Tips: Exam questions based on short case descriptions

The goal here is to influence study strategies to involve more in-depth learning by use of short case descriptions. As a beneficial side-effect, systematically constructed case descriptions can be used to function as the basis for a large and useful material of examination questions.


If students know that a course ends with a written exam and questions that can be studied by heart, less effort is put into deep learning. If the course instead ends with an examination that requires deeper knowledge, the students need to use other strategies for learning.

The examples presented here are taken from the nursing program, where one learning goal is to be able apply basic knowledge (about e. g. reproductive organs, gynecology and obstetrics) in meetings with very diverse patients. This means that the student needs to be able to adapt the information depending on which patient they meet.


During the course, the students are allowed to work with patient cases similar to those used in the examination. Students are thus forced to relate their reading of textbooks and other material to different patient cases. During the examination, they need to apply their konowledge (from the course material) to the particular patient they have “in front of them”, and adapt how to present information related to e. g. reproductive organs, gynecology and obstetrics.

Concrete steps

Below are some examples of how questions can be designed to be used in seminars during the course, as well as in the examination:

“You are a nurse at the local health center and meet 13-year-old Anna who comes to you because of low abdominal pain. She has just got her first period. Explain to Anna what happens during menstruation. Also explain the same thing to a trainee nursing student but in a little different words and deeper. (Adapt the information to the person you are informing).”

“You are a nurse in the emergency room and meet Amanda, 23, who complaints about experiencing nausea and fatigue. She is single and has had to take sick leave from work as a waitress due to the nausea. The pregnancy test is positive and she had her last period 5 weeks ago. Explain to Amanda what this means. Also explain to Amanda what happens during a conception because she asks about it!”

“You are a nurse at the urologist and meet a patient to be operated on for a prostate cancer. He wonders what the prostate is for and where it sits. Explain the anatomy and physiology of the male reproductive organs.”

“You are a nurse at a local health center and meet Anna,16, who wants to get tested for chlamydia for the fifth time. The youth clinic is closed and therefore she has turned to the local health center. Explain to Anna why it is important to protect yourself during sexual intercourse and what symptoms and complications a chlamydia infection can cause.”

“You are a nurse in the emergency room and meet Sofia, 25, who is pregnant in week 26. She complaines about headaches, fatigue and swollen lower legs. Sofia herself is worried that it could be preeclampsia and wonders if this may be dangerous. Explain to Sofia what preeclampsia is, how she will be examined and how it can be treated.”

The case descriptions can be made quite concise and still vary within a wide range. The changes can be made systematically (vary the patient, vary the issue). This means that in recurring exams, the cases can be changed quite easily with minimal work effort, but still be relatively equivalent. This makes plagiarism more difficult and has the effect that the answers are also relatively concise.


Students are influenced to change their study strategy in the direction of more in-depth learning.

Biggs, J & Tang, C. (2011). Teaching for Quality Learning at University. Maidenhead: Open University Press. Chapter 10.

Written by

Lisa Hällsten (University lecturer Nursing)
Tomas Jansson (UPE, Project management)