how to answer essays questions.pdf

GUIDING PRINCIPLES TO ANSWERING ESSAY QUESTIONS AND OBJECTIVE STRUCTURED CLINICAL EXAMNATION (OSCE) LECTURE BY DR F. E. ALU(JP, MBBS, FWACS, FMCOG, FICS, MNIM) CHIEF CONSULTANT/SENIOR LECTURER INTRODUCTION Essay writing is an important component of clinical examinatio...

GUIDING PRINCIPLES TO ANSWERING ESSAY QUESTIONS AND OBJECTIVE STRUCTURED CLINICAL EXAMNATION (OSCE) LECTURE BY DR F. E. ALU(JP, MBBS, FWACS, FMCOG, FICS, MNIM) CHIEF CONSULTANT/SENIOR LECTURER INTRODUCTION Essay writing is an important component of clinical examination in Medicine. Along with the MCQ, it constitutes an important segment of the entire examination and a pass is required in this segment as is in the clinical examination. It is important to note that an essay generally has an introduction, the body of the essay (most important part) and a conclusion. In most cases, the question is asking what you would do rather than what your consultant or another colleague would do. IMPORTANT QUESTIONS TO ASK BEFORE ANSWERING ANY QUESTION a. First ask yourself what the question is asking you to do (ie what does the Examiner want). b. What does the question not want. c. Decide exactly what you need to write and how you need to argue your point. d. Do you need an INTRODUCTION and a CONCLUSION. e. What are the relevant issues (best to underline the key words in the questions) f. Make an outline of what you intend to write (very key as the points and flow may disappear once you start answering while more points are likely to be added as you develop the outline). g. What is the logical approach to the question. UNDERSTANDING THE WORDINGS OF THE QUESTION a. Evaluate: Place a value (or price) on your answers eg Evaluate the role of amniocentesis in prenatal diagnosis b. Critically appraise: fault finding and estimation of value eg Critically appraise the role of destructive operations in modern obstetrics practice c. Justify: Prove right by arguing your points and giving reasons for them eg Justify your management of a primigravida who presents in labour with breech presentation at term d. Discuss: Argue for and against eg Discuss your management of a 65year old women who presented at the gynaecological clinic with PMB e. Describe: Descriptive and narrative in nature. Dwells on the particular characteristics of the subject and these should form the building block for your answer eg Describe step by step how you would conduct a sterile speculum examination in a primigravida with PROM at 36 weeks gestation; Describe the use of ultrasound in Obstetrics f. OUTLINE: Here it is important you provide a list of the main points only in organized/systematic manner, eg Outline complications of TWIN gestation (1st trimester/2nd trimester/3rd trimester/postpartum g. MENTION: List and give a brief explanation h. COMPARE AND CONTRAST: Bring out the similarities and differences between two or more subjects of discussion stating the roots/causes/significance of the similarities and differences i. EXPLAIN: Here you imagine you are writing for someone who knows absolutely nothing about the subject…. So, provide as much details as possible and give definitions of any jargon or key terms you use. Keep in mind any “what”, “how”, and “why” questions! J. DEFINE: Here you are expected to give the exact meaning of the subject of the question. If there are SEVERAL definitions ensure you mention them. If you choose to use only one definition explain why? Eg Define PPH APPROACH TO ANSWERING THE QUESTION a. Go through each question and UNDERLINE the KEY words b. Jot down a rough plan for EACH question (MAKE AN OUTLINE) c. Start with the “EASY” question (helps you build confidence) d. Time yourself (helps you make judicious use of your time) e. Read through your answers if possible (check for grammatical or spelling errors) f. Do not quote figures you are not sure of (better to use words like “majority”, “mainly”, a “few” etc). g. Aim to answer ALL questions! (they carry EQUAL marks) SAMPLE ESSAY QUESTIONS A 28 year old G3P2⁺⁰ 2 alive woman with TWIN gestation presented in the labour ward of Asokoro District Hospital Abuja at a gestational age of 37 weeks and 5days. At presentation she was having strong uterine contractions of 3 in 10 minutes lasting 50 seconds. The fetal heart tones of both twins were heard and regular. Vaginal examination revealed a cervical dilatation of 6cm with the fetal membranes bulging and the leading twin in cephalic. Discuss how you will conduct her labour and delivery. MANAGEMENT OF TWIN GESTATION IN LABOUR This is a high risk pregnancy and requires multidisciplinary approach. She will be admitted into the delivery room and her antenatal records would be reviewed while a brief history will be taken to confirm she is in labour and a quick general and physical examination done to confirm other initial findings. Blood samples will be taken for PCV and grouping and crossmatching of at least 2 units of blood as the risk of PPH is high. An intravenous line will be secured early in labour and an infusion of Dextrose/Saline started so that oxytocin can be added when necessary. I will inform senior colleagues as assistance may be need at one stage or the other in the course of her management. The Neonatologists will also be invited to assist in resuscitation of the babies and the Anaesthetists alerted in case of operative intervention. I will perform a VE to confirm the cervical dilatation and ARM will be done since cervical dilatation is already 6cm with bulging membranes while guarding against cord prolapse. Her labour progress is monitored using a partograph with electronic or intermittent foetal heart rate monitoring.while VE is done every 4 hours. TWINS CONT’D In the absence of complications, labour is allowed to progress to the second stage and vaginal delivery conducted in the normal way. Episiotomy is given if necessary while the baby will be handed over to the Neonatologist for care. After delivery of the 1st twin, the abdomen is quickly palpated to determine the lie and presentation of the 2nd twin and presence of uterine contractions. If the lie is not longitudinal it should be corrected to longitudinal. A VE will be done to assess state of cervical dilatation, & exclude cord prolapse. Oxytocin is added to the IV Fluid if contractions are inefficient or have ceased completely. ARM is done following delivery of 1st twin to deliver 2nd twin normally or by assisted breech delivery. If fetal distress is present a breech extraction is done. C/S is performed if the 2nd twin is retained. Active management of the 3rd stage of labour is done to prevent PPH which may occur as a result of uterine atony from uterine overdistention and hyperplacentation. The patient is monitored closely and her vital signs checked regularly postpartum as primary PPH can occur at this stage. Episiotomy is repaired if it was given and the patient and her babies will be transferred to the lying in ward for further observation. GYNAECOLOGY ESSAY 1. Mrs NE, a 61-year old P6+ 0 6Alive, obese (BMI 38kg/m²), menopausal woman presents to the Gynae clinic of Nile University Teaching Hospital Abuja with history of postmenopausal bleeding of 6 months duration and slightly offensive watery vaginal discharge of 3 months duration. She also complains of tiredness and dizziness after every episode of bleeding. Her LMP was 8years ago. She is a known hypertensive and diabetic patient on medications for her condition. Vaginal examination showed a normal cervix with evidence of bleeding from the uterus which was darkish. Abdominal Ultrasound scan showed a normal sized uterus with thickened endometrial plate of 19mm with normal adnexa. a. What is the most likely diagnosis? b. What investigation would you perform to help you confirm the diagnosis? c. Discuss other investigations you would perform for her prior to her definitive treatment and her management if her disease condition was in the EARLY stage. d. What treatment will you offer her if her disease condition is in stage 1. GYNAECOLOGY ESSAY CON’TD a. The most likely diagnosis is endometrial carcinoma. b. Endometrial biopsy plus histologic examination of the specimen should be done to confirm the diagnosis. c. DISCUSS: OTHER INVESTIGATIONS PRIOR TO SURGERY i. CXR to rule out metastasis & because of her age. ii. ECG for her age. iii. CT/MRI of the pelvis and abdomen for evidence of metastatic disease. iv. Hysteroscopy/cystoscopy/sigmoidoscopy for evidence of metastatic disease. v. PCV/Haemoglobin to rule out anaemia (PMB with c/o tiredness and dizziness) vi. Other investigations to be done in preparation for definitive treatment will include: FBC; Urinalysis; LFTs; Renal function tests (E/U/Cr); Blood sugar; Grouping and crossmatching of blood as patient may require blood transfusion; HIV/Hepatitis. a. TREATMENT: a. Blood transfusion if PCV/Hb estimation confirms ANAEMIA and since patient is symptomatic b. Mainstay of Treatment is TAH + BSO with or without lymphadenectomy. c. Post operative Radiotherapy not necessary but reduces risk of pelvic recurrence. d. Hormonal therapy: progestogens for distant or recurrent disease. e. Adjuvant chemotherapy: Cisplatin if disease progresses but chemotherapy results are disappointing. f. Follow up is important to monitor progress. OBSTETRICS ESSAY QUESTION 2 1. Mrs JC is a 30-year old G1P0⁺⁰ (Primigravida) who presented at the antenatal clinic of Wuse District Hospital Abuja with complaints of having passed her expected date of delivery (EDD) and yet to go into labour. Her gestational age at presentation is 41weeks and 3days. She has good foetal movements and the symphysiofundal height measured 39 weeks. a. What are her management options and why? b. If she chooses induction of labour, describe step by step how you will go about the induction? POSTDATED PREGNANCY a. Management options include: 1. Expectant management because some women can still go into labour after 41weeks and before 42 weeks. 2. IOL because perinatal morbidity and mortality increases rapidly after 41 weeks. 3. Caesarean section if labour fails to start spontaneously, or IOL is contraindicated, or the woman prefers C/S. POSTDATED PREGNANCY CONT’D b. If she chooses IOL her management will involve her being admitted into the labour ward and review of her antenatal records to confirm her dates and exclude any contraindication to vaginal delivery. This will require a review of any early USS reports if available. Before the commencement of induction, which should ideally be in the morning, the procedure must be explained to the woman, including the risks and benefits, and her written informed consent obtained. A general physical examination should be performed to check for pallor, jaundice, BP, her height, weight, oedema. IOL FOR POSTDATE CONT’D This will be followed by a systemic examination with emphasis on abdominal obstetric examination to check the SFH, the lie, position, presentation, and descent of the presenting part and the foetal heart auscultated. A vaginal examination is done to assess the favourability of the cervix and adequacy of the pelvis for vaginal delivery. If the cervix is not favourable (as evidenced by a Bishop score of