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 Lead in statement: 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 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 B Complete miscarriage C Ectopic pregnancy D Heterotopic pregnancy E Incomplete miscarriage F Inevitable miscarriage G Missed miscarriage H Molar pregnancy I Ruptured ectopic pregnancy J Threatened miscarriage K Tubal pregnancy

EMQ 2 Answer – C ectopic pregnancy 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. 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