evaluations in medical education

8/2/2019 Evaluations in Medical Education

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Evaluations in Medical Education

A Review of Feedback What were some points in the lecture that were helpful in giving & receiving feedback?

What happens if we dont receive feedback well?

What is an evaluation? Form of feedback Its re-focusing ones vision on what is important/on their goals It should include SMART goals Example:Faculty Evaluation Sheet

Writing Test Questions Your goal is not to teach, but to evaluate

Should evaluate the students understanding of the material rather than details Example: Which question better evaluates community doctors leprosy knowledge?

According to WHO protocol, which form of leprosy requires treatment with multi-drugtherapy(MDT)?

a)paucibacillary leprosy (PB) b) multibacillary leprosy (MB) c) PB & MBd) sometimes PB but always MB e) always PB but sometimes MB

Since which year has the WHO has supplied MDT free of cost to leprosy patients in allendemic countries?

a) 1990 b) 1995 c) 2000 d) 2005 e) 2010

Some sample test questions

Q1. The most common site of pulmonary atelactasisin children is:

a. Right upper lobe

b. Right middle lobe

c. Right lower lobe

d. Left upper lobe

e. Left lower lobe

Q2. A routine physical examination of a newbornreveals a grade 2/6, short, harsh systolic murmur atthe apex. The newborn is completely asymptomatic.

The most likely diagnosis is:a. Atrial septal defect

b. Ventricular septal defect

c. Mitral stenosis

d. Mitral regurgitation

e. Patent ductus arteriosus

Q3. All of the following conditions can present withspherocytosis in peripheral blood smear except:

a. ABO incompatibility

b. Thermal injury

c. Wilson disease

d. Autoimmune hemolytic anemiae. Pneumococcal sepsis

Q4. A 7-day-old newborn girl appears for a routinephysical check-up. Her mother noticed grapelikemass protruding through the child's vagina. The girlis asymptomatic. The most likely diagnosis is:

a. Vaginal prolapse

b. Rectovaginal fistula

c. Urethral prolapse

d. Uterine prolapse

e. Sarcoma botryoides

Q6. The most important hormone responsible for the

onset and progression of puberty is:a. Estrogen

b. ACTH

c. TSH

d. Progesterone

e. GnRH

Q7. A 2 year old boy appears with intermittentloose stools for the past 1 month. Stools typicallyoccur during the day and not overnight. The boy isotherwise healthy. The growth and development arenormal. The most likely diagnosis is:

a. Chronic enteritis

b. Rotavirus enteritis

c. Salmonella enteritis

d. Food allergy

e. Toddler's diarrhea

Angkor Hospital for ChildrenFaculty Development Course


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Q8. The best diagnostic antibody titer in patients withstreptococcal skin infection is:

a. Antistreptolysin O titer is elevated.

b. Serum C3 level is decreased.

c. Serum C3 level is increased

d. Antistreptolysin O titer is decreased

e. Deoxyribonuclease (DNase) B antigen is

present.

Q9. A 5-year-old boy appears with an abrupt onset ofincreased urinary frequency for the last 3 days. Hehas been voiding every 10-15 minutes during the day.The mother denies history of fever, abdominal pain,dysuria, nocturia, or daytime incontinence. Theurinalysis result is normal. The next step inmanagement is:

a. Trimethoprim-sulfamethoxazole

b. Restriction of fluid intake

c. Renal ultrasonography

d. A 24-hour urine sample for calcium

e. Reassurance

Q10. The following statement is not true aboutKlinefelter syndrome:

a. Maternal age is advanced in most cases.

b. An extra X chromosome is maternal origin in

majority of cases.

c. This syndrome is most commonly due to

meiotic nondisjunction of a X chromosome.

d. About 3% of infertile males have Klinefelter

syndrome.

e. About 1% of mentally retarded males have

this syndrome.

Q13. All of the following conditions can cause opticneuritis except:

a. Devic disease

b. Lead poisoning

c. Vincristine therapy

d. Corticosteroids

e. Bacterial meningitis

Q15. A 15-year-old boy appears with swelling,tenderness, and increased prominence of the righttibial tubercle. He participated in high school sports.The following therapy is not beneficial in thiscondition:

a. NSAIDs

b. Rest

c. Restriction of activities

d. Knee immobilizer

e. Isometric exercise program

Q16. The following statement is not true aboutpoisoning in children:

a. The most common site of poisoning is home.

b. Most commonly occurs under 5 years of age.

c. Ingestion is the most common route.

d. Majority of cases involve nondrug products.

e. Education regarding prevention of poisoning

should be discussed in well-child visits, after

a child is mobile.

Q17. The preferred oral therapy for an infection inhuman bite wounds is:

a. Penicillin

b. Doxycycline

c. Ciprofloxacin

d. Erythromycin

e. Amoxicillin-clavulanate

Q18. The preferred intravenous therapy for aninfection in animal bite wounds is:

a. Cefotaxime

b. Ceftriaxone

c. Ciprofloxacin

d. Penicillin

e. Ampicillin and sulbactum

Q22. Pulmonary hypoplasia in newborns is mostlikely due to all of the following conditions except:

a. Potter syndrome

b. Oligohydramnios

c. Diaphragmatic herniad. Spinal cord lesions

e. Pneumothorax

Q23. The preferred therapy for patients with chroniccholestasis without biliary obstruction is:

a. Kasai operation

b. Phenytoin

c. Discontinue fatty foods

d. Ursodeoxycholic acid

e. Gentamicin

Q24. A complication of using a hydrogen pumpinhibitor (e.g., omeprazole, lansoprazole) is:

a. Acquired pyloric stenosis

b. Diarrhea

c. Vomiting

d. Gastroesophageal narrowing

e. Bacterial overgrowth

Q25. The usual site of obstruction in infants with anupper airway obstruction is:

a. Larynx

b. Trachea

c. Nasopharynx

d. Oropharynx

e. Enlarged tongue

Q27. The most common organism in patients withempyema (purulent pleurisy) is:

a. Staphylococcus aureus

b. Group A Streptococcus

c. Tuberculosis

d. E. coli

e. Streptococcus pneumoniae


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Q28. The most common organism in patients withpost-traumatic empyema is:

a. S. pneumoniae

b. S. aureus

c. E. coli

d. Pseudomonas

e. S. epidermidis

Q29. The most common cause of gross hematuria is:

a. Urinary tract infections

b. Meatal stenosis

c. Trauma

d. IgA nephropathy

e. Glomerulonephritis

Q30. The most common cause of chronic glomerulardisease is:

a. IgA nephropathy

b. SLE

c. Glomerulonephritis

d. Henoch-Schonlein purpurae. Reiter syndrome

8. A 10-month-old white female is brought to your office for a routine health evaluation. Her diet consists of table foodand whole milk and she is a good drinker. Her weight and length are at the 50th percentile and no changes arenoted in her growth curves. Her physical examination is notable for pallor; otherwise there are no abnormalities. Herhemoglobin is 7.5 grams per deciliter and the peripheral blood smear reveals microcytic hypochromic cells.

Which of the following is the MOST likely etiology of this anemia?

A) ThalassemiaB) Sickle cell anemiaC) Transient viral suppression of her bone marrow

D) Anemia of chronic diseaseE) Iron deficiency anemia

200. A previously well 15-year-old girl presents to your emergency department complaining of severe headache anddiplopia. She has also had a single episode of emesis, which was described as nonbilious and non-projectile. Shehad a routine health examination the previous week at which time she was started on oral contraception. She deniestrauma.

On examination, she is slightly obese, alert, and cooperative but anxious teenager. The eye examination is significantfor bilateral papilledema and bilateral inferior nasal visual field defects. Her neck is supple. The remainingexamination, including full neurological examination, is unremarkable.

Head CT is unremarkable. Cerebrospinal fluid evaluation has an opening pressure of 49mm water, 0 WBC, 0 RBC,glucose 68, protein 18, gram stain negative. She reports improvement in the headache following the lumbar puncture

This teenager has:

A) Pseudotumor cerebriB) A brain tumor not visible on the head CTC) HSV encephalitisD) Undeclared head traumaE) Nothing, she is malingering

221. A 3-year-old boy is seen in the emergency department after coughing and gagging while eating a peanut. He nowhas difficulty breathing. His physical examination is significant for wheezing on the right side hemithorax. Whatradiographic finding is classic for this condition?

A) Atelectasis on the side of aspirated contentB) An expiratory film demonstrating air trapping with hyperinflation of the lung shifting away from aspirated sideC) Bilateral hyperexpansion

D) Peanut seen on the radiographE) An inspiratory film demonstrating a left lower lobe consolidation

Answers

1 (a) Right upper lobe (63% of cases)2 (b) VSD3 (e) Pneumococcal sepsis does not cause spherocytosis. However, clostridial septicemia with exotoxemia can

cause spherocytosis.4 (e) Sarcoma botryoides is a vaginal adenocarcinoma.6 (e) GnRH is a hypothalamic gonadotropin-releasing hormone.7 (e) Toddlers diarrhea is common between 1 to 3 years of age. These healthy children eat carbohydrate-

containing beverages and eat snacks throughout the day. Therefore, carbohydrate-containing beveragesshould be reduced, fat containing foods should be increased, and the fluid volume may be reduced.

8 (e) Deoxyribonuclease (DNase) B antigen9 (e) Reassurance; the condition is self-limited and symptoms resolve within 2-3 months. Rarely, anticholinergic

therapy is effective. This boy is diagnosed with pollakiuria or daytime frequency syndrome of childhood. This


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may be due to stress for an unknown reason or before the onset of kindergarten.10 (a) Maternal age is not advanced in most cases. The Klinefelter syndrome is 47, XXY.13 (d) Intravenous corticosteroid therapy can improve a visual recovery in young adults but does not alter visual

outcome. Oral corticosteroid should not be used because of increased recurrence rate of optic neuritis.Neuromyelitis optica (Devic disease) can cause bilateral optic neuritis.

15 (a) NSAIDs (nonsteroidal anti-inflammatory drugs) and other anti-inflammatory drugs are not useful in Osgood-Schlatter disease.

16 (e) Education regarding prevention of poisoning should be discussed in well-child visits, even before a child ismobile.

17 (e) Amoxicillin-clavulanate is the preferred oral therapy for an infection in human and animal bite wounds.18 (e) Ampicillin and sulbactum are the preferred intravenous therapies for an infection in animal and human bite

wounds. Ticarcillin-clavulanate is an alternative therapy.22 (e) Pneumothorax does not cause pulmonary hypoplasia. However, pneumothorax can occur in a patient with

hypoplastic lungs resulting in pulmonary collapse.23 (d) Ursodeoxycholic acid (15 mg/kg/day) increases a bile flow, interrupts an enterohepatic circulation of bile

acids, and reduces a cholestatic jaundice.24 (e) Achlorhydria-related bacterial overgrowth25 (d) Oropharynx27 (e) S. pneumoniae28 (b) S. aureus29 (a) Documented or suspected UTIs; answers (b), (c), (d), and (e) also cause gross hematuria.30 (a) IgA nephropathy

8. E - Iron deficiencyIron deficiency anemia is the most common cause of microcytic hypochromic anemia in this age group. This etiology is alsosuggested by the history of whole milk intake. Thalassemia is a possibility but less likely given the patient's history and theknown frequency of the disease. Sickle cell anemia and transient viral suppression do not usually present with a microcytichypochromic anemia. Anemia of chronic disease is not supported by the clinical presentation given the healthy physicalexamination and weight at the 50th percentile without any changes in her growth curves.

Behrman RE, Kliegman RM, Jenson HB, Eds. Nelson textbook of pediatrics, 17th ed. Philadelphia, PA: Saunders,2004: 1614-1616.

200. A - Pseudotumor cerebri

This child has pseudotumor cerebri, a condition consisting of signs and symptoms of elevated intracranial pressure withnormal ventricles and normal CSF. Many things cause pseudotumor cerebri, including medications (e.g. tetracycline,steroids and oral contraceptive pills), metabolic or nutritional derangements (e.g. hypoparathyroidism, Vitamin A excess or

deficiency, iron deficiency anemia and pregnancy), and infections (e.g. roseola, chronic otitis media). It classically presentswith headache, and/or mild to moderate emesis and/or papilledema. Constitutional symptoms (e.g. failure to thrive,fatigue), severe emesis, focal neurologic symptoms not referable to the optic nerve or altered sensorium are all signs thatsomething other than pseudotumor is the cause. Diagnosis is made by exclusion of an intracerebral focal lesion andconfirmation of normal ventricles by imaging, measurement of the opening pressure as well as obtaining cerebrospinal fluidto demonstrate normal cytology and protein, as well as a thorough neurologic exam. The treatment is to first remove thetrigger, followed by therapeutic lumbar puncture and removal of cerebrospinal fluid. Alternatively, either steroids oracetazolamide have shown limited efficacy. Tumors should be visible on CT scans of the head. The diagnosis ofencephalitis is not supported by the cerebrospinal fluid cytology. Head trauma severe enough to cause signs and symptomsof elevated intracranial pressure should have findings demonstrated on the head CT. There are no reasons to believe thatthis child is feigning i llness and she has objective signs of neurologic problems

Behrman RE, Kliegman RM, Jenson HB, Eds. Nelson textbook of pediatrics, 17th ed. Philadelphia, PA: Saunders,2004:2048-9.

221. B - An expiratory film demonstrating air trapping with hyperinflation of the lung shifting away from aspiratedside

In foreign body aspiration, inspiratory films are typically normal. In expiration, the lung with the aspirated contents remainshyperinflated and the mediastinal shift away from the lung with the aspirated contents occurs. Breath sounds are diminishedon the affected side. Air enters the distal portion of the lung on inspiration, but is blocked on expiration by the foreign bodyproducing an obstructive hyperinflation. The peanut is not radiopaque and will not be visible on the radiograph.

Behrman RE, Kliegman RM, Jenson HB (Eds). Nelson Textbook of Pediatrics. 17th Edition. Saunders, PhiladelphiaPA 2004:1410-1411.


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Some Facts about Leprosy

CAUSE

Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae (M. laprae).

M. leprae multiplies very slowly and the incubation period of the disease is considered to be about five years.

TRANSMISSION

Leprosy is transmitted by air through droplets from the nose and mouth, during close and frequent contactswith untreated cases.

Leprosy is one of the least infectious diseases, because:

Over 99% of the population has adequate natural immunity;

Over 85% of the clinical cases are non-infectious, and

An infectious case is rendered non-infectious within one week, most often after the very first dose of

treatment.

SYMPTOMS

Leprosy mainly affects the skin and peripheral nerves.

If left untreated, it can lead to progressive and permanent damage of nerves, leading to loss of sensation and

sweating in the extremities and paralysis of muscles in the hands, feet and face.The disease is classified as paucibacillary (PB) or multibacillary (MB), depending on the bacillary load.

PB leprosy is a milder disease characterized by few (up to five) skin lesions (pale or reddish), whereas MB is

associated with multiple (more than five) skin lesions, nodules, plaques, thickened dermis or skin

infiltration.

TREATMENT TODAY

In 1981, a World Health Organization (WHO) Study Group recommended multi-drug therapy (MDT), a

combination of three drugs.

MDT effectively kills the pathogen and cures the patient.

Treatment provided in the early stages averts disability.

With minimal training, leprosy can be easily diagnosed by clinical signs alone.

WHAT IS MDT

MDT comprises of three drugs, dapsone, rifampicin and clofazimine. Rifampicin and clofazimine were

discovered in the early 1960s.

MDT is safe, effective and easily administered under field conditions.

MDT is available in convenient monthly calendar blister packs.

Since 1995, WHO has been providing free MDT for all patients in the world, initially through the drug fund

provided by the Nippon Foundation and since 2000, through the MDT donation provided by Novartis and

the Novartis Foundation for Sustainable Development.

Novartis has pledged free supply of MDT till 2010.

HIGHEFFECTIVENESS OF MULTIDRUG THERAPY

Transmission of leprosy is interrupted after the very first dose of MDT. In other words, patients are no longer

infectious to others after being administered the first dose of the treatment regimen.

PB patients treated with MDT are cured within six months.

MB patients treated with MDT are cured within 12 months.

There are virtually no relapses, i.e. no recurrences of the disease after treatment is completed.

No resistance of the bacillus to MDT has been detected.

WHO estimates that early detection and treatment with MDT has prevented about four million people from

becoming disabled.

MDT is very cost-effective as a health intervention, considering the economic and social losses

averted.

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