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
SEQUENCE
Circum-umbilical
colicky pain
QUESTIONS
Embryology
Histology
Pain localised to RIF
Why changed?
Abd. Palpation
Pt of max tenderness
Tenderness
rigidity, rebound tend.
Parietal perit.
McBurney’s Pt
Temp Pulse
Complications
Pathogenesis
Generalized
Pain, phy.signs
Generalized peritonitis
Why?
Laparotomy
Ant abd wall,
Positions
Gangrene, Perforation Bacteriology, Antibiotics
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.
ANA
PHY
1A
1B
1C
1D
1E
1F
2A
2B
2C
3A
3B
4A
4B
4C
5A
5B
6A
6B
X
X
X
X
X
PAT
MIC
BIO
PHA
CLIN
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
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
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
A.
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
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
A.
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: 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.
4. 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
Sensory function
Structural damage
Immune mechanisms
Infection
ANAT
PHYS
MICRO PHARM MED
DERM