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

Male 25 yr PGH Surg.Wd

Abd. Palpation Pt of max tenderness Temp Pulse Generalized Pain, phy.signs

SEQUENCE Circum-umbilical colicky pain Pain localised to RIF Tenderness rigidity, rebound tend. Complications Generalized peritonitis Laparotomy

Gangrene, Perforation Bacteriology, Antibiotics

QUESTIONS

Embryology Histology Why changed?

Parietal perit.

McBurney’s Pt Pathogenesis Why?

Ant abd wall, Positions Culture/ABS

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 Acute 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 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.

1A 1B 1C 1D 1E 1F 2A 2B 2C 3A 3B 4A 4B 4C 5A 5B 6A 6B

ANA

X X X X X X X X

PHY

X X

PAT MIC

X X X X X X X X X X

BIO PHA CLIN

X X X X X X X

MCQ - TYPE A

A.

B.

C.

D.

E.

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

MCQ – TYPE A

A.

B.

C.

D.

E.

pharyngeal end of the auditory tube presence of mastoid air cells children a longer cartilaginous part of the auditory tube in relation to the bony part 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

MCQ – TYPE R

Theme: Options: Cardiovascular drugs 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.

3.

4.

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.

SKIN: THEMES FOR INTEGRATED QUESTIONS THEME

Protective function

ANAT PHYS MICRO PHARM MED DERM

Sensory function Structural damage Immune mechanisms Infection