Practice creating well-focused questions

Example 1

A 52 year old man came to me for a routine preventive health exam. I heard a 2/6 holosystolic murmur best heard at the right sternal border. He has no previous history of a murmur so I ordered an echocardiogram. A week later I got the report that the test showed trivial mitral regurgitation and mild tricuspid regurgitation. What should I do?

Examine the online consultation question above. Which of the following components of a well-focused question does it contain?

a finding only
an outcome only
both a finding and an outcome
neither a finding or an outcome

Example 2

A patient has sent me a Newsweek article about the use of ultrafast (electron beam) CT for evaluation of CAD at early stages. In the article it is touted as being much more reliable at predicting risk than the cholesterol test. Is there any information about this new technology?

Examine the online consultation question above. Which of the following components of a well-focused question does it contain?

a finding only
an outcome only
both a finding and an outcome
neither a finding or an outcome

Example 3

I have a 68 year old woman with diastolic dysfunction. She had been complaining of DOE for the past year. She had trace edema but clear lungs, and no gallop. Due to the concern about CHF an echo was obtained and this showed a high EF consistent with diastolic function. No evidence of valvular heart disease or hypokenisis. I placed the pt on verapamil starting at 120 mg a day and have titrated this up to 240 mg. So far there has been little change.

Which of the following questions regarding this case is the most well-focused?

What drug would you suggest?
Would an increase of the verpamil or addition of a beta blocker help with her symptoms?

Example 4

I have a 50 year old patient with CAD, s/p stenting of circumflex artery 2 years ago, asymptomatic since then, newly diagnosed with DM. Only medications now are metformin and ASA. Pt has had erectile dysfunction for some time and is very interested in trying Viagra.

Which of the following questions regarding this case is the most well-focused?
Given that this patient has no chest pain with exercise, what is the risk that use of Viagra will provoke myocardial ischemia?
Would this be safe?

Example 5

Which of the following emails contains the most well focused question?
A 52 year old man came to me for a routine preventive health exam. I heard a 2/6 holosystolic murmur best heard at the right sternal border. He has no previous history of a murmur so I ordered an echocardiogram. A week later I got the report that the test shows trivial mitral regurgitation and mild tricuspid regurgitation. Does trivial mitral regurgitation and mild tricuspid regurgitation on echo represent significant valvular heart disease?
A patient has sent me a Newsweek article about the use of ultrafast (electron beam) CT for evaluation of CAD at early stages. In the article it is touted as being much more reliable at predicting risk than the cholesterol test. Do you have any information about this new technology?

 

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