Assessment Exam IV follow up

Hi group,

I wanted to give you guys feedback about this last exam, to "wrap up" the challenges many of you had to some of the questions. After analysis, I accepted more than 1 answer on 3 different questions:

* on the question regarding "soft black stools"---I also accepted the answer about possible iron intake. I can see that just describing the stool as "soft black" was not enough of a hint for you to all think "tarry black"-and then choose the answer about GI bleeding that was desired.



* the question about colon cancer screening did have 2 correct answers-a colonoscopy every 10 years was also acceptable (I think I meant to mark that as an "all that applies")---so either answer was accepted.



* the question about your initial response to the female complaining about a vaginal discharge and wondering if she might have an STD ---I did also accept the answer some of you wanted---to first ask her about if she is having unprotected sex. Your rationale that you gave-"that if you asked her to describe her discharge-this is subjective; you would see that on your physical exam anyway so the more important question to first ask was to determine if risk factor was present"-is good-so I accepted that answer also. However-for test-taking skills-please realize that this would not have been the best answer. The stem asked for what should your initial (first) response be. You would want to try to get more details about her complaint-i.e. ask her to explain more about the discharge she is noticing before then asking questions to determine a causative factor. Your rationale was that you would be able to see the discharge in your physical exam.....maybe not, if she had cleansed herself right before the visit. Discharges can just be intermittant---Also, on your weekly lab exercises I stressed in the history taking that anytime you hear a "yes" to a question---i.e. you hear the person state there is something that could be abnormal---you ask questions about the issue to try to get a better picture of what is going on. This then guides you in what to assess further-either by looking for the issue in your physical exam and/or looking at other objective data-such as diagnostic test results. So first things first, ask her to describe the discharge she has been noticing(color, amount, how often, how long noticing). Asking about risk factors for STD-as well as other causative factors-would be the next questions you would ask. This would also help maintain a bit more sense of calm in the examination---you did not immediately just jump on a question that would make her more anxious by justifying her concern.....

now THAT was more of a discussion about a female discharge than you expected to see on a blog :-)

I hope you all have a good weekend. Hang in there, your semester is almost done. Happy studying. Go Cowboys.

CL