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It is usually hereditary Serum calcium levels are frequently increased.B+" +Technical Item FlawsSevere obesity in early adolescence: usually responds dramatically to dietary regimens often is related to endocrine disorders Has a 75% chance of clearing spontaneously Shows a poor prognosis Usually responds to pharmacotherapy and intensive psychotherapyD&((" &-#/Use of Imprecise Terms in Examination Questions00(SPatients with pseudogout have pain: A. frequently B. usually C. often D. commonly(T!%/Technical Item FlawsSecondary gain is synonymous with malingering a frequent problem in obsessive-compulsive disorder a complication of a variety of illnesses and tends to prolong many of them never seen in organic brain damage:((" $Technical Item FlawsPeer review committees in HMOs may move to take action against a physician s credentials to care for participants of the HMO. There is an associated requirement to assure that the physician receives due process in the course of these activities. Due process must include which of the following? notice, an impartial forum, council, a chance to hear and confront evidence against him/her proper notice, a tribunal empowered to make the decision, a chance to confront witnesses against him/her, and a chance to present evidence in defense reasonable and timely notice, impartial panel empowered to make a decision, a chance to hear evidence against himself/herself and to confront witnesses, and the ability to present evidence in defenseF'((" &Technical Item FlawsA 58-year-old man with a history of heavy alcohol use and previous psychiatric hospitalization is confused and agitated. He speaks of experiencing the world as unreal. This symptom is called depersonalization derealization focal memory deficit signal anxietyF(D(" D,"An 8-year-old boy needs to be coaxed to go to school, and often, while there, he complains of severe headaches or stomach pain. Sometimes his mother has to take him home because of his symptoms. 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Begin vignettes with presenting problem and its history, followed by related history and physical findings, results of tests, initial treatment---in same order.B8>6 @`H  0޽h ? ̙33y___PPT10Y+D=' G = @B +a0 (  x  c $(Y0P  RB  s *DԔ    <dqPBBxph___PPT9JB n3. The stem of the item must pose a clear question, and it should be possible to arrive at an answer with the items covered up. All distracters (e.g., incorrect options) should be homogeneous; in most cases, this means that they should fall into the same category as the correct answer (e.g., all diagnostic tests, treatments, diagnoses, etc.) Avoid using  double options (e.g., do W and X; do Y because Z) unless the correct answer and all distractors are double options. Avoid vague terms (usually, often, frequently) and absolutes (always, never and all)zA=G=V   @`H  0޽h ? ̙33y___PPT10Y+D=' G = @B +K0 rj(    0H0TLD___PPT9& A 32-year-old man has a 4-day history of progressive weakness in his extremities. He was healthy except for an upper respiratory tract infection 10 days ago. His temperature is 37.8 C (100 F), blood pressure is 130/80 mm Hg, pulse is 94/min and respirations are 42/min and shallow. He has symmetric weakness of both sides of the face and the proximal and distal muscles of the extremities. Sensation is intact. No deep tendon reflexes can be elicited; the plantar responses are flexor. Which of the following is the most likely diagnosis? Acute disseminated encephalomyelitis Guillain-Barre syndrome Myasthenia gravis Poliomyelitis Polymyositis2j j @`  < UGood Type-A Question for Step 2 ,RB  s *DԔH  0޽h ? y___PPT10Y+D=' = @B +b0  (  r  S 000  r  S d    0` `XP___PPT92* [A 60-year-old man is brought to the emergency department by the police, who found him lying unconscious on the side walk. After ascertaining that the airway is open, the first step in management should be intravenous administration of: Examination of cerebrospinal fluid Glucose with vitamin B1 (thiamine) CT scan of the head Phenytoin Diazepam >mm @`RB  s *DԔH  0޽h ? ̙33y___PPT10Y+D=' = @B +o0 0&(  r  S t  RB  s *DԔ$  0ȶ 0 Absolute terms: terms such as  always or  never are used in optionsF7  c KS0e0e `@   "p`H  0޽h ? y___PPT10Y+D=' = @B +0 @LD(  Lx L c $    L c $PP   "p`PpRB L s *DԔ L 0D @ < H L 0޽h ? y___PPT10Y+D=' = @B +0 PHH(  H H c 0e0e    H 0U @ :Frequency terms: options are vague (e.g., rarely, usually)*;)RB H s *DԔ H c 0e0e P`p  "p`PpH H 0޽h ? y___PPT10Y+D=' = @B + 0 `(  x  c $   x  c $\   RB  s *DԔPPH  0޽h ? y___PPT10Y+D=' = @B +0 P(  PX P 0A?H P 0޽h ? y___PPT10Y+D=' = @B +Y0 xp(  r  S pP0   RB  s *DԔ    0(G  P ^Long correct answer: correct answer is long, more specific or more complete than other options4_I  c p G 0e0e ` P G  "p`H  0޽h ? y___PPT10Y+D=' = @B +0 ?7\(  \x \ c $G p G  RB \ s *DԔ`` \ 0G   g'Options are long, complicated or double$(' \ c G 0e0e ` G  "p`H \ 0޽h ? y___PPT10Y+D=' = @B +A0 h`(  r  S +G  G  RB  s *DԔ  0S  PWord Repeats: a word or phrase is included in the stem and in the correct answer*Q C  c 1G 0e0e Pp  G  "p`H  0޽h ? y___PPT10Y+D=' = @B +0 |o(  |x | c $;G @0  G   | c $DG   G  "p`Pp | BGG `Pp@ UGood Type-A Question for Step 2 ,RB | s *DԔp0pH | 0޽h ? y___PPT10Y+D=' = @B +0  v(     c UG 0e0e  G    0XG   dConvergence Strategy: the correct answer includes the most elements in common with the other options.eO  c ,bG 0e0e 0P G  "p`RB  s *DԔppH  0޽h ? y___PPT10Y+D=' = @B +0 6.((  ( ( c kG 0e0e  G  RB ( s *DԔ ( 0xmG  ` d(Numeric data are not stated consistently )( ( S qG P 0 G  "p`PpH ( 0޽h ? y___PPT10Y+D=' = @B +0 ho(  hx h c $}G P G   h c $G  G  "p`Pp h B8G p UGood Type-A Question for Step 1 ,RB h s *DԔppH h 0޽h ? y___PPT10Y+D=' = @B +10 XP0(  0 0 S pG ` G  "p`Pp 0 c ؛G 0e0e 00@ G  RB 0 s *DԔ@@ 0 0,S @ JLanguage in the options is not parallel; options are in an illogical order KJH 0 0޽h ? y___PPT10Y+D=' = @B +0 Xo(  Xx X c $0G  G   X c $ G   G  "p`Pp X BS` @@ UGood Type-A Question for Step 1 ,RB X s *DԔ@@H X 0޽h ? y___PPT10Y+D=' = @B +70 ^V4(  4 4 S G p  G  "p`Pp 4 c G 0e0e p G   4 0G  P P None of the above is used as an option )(RB 4 s *DԔH 4 0޽h ? y___PPT10Y+D=' = @B +v0  8-(  8 8 c (LG 0e0e pP G  RB 8 s *DԔ 8 0lS @p e-Stems are tricky or unnecessarily complicated.. 8 c G 0e0e 0 S "H 8 0޽h ? y___PPT10Y+D=' = @B +0 tF(  tx t c $G ` G   t c $S  G  "p`PpH t 0޽h ? y___PPT10Y+D=' = @B +60 0v(    0G P@z0 EOther NBME Issues,7  <TG    Data and Laboratory Results Interpretation Figures X-rays, MRI, CT, Ultrasound, Pathology, etc. Multimedia (Physical Exam, Heart Sounds, etc.) RB  s *DԔH  0޽h ? 0  L(  Lr L S tU U  L S S U "p`PpRB L s *DԔ@@H L 0޽h ? y___PPT10Y+D=' = @B +r0@Pbpk 2 @ AI pSSRVQYP\_# BB'@I*cl,P%{ZÉ20EOgV(y41Oh+'0x' `h  Technical Item FlawsOffice of the PresidentLUHS86Microsoft PowerPoint@p /~@`k~@йjKYSG`&g  '=  y-w--$--x--$--y--$--z--$--{--$--|--$ --}--$ --~--$ ----$  ----$----$----$----$----$----$----$----$----$----$----$----$----$----$----$----$----$----$ ----$ !! ----$!""!!----$"##""----$#$$##----$$%%$$----$%&&%%----$&''&&----$'((''----$())((----$)**))----$*++**----$+,,++----$,--,,----$-..------$.//..----$/00//----$01100----$12211----$23322----$34433----$45544----$56655----$67766----$78877----$89988----$9::99----$:;;::----$;<<;;----$<==<<----$=>>==----$>??>>----$?@@??----$@AA@@----$ABBAA----$BCCBB----$CDDCC----$DEEDD----$EFFEE----$FGGFF----$GHHGG----$HIIHH----$IJJII----$JKKJJ----$KLLKK----$LMMLL----$MNNMM----$NOONN----$OPPOO----$PQQPP----$QRRQQ----$RSSRR----$STTSS----$TUUTT----$UWWUU----$WXXWW----$XYYXX----$YZZYY----$Z[[ZZ----$[\\[[----$\^^\\----$^``^^----$`aa``----$abbaa----$bddbb----$dffdd----$fhhff----$hkkhh----$kmmkk----$mqqmm----$quuqq----$uxxuu---'@Times New Roman-. =2 $Leischner Institute Scholars Program."System9-@Times New Roman-. 2 Question.-@Times New Roman-.  2 B-.-@Times New Roman-. 2 EWriting Session .---%$$--'@Times New Roman-. +2 ;John M. Lee, M.D., Ph.D. .-@Times New Roman-. +2 GProfessor of Pathology, .-@Times New Roman-. 32 R Pharmacology and Neuroscience.-@Times New Roman-. 2 e3January 16, 2008.-՜.+,0\   $ , On-screen Show$Loyola University Medical CenterT! &Times New RomanArialMonotype Sorts WingdingsDefault Design>Leischner Institute Scholars Program Question-Writing SessionUSMLE 1 Step OrganizationSystemProcessOrganization of FHBOrganization of MHDSlide 7Slide 8Slide 9 Slide 10/General Rules for Developing A-Type Questions /General Rules for Developing A-Type Questions Slide 13Technical Item FlawsTechnical Item Flaws0Use of Imprecise Terms in Examination QuestionsTechnical Item Flaws0Use of Imprecise Terms in Examination Questions Slide 19Technical Item FlawsTechnical Item FlawsTechnical Item FlawsAn 8-year-old boy needs to be coaxed to go to school, and often, while there, he complains of severe headaches or stomach pain. Sometimes his mother has to take him home because of his symptoms. At night, he tries to sleep with his parents. When they insist he sleep in his own room, he says there are monsters in his closet. These findings are most consistent with which of the following diagnoses?Technical Item FlawsTechnical Item FlawsGenes on the bacterial chromosome have the following linkages in conjugal transfer: x and y, 25% of the time; y and z, 50% of the time. If the gene order is x-y-z, approximately what percentage of the time will x and z be transferred together?Technical Item FlawsThe first-born infant of an Rh-negative 26-yr-old woman who had two previous second trimester abortions has severe hemolysis and circulatory failure. This condition could have been prevented by treating the mother with which of the following?Technical Item FlawsTechnical Item FlawsDrug Y has a volume of distribution (Vd) of 75 L in both younger and older adult men. In younger adults, it has a clearance rate of 15 L/h, 50% of which is via the liver and 50% via the kidneys. For younger men, the maintenance regimen is 100 mg every 6 hours. Which of the following regimens will produce essentially the same steady-state concentration in an older man, whose creatinine clearance is reduced to half that of younger men, but whose hepatic function in unimpaired? Slide 32*The Basic Rules for One-Best-Answer Items  Fonts UsedDesign Template Slide Titles!_9LUHSLUHS  !"#$%&'()*+,-./0123456789:;=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)PicturesvCurrent UserSummaryInformation('PowerPoint Document(<]DocumentSummaryInformation8