Exam technique tips - how to answer questions comprehensively
The best way of learning how to answer exam questions is to do old ones
General advice
- Going to every lecture and tutorial, studying every detail and
remembering every piece of information DOES not guarantee success
- By nature exams are an artificial assessment process.
- Answers are given in a specific academic and cultural context that is
pre-ordained and predictable
- All post-graduate medical specialist trainees invest a significant
amount of time and energy understanding this concept, so should medical
students
- Correct use of terminology is critical to understanding specialised
areas of knowledge. Each discipline has its own specific vocabulary and key
terms. Knowing the definitions and the nuances of meaning is important.
- The accurate and liberal use of this in an exam setting is the starting
point to develop and elaborate your answers into a form that is acceptable
for the examiners.
- Insightful and adaptable students know the 'lingo' and learn to speak it
the right social or professional context.
Biochemical pathway
e.g. beta oxidation of fatty acid, Krebs cycle
- Clinical significance - what function does the pathway serve
- Site of pathway - organs, tissue type
- Connections to other pathways - feed in / feed out
- Major substrates - sources, type, significance
- Type of chemical reaction e.g. oxidation, phosphorylation
- Catalysing enzyme
- Control of pathway e.g. rate-limiting, conformational change, endocrine,
neurological
Physiology process / Endocrine pathway
e.g. blood pressure, carbon dioxide tension, aldosterone
- Clinical significance - why is the parameter important to control
- Sensor / Afferent pathway - organ, location, neurological or endocrine pathway
that senses derangement
- Controller - organ, location
- Effector / Efferent pathway - organ, location, neurological or endocrine pathway
to correct derangement
Contributing or modifying events to feedback loop
- Details of biochemical or histological structures involved (see biochemical
process and histology)
- Responses to different situations - physiologic e.g. standing up or pathologic
e.g. blood loss
Asked to draw a graph
e.g. oxygen diassociation curve, drug-receptor binding
- Label axis and give units
- Draw the curve
- Label major points of curve e.g. values, clinical significance and relationship
to biochemical event or physiological concept
- List modifiers to the curve and illustrate (explain underlying biochemical or
physiological processes
Neuroanatomy
e.g. facial nerve, sympathetic nervous system
- Nuclei - origin and location
- Pathway - anatomic course
- Ganglion - major synapses and location
- Innervation - organ affected and function served (somatosensory, somatomotor,
autonomic, special sense)
- Neurotransmitters - classification, receptor sub-types
Disease / Pathology / Immunology/ Microbiology
e.g. atherosclerosis, TB
- Causes - predisposing, precipitating, perpetuating (for infection give likely
organisms)
- Pathogenesis - chronology of anatomical or physiological derangements, events at
biochemical, microscopic and macroscopic level, physiological or anatomical
compensatory mechanisms
- Natural history / Sequalae / Complications - possible outcomes, causes and
mechanisms - resolving, ongoing, worsening (classify also as short, mid and long
term events)
- Morphology - gross and histopath - visible and microscopic events and changes
related to all of above
- Clinical features (see below)
- Investigations (see below)
Surgical processes - derangements of anatomy
e.g. tumours, infections
- Compression
- Perforation / Rupture - hollow viscus, blood vessels
- Torsion
- Obstruction
- Fistulas / Sinus
- Abscess
- Ulceration
- Herniation
Histological structure
e.g. liver
- Anatomic location and organ involved
- Parenchymal structure
- Surrounding structures - connective tissue, capsules, drainage
- Function of components
- Blood supply and drainage
- Nerve supply and function
Clinical features - symptoms and signs
e.g. shock
- Related to disease process (see above)
- Give chronology of derangements (see pathologic processes and surgical
processes)
- Manifestations of the anatomical and physiological responses to the disease
- Manifestation of any complications (see pathology)
Pharmacodynamic concepts
e.g. heroin-naloxone,
- Receptor
- Secondary messengers
- Drug mechanisms and physiologic effect
- Agonist / Efficacy / Potency /Antagonists
Pharmacokinetics
e.g. alcohol
- Absorption / Bioavailability / First pass metabolism
- Distribution / Volume of distribution / Lipid solubility / Organ blood flow /
Multi-compartment models
- Metabolism / Site of metabolism Organ blood supply / Enzymes pathways /
Metabolites / Toxic metabolites / Half life
- Elimination / Site of elimination / Organ blood flow
- Drug interactions - pharmacodynamic , physiologic, chemical
any factors that alter the above drug interactions / enzyme induction / enzyme
inhibition, organ blood flow, body weight, muscle mass, fat content
Clinical medicine
e.g. diabetic ketoacidosis
- Epidemiology / Causes
- Clinical features (see above)
- Investigations
- Management
- Prognosis
Infectious disease
e.g. bacterial, viral, fungal
- Microbiology - common and uncommon organisms
- Immunological responses
- Pathology (see above)
- Disease - common organs affected and manifestations (see clinical features)
- Treatment - antimicrobials
Basic Clinical pharmacology - drugs
e.g. penicillin, aspirin, beta blocker
- Pharmacologic classification e.g. B2 adrenergic antagonist
- Therapeutic classification e.g. antihypertensive
- Mechanism of action
- Indications (uses)
- Contraindications (when not to use)
- Drug interactions - pharmacologic, physiologic, chemical
- Side effects - extension of action, idiosyncratic, allergic