What makes an mcq?

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."

Which of the below is not a major risk factor for ectopic pregnancy?

a) pelvic inflammatory disease 

b) corpus luteum cyst 

c) in utero exposure to diethylstilbestrol 

d) use of intrauterine device 


This question is even referenced to a table in Tintinalli. As an example of an MCQ it has heaps to recommend it:

• it’s well referenced to a major source
• it tests a specific area of knowledge
• there is a clearly correct answer to the question

So, what’s your answer? Should be pretty straight forward if you've done the required reading.

It’s a very good example of straight out "test your knowledge" style questions that were (irritatingly) popular in the old exam. They're written on one topic (risk factors for ectopic pregnancy) based on a single table/paragraph in a single source. It's good to practice writing these because they build knowledge very well.  But when it comes to the new exam ACEM has said (& whether they follow through through or not is a different discussion) that the new exam multi choice questions are going to be more clinically based. 

So, let’s rephrase the question in clinical form. It still tests exactly the same topic points as your first MCQ but it's a slightly different feel, and a slightly different thought process. Knowledge of the risk factors needs to be interpreted in the context of a patient. That is, knowing what the risk factors are is one thing, being able to work out which one applies is something else.

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 

Writing questions like the one directly above is an invaluable way to help get yourself into the mindset of the examiners which in turn will help you in the real exam. We’ve been discussing these this week in our virtual study group to help our candidates get a step ahead in their preparation for the exam.

Oh, and we’ll have some answers and commentary in a future blog!