
    and hyperreflexia of the right lower limb, an
    extensor plantar response on the right, normal
    strength of the right arm, and normal facial
    movements. Answer A
  • 2. A 68-year-old right-handed man has right
    spastic hemiparesis, an extensor plantar response
    on the right, and paralysis of the lower
    two-thirds of his face on the right. His speech
    is fluent, and he has normal comprehension of
    verbal and written commands. Answer G

85
Sample Lead-ins and Topics for Option Lists
  • For each of the following patients, select the
    most likely (cause).
  • Underlying mechanism of disease, medications,
    toxic agents
  • For each of the following patients select the
    (eg, nerve) that is most like to be (abnormal,
    defective, deficient, nonfunctioning).
  • -lists of nerves, muscles, enzymes, hormones,
    proteins, types of cells, pathologic processes,
    neurotransmitters
  • For each of the following patients, select the
    (finding) that would be expected.
  • Laboratory results, physical signs

86
More sample lead-ins topics for option lists
  • For each of the following patients, select the
  • eg, drug that should be administered.
  • For each of the following patients with chief
    complaint, select the most likely diagnosis.
  • For each of the following patients, select the
    most appropriate next step in patient care.
    (drugs, lab tests, disposition choices)

87
Options Sets in R-Type Items
  • Arteries
  • Nerves
  • Muscles
  • Amino acids
  • Peptides
  • Hormones
  • Enzymes
  • Cell components
  • Cell types
  • Blood components
  • Diagnoses
  • Karyotypes
  • Proteins
  • Lipids
  • Pathogens
  • Cytokines
  • Anatomic structures
  • Metabolic defects
  • Organelles
  • Drugs/drug classes
  • ECM components
  • Diagnostic tests

88
Writing the Item Stems for R-Type Items
  • Patient vignettes
  • Use for basic clinical science questions
  • Homogeneous in construction
  • Include same demographic features in each one
  • All the same age group
  • Make sure only one best answer and usually 4
    distractors

89
Steps in writing R-type items
  • Identify the theme first
  • Write the lead-in statement
  • List all the options
  • Write the vignettes (stems)
  • Review the item
  • Be sure there is only ONE single best answer for
    each stem
  • Be sure each item has several distractors

90
R-Type Item Good Example
  • Theme Fatigue
  • Lead in For each patient with fatigue, select
    the most likely diagnosis.
  • Options Many causes of fatigue (anemia, CHF,
    depression, infections etc)
  • Vignettes 2 or more that correspond to
    diagnoses in your list
About PowerShow.com