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What do I do if I fail the Infectious Disease board exam?
The first thing you should do is just take it easy, sleep on it. Give yourself a few days, a week or two to come to terms with what has happened. Your next exam is six months to a year away. Dr. Jack has more advice in this video, What Do You Do If You Fail Your Medical Board Exam?
Infectious Disease Certification Exam Scoring
Overall performance is reported on a standardized score scale ranging from 200 to 800, with a mean of 500. To pass the Critical Care board examination, your standardized score must equal or exceed the standardized passing score. Your performance on the entire exam determines your pass-fail decision.
The passing standard for the Infectious Disease exam is set by ABIM committee using standard-setting techniques that follow best practices in assessment. Because the passing standard is based on a specified level of mastery of Infectious Disease content, no predetermined percentage of examinees will pass or fail the exam.
Infectious Disease Certification Exam Format
The Infectious Disease Certification Exam (CERT) board exam is composed of up to 240 single-best-answer multiple-choice questions. Most questions describe patient scenarios and ask about the tasks performed by physicians in the course of practice. (Note that around 40 of these are new questions that do not count in your score.)
Example of a single-best-answer multiple-choice question format:
A 35-year-old man presents to the emergency department with fever, severe eye pain, discharge, and reduced vision. He had gone on a hike a 2 days ago and was hit in the left eye with a tree branch. He feels like there is something in his eye. On ophthalmological examination, his left eyelids are swollen with a thick yellow purulent discharge, along with conjunctival chemosis and corneal edema. Gram stain and culture of the aqueous humor and foreign body extracted from the eye reveals gram-positive organisms with intracellular clear oval structures located centrally. Which of the following organism is most likely responsible for his condition?
◯ A. Staphylococcus aureus
◯ B. Staphylococcus epidermidis
◯ C. Pseudomonas aeroginosa
◯ D. Bacillus cereus
◯ E. Clostridium botulinum
D. Bacillus cereus
This patient is suffering from bacterial endophthalmitis due to infection with B cereus. B cereus is a large gram-positive rod found in nature. It produces endospores which may be seen in some gram stains as clear areas located centrally within the organism. The infection can occur from therapeutic injections, intraocular surgery, ocular trauma, or secondary to hematogenous spread. Most cases of B cereus endophthalmitis occur due to ocular trauma, particularly by foreign objects that are contaminated with organic matter such as soil, making it the second most frequent cause of post-traumatic bacterial endophthalmitis. It progresses rapidly and aggressively and can cause permanent visual impairment within hours of symptom onset, with most patients having poor visual outcomes.
Although S aureus and S epidermidis are common pathogens implicated in post-surgical and post-injection endophthalmitis, this patient’s gram stain reveals a spore-forming bacteria.
Endophthalmitis due to Pseudomonas aeroginosa usually occurs due to eye trauma with contaminated contact lenses; it is a gram-negative rod and is unlikely to be the cause of this patient’s condition.
Clostridium botulinum is an endospore-forming, gram-positive rod that causes botulism, a form of neuromuscular paralysis when the spores or toxin are ingested or wounds infected with the bacteria.
Mandell GL, Bennett JE, Blaser MJ. Mendell, Douglas and Bennetts Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier, Saunders; 2015: 2413. Durand ML. Bacterial and Fungal Endophthalmitis. Clin Microbiol Rev. 2017;30(3):597–613. doi:10.1128/CMR.00113-16 Hong M, Wang Q, Tang Z, et al. Association of Genotyping of Bacillus cereus with Clinical Features of Post-Traumatic Endophthalmitis. PLoS One. 2016;11(2):e0147878. Published 2016 Feb 17. doi:10.1371/journal.pone.0147878