http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com ' ' OTHER E DUCATIONAL TOOLS BY CONRAD FISCHER, MD Books Master the Boards USMLE• Step CK Master the Boards USMLE• Step Master the Wards Internal Medicine Clerkship: Survive Clerkship & Ace the Shelf Internal Medicine Question Book Master the Boards USMLE• Medical Ethics Flashcards USMLE• Diagnostic Test Flashcards: The 200 Questions You Need to Know for the Exam for Steps & USMLE• Examination Flashcards: The 200 "Most Likely Diagnosis" Questions You Will See on the Exam for Steps2 & USMLE• Pharmacology and Treatment Flashcards: The 200 Questions You're Most Likely to See on Steps 1, & USMLE• Physical Findings Flashcards: The 200 Questions You're Most Likely to See on the Exam Online Dr Conrad Fischer's USMLE• Disease Deck Revised! (app) Dr Conrad Fischer's Comprehensive Cases Updated USMLE• Step Qbank :1 http://medsouls4you.blogspot.com �� ,·I ,I http://medsouls4you.blogspot.com MASTER TH E BOARDS I n tern al M ed i ci n e TH E H I G H EST-YI E LD REVI EW FO R TH E AB I M® EXAM �a'I·B1•13·li"·UI� I< A P L A N M E D I CA L http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com ABIM• is a registered trademark of the American Board of Internal Medicine, which neither sponsors nor endorses this product This publication is designed to provide accurate and authoritative information in regard to the subject matter covered It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service If legal advice or other expert assistance is required, the services of a competent professional should be sought © 2013, 201 by Conrad Fischer, MD The authors of the following sections have granted Conrad Fischer, MD, and Kaplan Publishing exclusive use of their work: Niket Sonpal, MD-Chapter 6: Gastroenterology Published by Kaplan Publishing, a division of Kaplan, Inc 395 Hudson Street, 4th Floor New York, NY 10014 All rights reserved The text of this publication, or any part thereof, may not be reproduced in any manner whatsoever without written permission from the publisher Printed in the United States of America 10 ISBN -13: 978-1-60978-880-3 Kaplan Publishing books are available at special quantity discounts to use for sales promotions, employee premiums, or educational purposes For more information or to purchase books, please call the Simon & Schuster special sales department at 866-506-1949 http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com DEDICAT I ON This book is dedicated to: Conrad Fischer, MD Conrad is an amazing educator with tremendous passion and commitment The author wishes to recognize himself for the months of backbreaking work it took to stay up night after night to create this book http://medsouls4you.blogspot.com v http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com ACK N OWLEDG M EN TS The author wishes to acknowledge dear Debbie C., who patiently waited for another book to be born Thank you for being so kind and warm Dr Sonpal would like to acknowledge and dedicate his chapter to his mom Thank you for supporting me in all my dreams http://medsouls4you.blogspot.com vii http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com ABOUT THE AUTHOR Conrad Fischer, MD, is director of educational development for the Department of Medicine at Jamaica Hospital Medical Center in New York City Jamaica Hospital is a robust window on the world of medicine Dr Fischer is also chairman of medicine for Kaplan Medical, teaching USMLE Steps 1, 2, and 3, Internal Medicine Board Review and Attending Recertification, and USMLE Step Physiology Dr Fischer is associate professor of physiology, pharmacology, and medicine at Touro College of Osteopathic Medicine in New York City Niket Sonpal, MD, author of the Gastroenterology chapter, is chief resident at Lenox Hill Hospital and assistant clinical professor at Touro College of Osteopathic Medicine in New York City He is also co-author of Master the Boards USMLE Step CK and a member of the faculty on Kaplan Medical's Step High-Yield course http://medsouls4you.blogspot.com ix � http://medsouls4you.blogspot.com M a ster t h e Board s : I ntern a l M e d i c i n e GGT or GGTP: gamma-glutamyl transpeptidase GH: growth hormone GI: gastrointestinal GN: glomerulonephritis GnRH: gonadotropin-releasing hormone HAP: hospital-acquired pneumonia HCG: human chorionic gonadotropin HD: Hodgkin disease or Huntington disease Her 2/neu: human epidermal growth factor receptor HFE: gene associated with hemochromatosis HIT: heparin-induced thrombocytopenia HIV: human immunodeficiency virus HOCM: hypertrophic obstructive cardiomyopathy HP: Helicobacter pylori HPF: high power field HPV: human papillomavirus HRCT: high-resolution CT HSIL: high-grade squamous intraepithelial lesion HSP: Henoch-Schonlein purpura HSV: herpes simplex virus IBD: inflammatory bowel disease IBS: irritable bowel syndrome IBS-A: irritable bowel syndrome, with alternating stool pattern IBS-C: irritable bowel syndrome, constipation-predominant IBS-D: irritable bowel syndrome, diarrhea-predominant IBS-PI: postinfectious irritable bowel syndrome ICU: intensive care unit IgA: immunoglobulin A IGF: insulinlike growth factor 444 http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com A p p e n d ix: A b b reviat i o n s a n d M n e m o n ics IgG: immunoglobulin G IgM: immunoglobulin M IGRA: interferon gamma release assays ILD: interstitial lung disease intramuscular IM: INR: international normalized ratio IRIS: immune reconstitution inflammatory syndrome idiopathic thrombocytopenic purpura ITP: IUD: intrauterine device IV: intravenous IVIG: intravenous immunoglobulins JVD: jugulovenous distension KOH: potassium hydroxide KS: Kaposi sarcoma KUB: kidney, ureter, bladder LA: left atrial LAP: leukocyte alkaline phosphatase LBD: Lewy body dementia LDH: lactate dehydrogenase low-density lipoprotein LDL: LES: lower esophageal sphincter LH: luteinizing hormone LMW: low molecular weight LOC: loss of consciousness LP: lumbar puncture LSIL: low-grade squamous intraepithelial lesion LTVV: low tidal volume ventilation LV: left ventricular LVESD: left ventricular end systolic diameter http://medsouls4you.blogspot.com 445 -i http://medsouls4you.blogspot.com Master the Boards: I nternal M edicine M (spike): monoclonal spike mycobacterium avium complex MAC: mycobacterium avium intracellular MAl: MALT: mucosa-associated lymphoid tissue MAOI: monoamine oxidase inhibitors MAT: multifocal atrial tachycardia MCA: middle cerebral artery MCD: minimal change disease mean corpuscular hemoglobin concentration MCHC: MCV: mean corpuscular volume MDI: metered dose inhaler MDS: myelodysplastic syndrome MENII: multiple endocrine neoplasia type II MGUS: monoclonal gammopathy of undetermined significance MHA-TP: Ml: myocardial infarction MIBG: metaiodobenzylguanidine MMA: methylmalonic acid mustargen, oncovin, procarbazine, prednisone MOPP: MPA: microscopic polyangiitis MRA: magnetic resonance angiography magnetic resonance imaging MRI: methicillin-resistant Staphylococcus aureus MRSA: MS: mitral stenosis or multiple sclerosis MUGA: MVP: NDI: NHL: multigated acquisition mitral valve prolapse NASH: 446 microhemagglutination assay-Treponema palladium test nonalcoholic steatohepatitis nephrogenic diabetes insipidus non-Hodgkin lymphoma http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com A p p e n d i x : A b b revi at i o n s a n d M n e m o n i cs NIPPY: noninvasive positive pressure ventilation NPH: neutral protamine hagedorn or normal pressure hydrocephalus NPO: nil per os (nothing by mouth) NSAIDs: nonsteroidal antiinflammatory drugs NSCLC: non-small cell lung cancer NSTEMI: non-ST segment elevation myocardial infarction O&P: ova and parasite OA: osteoarthritis 01: opportunistic infection OSA: obstructive sleep apnea PA: pulmonary artery PAD: peripheral arterial disease PAN: polyarteritis nodosa P-ANCA: perinuclear anti-neutrophil cytoplasmic antibodies PAS: periodic acid-Schiff PBC: primary biliary cirrhosis PCI: percutaneous coronary intervention PCOS: polycystic ovarian syndrome PCP: pneumocystis pneumonia PCR: polymerase chain reaction PCT: porphyria cutanea tarda PE: pulmonary embolus PEA: pulseless electrical activity PEEP: positive end-expiratory pressure PEFR: peak expiratory flow rate PET scan: positron emission tomography scan PFO: patent foramen ovale PFT: pulmonary function test(ing) PID: pelvic inflammatory disease http://medsouls4you.blogspot.com 447 i http://medsouls4you.blogspot.com M a ster t h e B o a rd s : I n tern a l M e d i c i n e PIP: proximal interphalangeal joint PMI: point of maximal impulse PML: progressive multifocal leukoencephalopathy PMR: polymyalgia rheumatica PMS: premenstrual syndrome PNH: paroxysmal nocturnal hemoglobinuria PPD: purified protein derivative PPI: proton pump inhibitors PR: progesterone receptor PSA: prostate-specific antigen PSGN: post-streptococcal glomerulonephritis PSP: progressive supranuclear palsy PT: prothrombin time PTH: parathyroid hormone PTU: propylthiouracil PUD: peptic ulcer disease P vera: polycythemia vera RA: rheumatoid arthritis or right atrium RAIU: radioactive iodine uptake RAST: radioallergosorbent RBC: red blood cell RDW: red cell distribution of width RF: rheumatoid factor RLS: restless leg syndrome RMSF: Rocky Mountain spotted fever RPGN: rapidly progressive glomerulonephritis RPR: rapid plasma reagin RTA: renal tubular acidosis RUQ: right upper quadrant 448 http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com A p p e n d ix: A b b reviat i o n s a n d M n e m o n i c s RV: right ventricular or residual volume SAAG: serum ascites albumin gradient SABA: short-acting beta agonists SAH: subarachnoid hemorrhage SBP: spontaneous bacterial peritonitis SC (disease): sickle-hemoglobin C disease SCC: squamous cell carcinoma SCD: subacute combined degeneration SCID: severe combined immunodeficiency SCLC: small cell lung cancer SERM: selective estrogen receptor modulator SI: sacroiliac SIADH: syndrome of inappropriate antidiuretic hormone SJS: Stevens-Johnson syndrome SLE: systemic lupus erythematosus SMA: smooth muscle antibodies SPEP: serum protein electrophoresis SRI: serotonin reuptake inhibitors SS (disease): sickle cell anemia SSRI: selective serotonin reuptake inhibitor SSSS: staphylococcal scalded skin syndrome SSTI: skin and soft tissue infections STD: sexually transmitted disease STEM!: ST segment elevation myocardial infarction SVT: supraventricular tachycardia TB: tuberculosis TEE: transesophageal echocardiography TEN: toxic epidermal necrolysis TIF: transoral incisionless fundoplication http://medsouls4you.blogspot.com 449 i http://medsouls4you.blogspot.com M a ster t h e B o a rd s : I n te r n a l M e d i c i n e TIPS: transjugular intrahepatic portosystemic shunt TLC: total lung capacity TMG: toxic multinodular goiter TMP-SMZ: trimethoprim-sulfamethoxazole TRALI: transfusion-related acute lung injury TRAP: tartrate resistant acid phosphatase TRH: thyrotropin releasing hormone TSH: thyroid-stimulating hormone TSP: tropical spastic paraparesis TSS: toxic shock syndrome TTE: transthroacic echocardiography TTP: thrombotic thrombocytopenic purpura UA: urinalysis UAG: urinary anion gap UC: ulcerative colitis USPSTF: United States Preventive Services Task Force V/Q scan: ventilation/perfusion scan VAD: vincristine, adriamycin, dexamethasone VAP: ventilator-associated pneumonia VATS: video-assisted thoracic surgery VBG: venous blood gas VC: vital capacity VDRL: Venereal Disease Research Laboratory VEGF: vascular endothelial growth factor V-fib: ventricular fibrillation VSD: ventricular septal defect VT: tidal volume V-tach: ventricular tachycardia VWD: von Willebrand disease 450 http://medsouls4you.blogspot.com http://medsouls4you.blogspot.com A p p e n d i x : A b b revi at i o n s a n d M n e m o n i c s VWF: von Willebrand factor VZIG: varicella zoster immune globulin VZV: varicella zoster virus WBC: white blood count WPW: Wolff-Parkinson-White syndrome ZES: Zollinger-Ellison syndrome M N EMONICS ABCDE: Asymmetric; Borders are uneven; Color changes; Diameter changes; Evolution CHADS2: Congestive failure (defined as an EF 75; Diabetes mellitus; Stroke (2 points) CHOP: Cyclophosphamide, Adriamycin, Vincristine (Oncovin), Prednisone CREST syndrome: Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia CURB65: Confusion; Urea (BUN above 20); Respiratory rate >30 per minute; Blood pressure (Systolic [...]... time you must pass the ABIM Maintenance of Certification Exam The exam is given twice per year, once in the spring and once in the fall REVIEW BEYOND THE ABIM Others besides those taking the Internal Medicine Certification Exam for the first time may find this book helpful While the material goes beyond that needed for the USMLE, knowledge for that exam is presented (and reflective of the types of questions... http://medsouls4you.blogspot.com GENERAL INTERNAL MEDICINE I NTRODUCTION General internal medicine, which includes all screening, i s one o f the most highly tested areas of the boards Although this chapter is brief, nearly every fact is eligible to be tested The American Board of Internal Medicine (ABIM) examination is meant to test the basic competence of the general internist As such, the level of oncology tested,... BOOK Master the Boards: Internal Medicine is not a textbook-it is a review book: a review of the information that you need to know for this exam The layout is primarily presented as an outline, mostly with the use of short phrases either in paragraph form or in bulleted or numbered lists Comparative material is presented in tables, and there are images that represent some of the issues discussed in the. .. will share with you, then, the solvent for painful efforts in the area of medicine • • • Everything you are learning here is useful to help people The "smartest" or most knowledgeable that most people ever are in medi cine is the day they walk into their boards This is, therefore, a high point or peak experience Don't waste it You can always rest later; you can't study for your boards later My suggestion... Answer: The correct answer is (e) This statement is correct The question is intel ligently put because it sidesteps the issue of whether you should be doing the test in favor of a statement that everyone can agree upon Another correct statement could have been: "If a man fully understanding the risks and benefits of PSA testing is requesting the test, then the test should be performed." nP Every boards. .. pattern of the most frequently asked questions on the exam: 1 What is the most likely diagnosis? 2 What is the best initial test? 3 What is the most accurate test? 4 Which of the following physical findings is most likely to be found in this patient? 5 What is the best initial therapy? In addition, we will show you the most likely results of EKGs, x-rays, and CT and MRI scans to be found on the test... for the American Board of Internal Medicine (ABIM) examination or for greater depth of study in internal medicine Initially, the volume of informa tion you must absorb will seem overwhelming All I can tell you for sure is: • • While the knowledge you must eventually acquire seems infinite, it isn't The amount you need for this standardized test is certainly finite The format this book follows is the. .. Subspecialties? Not to worry! Say you love pulmonary and hate hematology, or the other way around You actually can pass the ABIM examination by picking your favorite subjects and studying them really, really well Remember, on the ABIM exam, no one ever asks your ranking A "pass" is as good as the 99th percentile in the eyes of the world Therefore, for the less attentive person, it is better to I am sorry, what... On the other hand, the American Urological Association recommends screening with PSA and a digital rectal examination starting at the age of 40 You are not tested on the recommendations of private organizations with a strong financial interest in the outcome of a test The National Cancer Institute permissively recommends screening PSA starting at the age of 50 "Permissively" means they acknowledge the. .. long time The good news is: There are many, many things you will study just for boards that you will later diagnose and recognize simply because you learned them for a test FAIRNESS Is the test fair? ABSOLUTELY! No one designing the ABIM exam is trying to fool you or make you fail There is a rigorous intellectual honesty to the test Your efforts are not lost If you fol low the blueprint for the exam, ... written permission from the publisher Printed in the United States of America 10 ISBN -1 3: 97 8-1 -6 097 8-8 8 0-3 Kaplan Publishing books are available at special quantity discounts to use for sales... co-author of Master the Boards USMLE Step CK and a member of the faculty on Kaplan Medical's Step High-Yield course http:/ /medsouls4you.blogspot.com ix http:/ /medsouls4you.blogspot.com http:/ /medsouls4you.blogspot.com. .. chest x- ray i n h eavy s mokers e PSA http:/ /medsouls4you.blogspot.com http:/ /medsouls4you.blogspot.com M a ster t h e B o a rd s : I nte r n a l M e d i c i n e j �� -Answer: 1- � The