MED 403 — Investigation of Disease I

• Order laboratory and imaging investigations rationally, using knowledge of test purpose, indications, sensitivity, specificity, reference intervals and interfering factors. not yet covered
• Collect, label, store and transport specimens correctly and safely, including venipuncture and urine collection. not yet covered
• Describe how specimens are processed in the laboratory and the methods used to test them in chemical pathology, microbiology and anatomic pathology. not yet covered
• Interpret laboratory results, including units of measurement and unit conversion, and correlate them with the patient's signs and symptoms. not yet covered
• Explain the principles of quality assurance and laboratory safety. not yet covered
• Explain the role, uses and limitations of cytopathology, histopathology and autopsy, and request them appropriately. not yet covered
• Describe the principles, indications, contraindications and radiation risks of the main imaging modalities, and apply imaging judiciously in a resource-limited setting. not yet covered

Chemical Pathology

• Rational ordering of tests not yet covered
• Sample collection not yet covered
• Processing of samples in the laboratory and the methodology involved in testing them not yet covered
• Interpretation of results not yet covered
• Quality assurance not yet covered

The role of the laboratory in the diagnosis of disease

• Describe the use of laboratory tests in clinical practice (diagnosis, screening, monitoring and prognosis). 17 questions
• Define the sensitivity, specificity, reliability (precision) and accuracy of a laboratory test. 26 questions
• Explain the meaning of the reference interval of a test. 9 questions
• Describe how biological variability affects laboratory results. 19 questions
• Explain the principles of anticoagulation in blood collection tubes. 19 questions
• Define pre-analytical, analytical and post-analytical variables. 25 questions
• Explain patient factors that alter test results. 20 questions
• Calculate sensitivity, specificity and predictive values from a 2x2 table. 22 questions

Collection, transport and storage of samples for chemical analysis

• Describe and perform proper patient identification procedures. 9 questions
• Select and use the proper equipment for venipuncture. 22 questions
• Apply the proper labelling procedure and complete request forms. 13 questions
• Identify preferred venous access sites. 12 questions
• Describe the care of the patient after venipuncture. 15 questions
• Apply safety and infection control procedures. 19 questions
• Identify quality assurance issues in sample collection. 23 questions
• List effects of exercise, posture and tourniquet application on values. 10 questions
• Describe random, timed and midstream urine collection. 15 questions
• Describe urine specimen preservatives. 10 questions
• Perform and interpret urinalysis. 15 questions
• Describe steps for safe transport and storage. 17 questions

Units of measurement

• Describe the different ways of expressing the concentration of compounds in blood and other body fluids (conventional metric units, SI units, international units, degree of dilution) and use them to interpret analytical reports. 21 questions
• Describe the International System of Units (SI). 14 questions
• Describe the decimal multiples and submultiples of SI units. 14 questions
• Describe the applications of SI units in laboratory medicine. 14 questions
• Apply unit conversion rules (e.g. glucose: mg/dL ÷ 18 = mmol/L; creatinine: mg/dL × 88.4=µmol/L). 17 questions

Quality assurance

• Explain the concepts and principles of quality assurance, and its importance in monitoring and improving laboratory performance. 12 questions
• Define and explain the terminology of quality assurance (e.g. quality control, accuracy, precision, bias, systematic and random error). 16 questions
• Outline the components of quality assurance. 6 questions
• Explain how to control pre-analytical, analytical and post-analytical variables. 22 questions
• Explain the general operation of a statistical quality control system and how control rules respond to systematic and random error (e.g. Levey–Jennings charts and Westgard rules). 19 questions
• Explain the use of patient data and internal quality control, and of external quality control through proficiency testing programmes. 23 questions

Medical Microbiology

• Describe the role of the clinical microbiologist in the diagnosis and management of infectious diseases. not yet covered
• Describe the safety precautions to be taken in handling all specimens and pathogens. not yet covered
• Explain the principles of rational requesting of microbiological investigations. not yet covered
• Interpret the results of microbiological tests. 3 questions

Safety and behaviour in the laboratory; the clinical microbiologist

• Describe the role of the clinical microbiologist. 7 questions
• Describe safety precautions in handling specimens. 22 questions
• Explain principles of rational requesting. 27 questions

Urine collection and processing

• Describe the requesting, collection, processing and examination of urine specimens. 27 questions
• Perform and interpret urine microscopy, and interpret urine culture results, including significant bacteriuria. 19 questions

Examination of stool specimens

• Describe the requesting, collection, processing and examination of stool specimens. 15 questions
• Perform stool microscopy and identify parasites in stool samples. 20 questions

Processing of body fluids, especially CSF and ascitic fluid

• Describe the requesting, collection, processing and examination of cerebrospinal fluid and ascitic fluid. 23 questions
• Interpret CSF microscopy and culture results in suspected meningitis, together with CSF glucose and protein. 13 questions

Blood cultures

• Describe blood culture techniques for aerobic and anaerobic organisms, including indications, timing, number of sets, volume and aseptic collection. 19 questions
• Interpret blood culture results, including distinguishing contaminants from true pathogens 12 questions

Other specimens and laboratory methods

• Describe the requesting, collection, processing and examination of sputum, and the processing of swabs for microbiological investigation. 31 questions
• Describe the culture of aerobic and anaerobic bacteria and fungi, and perform basic culture techniques. 28 questions
• Describe the basic principles of identifying bacteria and fungi, and perform presumptive 22 questions
• identification tests. 22 questions
• Outline how antibiotic susceptibility tests are performed and interpreted. 14 questions
• Describe the identification of parasites in various samples (e.g. blood films for malaria parasites, 18 questions
• stool, urine). 29 questions
• Describe the isolation and identification of the most common viruses in Ghana. 12 questions
• Describe the serological techniques used to diagnose infectious diseases, and perform selected serological tests. 20 questions
• Describe the use of molecular biological techniques (e.g. PCR) in the microbiology laboratory. 14 questions
• Interpret the results of microbiological tests. 3 questions

Histopathology

• Define cytopathology, and explain its diagnostic value and its principles. not yet covered
• Explain the role of histopathological diagnosis in the management of diseases. not yet covered
• Explain when and how to request an autopsy. 4 questions

Role of cytopathology in the diagnosis of diseases

• Define cytopathology and explain its diagnostic value. 11 questions
• List types of cytopathological specimens. 10 questions
• Outline advantages and disadvantages of cytology. 8 questions
• Explain importance of cytology as a screening tool. 19 questions
• Describe uses of gynaecological and non-gynaecological cytology. 18 questions
• Outline limitations of cytology. 9 questions
• Outline the limitations of cytology, and explain the importance of clinical details and of cooperation between clinicians and pathologists. 11 questions

Histopathology in the diagnosis and management of diseases

• Explain the role of histopathological diagnosis in the management of diseases, including its diagnostic, prognostic and follow-up functions. 13 questions
• Identify when to employ histopathological methods in the management of diseases. 16 questions
• Explain the limitations of routine histopathology in the diagnosis and prognostication of disease. 12 questions
• Outline the procedures involved in processing and reporting histopathological material (fixation, grossing, processing, sectioning, staining, reporting). 9 questions
• Describe how to obtain and present specimens for histopathological analysis. 12 questions
• Describe how to store, preserve and transport specimens for histopathological analysis. 16 questions
• Explain the value of histopathological diagnosis in the management of specific diseases and tumours. 11 questions
• Explain the importance of teamwork in the use of histopathological services, and the role of the anatomic pathologist in patient management. 13 questions

Autopsy pathology

• Explain when and how to request an autopsy. 4 questions
• Explain when not to request an autopsy. 5 questions
• Identify the authority through which autopsies can be performed (medico-legal authority versus consent of the next of kin for a hospital autopsy). 7 questions
• Describe the benefits of an autopsy. 12 questions
• Describe how to perform a basic autopsy. 21 questions

Medical Imaging

• Explain the diagnostic value of imaging in clinical medicine. not yet covered
• Describe the nature of ionising radiation and the units of radiation and dose. not yet covered
• Describe the principles, uses and limitations of various imaging modalities. not yet covered
• Explain the judicious application of imaging methods. not yet covered

The diagnostic value of imaging and requesting investigations

• Explain the diagnostic value of imaging. 12 questions
• Outline advancement of medical imaging technology. 18 questions
• Fill out radiological request forms correctly. 11 questions
• Decide correctly when to request which investigation. 7 questions
• Name basic imaging modalities. 14 questions
• Recognise normal and abnormal findings. 15 questions

Radiation: nature, units, dose and hazards

• Describe the nature of ionising radiation and the units of radiation and dose (e.g. gray and sievert). 12 questions
• Describe radiation hazards and the principles of radiation protection. 11 questions
• Describe background radiation, and compare medical exposures with it. 11 questions

Radiation-based imaging methods

• Describe the principles, uses and limitations of plain radiography and fluoroscopy, including conventional radiography. 20 questions
• Describe contrast radiography and fluoroscopy, and the contrast examinations listed in the background notes. 29 questions
• Describe digital radiography and PACS (Picture Archiving and Communication Systems), and explain how teleradiology has moved from an adjunct to an essential element of medical practice. 11 questions
• Describe mammography and digital mammography. 17 questions
• Describe computed tomography (CT). 23 questions
• Describe conventional angiography. 16 questions
• Describe radioisotope imaging, including SPECT (single photon emission computed tomography) and PET (positron emission tomography) whole body imaging, which are normally done by the nuclear medicine specialist or radiotherapist. 16 questions

Non-radiation-based imaging methods

• Describe the principles, uses and limitations of ultrasound scanning and Doppler. 17 questions
• Describe the principles, uses, limitations and contraindications of magnetic resonance imaging 15 questions
• (MRI). 16 questions

Judicious application of imaging methods

• Explain the judicious application of imaging methods, recognising that unnecessary investigations increase waiting times, waste limited resources, lower standards and may add unnecessarily to patient irradiation. 17 questions
• Compare conventional radiography with computed tomography: summation of images onto one image versus information at various slice levels; resolution; and radiation dose (conventional radiography gives a much lower dose and can image any part of the body, especially the bony skeleton). 12 questions
• Explain why CT serves as the reference standard among visualising methods but at a significantly higher radiation dose, and state the approximate equivalents: one head CT ≈ 120 chest X-rays; one chest CT ≈ 400; one abdominal CT ≈ 500. 9 questions

Interventional radiological procedures

• Describe the interventional radiological procedures: biopsy, drainage procedures, vascular therapies, hepatobiliary interventions, genitourinary interventions and interventional neuroradiology 14 questions
• Explain the advantages and risks of image-guided intervention compared with open surgery. 10 questions