Disclaimer: This article is primarily intended for my students, and is specific to Kerala University of Health Sciences (KUHS). However, others may find this useful, too.

Background Information:

Both Paper I and Paper II have two ‘Problem Solving’ questions, each worth 5 marks. We will consider the questions of Paper I and Paper II separately.

Key Messages:

Paper I

There are several possible variants of the ‘Problem Solving’ type questions:

Variant 1: As Medical Officer of the PHC

One of the commonest questions is ‘….as Medical Officer of the Primary Health Centre….’. Questions of this type generally require one of three actions:

1. Investigation of an outbreak
2. Prevent and control (something)
3. Address (a particular problem)

Identifying the variant is fairly simple, as the question includes the word(s) ‘outbreak’; ‘prevent and control’; and ‘address’, respectively.

In order to answer the first (investigation of an outbreak) type of question, one needs to apply the steps of ‘investigation of an epidemic’ to the condition mentioned in the question.

Example: The question states that there is an outbreak of food poisoningà Apply the steps of ‘investigation of an epidemic’ while addressing potential causes of food poisoning.

As the question does not mention prevention and control of the outbreak, one might fail to include details of the same. However, to score well, do include general measures to prevent and control an outbreak of food poisoning. These measures should be specific to the situation- restaurant/ function, etc. (mention some elements of ‘sanitation of eating places’ for commercial establishments).

The remaining two types of questions need to be approached in the same manner, so I will discuss them together. Both, ‘address (a particular problem) and ‘prevent and control (something)’ often involve the implementation of a National Program in addition to the prevention and control of the condition in question. All such questions must begin with an assessment of the situation. This will enable proper classification, management and follow-up actions. Following assessment, appropriate steps for each possible situation should be described. Preventive and control measures for the condition should mentioned in detail, with specific details for the modes of intervention under each level of prevention. A mention of the related National Program is desirable.

Example: The question requires one to mention ‘..steps to prevent and control anaemia in pregnancy..’à Mention the normal value of haemoglobin in pregnancy, and classify anaemia. Next, mention how the patient would be assessed- both history and examination, and laboratory investigations. Then describe the appropriate management for each scenario (mild anaemia, severe anaemia) in each trimester of pregnancy. Include a note on how the condition could be prevented in the next pregnancy, and the benefits/ services under the related National Program(s).

 

Variant 2: Diet chart

The second variant involves preparing a diet chart for a specified person. Usually, this would be a pregnant woman; a woman with anaemia in pregnancy; or a lactating mother. However, one may have to prepare a diet chart for a non-pregnant person as well.

In order to answer such questions, simply apply the dietary principles to a hypothetical person of your choice. Take care to mention the principles AND the calculations of calories, protein, iron, etc.

 

Variant 3: Critical factors in history

This variant presents a scenario involving a person with some abnormality (overweight/ obesity; early pregnancy, etc.), and candidates are required to describe the crucial aspects of history (and examination) that should be elicited in that situation. The situation presented in the question would determine the critical factors.

Example: The question requires mention of critical factors in history of a person with ‘..BMI 28.5..’àMention questions related to the risk factors for development of overweight, and its potential consequences/ complications. These would include questions pertaining to diet, physical activity, family history, features of diabetes mellitus/hypertension, etc. The questions mentioned in the answer should be aligned with established modifiable and non-modifiable risk factors; and potential management approaches.

 

Variant 4: Manage case

This variant mentions a clinical scenario, and candidates are required to document how they would manage the case. Often, the case pertains to a nutritional problem. The first step in any such question is assessment of the patient. Mention how you would proceed to assess the patient, specifying items from history, physical examination and laboratory investigations that are appropriate in that situation. Next, describe the various treatment pathways you would take depending upon the findings of assessment. Treatment approaches should be aligned with existing guidelines/ national programs.

Example: The question describes ‘poor feeding’ in a childà Assess the child: History of recent illness, duration of poor feeding; diet history; development history; Physical examination; Anthropometry to assess growth and determine if malnutrition exists (specify anthropometric measures); Laboratory investigations (anaemia); Classify as normal/underweight/severe malnutrition; Management as per classification (specify for each possibility).

 

Variant 5: Give advice

Here, candidates are presented with a patient profile, and required to give advice to the person(s) concerned. The primary task is to understand what the question is really asking- often, some terms/ words would have been substituted without changing the meaning. Candidates must first determine the true meaning of the question. Thereafter, it is a matter of simply writing the answer like any short answer question.

 

Variant 6: Levels of prevention

This is the last variant of problem-solving type questions. Here, the candidate must describe the preventive measures in a structured manner- the levels of prevention and modes of intervention. Usually, the question will mention a condition where this has been described in the same manner (in the textbook). Candidates may be awarded some marks if they mention the levels of prevention and modes of intervention under each level alone. However, the question is not about that- the prevention of the condition mentioned in the question must be described under those headings.

 

Summary

There are six variants of ‘Problem-solving’ type questions asked in KUHS theory examinations:

1. Medical Officer of PHC
2. Diet Chart
3. Critical factors in history
4. Manage Case
5. Give Advice
6. Levels of Prevention

Useful Link:

Link to previous article on how to identify the study design from a question:

https://communitymedicine4asses.com/2017/08/17/how-to-identify-the-study-design-from-a-question/