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GPST / GPVTS SHORTLISTING

Clinical Problem Solving (Examples of MCQs & EMQs)

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Example MCQ & EMQ

Example Role Play

Example Prioritisation

The Clinical Problem Solving Paper forms an integral part of Stage 2 of the GP ST / GP VTS shortlisting process. The paper is 90 minutes long and consist of a series of questions in an MCQ or EMQ format. In February 2007, the paper consisted of 99 questions (making an average answer time of just under a minute per question). The level of clinical knowledge required for the exam is that of FY1 / House Officer level; the paper covers all main specialties.

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The MCQ format

There is no absolutely set format for GPVTS / GPST MCQs, though in 2007 the main format was "Single Best Answer - Best of Five". In 2006, most deaneries used the True/False format. Questions tend to be scenario based. Most questions are stand-alone, though some are linked to previous questions; for example, the first question may ask for a diagnosis, whilst a second question may ask for the best first line of treatment, with a third question asking for further management strategy.

	EXAMPLE OF AN MCQ QUESTION - SINGLE BEST ANSWER (BEST OF FIVE)
	Mr Peterson is a 72-year-old retired carpenter. His brother recently died of a heart attack at the age of 75 and Mr Peterson comes to see you to request a check up. He claims to be fit and well, and walks his puppy dog for an hour every day on the Moors. He denies any chest pain or shortness of breath and is on no medication. On examination, he has a good volume pulse at 78 beats per minute and blood pressure is 122/68 mmHg. You hear an ejection systolic murmur at the left sternal edge. There are no murmurs at the carotids. What is the most likely diagnosis? 1 - Aortic stenosis 2 - Aortic sclerosis 3 - Pulmonary valve stenosis 4 - 'Flow' murmur 5 - Hypertrophic obstructive cardiomyopathy Answer: 2 While all the options are associated with an ejection systolic murmur, it is the additional clinical features that aid diagnosis. This is a fit 72-year-old man with no angina or dyspnoea; therefore functional valve disease or left ventricular outflow obstruction is unlikely. This rules out options 1, 3 and 5. Aortic sclerosis is a thickening of the aortic valve - very common with advancing age - and can be differentiated from stenosis by the absence of radiation to the carotid arteries. While flow murmurs are also benign and commonly detected on examination, they are a result of turbulent flow associated with a hyperdynamic state e.g. anxiety, sepsis or pregnancy. Since the pulse rate and blood pressure are not elevated, a flow murmur is unlikely.

The EMQ format

EMQ questions are essentially the same as MCQ - Single Best Answer questions except that there are usually more options to choose from and the same options are used for different scenarios.

EXAMPLE OF AN EMQ QUESTION

Options

1 - Mesenteric adenitis 6 - Constipation

2 - Inflammatory bowel disease 7 - Intussusception

3 - Acute appendicitis 8 - Peptic ulcer

4 - Henoch-Schonlein purpura 9 - Renal stones

5 - Urinary tract infection 10 - Bowel obstruction

Questions

Pick the most likely diagnosis for each of the following scenarios.

a. An 8 year old boy has lost his appetite and had central abdominal pain which has now

radiated to the right iliac fossa.

b. A child complains of abdominal pain and has a purpuric rash on the buttocks with some

joint pains.

c. A 4-month-old girl has a recent episode of gastroenteritis. Now she has episodic

screaming and pallor. There is some passage of blood and mucous in the stool.

Ultrasound shows a ‘doughnut sign’.

d. A 15 year old boy has had pains most nights for at least a month. He is afebrile. The

pains are eased by drinking milk.

e. The patient has recurrent abdominal pain and malabsorption.

Answer

a. = 3 b. = 4 c. = 7 d. = 8 e. = 2

How ISC Medical can help you with the GPST / GPVTS MCQs and EMQs paper

In order to assist you with the Clinical Problem Solving paper, we have developed a range of books which is designed to make you practice questions on all specialties in a wide range of formats.

	ESSENTIAL REVISION BOOKS		OTHER USEFUL REVISION BOOKS

CLIck here for full details ON ALL OUR GPVTS / GPST BOOKS and to order

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