Advanced Technique - How to Select an Investigation

MCQs, KFPs and AKTs (especially KFPs) both tend to run investigation questions as EMQs –long lists of multiple investigations all of which look appealing.

The academic theory behind this is that it is meant to mimic real life and the huge array of investigations on offer.

So, how on earth does one make heads or tails of long rambling lists of investigations?

The key lies in the question wording.

Consider these two questions:

• What investigations would you next arrange to confirm the most likely diagnosis?
• What initial investigations would you arrange?

What’s the difference?

Let’s take a closer look.

• What investigations would you next arrange to confirm the most likely diagnosis?
• What initial investigations would you arrange?

They might look the same, but they are asking very different things. One is asking you to confirm a diagnosis, whereas the other is asking for an initial set of investigations.

Let’s use a very basic example.

James Jacks, presents with new onset heartburn, abdominal pain and three episodes of dark stools. He has no past medical history of note, he smokes 20 cigarettes per day, and he works as an accountant.

An initial investigation here might be to do a FBC and ferritin.

A confirmation investigation might be to do a gastroscopy.

See the difference?

Initial investigations tend to be more generic, because often it is clinically appropriate to start slow before going straight to a more intrusive or expensive test.

Confirmation investigations do just that – they confirm your diagnosis. More often than not initial investigations can’t do this.

Our PassGP Examiners will give you a thorough grounding in all things investigations – as ever, we've got you.