Omani women were found to exhibit highly atypical symptoms of menopause. Increased severity of symptoms was found to be related to age, advanced stage of menopause, and lower educational level.

IntroductionResistance to thyroid hormone is a rare syndrome, where although the level of thyroid hormone is elevated, the level of thyroid stimulating hormone is not suppressed. The patient in our case report is, to the best of our knowledge, the first with this syndrome identified in Oman.Case presentationIn one Omani family, a 15-year-old girl of Arabian origin was pre-diagnosed with resistance to thyroid hormone. Blood sample was collected and deoxyribonucleic acid was isolated for molecular genetic testing. The results revealed a rare mutation A268G in the gene for thyroid hormone receptor beta. We believe that this mutation is the cause of the pathology in our patient.ConclusionWe report the presence of a rare mutation in the thyroid hormone receptor beta gene for the first time in the Omani population. Due to the rates of consanguinity being high among the Omani population, we are aiming to screen our patient’s family members and provide genetic counseling.

Background Properly constructed multiple-choice questions (MCQs) in high stakes examinations are expected to have high validity and reliability scores. However, several reports show that teacher-generated high stakes examinations do not always achieve the required high level of quality if item constructors are not trained in item writing, or if they are not proficient in the principles of assessment. AimThis evaluation aimed to assess the validity, reliability and quality of a 150 item multiple choice question test in the Membership of the Royal College of General Practitioners International Examination in Oman. Design of the studyComputer-based test-item analysis according to a set of pre-validated quality criteria. Participants and settingTwenty doctors who underwent Family Medicine Residency Programme of the Oman Medical Speciality Board, or its equivalent, and were eligible to sit the test. Method The test-item analysis included item difficulty, item discrimination level and quality of distractors. Results Across 150 A-type items, 69% were of applied format. Kuder-Richardson 20 was 0.81. The mean test score was 86.3% and standard error of measurement was ± 5.0. The mean difficulty index of the 150 items was 43%. Of all items, 50.7 % were at the level of moderate or better discrimination. Only 20% of items had more than two distractors functioning according to a quality criterion. Conclusion Distractor performance was found to be less than optimal and, if the time spent on test-item construction can be made more effective, that would be of great practical significance to teaching faculty. Despite the limitations of the study by low numbers of examinees, which impacts upon its validity, it is still the belief of the authors, that the analysis and suggestions made are useful as a guide to item writers, providing some answers as to how to improve the overall quality of MCQs in the future. To further improve this study it is now the intention to collect data from a larger number of subsequent examinations to increase the validity of the item analysis. NOTES ON CONTRIBUTORSThord Theodorsson, MRCGP[INT], Senior Consultant,