Introduction to extended
matching questions
Dr Lisa Joels MD FRCOG
July 2011
© Royal College of Obstetricians and Gynaecologists
Extended matching questions
• Testing application of core knowledge to
specific clinical scenario
• List of options
• Single best..../ single most appropriate….
– May be a number of correct options but which is
best?
– There will be distractors in the option list
• All the necessary information will be
presented
– don’t guess/over-interpret scenario
EMQ format
• List of options
– Could be 5-20
– Usually 10-12
• Lead in statement:
– Each of the following clinical scenarios below relate to
women with menstrual disorders. For each patient select
the single most appropriate initial investigation. Each
option may be used once, more than once or not at all.
• The key word here is “initial”.
– Many options will be appropriate investigations but which
would you do first?
EMQ example
• Each of the following clinical scenarios below relate
to women with menstrual disorders. For each patient
select the single most appropriate initial
investigation. Each option may be used once, more
than once or not at all.
– A 55 year old woman has had a brown vaginal loss for
seven days. She is taking continuous combined hormone
replacement therapy. On speculum examination the vulva
and vagina are atrophic and the cervix is normal. Bimanual
examination is unremarkable
EMQ option list
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
Cervical cytology
Clotting screen
Computerised tomography scan
Diagnostic laparoscopy
Endocervical swabs for Chlamydia trachomatis
Hysteroscopy and endometrial biopsy
Luteal phase serum progesterone
Magnetic resonance imaging scan
No investigation needed
Serum follicle stimulating hormone level
Serum prolactin
Serum testosterone
Ultrasound scan of pelvis
EMQ example
• A 55 year old woman has had a brown vaginal
loss for seven days. She is taking continuous
combined hormone replacement therapy. On
speculum examination the vulva and vagina
are atrophic and the cervix is normal.
Bimanual examination is unremarkable.
– Answer
M
Ultrasound scan
EMQ example 2
• A 21 year old woman presents at 7 weeks’
gestation with vaginal bleeding and left iliac
fossa pain. She was treated for an
asymptomatic chlamydial infection two years
previously. Examination reveals tenderness in
the left adnexum and her serum beta-hcg
level is 6,000 mIU/ML. A pelvic ultrasound
scan shows an empty uterus.
EMQ option list
• A
Choriocarcinoma
•
•
•
•
•
•
•
•
•
•
Complete miscarriage
Ectopic pregnancy
Heterotopic pregnancy
Incomplete miscarriage
Inevitable miscarriage
Missed miscarriage
Molar pregnancy
Ruptured ectopic pregnancy
Threatened miscarriage
Tubal pregnancy
B
C
D
E
F
G
H
I
J
K
EMQ 2
• A 21 year old woman presents at 7 weeks’ gestation
with vaginal bleeding and left iliac fossa pain. She
was treated for an asymptomatic chlamydial
infection two years previously. Examination reveals
tenderness in the left adnexum and her serum betahCG level is 6,000 mIU/ML. A pelvic ultrasound scan
shows an empty uterus.
• Answer – C ectopic pregnancy
EMQ tips
• Read the lead in statement and questions first
– Work out your answer without looking at the list
– Check your answer is on the list
– (This avoids distractors confusing you)
• EMQ’s are 40% of the overall mark
• Time management
– Paper 1 & 2 – 120 minutes
– Spend 85 minutes on EMQ’s = 2 mins per question
EMQ’s
• Option lists will be in alphabetical or
numerical order
• Really do use same answer twice
• May involve interpretation of data or statistics
• Use your experience, think about what you do
every day
Summary
• Read the lead in statement carefully to identify the
key word
• Read the question carefully
• Decide on your answer
• Check that answer is on the list
• Time management
– Do EMQ’s first
– Move on to MCQ’s after 85 minutes and come back to
unfinished EMQ’s at the end
– Transfer all the answers to the answer sheet within the
allocated examination time