Clinical case questions are differentiated by a long description of a patient’s history, physical examination findings, and perhaps the lab data. The task of a student is to go through all of this information and come up with the best appropriate response or answer to the question being asked in the exam.

QUESTION TRAPS IN CLINICAL CASE STUDIES:

• The last statement of the clinical case question is the most significant component of the question. This is the phrase that possess the question. You may not have any idea what you will be asked until this moment. Thus, many students are inclined to skip the final sentence and then skim the case for the information needed to create the response. This is not, in general, the optimal strategy.

• Clinical case questions are frequently produced by first creating a classic case and then adding one or two additional elements. These details, on their own, may point to one of the supplied solution possibilities. To correctly answer these questions, you must read the entire case and consider all the facts provided as a whole. What matters is the whole picture of the case, not any one particular detail.   

• The authors are aware that, due to the length of the questions, the aspirants prefer not to read the entire question. They are aware that some test-takers are looking for that one key piece of information. As a result, a single piece of information may steer you away from the correct answer and towards one of the erroneous distractors. Avoid failing into this trap. You must concentrate on the overall significance of the case rather than just one aspect of it.

STRATEGY FOR CLINICAL CASE QUESTIONING:

The proper way to tackle these problems is to think of an answer, seek it, and then choose it. If none of the alternatives in answer captivate you, take a wild guess and go on to the next question. This is the same method we advocate for all questions, but it is important when there are a big number of them.

SO, HOW ARE THESE LONG CLINICAL QUESTIONS CREATED?

To answer these long clinical questions, you must first comprehend what the test author was thinking when he or she created them.

Every day, the NEXT  SOLUTIONS faculty generates new clinical questions. When developing a clinical question, NEXT  SOLUTION’S instructors and all exam setters follow these steps:

CLINICAL QUESTIONS might be classified as BACKGROUND or FOREGROUND. What is the significance of this?

Knowing what kind of a question you are asking can assist you to choose the ideal resource to contact for an answer.

BACKGROUND QUESTIONS seek information on an ailment, disease, condition, process, or object in general. These questions often address who, what, where, when, how, and why concerning a condition, test, or therapy, for example.

As an example,

• How much weight does a lady have to be classified as mildly obese?
• What are the clinical symptoms of menopause?
• What factors contribute to migraines?

FOREGROUND QUESTIONS seek particular information to help guide clinical judgments. These inquiries usually pertain to a specific patient or demographic. When opposed to background questions, foreground questions are more particular and complicated.

Foreground questions frequently study comparisons, such as two medications, two therapies, two diagnostic tests, and so on. Treatment/therapy, diagnosis, prognosis, and etiology/ harm are the four primary categories of foreground issues.

As an example,

• Is Crixivan beneficial in delaying the pace of functional deterioration in a 45-year-old male patient with LOU GEHRIG’S DISEASE when compared to a placebo?
• Are intranasal steroids more beneficial than antihistamines in the treatment of ALLERGIC RHINITIS SYMPTOMS in pediatric patients?

FORMULATING A WELL-BUILT CLINICAL QUESTION:

While framing a clinical foreground question, all 4 components are included in a well-constructed way which is known as PICO.

The PICO model is a useful technique used by highly qualified faculty of NEXT  SOLUTIONS INSTITUTE for framing long clinical questions along with organizing and narrowing any primary topic into a searchable question where-

P stands for – PROBLEM, PATIENT, POPULATION. (How would characterize a group of patients who are similar to you? What are the patient’s most crucial characteristics?)

I stand for INTERVENTION, PROGNOSTIC FACTOR, AND EXPOSURE. (What is the primary intervention you are considering? What are your plans for this patient?)

C stands for CONTRAST (What are you intending to compare the intervention to another therapy, medicine, placebo, a different diagnostic tet, and so on?)

It is necessary to provide this component and to be as explicit as feasible.)

O stands for OUTCOME (What are you attempting to achieve, assess, improve, or influence?

Outcomes might be disease-or-patient centered.

STUDY DESIGN ABOUT ANSWERING LONG CLINICAL QUESTIONS:

Questions can be further subdivided into those pertaining to therapy, diagnosis, prognosis, and etiology /harm.

THERAPY: Treatment questions in order to attain a specific end. Drugs, surgical intervention, dietary changes, counseling, and other interventions may be used.

DIAGNOSIS: The diagnosis of a problem in a patient who exhibits certain symptoms.

PROGNOSIS: Concerns about the course of an illness or the chance that a disease may arise.

You should always opt for the study design that will produce the most evidence.  Examine the study design pyramid shown below.

META-ANALYSIS: A statistical approach that integrates the findings of numerous research into a single weighted estimate, with more preference given to findings from studies with more events and in certain cases, higher-quality studies.

SYSTEMATIC REVIEW: A systematic review is one in which specific and acceptable methodologies are utilized to discover, assess, and summarise papers that address a certain subject. ( It may or may not include a meta-analysis.) unless otherwise noted, the phrase systematic review in clinical evidence refers to a systematic review of RCTs.

RANDOMISED CONTROLLED TRIAL: A randomized controlled trial is a study in which participants are randomly allocated to groups, one of which receives the intervention being evaluated and the other receives an alternative therapy or placebo. This approach of controlled trial allows for the evaluation of the relative effectiveness of treatments.

CONTROLLED CLINICAL TRIAL: A randomized controlled clinical trial is one in which participants are randomly assigned to one or both of two or more treatment groups. The word is used in clinical evidence to refer to controlled trials in which treatment is assigned by a mechanism other than random allocation. A randomized controlled trial is a study in which the allocation technique is random selection (RCT). Non- randomized controlled trials are more likely to be biased than randomized controlled trials.

COHORT STUDY: It is a non-experimental study design that follows a group of people (a cohort) and then examines how occurrences differ among individuals within the group. Research that evaluates a cohort that differs in terms of exposure to a suspected risk factor (for example, smoking) is valuable for determining whether exposure is likely to produce specific occurrences (e.g. lung cancer). Expected and impending cohort studies (in which subjects are followed forward in time) are more trustworthy than retrospective cohort studies.

CASE COMMAND STUDY: A case-command study is a study design in which a group of persons who have experienced an event (typically an unfavorable event) and a group of people who have not experienced the same event are compared to see how their exposure to suspect (usually noxious) substance differs. This research design is particularly beneficial when attempting to determine the etiology of unusual occurrences, such as rare malignancies.

CASE SERIES: An examination of a group of persons who have the condition (there is no comparison group in the case series).

HOW TO BEAT CLINICAL QUESTIONS?

1. MAKE DIAGNOSIS: The first step in answering a clinical question is to make a diagnosis. From where you answer the question as vaguely as possible based on what you have diagnosed.

• READ EVERY WORD CAREFULLY: Because of space constraints, PG exam questions must be succinct. As a result, if a piece of information is provided in the query, it is typically necessary to establish a diagnosis. But now comes the thrilling part. If they inform you that something is missing, it is important that you make the correct diagnosis. So, keep that in mind. After all, they don’t have much room, so if they take the time to inform you if something is there or absent, you can guarantee it is important.

• TRAIN YOURSELF: In order to put these points to use, you must first prepare for the test. When answering the questions on the fake exam, consider what the faculty could be looking for when creating the question. What improvements might have been made to the question to ensure that each of the other responses was correct? You will engage with the subject and learn a lot more this way.

Clinical questions will continue to frighten you until you begin practicing for them and put all of the preceding suggestions into practice.

Exam preparation can help you do a lot better in NEET PG and other PGMEEs.

When you will enter the exam, you will feel much more at an ease. And much happier as I walked out of it.