Standardized Exam

Review
Format and structure of test items
• Items = Questions
• Purposes of testing:
 To communicate to students material that is important
 To identify areas of deficiency, in need of remediation, or further learning
 To motivate students to read on their own and to fill individual gaps.
 To determine final grades or make promotion decisions
 To identify areas where instruction can be improved
Content sampling
How to evaluate: Exam content should align with course objectives
• Important topics should be weighted more heavily
• Content determines the number and topic areas of the questions
• It is impractical to cover all testing topics in equal lengths.
The Comprehensive Basic Science Examination content outline includes:
15%–20%
Biochemistry and molecular biology
Biology of cells
Human development and genetics
Biology of tissue response to disease
Pharmacodynamic and pharmacokinetic processes
Microbial biology
Normal age-related findings and care of the well patient
Immune System
1%–5% Blood & Lymphoreticular System
5%–10% Behavioral Health
1%–5% Nervous System & Special Senses
5%–10% Skin & Subcutaneous Tissue
1%–5% Musculoskeletal System
5%–10% Cardiovascular System
5%–10% Respiratory System
5%–10% Gastrointestinal System
5%–10% Renal & Urinary System
5%–10% Pregnancy, Childbirth, & the Puerperium
1%–5% Female Reproductive System & Breast
1%–5% Male Reproductive System
1%–5% Endocrine System
5%–10% Multisystem Processes & Disorders
5%–10% Biostatistics, Epidemiology/Population Health, & Interpretation of the Medical Lit.
5%–10% Social Sciences, Including Communication, Medical Ethics, and Death & Dying
Content sampling
• Purpose of exams: to evaluate skills
• Evaluate decisions, judgments, or conclusions that extend beyond the particular set of
items into a larger domain.
 (They evaluate a much broader knowledge)
Content sampling
• The testing time should reflect the relative importance of the topic
• The more content, the more time needed.
• Tests must be generalizable.
 (e.g., a test of general medical practice with only cardiovascular-related questions), the test
results will be biased and won’t be generalizable.

• If the test is too short, the scores may not be precise.

Basic sciences
• Clinical knowledge and knowledge of foundational science principles.
• Acquired during preclinical studies.
• How to identify when a question is about basic sciences?
 Depends on the lead-in
Basic sciences
Examples of lead-ins that require basic science knowledge:

• Which of the following is the most likely cause/mechanism of this effect?

• Which of the following is the most likely causal infectious agent?
• This patient most likely has a defect in which of the following?
• This patient most likely has a deficiency in which of the following enzymes?
• Which of the following cytokines is the most likely cause of this condition?
• Which of the following structures is at greatest risk for damage during this procedure?
• The most appropriate medication for this patient will have which of the following mechanisms of action?
Multiple-Choice item formats
• Multiple-choice items can be divided into two families:

 Those that require test-takers to indicate all responses that are appropriate (true-
false).

 Those that require test-takers to indicate a single, most accurate response (one-
best-answer).
 True-false item example
Which of the following are X-linked recessive conditions?

1. Cystic fibrosis

2. Duchenne muscular dystrophy

3. Hemophilia A (classic hemophilia)

4. Tay-Sachs disease
 True-false item example
Which of the following are X-linked recessive conditions? Stem

1. Cystic fibrosis

2. Duchenne muscular dystrophy

3. Hemophilia A (classic hemophilia)

4. Tay-Sachs disease

This is an acceptable true-false item from a structural perspective.

 True-false item example
Which of the following are X-linked recessive conditions? Stem

1. Cystic fibrosis

2. Duchenne muscular dystrophy

3. Hemophilia A (classic hemophilia)

4. Tay-Sachs disease

This is an acceptable true-false item from a structural perspective.

Note that the stem is clear and the options are absolutely true or false with no ambiguity.
 True-false item general rules
Test-takers are required to select all the options that are “true,”

True-false items must satisfy the following rules:

• Item and option text must be clear and unambiguous.
• The lead-in should be closed and focused.
• Options must be absolutely true or false; no shades of gray are permissible.
• Options should be homogenous so that they can be judged as entirely true or entirely false.
Multiple-Choice item formats
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over
the past 2 years. She has not yet started dialysis. Examination shows no abnormalities.
Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular
volume is 94 μm3. A blood smear shows normochromic, normocytic cells. Which of the
following is the most likely cause?
A. Acute blood loss
B. Chronic lymphocytic leukemia
C. Erythrocyte enzyme deficiency
D. Erythropoietin deficiency
E. Microangiopathic hemolysis
F. Polycythemia vera
G. Sideroblastic anemia
H. β-Thalassemia trait
Multiple-Choice item formats
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over
the past 2 years. She has not yet started dialysis. Examination shows no abnormalities.
Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular
volume is 94 μm3. A blood smear shows normochromic, normocytic cells. Which of the
following is the most likely cause?
A. Acute blood loss
B. Chronic lymphocytic leukemia
C. Erythrocyte enzyme deficiency
D. Erythropoietin deficiency
E. Microangiopathic hemolysis
F. Polycythemia vera
G. Sideroblastic anemia
H. β-Thalassemia trait
The one-best-answer family
Stem:

A 32-year-old man has a 4-day history of progressive weakness in his extremities. He has been
healthy except for an upper respiratory tract infection 10 days ago. His temperature is 37.8°C
(100.0°F), pulse is 94/min, respirations are 42/min and shallow, and blood pressure is 130/80 mm Hg.
He has symmetric weakness of both sides of the face and the proximal and distal muscles of the
extremities. Sensation is intact. No deep tendon reflexes can be elicited. Babinski sign is present.

Lead-in:

Which of the following is the most likely diagnosis?

A. Acute disseminated encephalomyelitis

B. Guillain-Barré syndrome

C. Myasthenia gravis

D. Poliomyelitis

E. Polymyositis
The one-best-answer family
Stem:

A 32-year-old man has a 4-day history of progressive weakness in his extremities. He has been
healthy except for an upper respiratory tract infection 10 days ago. His temperature is 37.8°C
(100.0°F), pulse is 94/min, respirations are 42/min and shallow, and blood pressure is 130/80 mm Hg.
He has symmetric weakness of both sides of the face and the proximal and distal muscles of the
extremities. Sensation is intact. No deep tendon reflexes can be elicited. Babinski sign is present.

Lead-in:

Which of the following is the most likely diagnosis?

A. Acute disseminated encephalomyelitis

B. Guillain-Barré syndrome

C. Myasthenia gravis

D. Poliomyelitis

E. Polymyositis
Stem:

A 32-year-old man has a 4-day history of progressive weakness in his extremities. He has been healthy
except for an upper respiratory tract infection 10 days ago. His temperature is 37.8°C (100.0°F), pulse is
94/min, respirations are 42/min and shallow, and blood pressure is 130/80 mm Hg. He has symmetric
weakness of both sides of the face and the proximal and distal muscles of the extremities. Sensation is
intact. No deep tendon reflexes can be elicited. Babinski sign is present.

Lead-in:

Which of the following is the most likely diagnosis?

A. Acute disseminated encephalomyelitis

B. Guillain-Barré syndrome

C. Myasthenia gravis

D. Poliomyelitis

E. Polymyositis
One-best-answer items general rules
Test-takers are required to select the single best answer

One-best-answer items must satisfy the following rules:

• Item and option text must be clear and unambiguous.
• The lead-in should be closed and focused, and ideally worded in such a way that the test-
taker can cover the options and guess what the correct answer is. This is known as the
“cover-the-options” rule.
• All options should be homogeneous so that they can be judged as entirely true or entirely
false on a single dimension.
• Incorrect options can be partially or wholly incorrect.
in·fer·ence
/ˈinf(ə)rəns/

    
noun
1.a conclusion reached on the basis of evidence and reasoning.
The “cover-the-options” rule
• If a lead-in is properly focused, a test-taker should be able to read the stem and
lead-in, cover the options, and know what the right answer is without seeing
the available options.
 The “cover-the-options” rule
• A test-taker should be able to read the stem and lead-in, cover the options, and guess what the right answer is
without seeing the available options.

A 58-year-old man comes to the office because of pain in the right knee for the past 3 days. He has a history of
type 2 diabetes mellitus, hypertension, and hyperlipidemia controlled with an oral hypoglycemic drug and an ACE
inhibitor. There is no family history of similar disorders. On physical examination, the knee is swollen, passive
motion produces pain, and ballottement discloses an effusion. Synovial fluid is cloudy and contains positive
birefringent crystals and no bacteria. X-ray shows chondrocalcinosis.

Which of the following is the most appropriate pharmacotherapy?

(A) Allopurinol

(B) Betamethasone

(C) Ibuprofen

(D) Infliximab

(E) Levofloxacin
 The “cover-the-options” rule
• A test-taker should be able to read the stem and lead-in, cover the options, and guess what the right answer is
without seeing the available options.

A 58-year-old man comes to the office because of pain in the right knee for the past 3 days. He has a history of
type 2 diabetes mellitus, hypertension, and hyperlipidemia controlled with an oral hypoglycemic drug and an ACE
inhibitor. There is no family history of similar disorders. On physical examination, the knee is swollen, passive
motion produces pain, and ballottement discloses an effusion. Synovial fluid is cloudy and contains positive
birefringent crystals and no bacteria. X-ray shows chondrocalcinosis.

Which of the following is the most appropriate pharmacotherapy?

(A) Allopurinol

(B) Betamethasone

(C) Ibuprofen

(D) Infliximab

(E) Levofloxacin