How to Answer Abstract and Weird MCQ Questions
Jun 09, 2024
Sometimes, some MCQ questions are just plain weird. Case in example - consider this hypothetical question:
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Jenny Epworth, a 23-year-old individual, returns for the results of her investigations. She presented with frequent palpitations and is desperate for symptomatic relief. She admits feeling tense and wound up and she puts this down to her impending university examinations. She has a past medical history of severe Raynaud’s phenomenon. On examination her heart rate is 82 beats per minute and regular and her blood pressure is 119/79mmHg. All other examination is normal.
The results of her investigations are shown below:
Full blood count – normal
Urea and electrolytes – normal
Fasting blood glucose – normal
Thyroid function tests – normal
Glycosylated haemoglobin – normal
Holter monitor report: normal sinus rhythm average 76/minute. Occasional atrial ectopic beats noted.
Echocardiogram - normal
What is the MOST appropriate next step?
A. Take nil action
B. Bisoprolol 1.25mg orally once daily
C. Clonidine 50mcg orally twice daily
D. Digoxin 62.5mcg orally daily
E. Verapamil modified-release 180 mg orally daily (Score: 1)
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What did you make of it? Chances are you said to yourself that all of the answers are wrong, and that in real life you would never do this. You might be tempted to refer for CBT, observe, provide self-help advice, or if you felt pharmacological treatment was indicated you might start a SSRI.
So, how do questions like this occasionally feature? In my experience, these arise for a few reasons:
-this question started off life as a much easier (and more sensible) variant, then at some point a review committee determined that it should be made harder - resulting in the SSRI answer being discarded.
-the entire curriculum needs sampling and testing in the exams (a process called blueprinting) - so someone along the way thought they could kill two birds with one stone by testing both manifestations of anxiety and Raynaud's in one question.
- a writer simply wanted to show off by making a complex question which intertwines lots of concepts together into one question - resulting in a question which is academically sound but real-life abstract.
In any case, these questions are more often than not an inevitable fact of life - to put it another way you should expect these sorts of questions, and when you see one, to not panic - as most of your colleagues will be equally baffled.
So now you know this, how should you approach one? I have four pieces of examination tip to offer:
-in the MCQ the word counts are short. If something is included, chances are it's relevant. So take special notice when you see a seemingly random past medical history (such as severe Raynaud's) - chances are it's not random, but really rather relevant.
-as per last week's "lesson", look out for the pivot word. Did you spot it here? "...and is desperate for symptomatic relief" - the pivot words means doing nothing is not an option that will score.
-on the same token as the above tip, pay special attention to anything which resembles a contraindication - they are often subtle. In this instance, she has Raynaud's - which renders our beta blocker useless.
-on the same token as the above tip, pay special attention to anything which resembles a contraindication - they are often subtle. In this instance, she has Raynaud's - which renders our beta blocker useless.
-try find an answer which ticks off multiple birds with one stone. In this instance, a rate limiting CCB would (or might) address both her severe Raynaud's and her palpitations.
-look for the least worst option. Sometimes there are no best options - rather than fight it or getting angry, take the pragmatic view and find the option which is least inferior. This technique would work well here: the pivot words mean doing nothing is not an option, her Raynaud's contraindicates a beta blocker, and she is not in AF so digoxin is inappropriate.
Finally if all else fails, don't let this sort of question ruin your exam psychologically. Accept that it is bizarre, abstract, arguably unfair and move on.
