INTERNAL MEDICINE BOARDS - PART 1 ppt

[...]... Board of Internal Medicine 510 Walnut Street, Suite 17 00 Philadelphia, PA 19 10 6-3 699 21 5-4 4 6-3 500 or 80 0-4 4 1- 2 246 Fax: 21 5-4 4 6-3 633 www.abim.org Educational Commission for Foreign Medical Graduates (ECFMG) 3624 Market Street Philadelphia, PA 19 10 4-2 685 21 5-3 8 6-5 900 Fax: 21 5-3 8 6-9 19 6 www.ecfmg.org Federation of State Medical Boards (FSMB) P.O Box 619 850 Dallas, TX 7526 1- 9 850 81 7-8 6 8-4 000 Fax: 81 7-8 6 8-4 099... Dermatology 4% Obstetrics/Gynecology 3% Ophthalmology 2% Miscellaneous Total CROSS-CONTENT AREAS 3% 10 0% RELATIVE PROPORTIONS Critical Care Medicine 10 % Geriatric Medicine 10 % Prevention 6% Women’s Health 6% Clinical Epidemiology 3% Ethics 3% Nutrition 3% Palliative/End-of-Life Care 3% Adolescent Medicine 2% Occupational Medicine 2% Substance Abuse 2% Source: www.abim.org, 2007 Your score report will... C6,C7,C8,C9 C5b–C9 Membrane attack complex Cell lysis FIGURE 1. 1 The complement reaction sequence (Reproduced, with permission, from Brooks GF et al Jawetz, Melnick, & Adelberg’s Medical Microbiology, 24th ed New York: McGraw-Hill, 2004, Fig 8-9 .) ■ Deficiencies that lead to disease include the following: ■ CH50: Any C1–C9 ■ C1-INH: Hereditary angioedema ■ C1, C2, C4: Recurrent sinopulmonary infections (encapsulated... Neisserial infections Testing for B- and T-cell deficiency is as follows: ■ ■ ■ deficiency (C5–C9) in an otherwise healthy patient presenting with recurrent Neisseria meningitis Humoral (B-Cell) and Cellular (T-Cell) Deficiency Testing ■ Think of terminal complement CD19: For B-cell immunity IgG, IgM, IgA, IgD, IgE: For antibody CD3, CD4, CD8: For T-cell immunity CD16, CD56: For natural killer cell immunity... testing should use ᮍ (histamine) and ᮎ (saline) controls Skin-testing wheal-and-flare reactions are measured 15 –20 minutes after placement Laboratory Allergy Testing ■ ■ ■ ■ Radioallergosorbent (RAST) serologic testing is performed to confirm the presence of allergen-specific IgE antibody Results are comparable to skin testing for pollen- and food-specific IgE Recommended when the subject has anaphylactic... (symptoms > 2 days per week but < 1 time per day or > 2 nights per month; PEF ≥ 80%): ■ Low-dose inhaled corticosteroids are preferred ■ Other medications include leukotriene modifiers, theophylline, and cromolyn Moderate persistent asthma (daily symptoms or > 1 night per week and PEF 60–80%): ■ Low- to medium-dose inhaled corticosteroids and long-acting inhaled β2-agonists are preferred ■ Alternative... and cyanosis (late-stage disease) DIFFERENTIAL Asthma without ABPA, pneumonia (bacterial, viral, fungal, acid-fast bacilli), Churg-Strauss syndrome, eosinophilic pneumonias, CF 10 ■ ■ Essential criteria for ABPA-S (seropositive ABPA) are as follows: ■ The presence of asthma ■ ᮍ immediate skin tests to Aspergillus ■ Elevated total serum IgE (> 10 00 ng/mL) ■ Elevated serum Aspergillus-specific IgE and/or... xviii I NTRODUCTION TA B L E 2 First-Time Test Taker Performance YEAR NUMBER TAKING PERCENTAGE PASSED 2006 7006 91% 2005 70 51 91% 2004 7056 92% 2003 67 51 92% 2002 7074 87% Source: www.abim.org, 2007 T H E R E C E RT I F C AT I O N E X AM The recertification exam is given twice per year, typically in the spring (April or May) and in the fall (October) It is a one-day exam that consists of three modules... medications necessary Mild persistent > 2 days per week but < 1 time PEF ≥ 80% per day or > 2 nights per month Add low-dose inhaled corticosteroids Leukotriene modifiers, theophylline, and cromolyn may also be added Moderate Daily symptoms or > 1 night per persistent week PEF 60–80% ↑ to medium-dose inhaled corticosteroids and add a long-acting inhaled β2-agonist Leukotriene modifiers or theophylline may also... and mannose-binding lectin pathways (see Figure 1. 1) CH50 is a screening test for the classic complement pathway All nine elements of C1–C9 are required to produce a normal CH50 A normal CH50 does not exclude the possibility of low C3 or C4 Alternative pathway Microbial surfaces Immune complex ALLE RGY & I M M U NOLOGY MB lectin pathway Classic pathway Microbial surfaces MGL Activated C1 C4 C2 C3 . in- stead of “Osler’s nodes”). TESTING AND LICENSING AGENCIES American Board of Internal Medicine 510 Walnut Street, Suite 17 00 Philadelphia, PA 19 10 6-3 699 21 5-4 4 6-3 500 or 80 0-4 4 1- 2 246 Fax: 21 5-4 4 6-3 633 www.abim.org Educational. 80 0-4 4 1- 2 246 Fax: 21 5-4 4 6-3 633 www.abim.org Educational Commission for Foreign Medical Graduates (ECFMG) 3624 Market Street Philadelphia, PA 19 10 4-2 685 21 5-3 8 6-5 900 Fax: 21 5-3 8 6-9 19 6 www.ecfmg.org Federation. 19 10 4-2 685 21 5-3 8 6-5 900 Fax: 21 5-3 8 6-9 19 6 www.ecfmg.org Federation of State Medical Boards (FSMB) P.O. Box 619 850 Dallas, TX 7526 1- 9 850 81 7-8 6 8-4 000 Fax: 81 7-8 6 8-4 099 www.fsmb.org This page intentionally left blank ALLERGY