Non-Hodgekin Lymphoma
Non-Hodgekin Lymphoma
Please Create a test question about Non-Hodgekin Lymphoma following these guidelines
The questions should be original short situational-based scenarios, sometimes referred to as “vignettes”. Some questions may be straightforward “1-step” questions. However, a substantial portion of questions should be more complicated. That is, “2 or 3-step” questions asking something about that advanced role, advanced concept, or advanced practice. These types of questions provide an opportunity for students to take two steps: (1) determine the correct concept based on the vignette, and then (2) answer the question based on that concept in order to answer the question correctly.
All questions should be positively phrased, single one-best answer type questions. There should not be any negative questions (phrases using the words NOT, LEAST, EXCEPT, and so forth).
Each question should stand alone and not be related to any question before or after it.
Each question should have at least five answer options, (A-E). “All of the above”, “none of the above” or any variation of “a, b, and c” should not be used as possible answer options.
Questions may have accompanying images or audios.
The explanation of the correct answer should be accompanied by a brief explanation of the correct and incorrect answer options (in brief paragraph form – see examples below). The length of the explanation may vary with each question, but most should be between five and seven sentences. Please use references to support your rationales (again, please see examples).
Question-writing Principles
The best test question is one that well-prepared, well-qualified examinees answer correctly and that poorly prepared examinees answer incorrectly— that is, a good test question should distinguish between those who are experienced, confident, and well-versed in the subject from those who are not.
Avoid using race identifiers unless pertinent to question. Also, avoid using “woman” or “man” in descriptors. Literature suggests that it is better to use an occupation, for example, a 23-year-old waitress, or a 21-year-old college student.
Each question/item you will be writing consists of the following basic parts:
The stem consists of a question or statement, preceded by a clinical vignette or short case, and sometimes a chart, table, or illustration.
The list of choices (a total of 5) which include one correct answer and 4 incorrect distractors.
Individual explanations of the correct answer and each incorrect answer choice. The correct answer is explained first, then each incorrect answer in alphabetical order (according to letter).
References should be included with your rationales and formatted in proper APA format.
The Stem
The stem states the problem or asks the question. A well-prepared examinee will be able to formulate an answer to the question after reading the stem, so that all he or she must do is scan the choices for the answer that matches what he or she believes to be the answer to the question.
Stems are written in the form of a question or statement. The stem may be in the form of an incomplete statement.
Vignettes. All questions are preceded by a vignette. Questions that presuppose certain knowledge and require understanding and judgment are preferred to those that test rote memory.
Rote Memory Question: (Questions like this are not acceptable. If the question can stand alone from the story, it is a good chance that it is not application based.)
1. In a patient with kwashiorkor, the most important diet deficiency is a lack of
(A) calories
(B) calcium
(C) vitamins
(D) fats
(E) proteins
Clinical Vignette Question (Acceptable format):
2. A 49-year-old accountant with hypertension, grade II hypertension retinopathy, hypokalemia, and high plasma aldosterone is placed on a high-salt diet and desoxycorticosterone acetate (Doca), 10 mg intramuscularly every 12 hours for 3 days. At the end of this time, plasma renin activity is elevated. Which of the following measures should be recommended?
(A) Treatment with spironolactone, 400 mg daily for 6 weeks
(B) Adrenal exploration
(C) Iodocholesterol scan
(D) Renal vein catheterization
(E) Adrenal venography
Negatively worded stems (for example, “NOT,” “EXCEPT,” “LEAST” in the stem) are not acceptable.
Pay attention to the logical order of the stem. Read and compare the two stems below:
NOT: Which area of the brain is most likely to be damaged in a 35-year-old man with a head injury who is experiencing problems with sleep and arousal?
BUT: A 35-year-old patient with a head injury has problems with sleep and arousal. Which area of his brain is mostly likely to be damaged?
(A) Amygdala
(B) Basal ganglia
(C) Cerebellum
(D) Reticular system
(E) Thalamus
In the second stem, the examinee begins with the problem (head injury affecting sleep and arousal) and is left with the thrust of the question (which area of the brain is most likely damaged?). The end of the stem flows logically and directly into the distractors.
Stems dealing with controversial issues generally should be avoided. If used, they must acknowledge the existence of a controversy. A “controversial” stem can be made acceptable by specifying the person to whom the answer is acceptable or by defining the circumstances under which the given answer will be correct. An example follows:
NOT: In the treatment of breast cancer, why is radical mastectomy better than simple mastectomy?
BUT: Physicians advocating radical mastectomy as the treatment of choice for stage I breast cancer contend that it is superior to other treatments for what reason?
The first stem asserts that radical mastectomy is better than simple mastectomy, which may not be true in all circumstances. By specifying when radical mastectomy is the treatment of choice (i.e., for stage I breast cancer), the controversial nature of this question is tempered.
The Answer Choice Options
The answer choice options include the correct answer and the distractors prefaced by capital letters. The correct choice should be simply and unambiguously stated. There should be no way that the examinee can select the correct choice other than by knowing the correct answer— that is, the examinee should not be able to select the correct answer because it differs in length, grammatical construction, or type of words used, or because it is one of two mutually exclusive choices.
It is important that as much care be taken in preparing the distractors as in writing the stem and the answer. Distractors should be both plausible and unambiguously incorrect.
“All of the above” and “None of the above” are unacceptable distractors or answers.
Do not use mutually exclusive choices. Correct choices frequently tend to be one of two mutually exclusive choices.
Answer choice options should be parallel in length and construction, and logically ordered. The verbs in all answer choices must be consistent in tense.
NOT: A diagnosis of trichomoniasis is best established by the presence of
(A) multiple encysted larvae in skeletal muscle are diagnostic
(B) facial edema
(C) eggs in feces
(D) eosinophilia
(E) muscle pain
Notice that the correct answer, choice (A), is much longer than the distractors and does not grammatically follow the stem. Also, the choices describing physical symptoms are mixed with the choices describing the results of laboratory tests. The question should be rewritten as follows:
BUT: A diagnosis of trichomoniasis is best established by the presence of
(A) facial edema
(B) muscle pain
(C) encysted larvae in muscle
(D) eggs in feces
(E) eosinophilia
The Answer and Explanations
For each question (stem + answer/distractor choices) you should provide a discussion/explanation of each answer choice option. Each answer choice option must have a discussion/explanation that can stand autonomously. Please use the physical format shown in the examples for your explanation. Although the explanation may reiterate the correct answer, its didactic purpose is achieved only by going one step beyond the explicit content of the question. Please see examples.
References
Each rationale must include a reference back to the textbook(s) or other resources used.
Please use the APA format for the references.
Examples
The following are examples used in a clinically-based multiple choice testing bank. These examples below are provided (from NURS 622) to give you an illustration of the depth and breadth required in question writing. Your questions from NURS 620 Pathophysiology will be different. The key is to make the question application-based, not knowledge-based per se.
1. Rebecca, a twenty three year old Hispanic waitress, presents to the office with complaints of lower abdominal pain. In an attempt to build rapport and relationship, you begin your interview with a broad open-ended question, “Can you tell me about your pain?” As she begins to speak you realize that her English is poor, although she seems to understand more than she can speak. In spite of the look of confusion on your face, Rebecca enthusiastically continues to communicate her concerns to you in words intertwined with Spanish and English. It appears that she believes she is communicating clearly. Since your ability to speak or understand Spanish is limited, which of the following actions would continue to build rapport and enhance communication?
A. Hold your hand up toward Rebecca in order to nonverbally stop the conversation and walk out of the room to get an interpreter.
B. During a pause in her story, you calmly and clearly state, “I do not speak Spanish well. One moment and I will get an interpreter so that I can understand your concerns better.”
C. Attempt to translate her language as best as you can and fill in the rest through body language and pointing.
D. Smile and nod throughout her story while attempting to ascertain as much information as possible. If more clarification is needed ask closed ended questions to obtain the information.
E. Close the patient record and ask Rebecca to sit on the examination table so that you can obtain primarily objective data for diagnosis.
Explanation: The answer is B. During a pause in her story, you calmly and clearly state, “I do not speak Spanish well. One moment and I will get an interpreter so that I can understand your concerns better”. The use of a trained non-relative translator facilitates communication and fosters relationship and understanding when there are language barriers between clinician and patient. By communicating clearly and calmly your intentions, the patient recognizes that you are not simply walking out of the room during her discourse, but rather, that you are attempting to improve communication through the use of someone who speaks her primary language fluently. Hold your hand up toward Rebecca in order to nonverbally stop the conversation and walk out of the room to get an interpreter is incorrect. The nonverbal gesture to stop the conversation may represent an offensive cultural mannerism. Additionally, leaving the room without explanation with someone who has limited English proficiency may leave the patient questioning the interview or the relationship with the provider. Attempt to translate her language as best as you can and fill in the rest through body language and pointing is incorrect. Attempting to translate when you are not fluent in a language will result in miscommunication which could lead to an erroneous diagnosis and understanding. Smile and nod throughout her story while attempting to ascertain as much information as possible. If more clarification is needed ask closed ended questions to obtain the information. Smiling and nodding throughout a discourse does enhance rapport. But misunderstanding can still develop as it is difficult to ascertain whether the closed ended questions are being understood in a situation in which there is limited English proficiency. Close the patient record and ask Rebecca to sit on the examination table so that you can obtain primarily objective data for diagnosis is incorrect. Eliminating the history portion of the diagnostic process will result in inadequate information in which to identify the correct diagnosis and does not enhance rapport with the patient.
Reference
Bickley, L. S. & Szilagyi, P.G. (2013). Bates’ guide to physical examination and history taking (11th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
2. During a comprehensive health history you discover that Anthony, a 21 year old college student, reports an alcohol history of binge drinking every Friday and Saturday evenings. He admits to drinking 7 to 8 beers and “some vodka shots” with his buddies during each encounter. He denies feeling like he needs to decrease his alcohol consumption or feeling guilty. He states that his girlfriend badgers him for drinking so much on weekends because it interferes with his ability to get up for work on Sundays. Anthony seems unconcerned and states that “If I’m too tired for work I just take a little drink in the morning and I’m good to go.” Which of the following statements is correct?
A. Anthony’s alcohol drinking history and attitudes suggest alcohol misuse. Further questions related to black outs, accidents, and job or interpersonal problems are warranted.
B. Anthony’s alcohol drinking history and attitudes are typical for college students and does not warrant further discussion.
C. Anthony’s alcohol drinking and attitudes suggest tolerance and interventional counseling should be initiated immediately.
D. Anthony’s alcohol drinking and attitudes have not resulted in physical harm to himself or others and therefore do not represent physical dependence.
E. Anthony’s alcohol drinking and attitudes suggest that he is a social drinker without risk of addiction.
Explanation: The answer is A: Anthony’s alcohol drinking history and attitudes suggest alcohol misuse. Further questions related to black outs, accidents, and job or interpersonal problems are warranted. Anthony’s reported alcohol use is greater than four drinks on one occasion which exceeds the level for safe drinking according to the National Institute of Alcohol Abuse and Alcoholism Safe Drinking Levels Without Contraindications to Alcohol Use. Additionally, he responds positively to two questions in the CAGE questionnaire. Any person responding positively to two answers or more should be asked about “blackouts…seizures, accidents or injuries while drinking, job problems, conflict in personal relationships.” (p. 89). Anthony’s alcohol drinking history and attitudes are typical for college students and does not warrant further discussion is incorrect. Although Anthony’s alcohol use may be representative of many college students his age, it does not negate the fact that he is misusing alcohol. Anthony’s alcohol drinking and attitudes suggest tolerance and interventional counseling should be initiated immediately is incorrect. Tolerance refers to the diminishing of one or more of the drug’s effects over time. Anthony does not report these effects. Anthony’s alcohol drinking and attitudes have not resulted in physical harm to himself or others and therefore do not represent physical dependence is incorrect. Physical dependence is present when reduction or cessation of alcohol intake occurs resulting in withdrawal symptoms. Anthony currently does not report any withdrawal symptoms of alcohol dependence. Physical harm to oneself or others represents an addiction rather than dependence. Anthony’s alcohol drinking and attitudes suggest that he is a social drinker without risk of addiction is incorrect. Social drinking for men is fewer than 14 drinks per week and fewer than 4 drinks at one occasion. Anthony clearly exceeds these levels with his 7-8 beers and shots of vodka.
Reference
Bickley, L. S. & Szilagyi, P.G. (2013). Bates’ guide to physical examination and history taking (11th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
