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Study Guide American Board of Medical Microbiology The American Board of Medica

Study Guide American Board of Medical Microbiology The American Board of Medical Microbiology ©2004 American Society for Microbiology 2 Study Guide EXAMINATION FORMAT A. Objective To measure the candidate’s knowledge in the five subject areas considered necessary for the effective practice of clinical or public health microbiology: 1. Bacteriology, including mycobacteriology. 2. Mycology. 3. Virology. 4. Parasitology. 5. Miscellaneous, including microbial genetics, laboratory safety and biohazard management, laboratory operation and management, cost accounting, preparation of dilutions or media, infection control, and serology. B. Examination Administration 1. The examination will be administered the Saturday preceeding the American Society for Microbiology General Meeting. 2. Proctors will supervise the examination. Candidates are allowed 6 hours in which to complete the examination, beginning at 9:00 a.m. and concluding at 4:00 p.m. This time frame allows for a 1-hour supervised break. The time allotted is considered to be much greater than that required for answering the questions, but the Board does not wish time constraints to be a factor in performance. 3. Bring several #2 lead pencils and a legal document with your photograph and signature to the examination. Acceptable legal documents are a driver’s license, government identification card, passport, or notarized photograph bearing your signature. 4. Reference materials and calculators are not permitted. C. Examination Content The content of the examination will be distributed as follows: Subject area % Examination Bacteriology 40–50 Mycology 15–20 Parasitology 10–15 Virology 15–20 Universal 5–10 D. Question Format and Content 1. Each question is multiple choice, with only one correct answer. 2. Questions have four or five possible responses. 3. In some cases, questions may require calculations. Examples include assessment of sensitivity, specificity, antimicrobial concentrations, dilution factors, and cost accounting results. 4. Approximately 60% of the questions test for basic recall of knowledge, direct interpretation of data, or simple synthesis of information. The remaining 40% of the questions require a higher level of thought process, reasoning skills, or interpretation of data. 5. Questions are updated and evaluated every year. Candidates can expect to see questions on technical advances or microbiological issues that occurred during the past year. 6. There is no penalty for guessing; only correct answers are graded. 7. Questions in the content areas of bacteriology, mycology, parasitology, and virology cover six areas: (a) diagnostic systems and interpretation of laboratory data, (b) public health, (c) infection control, (d) molecular biology, (e) infectious disease and pathogenesis, and (f) universal. 3 Suggested study topics are listed below; however, test questions may not be limited to these topics. a. Diagnostic Systems and Interpretation of Laboratory Data i. Sensitivity, specificity, and predictive value of positive and negative test results. Know the formulas for these characteristics of diagnostic assays and how to interpret them on the basis of actual data. ii. The principles and details of performance of commonly used and newly accepted assay systems, including antigen detection, direct fluorescent- antibody stains, enzyme-linked immunosorbent assays (ELISAs), nucleic acid hybridization and amplification, and cultures. Be able to determine which methods are superior in specific circumstances. iii. Proper and appropriate specimen collection and transport, tailored for specific disease processes. iv. Automated blood culture systems, identification systems, and antimicrobial susceptibility test systems—how they work and the kinds of technical problems associated with their use. b. Public Health i. How to handle an outbreak of any communicable disease, including the appropriate specimens to collect and to whom they should be sent. ii. Recommended immunizations, when to give them, and populations for which each vaccine is efficacious. iii. Serologic tests useful for epidemiological versus diagnostic studies (fungal serologies, for example). iv. Centers for Disease Control and Prevention (CDC)- mandated reportable diseases and reportable isolates, including case definitions. c. Infection Control i. Proper protocols for handling infected employees, patients with communicable diseases, and laboratory exposures to infectious agents. ii. Standard, contact, and airborne precautions, as well as other types of isolation as they pertain to specific infectious disease situations. iii. Infection control measures to practice in the case of exotic or new hemorrhagic fevers or other communicable diseases that were previously limited to geographically isolated areas. iv. Serologic tests recommended for employees, immunocompromised patients, and other groups at risk for acquiring infections. v. Biohazard classifications, waste disposal, and laminar flow hood use. vi. Other issues of laboratory and hospital biological safety. d. Molecular Biology i. The principles and performance of polymerase chain reaction (PCR) and other nucleic acid amplification procedures, DNA homology studies, DNA probe tests, and new molecular methods (such as restriction fragment length polymorphism and ribotyping) and their use in diagnosis and epidemiology. ii. The principles and performance of plasmid analysis and other molecular epidemiological methods. iii. Basic concepts, use of different markers, and technical performance information on the probe- based commercial products used in diagnostic microbiology. iv. The molecular basis for the common mechanisms of antimicrobial resistance. 4 e. Infectious Disease/Pathogenesis i. Modes of actions of antibiotics, toxicities, and mechanisms of resistance. ii. Suitability of antibiotics for specific infectious processes (for example, those that penetrate the cerebrospinal fluid [CSF] and might be useful for treatment of meningitis, those used for treatment of common diseases, and those used as antivirals and antifungals). iii. Disease processes and pathogenesis and diagnostic strategies for infectious diseases based on signs and symptoms. iv. Specimens appropriate for the diagnosis of infectious disease, based on the disease process. v. General patterns of susceptibilities for microorganisms with predictable patterns. vi. Antimicrobial susceptibility testing and interpretations, quality control practices, and NCCLS guidelines. vii. Serologic responses to common infections for which serology is the main diagnostic tool, such as hepatitis, Epstein-Barr virus (EBV), syphilis, human immunodeficiency virus (HIV) disease, brucellosis, toxoplasmosis, parvovirus, and other viral infections. viii. Life cycles of parasites as they pertain to diagnostic testing and infectious stages. ix. Staining characteristics of pathogenic microbes. f. Universal i. Shipping and mailing etiologic agents. ii. Decision-making strategies for choosing a test method. iii. Personnel and legal issues associated with directing a laboratory. iv. General aspects of laboratory safety (for example, working with radioactive compounds, earthquake- proofing equipment, and electrical precautions). v. Quality control and quality assurance activities. vi. Federal regulations governing laboratories, including the Clinical Laboratory Improvement Amendments (CLIA), the U.S. Occupational Safety and Health Administration (OSHA), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). E. Recent examinees identified the following activities as most beneficial for examination preparation: 1. Studying from established references and clinical microbiology texts, such as the American Academy of Pediatrics Red Book, Control of Communicable Diseases Manual, Biosafety in Microbiological and Biomedical Laboratories, Principles and Practice of Infectious Diseases, and ASM’s Manual of Clinical Microbiology. (Full references are listed following this section.) 2. Reviewing recent issues of Morbidity and Mortality Monthly Report (MMWR) and Clinical Microbiology Newsletter, American Society for Clinical Pathology (ASCP) Check Sample exercises, NCCLS guidelines, and review articles. 3. Discussing examination-type problems and being quizzed by mentors. 4. Working in those areas of the laboratory where the candidate may be less familiar. 5. Attending infectious disease rounds. F. Scoring 1. The examination answer sheets are scored electronically. Scores within five (5) points of the passing score are verified by hand. 2. The ABMM uses a criterion-referenced scoring system. This method sets a standard of performance in absolute, not relative, terms. As a result, candidates are not graded on a 5 curve and do not compete against each other. Each question is rated individually by its relative difficulty and scored according to a standard of performance predetermined by a consensus of the examination committee. Thus, if more difficult questions are chosen for a particular examination, the passing score will be lower than that of another examination of equal length but with easier questions, as determined by the committee. Each candidate’s score is based only on the number of correct answers; there is no comparison among candidates. 3. After the examination has been scored, the examination committee evaluates the responses. Occasionally, questions fail to perform as expected and are dropped from the scoring and the examinations are rescored. 4. Examination results are mailed to candidates within 10 to 12 weeks. Results are not released by telephone. References Chin, J. (ed.). 2000. Control of communicable diseases manual, 17th ed. American Public Health Association, Washington, D.C. Mandell, G. L., J. E. Bennett, and R. Dolin (ed.). 2000. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, 5th ed. Churchill Livingstone. Murray, P. R., E. J. Baron, M. A. Pfaller, F. C. Tenover, and R. H. Yolken (ed.). 2003. Manual of clinical microbiology, 8th ed. ASM Press, Washington, D.C. Pickering, Larry K. (ed.). 2003. Red book: report of the Committee on Infectious Diseases, 26th ed. American Academy of Pediatrics, Elk Grove, Ill. Richmond, J. Y., and R. W. McKinney (ed.). 1999. Biosafety in microbiological and biomedical laboratories, 4th ed. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Institutes of Health. U.S. Government Printing Office, Washington, D.C. SAMPLE QUESTIONS 1. In cases of possible sexual abuse involving children, the identification of oxidase-positive, gram-negative diplococci such uploads/Sante/ manual-guide.pdf