Approach to the Internal Medicine Board Examination

This chapter is different from the others. Its intent is to concentrate your mind on the American Board of Internal Medicine (ABIM) examination, its purpose, and its likely test scenarios. The ABIM moved to a written rather than oral test in the 1960s. The testing has been extensively validated and is unlikely to change much in its character. Essentially, the ABIM wants to determine if you have the core knowledge in all the disciplines to be an effective and efficient physician. It further wants to discriminate between you and the other test takers so that you can see how you compare with others taking the examination. Many candidates, in their increasing anxiety over the subject matter, lose sight of these major objectives. To pass the examination it is not necessary to regurgitate in photographic detail one of the standard textbooks of medicine or the latest Medical Knowledge Self-Assessment Program (MKSAP) review; however, you should feel that you know the core body of knowledge in all the major medical specialties.

General Internal Medicine Board Review Questions

This chapter provides 21 General Internal Medicine Board Review Questions.

Geriatrics

Geriatric medicine is the subspecialty of internal medicine that focuses on the care of patients over the age of 65. As life expectancy increases and the baby boom generation reaches old age, there will be a significant increase in this population. As of 2000 there were 35 million people 65 and older. This number is expected to double to over 70 million by 2030. The 85+ population is projected to increase from 4.2 million in 2000 to 7.3 million in 2020. There will never be enough geriatric specialists to care for this group of patients, so all health care providers must be aware of the key principles of geriatrics. The effects of normal aging and disease-related changes common in older adults necessitate a unique approach to caring for this group. There are several geriatric syndromes encountered regularly in elderly adults. These include polypharmacy, dementia, delirium, late-life depression, urinary incontinence, and falls.

Contraception

The general internist needs to be up to date in contraception management. Each year nearly half of all pregnancies in the United States are unintended. Counseling about contraceptive options, provision of a back-up method, and information about emergency contraception can decrease the risk of unintended pregnancy. This chapter focuses on the aspects of contraception emphasized in Medical Knowledge Self-Assessment Program (MKSAP) 14: hormonal contraception, use of barrier methods, intrauterine devices, and emergency contraception.

Basic Principles of Epidemiology and Biostatistics

One hundred women over the age of 50 received mammograms at a mobile breast cancer screening unit. Twenty-seven women had findings suspicious for malignancy on the mammogram; 19 of these women were confirmed as having breast cancer by biopsy. One woman had a negative mammogram but in the subsequent year developed breast cancer and is assumed to have had the disease at the time of screening. What is the sensitivity of the mammogram? The specificity? And the predictive value of a positive screening test?

The Neurologic Examination

The neurological examination is not challenging or complex. It does have many components and includes a number of skills that can be mastered only through repetition of the same techniques on a large number of individuals with and without neurological disease. Please remember that the purpose of the examination is to simply localize the lesion. Based on patient history alone, 80% of lesion locations should be known, and then a very specific neurological examination is performed to confirm the location. The examination is the less time consuming of the two parts of the patient's neurological evaluation.

Cardiology Board Review Questions

This chapter provides 20 Cardiology Board Review Questions.

Peripheral Vascular Disease

Atherosclerosis is a systemic disorder with regional manifestations in the heart, limbs, brain, and other organs. Advances in vascular biology, diagnostic imaging, pharmacotherapeutics, and intervention have provided physicians with greater opportunities to evaluate and manage patients with atherosclerotic vascular diseases. This chapter reviews several of these peripheral vascular diseases, including peripheral artery disease, abdominal aortic aneurysm, and carotid artery disease.

Adult Congenital Heart Disease

Historically, individuals with complex congenital heart disease rarely lived past childhood. Due to tremendous advances in diagnosis and treatment, now 85–90% of children born with congenital heart disease will survive into adulthood. Estimates suggest that over 1 million adults with congenital heart disease currently live in the United States. The number of adults with congenital heart disease (ACHD) is growing by approximately 5% each year. The majority of these patients do not appear to be followed by ACHD specialists. Therefore, it is essential that all physicians familiarize themselves with the unique clinical presentations of these patients, including the anatomy, physiology, and natural history in order to facilitate proper management and referral.

Acute Coronary Syndromes

In total, ACS presentations account for over 2 million annual hospital admissions in the United States. Almost 1.4 million people suffer an ACS each year, of which 55% are new events, 31% are recurrent events, and 14% are silent events. Of all diagnosed MIs, approximately 30% are STEMI and 70% are NSTE-ACS events. Despite recent declines in associated mortality, coronary artery disease causes one out of every five deaths in the United States. Notably, half of MI-related deaths occur within the first hour, primarily due to ventricular dysrhythmias. Therefore, the presentation of ACS challenges the clinician to rapidly integrate key aspects of the history, physical examination, and diagnostic tests in order to diagnose correctly and manage effectively this potentially life-threatening condition.