(BQ) Part 1 book “Board basics - An enhancement to MKSAP® 18” has contents: Cardiovascular medicine, endocrinology and metabolism, dermatology, general internal medicine, gastroenterology and hepatology.
Board Basics ® An Enhancement to MKSAP® 18 Essential Facts and Strategies for Passing WKH,QWHUQDO0HGLFLQH&HUWLƓFDWLRQDQG 0DLQWHQDQFHRI&HUWLƓFDWLRQ([DPLQDWLRQV Board Basics ® An Enhancement to MKSAP® 18 Your Last Stop before the Boards For the fifth consecutive edition of MKSAP, we bring you Board Basics, the only publication that compiles the essential facts and strategies for passing the Internal Medicine Certification and Maintenance of Certification (MOC) exams into one print book and e-book We are confident that this volume will continue to meet your needs How to Use Board Basics The goal of Board Basics is to prepare you for the Boards after you have completed a systematic review of MKSAP 18 and its more than 1200 multiple-choice questions We have combed through the MKSAP 18 content to produce a concise compilation of only the information that you will most likely see in the exam The sections of Board Basics are organized to mirror those of MKSAP, making it easy for you to locate information within the 11 MKSAP subspecialty sections to further your learning on specific topics as you need Board Basics is not a concise guide to patient care but, rather, an exam preparation tool to help you quickly recognize the most likely answers on a multiple-choice exam Drug dosages are not included since they are rarely, if ever, tested You will also see many sections in which information has been omitted because it is difficult to test or is otherwise unlikely to appear on the exam Broad differential diagnoses are not provided for most problems Instead, Board Basics focuses on the entities that have the highest probability of appearing on the exam as the “correct answers.” Critical points that appear on the exam are often presented here in isolation, stripped of context that is not relevant to answering a multiple-choice question If you review these points shortly before your exam, you will have the best chance of remembering what you need to know to well Knowing that most Board questions are prefaced with the words “most likely,” we have tried to be very directive, skipping important steps in the patient evaluation When you see the words “select” or “choose,” think in terms of selecting or choosing a particular answer, not an intervention in the practice of ii medicine Remember that Board Basics is not a patient care resource Content Organization Abbreviations, spelled out in a convenient list at the back of the book, are used frequently to increase reading efficiency Content is organized by topic and in consistent categories, such as Prevention, Screening, Diagnosis, Treatment, and Follow-up Special components have been designed to enhance learning and recall Look for: · Don’t Be Tricked: Incorrect answers that may masquerade as correct choices · Test Yourself: Abbreviated case histories and answers found in Board exam questions · Study Tables: Key concepts to prepare you for specific types of questions · Yellow highlighting: We applied our own “marker” to call your attention to important phrases Benefits of This Text For this edition of Board Basics, MKSAP 18 authors reviewed the latest literature and produced 11 concise text sections and 1200 Board-like multiple-choice questions Next, the content was turned over to 13 carefully selected program directors, instructors, and professors of medicine with expertise in Board preparation and the subspecialties of internal medicine These physicians culled the essential points from MKSAP 18 and added their insights to update the content of Board Basics As Editor-in-Chief, I reviewed and distilled the MKSAP 18 text by eliminating overlap and excessive material to focus the text as sharply as possible The end product is what you have in your hands—the best Board prep tool that you will find anywhere We hope you enjoy it and benefit from your study Best wishes on your exam Virginia U Collier, MD, MACP, FRCP Editor-in-Chief Board Basics Board Basics Editor-in-Chief Virginia U Collier, MD, MACP, FRCP2 Chair Emeritus, Department of Medicine Christiana Care Health System Newark, Delaware Honorary Professor of Medicine Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, Pennsylvania Contributors Victoria E Burke, MD1 Assistant Professor of Clinical Medicine Infectious Diseases Fellowship Associate Program Louisiana State University Health Sciences Center New Orleans, Louisiana Aaron J Calderon, MD, FACP2 Chair, Department of Medicine Program Director, Internal Medicine Residency Saint Joseph Hospital Professor of Clinical Medicine University of Colorado SOM Denver, Colorado FACP1 Ana M Cilursu, MD, Staff Rheumatologist Shore Physicians Group Shore Medical Center Somers Point, New Jersey Mark Corriere, MD, FACP2 Clinical Endocrinologist Maryland Endocrine Assistant Professor of Medicine Johns Hopkins School of Medicine Baltimore, Maryland Anthony A Donato, MD, MHPE, FACP1 Associate Program Director, Internal Medicine Professor of Medicine Sidney Kimmel Medical College at Thomas Jefferson University Tower Health Medical Group Philadelphia, Pennsylvania Richard S Eisenstaedt, MD, MACP1 Clinical Professor of Medicine Thomas Jefferson University Chair, Department of Medicine Abington Memorial Hospital Abington, Pennsylvania Nasrollah Ghahramani, MD, MS, FACP1 Professor of Medicine and Public Health Sciences Vice Chair for Educational Affairs Interim Chief, Division of Nephrology Penn State College of Medicine Hershey, Pennsylvania Robert G Kaniecki, MD1 Director, UPMC Headache Center Chief, Headache Division Assistant Director, Neurology Residency Training Program Director, Headache Fellowship Program Assistant Professor of Neurology University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Gregory A Masters, MD, FACP1 Principal Investigator, National Cancer Institute Community Oncology Research Program Helen F Graham Cancer Center and Research Institute Associate Professor of Medicine Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, Pennsylvania Brian S Porter, MD2 Cardiologist Core Physicians Exeter, New Hampshire Benjamin T Suratt, MD1 Professor of Medicine and Cell and Molecular Biology Vice Chair of Medicine for Academic Affairs Associate Chief, Pulmonary and Critical Care Medicine University of Vermont College of Medicine Burlington, Vermont Jennifer M Weiss, MD, MS1 Assistant Professor of Medicine Division of Gastroenterology and Hepatology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison, Wisconsin Jennifer Wright, MD, FACP1 Assistant Professor of Medicine Division of General Internal Medicine University of Washington School of Medicine Seattle, Washington iii Consultants Marta Kokoszynska, MD1 Instructor, Pulmonary and Critical Care Medicine University of Vermont Larner College of Medicine Burlington, Vermont Dhaval Shah, MD, MBBS1 Hematology/Oncology Physician Helen F Graham Cancer Center Newark, Delaware Board Basics ACP Editorial Staff Linnea Donnarumma1, Staff Editor Margaret Wells1, Director, Self-Assessment and Educational Programs1 Becky Krumm1, Managing Editor, Self-Assessment and Educational Programs1 ACP Principal Staff FACP2 Davoren Chick, MD, Senior Vice President, Medical Education Patrick C Alguire, MD, FACP2 Senior Vice President Emeritus, Medical Education MKSAP 18 Editor-in-Chief Sean McKinney1 Vice President, Medical Education Margaret Wells1 Director, Self-Assessment and Educational Programs Becky Krumm1 Managing Editor Valerie Dangovetsky1 Administrator Ellen McDonald, PhD1 Senior Staff Editor Megan Zborowski1 Senior Staff Editor Jackie Twomey1 Senior Staff Editor Randy Hendrickson1 Production Administrator/Editor Julia Nawrocki1 Digital Content Associate/Editor iv Linnea Donnarumma1 Staff Editor Chuck Emig1 Staff Editor Joysa Winter1 Staff Editor Kimberly Kerns1 Administrative Coordinator Has no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients Has disclosed relationship(s) with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients Disclosure of Relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients Patrick C Alguire, MD, FACP Royalties UpToDate Aaron J Calderon, MD, FACP Speakers Bureau MedStudy Stock Options/Holdings Pfizer Inc., Merck, Abbott Davoren Chick, MD, FACP Royalties Wolters Kluwer Publishing Consultantship EBSCO Health’s DynaMed Plus Other: Owner and sole proprietor of Coding 101 LLC; research consultant (spouse) for Vedanta Biosciences Inc Virginia U Collier, MD, MACP, FRCP Stock Options/Holdings Celgene, Pfizer Inc., Merck, Abbott, Johnson & Johnson, Medtronic plc, Amgen, Roche, Sanofi, Novartis, AbbVie Inc., Stryker, WellPoint Health Networks Mark Corriere, MC, USN, FACP Speakers Bureau Eli Lilly and Co., Sanofi, AstraZeneca Brian Porter, MD Other: Medtronic plc: educational support received to attend two-day course on pacemaker interrogations, programming, and implantation Acknowledgments The American College of Physicians (ACP) gratefully acknowledges the special contributions to the development and production of the 18th edition of the Medical Knowledge Self-Assessment Program® (MKSAP® 18) made by the following people: Graphic Design: Barry Moshinski (Director, Graphic Services), Michael Ripca (Graphics Technical Administrator), and Jennifer Gropper (Graphic Designer) Production/Systems: Dan Hoffmann (Director, Information Technology), Scott Hurd (Manager, Content Systems), Neil Kohl (Senior Architect), and Chris Patterson (Senior Architect) MKSAP 18 Digital: Under the direction of Steven Spadt (Senior Vice President, Technology), the digital version of MKSAP 18 was developed within the ACP’s Digital Products and Services Department, led by Brian Sweigard (Director, Digital Products and Services) Other members of the team included Dan Barron (Senior Web Application Developer/ Architect), Chris Forrest (Senior Software Developer/Design Lead), Kathleen Hoover (Senior Web Developer), Kara Regis (Manager, User Interface Design and Development), Brad Lord (Senior Web Application Developer), and John McKnight (Senior Web Developer) The College also wishes to acknowledge that many other persons, too numerous to mention, have contributed to the production of this program Without their dedicated efforts, this program would not have been possible MKSAP Resource Site (mksap.acponline.org) The MKSAP Resource Site (mksap.acponline.org) is a continually updated site that provides links to MKSAP 18 online answer sheets for print subscribers; access to MKSAP 18 Digital; Board Basics® e-book access instructions; information on Continuing Medical Education (CME), Maintenance of Certification (MOC), and international Continuing Professional Development (CPD) and MOC; errata; and other new information Disclosure Policy It is the policy of the American College of Physicians (ACP) to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities To this end, and consistent with the policies of the ACP and the Accreditation Council for Continuing Medical Education (ACCME), contributors to all ACP continuing medical education activities are required to disclose all relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients Contributors are required to use generic names in the discussion of therapeutic options and are required to identify any unapproved, off-label, or investigative use of commercial products or devices Where a trade name is used, all available trade names for the same product type are also included If trade-name products manufactured by companies with whom contributors have relationships are discussed, contributors are asked to provide evidence-based citations in support of the discussion The information is reviewed by the committee responsible for producing this text If necessary, adjustments to topics or contributors’ roles in content development are made to balance the discussion Further, all readers of this text are asked to evaluate the content for evidence of commercial bias and send any relevant comments to mksap_editors@acponline.org so that future decisions about content and contributors can be made in light of this information Resolution of Conflicts To resolve all conflicts of interest and influences of vested interests, ACP’s content planners used best evidence and updated clinical care guidelines in developing content, when such evidence and guidelines were available All content underwent review by peer reviewers not on the committee to ensure that the material was balanced and unbiased Contributors’ disclosure information can be found with the list of contributors’ names and those of ACP principal staff listed in the beginning of this book Educational Disclaimer The editors and publisher of MKSAP 18 recognize that the development of new material offers many opportunities for error Despite our best efforts, some errors may persist in print Drug dosage schedules are, we believe, accurate and in accordance with current standards Readers are advised, however, to ensure that the recommended dosages in MKSAP 18 concur with the information provided in the product information material This is especially important in cases of new, infrequently used, or highly toxic drugs Application of the information in MKSAP 18 remains the professional responsibility of the practitioner The primary purpose of MKSAP 18 is educational Information presented, as well as publications, technologies, products, and/or services discussed, is intended to inform subscribers about the knowledge, techniques, and experiences of the contributors A diversity of professional opinion exists, and the views of the contributors are their own and not those of the ACP Inclusion of any material in the program does not constitute endorsement or recommendation by the ACP The ACP does not warrant the safety, v reliability, accuracy, completeness, or usefulness of and disclaims any and all liability for damages and claims that may result from the use of information, publications, technologies, products, and/or services discussed in this program Publisher’s Information Copyright © 2018 American College of Physicians All rights reserved This publication is protected by copyright No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic or mechanical, including photocopy, without the express consent of the ACP Unauthorized Use of This Book Is Against the Law Unauthorized reproduction of this publication is unlawful The ACP prohibits reproduction of this publication or any of its parts in any form either for individual use or for distribution vi The ACP will consider granting an individual permission to reproduce only limited portions of this publication for his or her own exclusive use Send requests in writing to MKSAP® Permissions, American College of Physicians, 190 N Independence Mall West, Philadelphia, PA 19106-1572, or email your request to mksap_editors@acponline.org MKSAP 18 ISBN: 978-1-938245-47-3 (Board Basics) ISBN: 978-1-938245-73-2 Printed in the United States of America For order information in the U.S or Canada call 800-ACP1915 All other countries call 215-351-2600 (Monday to Friday, AM – PM ET) Fax inquiries to 215-351-2799 or email to help @acponline.org Errata Errata for MKSAP 18 will be available through the MKSAP Resource Site at mksap.acponline.org as new information becomes known to the editors Table of Contents Cardiovascular Medicine Acute Chest Pain Acute Coronary Syndromes (STEMI, NSTEMI, and Unstable Angina) Chronic Stable Angina Heart Failure Heart Failure with Preserved Ejection Fraction Nonischemic Dilated Cardiomyopathy 10 Hypertrophic Cardiomyopathy 11 Restrictive Cardiomyopathy 12 Palpitations and Syncope 13 Sinus Bradycardia and Heart Block 14 Atrial Fibrillation 17 Atrial Flutter 19 Supraventricular Tachycardia 20 Wolff-Parkinson-White Syndrome 23 Ventricular Tachycardia 24 Sudden Cardiac Death 27 Acute Pericarditis 28 Cardiac Tamponade and Constrictive Pericarditis 30 Cardiac Physical Diagnosis 30 Rheumatic Valvular Heart Disease 33 Aortic Stenosis 33 Bicuspid Aortic Valve 34 Aortic Regurgitation 35 Mitral Stenosis 36 Mitral Regurgitation 37 Mitral Valve Prolapse 38 Tricuspid Regurgitation 38 Prosthetic Heart Valves 39 Atrial Septal Defect 39 Coarctation of the Aorta 41 Patent Ductus Arteriosus 41 Patent Foramen Ovale 42 Ventricular Septal Defect 42 Infective Endocarditis 42 Thoracic Aortic Aneurysm and Dissection 45 Abdominal Aortic Aneurysm 46 Aortic Atheroemboli 46 Peripheral Artery Disease 47 Cardiac Tumors 49 Dermatology Eczemas 50 Psoriasis 52 Other Papulosquamous Disorders 53 Acneiform Lesions 54 Dermatophyte and Yeast Infections 56 Molluscum Contagiosum 58 Leishmaniasis 59 Herpes Zoster 59 Scabies 60 Bedbugs 61 Seborrheic Keratosis 62 Warts 62 Actinic Keratosis 62 Skin Cancer 63 Squamous Cell Carcinoma 63 Basal Cell Carcinoma 64 Dysplastic Nevi 64 Melanoma 65 Urticaria 66 Drug Allergy 67 Pemphigus Vulgaris and Pemphigoid 69 Erythema Multiforme 71 Stevens-Johnson Syndrome/ Toxic Epidermal Necrolysis 72 Dermatologic Signs of Systemic Disease 72 Endocrinology and Metabolism Diabetes Mellitus 76 Hyperglycemic Hyperosmolar Syndrome 81 Diabetic Ketoacidosis 81 Diabetes Care for Hospitalized Patients 81 Pregnancy and Diabetes 82 Hypoglycemia in Patients Without Diabetes 82 Hypopituitarism 83 Pituitary Adenomas 85 Diabetes Insipidus 86 Empty Sella Syndrome 87 Hyperthyroidism 87 Hypothyroidism 90 Thyroid Nodules 92 Hypercortisolism (Cushing Syndrome) 93 Adrenal Incidentaloma 94 Hypoadrenalism 95 Pheochromocytoma 96 Primary Hyperaldosteronism 97 Primary Amenorrhea 97 Secondary Amenorrhea 98 vii Polycystic Ovary Syndrome 99 Infertility 100 Male Hypogonadism 100 Hypercalcemia and Hyperparathyroidism 101 Multiple Endocrine Neoplasia 103 Hypocalcemia 103 Osteoporosis 105 Osteomalacia 107 Vitamin D Deficiency 107 Paget Disease 108 Gastroenterology and Hepatology Dysphagia 109 Achalasia 110 Gastroesophageal Reflux Disease 110 Barrett Esophagus 111 Esophagitis 112 Peptic Ulcer Disease 113 Nonulcer Dyspepsia 114 Gastroparesis 115 Complications of Bariatric and Gastric Surgery 115 Acute Pancreatitis 116 Chronic Pancreatitis 117 Autoimmune Pancreatitis 118 Acute Diarrhea 118 Chronic Diarrhea 119 Malabsorption 120 Celiac Disease 121 Inflammatory Bowel Disease 122 Microscopic Colitis 124 Chronic Constipation 124 Irritable Bowel Syndrome 125 Diverticular Disease 125 Mesenteric Ischemia and Ischemic Colitis 126 Differentiating Cholestatic and Hepatocellular Diseases 127 Hepatitis A 128 Hepatitis B 128 Hepatitis C 130 Alcoholic Hepatitis 131 Autoimmune Hepatitis 132 Hemochromatosis 132 Nonalcoholic Fatty Liver Disease 133 Primary Biliary Cholangitis 134 Primary Sclerosing Cholangitis 134 Cirrhosis 135 Acute Liver Injury and Acute Liver Failure 138 Liver Disease Associated with Pregnancy 139 Gallstones, Acute Cholecystitis, and Cholangitis 139 Upper GI Bleeding 141 viii Lower GI Bleeding 142 Bleeding of Obscure Origin 143 General Internal Medicine Biostatistics 144 Screening and Prevention 147 Smoking Cessation 149 Alcohol Use Disorder 150 Opioid Use Disorder 151 Intimate Partner Violence 151 Patient Safety 152 Medical Ethics and Professionalism 153 Palliative Care 154 Chronic Noncancer Pain 156 Chronic Cough 157 Systemic Exertion Intolerance Disease 157 Vertigo 158 Insomnia 159 Syncope 160 Musculoskeletal Pain 161 Dyslipidemia 165 Obesity 166 Male Sexual Dysfunction 167 Benign Prostatic Hyperplasia 168 Acute Scrotal Pain 168 Acute Prostatitis 169 Female Sexual Dysfunction 169 Breast Cancer Prevention and Screening 169 Breast Mass 170 Cervical Cancer Screening 171 Contraception 171 Menopause 172 Abnormal Uterine Bleeding 173 Dysmenorrhea 173 Chronic Pelvic Pain 174 Vaginitis 175 Eye Disorders 176 Hearing Loss 178 Otitis Media 179 External Otitis 179 Sinusitis 180 Allergic Rhinitis 180 Pharyngitis 181 Depression 182 Bipolar Disorder 183 Generalized Anxiety Disorder 184 Social Anxiety Disorder 184 Panic Disorder 184 Somatic Symptom and Related Disorders 185 Posttraumatic Stress Disorder 185 Obsessive-Compulsive Disorder 186 Eating Disorders 186 Schizophrenia 187 Attention-Deficit/Hyperactivity Disorder 187 Falls 187 Urinary Incontinence 188 Chronic Venous Insufficiency 188 Pressure Injury 189 Involuntary Weight Loss 190 Perioperative Medicine 190 Hematology Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria 193 Pure Red Cell Aplasia 194 Neutropenia 194 Myelodysplastic Syndromes 195 Myeloproliferative Neoplasms 195 Eosinophilia and Hypereosinophilic Syndromes 198 Acute Lymphoblastic Leukemia 198 Acute Myeloid Leukemia 198 Plasma Cell Dyscrasias 200 Normocytic Anemia 202 Microcytic Anemia 203 Macrocytic Anemia 204 Hemolytic Anemia 205 Sickle Cell Disease 207 Thalassemia 208 Approach to Bleeding Disorders 210 Common Acquired Bleeding Disorders 210 Hemophilia 211 von Willebrand Disease 212 Thrombocytopenia 213 Thrombotic Thrombocytopenic Purpura–Hemolytic Uremic Syndrome 214 Heparin-Induced Thrombocytopenia and Thrombosis 215 Transfusion Medicine 216 Thrombophilia 217 Deep Venous Thrombosis and Pulmonary Embolism 219 Anemia and Thrombocytopenia in Pregnancy 220 Infectious Disease Bacterial Meningitis 221 Brain Abscess 222 Herpes Simplex Encephalitis 222 West Nile Neuroinvasive Disease 222 Autoimmune Encephalitis 223 Cellulitis and Soft Tissue Infection 223 Diabetic Foot Infections 225 Toxic Shock Syndrome 226 Community-Acquired Pneumonia 227 Lyme Disease 229 Babesiosis 230 Ehrlichiosis and Anaplasmosis 231 Rocky Mountain Spotted Fever 231 Cystitis 232 Pyelonephritis 233 Tuberculosis 233 Mycobacterium avium Complex Infection 235 Aspergillosis 236 Candida Infections 237 Cryptococcal Infection 237 Endemic Mycoses 238 Chlamydia trachomatis Infection 238 Neisseria gonorrhoeae Infection 239 Pelvic Inflammatory Disease 240 Syphilis 240 Herpes Simplex Virus Infection 242 Genital Warts 244 Osteomyelitis 244 Fever of Unknown Origin 246 Primary Immunodeficiency Syndromes 246 Complement Deficiency 247 Bioterrorism 248 Smallpox 248 Anthrax 249 Plague 249 Tularemia 250 Botulism 250 Viral Hemorrhagic Fever 251 Travel-Related Illness 251 Zika Virus 252 Malaria 252 Leptospirosis 253 Infectious Gastrointestinal Syndromes 254 Posttransplantation Infections 255 Catheter-Associated UTIs 256 Hospital-Acquired and Ventilator-Associated Pneumonia 256 Clostridium difficile Antibiotic-Associated Diarrhea 257 Intravascular Catheter-Related Infection 258 HIV Infection 259 Pneumocystis jirovecii Pneumonia 262 Toxoplasmosis 263 Influenza Virus 264 Varicella-Zoster Virus 265 Epstein-Barr Virus 265 ix ... 97 8 -1 -9 3824 5-4 7-3 (Board Basics) ISBN: 97 8 -1 -9 3824 5-7 3-2 Printed in the United States of America For order information in the U.S or Canada call 800-ACP1 915 All other countries call 21 5-3 5 1- 2 600 (Monday... writing to MKSAP® Permissions, American College of Physicians, 19 0 N Independence Mall West, Philadelphia, PA 19 10 6 -1 572, or email your request to mksap_editors@acponline.org MKSAP 18 ISBN: 97 8 -1 -9 3824 5-4 7-3 ... MKSAP 18 Editor-in-Chief Sean McKinney1 Vice President, Medical Education Margaret Wells1 Director, Self-Assessment and Educational Programs Becky Krumm1 Managing Editor Valerie Dangovetsky1 Administrator