MEDICAL EDUCATION
AVOIDING COMMON ERRORS IN KEY FEATURE PROBLEMS
Occasionally, the maximum number of options/answers is not stated, e.g. “circle as many options as are appropriate”. You are expected to look carefully at the key information provided and the specific question asked. You are then supposed to be focused and answer within reason and not to provide blunderbuss answers hoping to make a strike somewhere. Since a maximum number of allowable answers or options may have already been pre-set in the scoring key, you may then get no marks.
Although the cases in the KFP are different, they each carry the same marks. However within a case, different questions are given different percentages of marks depending on how critical the decision-making is for that question. Incomplete but correct answers will be given a partial mark. Some cases are long and others are short. Read through all the questions carefully and apportion your time appropriately. Skip difficult questions and come back to them later. Try not to leave any questions unanswered. You will be surprised by the extent of residual knowledge you have acquired through the years. There is no negative marking or carry over of negative marking to the next question.
Write-in Answers
As a general rule of thumb for all written work, writing clearly and neatly is paramount as illegible answers cannot be marked. Avoid abbreviations which are not universally used and may be foreign to an examiner.
When providing ‘write-in’ answers, write in note form only,
in the spaces provided. Do not waste time writing in long sentences.
For example, if 2 diagnoses are required, simply list them as follows:
Rheumatoid arthritis
Polymyalgia rheumatica
Answers for the ‘write-in’ component are expected to be conceptually
distinct. Therefore avoid multiple versions of the same answers. This is illustrated
in the following scenario:
severe intractable epigastric pain since the past two hours. Case records revealed previous non-compliance to drugs and poor blood pressure control. His last measurement a week ago was 180/110 mm Hg. He has a history of dyspepsia for many years. He smokes 30 cigarettes daily for the past 40 years and indulges in heavy drinking during his weekend alcoholic binges.
What are the possible diagnoses for his presenting problem? List up to 4.
Listing down 4 related and linked diagnoses like Gastric Ulcer, Duodenal Ulcer, Peptic Ulcer, Dyspepsiashould not be done as you have used up all your 4 choices. You will then be unable to offer “essential” answers like acute myocardial infarct, acute pancreatitis, dissecting aortic aneurysm, perforated peptic ulcer, thus resulting in partial marks being awarded.
Discussion of Case 1 KFP
Consider the KFP for Case 1 written below and attempt to answer the questions.
It may help you to underline key features in the scenario provided,
and keywords in the question, to assist you in providing exactly
what is being requested. Match your answers to the model answers. We
will discuss the clinical reasoning behind the choice of accepted answers
and also highlight some quirks which reflect different approaches to
practice in Malaysia and Australia.
KFP Case 1
Mr. Tan, a 59-year-old school bus driver presents with
a persistent cough with muco-purulent sputum for ten weeks despite
being treated with cough mixtures, bronchodilators and three courses
of antibiotics. He is a chronic smoker; thirty cigarettes per day for
the last 40 years. He has a history of dyspepsia for which he takes
Ranitidine. He is otherwise well.
Question 1
What are the most important differential diagnoses?
List, in note form only, up to five (5) diagnoses.
On examination, apart from marked nicotine staining of the fingers and occasional pulmonary crepitations that cleared on coughing, no significant abnormalities are detected.
Question 2
Which investigations would you organise first?
Circle up to four (4) options from the following list.
| Code | Answer/Description of key words or phrases | Score |
| 1 | 24 hour ambulatory oesophageal pH monitoring | |
| 2 | Arterial blood gases | |
| 3 | Barium swallow | |
| 4 | Blood cultures | |
| 5 | Bronchoscopy | |
| 6 | Chest X-ray (CXR) | |
| 7 | CT scan of chest | |
| 8 | CT scan of sinuses | |
| 9 | Electrocardiograph (ECG) | |
| 10 | Endoscopy | |
| 11 | Full blood count (FBC) | |
| 12 | Human immunodeficiency virus (HIV) | |
| 13 | Spirometry | |
| 14 | Mantoux test | |
| 15 | Sinus X-rays | |
| 16 | Sputum for cytology | |
| 17 | Sputum for microscopy, culture and sensitivities | |
| 18 | Urinalysis |
