We came across an issue this week regarding the issue of history and examination findings. There has always been a bit of a blurred line in the exam between the two, but in general history was stuff that you asked the patient, and examination was stuff you looked for and found on the patient.
So, in the context of an obstructed airway, are voice changes, difficulty swallowing secretions and stridor or wheeze history, or examination findings?
"..more precisely, it depends on how you ask the question and how you answer it...."
A couple of weeks ago in our virtual study group - a key component of the fellowshipexam.com course - we had a great question.
What is the best (or definitive way) to reduce a pulled elbow?
As a question, it highlights two very important issues when studying for the fellowship exam.
When you’re studying for the fellowship exam in particular:
"If you lined up 10 FACEMs and asked them....they'd each give slightly different answers."
Earlier this week we posed the question:
A 27 year old woman presents to your ED with RIF pain and PV bleeding. She is sexually active and uses a Mirena device. Her only gynaecological and obstetric history is an incidental diagnosis of ovarian cysts as a 22yo. A urine bHCG is positive.
Which of the following statements is true?
A) this patient's symptoms are likely due to an ovarian cyst
B) Because this patient has no documented history of PID an ectopic pregnancy is unlikely
C) This patient's use of an intrauterine contraceptive device places her at an increased risk of an ectopic pregnancy
D) This patient may have an ectopic probably caused by exposure to diethylstilbestrol
It's a good example of a clinically based multi-choice question that should be featuring on the new exam.
Now, knowing is NOT enough - you need to able to reason as well.
In the first week of the fellowshipexam.com course we spend a lot of time on the multi choice questions. The MCQ is an important part of the exam, and understanding the MCQ is easily as important as studying for it. We always ask our candidates to do some “homework” each week. As part of this one of our candidates set the very astute and scientifically tight MCQ below.
"Knowledge....needs to be interpreted in the context of a patient."
The fellowship faculty
We work as emergency physicians, and teach, blog and write at resus.com.au