1. Introduction to extended matching questions
Dr Lisa Joels MD FRCOG
July 2011
© Royal College of Obstetricians and Gynaecologists

2. 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

3. 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?

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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