Monday, February 3, 2014

Internal Medicine Board Review Courses

Are you studying for the ABIM Internal Medicine Board Exam? We’ve touched upon our suggestions for studying for the ABIM exam including a brief overview of the independent internal medicine board review courses.

There are a lot of internal medicine board review course options. We’ll cover the ones we’re aware of here. If you know of one we’ve missed, please post a comment or send us a note at support@knowmedge.com.

Independent Internal Medicine Board Review Courses

iMedicine Review

iMedicine Review – Shahid Babar

Website: www.imedicinereview.com

Taught by: Shahid Babar, MD FACP FHM

Overview: Dr. Babar has been conducting Internal medicine board review courses at various academic centers since 2007. He founded iMedicine Review in 2010 and in addition to continuing his live courses, he created educational apps for residents and physicians preparing for ABIM Internal medicine board exam. His courses are 3 ½ days long and take place in various cities around the country.

Locations / Dates: Dr. Shahid Babar’s will be teaching his iMedicine Review course at five different locations in 2014.

Cost
The cost of the iMedicine Review course varies depending on a few factors:

Physicians – $695.00
Residents – $595.00
Groups of 2 or more – $545.00
Chief Residents – $245.00

Contact
You can contact iMedicine Review through the website or directly by emailing info@imedicinereview.com.

Note: Dr. Shahid Babar is an advisor to Knowmedge .

Awesome Review

Awesome Review – Habeeb Rahman

Website: www.tutormd.com

Taught by: Habeeb Rahman, MD

Overview: This Internal Medicine Board Review course taught by Dr. Habeeb Rahman is a popular option for residents. While more expensive than some of the other review courses, the high-yield animations and notes presented by Dr. Rahman make this a worthwhile experience for many who take his Awesome Review course.

Locations / Dates: Dr. Habeeb Rahman will be teaching his Awesome Review course at ten different locations in 2014.

Cost
The cost of the Aweome Review course varies depending on the size of the group:

Group of less than 10 people: $1,045.00
10 or more people: $995.00

Contact
You can contact Awesome Review through the website or directly by emailing info@awesomereview.com or by calling 201-905-0102 or 201-888-1002.

Unique Review Course

Unique Course – Satish Dhalla

Website: www.uniquecourse.com

Taught by: Satish Dhalla, MD FACP

Overview: Of the three Internal Medicine Board Review independent courses, this is the oldest. Dr. Dhalla has been director of the Unique Course Board Review since 1995.

Locations / Dates: Dr. Satish Dhalla will be teaching his Unique Course twice in 2014.

Cost
The cost of the Unique Course is $1,095.00.

Other Internal Medicine Board Review Courses
There are a lot of other Internal Medicine Board Review courses. We’ll go through the ones we’re aware of here:

Mayo Clinic Internal Medicine Board Review

Website: Mayo Clinic Internal Medicine Board Review (IMBR)
Dates: June 16 – June 20
Location: Rochester, MN
Cost: $1,299.00

Cleveland Clinic Internal Medicine Board Review

Website: Annual Intensive Review of Internal Medicine
Dates: June 1 – June 6
Location: Cleveland, OH
Cost: $825 – $1,475

American College of Physicians (ACP)

Website: Intensive Review of Internal Medicine
Dates: June 1 – June 6
Locations: New York, NY
Cost: $865 – $1,465

Columbia University Internal Medicine Board Review

Website: Intensive Review of Internal Medicine
Dates: June 1 – June 6
Locations: New York, NY
Cost: $350 – $950

GoFrontRunners

Website: Internal Medicine Board Review
Dates: August 2 – August 3
Locations: Laguna Hills, CA
Cost: $575

MedStudy Internal Medicine Board Review

Website: ABIM Certification Board Review Course
Dates: May 21 – May 30
Locations: Dallas, TX
Cost: $1,245 – $1,545

American Physician Institute for Advanced Professional Studies (The Pass Machine)

Website: Internal Medicine Review Course
Dates: March 21 – March 23 / June 13 – June 15 / August 15 – August 17
Locations: Chicago, IL
Cost: $1,297

If you know any internal medicine board review courses we have missed, please let us know.

If you have used an internal medicine live course to study, please share your feedback with us in the comments section. We all benefit from learning about the various internal medicine board review courses that are offered.

Sunday, January 26, 2014

MKSAP 16 Review

You may have already come across Knowmedge’s coverage of several other ABIM Internal Medicine Board Review books. Today, we explore the “big daddy of them all”—the Medical Knowledge Self-Assessment Program (MKSAP), created by the venerable American College of Physicians (ACP). Ask any Internal Medicine resident—1^st, 2^nd, or 3^rd year—how they plan on studying for the Internal Medicine board exam, and their response will surely include “MKSAP.” Furthermore, residency chiefs have developed a tendency of using MKSAP questions for board review at morning report, noon conference or even afternoon educational sessions. There is a reason for its vast utility: MKSAP is truly an authoritative guide to reviewing the curriculum covered in the ABIM Internal Medicine Board Review Blueprint.

In its 16^th iteration, the MKSAP content has been refreshed as well as the user interface on the app/desktop versions creating a better learning experience.

Let’s begin with the many plusses of MKSAP 16:

First and foremost, with dozens of contributors in each of the major internal medicine sub-specialties, the medical content in the text and 1,200 questions is well-researched with bibliographic citations.
Lots of tables and figures help break up the text which can otherwise be cumbersome to stay engaged while reading. Later in your studying, revisiting these tables is a good approach.
One of my favorite features is the High-Value Care Recommendations that opens each book. Here’s why: the folks behind the ABIM, like the healthcare policy makers, are concerned about the overuse/inappropriate use of tests in the diagnostic work-up of commonly encountered symptoms. Thus, these points which emphasize unnecessary tests/treatments may be commonly tested on the actual exam. Furthermore, I’ve referred back to this section during patient care to determine if a test is actually necessary or extraneous before initiating treatment.
Dermatology contains vivid photos of the skin lesions commonly encountered on the exam. However, it would be nice if they had had a separate section with just images so you can quiz yourself near the end of your exam preparation.
Same goes for EKGs on the cardiology section and chest xrays on the pulmonary sections.
A Key Points highlighted box contains high-yield nuggets that help summarize major topics
Each subject area is a separate book (in the print version) or a separate heading in the digital version making it very easy to handle physically. I recall using MKSAP 15 on my specialty rotations. I’d carry the appropriate book around but they wouldn’t unfortunately fit in my white coat pocket. The MKSAP online version solves this problem as many residents have found.

Now for some areas that could be improved in MKSAP 16:

While the figures and photos do break up the monotony of the text portions, the question explanations are still too long. I can understand the need to have lengthy text in the syllabus (MKSAP 16 is a powerful clinical tool and a nice reference to have when reviewing a patient’s diagnosis), for questions, it’s not high-yield and efficient to have to read 4 or 5 paragraphs after each question. In fact, this was the reason Knowmedge was created. We felt that in the 21^st century, the Internet allows better methods to facilitate knowledge retention such as audio-visual explanations.
An H icon highlights topics that address “the learning needs of the increasing number of physicians who work in the hospital setting.” Since this feature is mentioned in the letter from Dr. Patrick Alguire (Editor-in-Chief ) at the beginning of each book, I initially thought it was beneficial. But then it occurred to me that for someone not studying for the Hospital Medicine Maintenance of Certification, it’s not entirely clear what to do with the icon. Surely, I don’t just skip over the blue text sections like porphyria cutanea tarda diagnosis and constipation management, which are just as likely to be on either exam. Instead, it ended up just being a distraction.
A final minor point (literally): the index on the print version of MKSAP is in the smallest type I have ever come across. It must be 8 point or less. I don’t have any near vision problems and I felt tempted to reach for a magnifying glass.
MKSAP Online: The digital version is much improved from the previous iterations such as MKSAP 15. While it now allows better analytics of your question responses, its interface is not as user friendly as one would hope. For instance, unlike most websites/ apps the menu toolbar appears on the upper right side of the screen rather than the left side. On the app, overlays should have been utilized for Normal Lab Values and Bibliography and Key Points rather than forcing the user to leave the current topic.

While there are areas of improvement that could be made, overall, the MKSAP 16 Books are a valuable and authoritative source for Internal Medicine Board Review.

Wednesday, January 15, 2014

Internal Medicine Board Review: Oncology

Oncology is an essential part of the Internal Medicine Medical Clerkship and ABIM Board exam. According to the ABIM exam blueprint, questions testing Oncology topics comprise ~7% of the exam. Initially, oncology seems like a very difficult subject given how the treatment regimens of the many types of carcinomas are ever-changing. However, realize that Internal Medicine exams are focused on the basics of the different malignancies. These 8 pearls will get you off to a good start for identifying
1. Which cancers correspond to lytic bone lesions? Blastic? Lytic or Blastic?

Lytic bone lesions
- Melanoma
- Multiple Myeloma
- Renal cell cancer
- Thyroid cancer

Blastic bone lesions
- Prostate cancer

Lytic or blastic lesion
- Lung cancer
- Breast cancer

Click on image to enlarge

2. Which paraneoplastic syndrome goes with which cancer?

USMLE Step 1 Exam Practice Question - Paraneoplastic Syndromes

Click on image to enlarge

3. Know these high-yield Breast Cancer facts for the ABIM and IM shelf exams

If the lesion is >1cm OR the patient has lymph node involvement → chemotherapy will be part of the treatment protocol.
If sentinel node biopsy is negative → no further lymph node biopsy is required
If the patient’s breast cancer is ER/PR (+) and patient is pre-menopausal →Tamoxifen is given X 5 years
If the patient’s breast cancer is ER/PR (+) and is post-menopausal → Aromatase inhibitors (eg. Anastrozole) is given
If the patient’s breast cancer is HER2/neu (+)→ Trastuzumab is given →can cause CHF →check echocardiogram to assess left ventricular function
Triple negative breast cancer (ER negative, PR negative, HER2/neu negative) have the worst prognosis

4. Don’t let chromosomal translocations overwhelm you

t (14,18) → Follicular Lymphoma
t (8,14) → Burkitt’s Lymphoma
t (9,22) → Known as Philadelphia Chromosome (BCR-ABL) gene fusion → good prognosis in CML patients and bad prognosis in ALL patients
t (15,17) → Acute promyelogenous Leukemia (M3) → good prognosis → Treatment is with All-Trans Retinoic Acid (ATRA)
t (11,14) →Mantle cell Lymphoma → highly aggressive form of Non-Hodgkin’s Lymphoma → cyclin D1 oncogene is overexpressed → treat with R-CHOP

5. Testicular cancer is broken down into seminomas and non-seminomas

Seminomas are Radiation sensitive and usually have a normal AFP and HCG level
Non-Seminomas (eg, yolk sac tumor, embryonal carcinoma, teratoma, choriocarcinoma) are radiation resistant and usually have elevated AFP and HCG level

ABIM Board Exam Maintenance of Certification Review - Testicular Cancer

Click on image to enlarge

6. High-yield facts about Colon Cancer for the ABIM and IM Shelf Exam

If cancer invades mucosa or sub-mucosa → colon resection is required
If cancer invades muscularis propria, serosa, or has LN involvement →colon resection is required +chemotherapy (usually FOLFOX) +/- Irinotecan. FOLFOX is 5 flurouracil, Oxaliplatin, and Leucovorin
Most common area of metastasis for colon cancer is the liver
If solitary liver lesion →resection of liver can be performed
If multiple liver lesions → poor prognosis and survival rate is low

7. Must know Oncological Emergencies a.) Superior Vena Cava Syndrome → caused by obstruction to the superior vena cava leading to:

Neck and facial swelling
Dyspnea
Cough
Physical examination will show distended jugular veins
Chest x-ray may reveal mediastinal widening or right hilar mas
Most common cause is lung cancer (particularly small cell lung cancer). Malignant lymphoma is also a well-known cause of superior vena cava syndrome
Management obviously requires treatment of the underlying malignancy but symptomatic measures such as diuretics and elevation of the bed usually suffice

b.) Spinal cord compression

Most common cancers that cause spinal cord compression are: Lung cancer, breast cancer, prostate cancer, multiple myeloma, and lymphoma
Back pain is the most commonly presenting symptom. Other concerning symptoms include muscle weakness, numbness/tingling, cauda equina syndrome, and loss of bowel or bladder control
Diagnosis is required promptly to prevent further neurological deterioration and an MRI OF THE ENTIRE SPINE IS REQUIRED FOR DIAGNOSIS
Management for spinal cord compression is with Dexamethasone 10 mg IV X 1 dose, followed by Dexamethasone 4 mg IV every 6 hours.
Radiation therapy can help in shrinking the tumor; however, recent studies indicate that surgical decompression is superior to RT. Therefore, an immediate neurosurgical consultation is required when this condition is suspected or diagnosed.

c.) Tumor lysis Syndrome

Intracellular contents leak out into the bloodstream.
Although this condition can occur with any malignancy, it is more common in aggressive lymphomas and hematological malignancies.
Hyperkalemia, Hyperuricemia, Hyperphosphatemia, Acute renal failure, and hypocalcemia are often seen in patients with tumor lysis syndrome
Management of tumor lysis syndrome requires electrolyte abnormality correction, aggressive hydration, and allopurinol

Once again, the folks who write the Internal Medicine licensing exams don’t expect you to have the depth of knowledge regarding the plethora of cancer diagnoses that an oncologist possesses. However, topics such as the ones mentioned in the pearls above should assist you with the oncology section of the med school clerkship shelf and ABIM board exams.

Medical Mnemonics: Normal Pressure Hydrocephalus

Medical Mnemonic: “Wacky, Wobbly, Wet”

Patients who present with the triad of urinary incontinence, wide-based gait and dementia are likely to have normal pressure hydrocephalus (NPH). Symptoms for these patients are often remembered by the mnemonic “wacky, wobbly, and wet.”

Wacky: Dementia and mental impairment
Wobbly: Wide based gait (Difficulty walking)
Wet: Urinary Incontinence

NPH is a condition where excess cerebrospinal fluid (CSF) has slowly built up in the ventricles. Patients with NPH are generally older (over the age of 60). CT or MRI of the brain would reveal dilated ventricles without dilatation of sulci.

This is the first in our series of Medical Mnemonics Monday posts. You can all previous and future medical mnemonics here.

Monday, January 6, 2014

Medical Mnemonics: Rheumatic Fever - Major and Minor Criteria

Medical Mnemonic: Rheumatic Fever – Jones Cafe Pal

Rheumatic fever occurs after a streptococcal infection (usually caused by Group A Beta-Hemolytic Strep (GABHS)). It is an inflammatory condition that affects the joints, skin, heart and brain. Major criteria are referred to as Jones criteria and can be remembered by the mnemonic of the same name.

J – Joint involvement which is usually migratory and inflammatory joint involvement that starts in the lower joints and ascends to upper joints
O – (“O” Looks like heart shape) – indicating that patients can develop myocarditis or inflammation of the heart
N – Nodules that are subcutaneous
E – Erythema marginatum which is a rash of ring-like lesions that can start in the trunk or arms. When joined with other rings, it can create a snake-like appearance
S – Sydenham chorea is a late feature which is characterized by jerky, uncontrollable, and purposeless movements resembling twitches

Minor criteria include

C – CRP Increased
A – Arthralgia
F – Fever
E – Elevated ESR
P – Prolonged PR Interval
A – Anamesis
L – Leukocytosis

Diagnosis of rheumatic fever is made after a strep infection (indicated by either throat cultures growing GABHS OR elevated anti-streptolysin O titers in the blood) and:

Two major criteria OR
One major criterion and two minor criteria

Mnemonics by themselves are not the answer to remembering everything. However, if you know the basics and underlying issues, then a mnemonic can serve to help you recall the exam details that can easily get lost.

This is the first in our series of Medical Mnemonics Monday posts. You can see all futuremedical mnemonics here.

Monday, December 23, 2013

High-Yield Internal Medicine Board Exam Pearls PDF eBook

The Knowmedge High Yield Internal Medicine Board Exam Pearls eBook is now available! This eBook brings together all the high-yield pearls you’ve seen on our blog over the past year covering all the major categories you will see on the ABIM Exam or the NBME Internal Medicine Shelf Exam. There are 17 chapters covering:

Cardiovascular Disease
Endocrinology & Metabolism
Gastroenterology
General Internal Medicine
Hematology
Infectious Disease
Nephrology / Urology
Oncology
Neurology
Dermatology
Pulmonary Disease & Critical Care
Rheumatology / Orthopedics

Enrich your internal medicine exam prep and build your Knowmedge! Download your free copy and pass it on to a friend!

Also, if you haven’t seen and downloaded our first eBook (Internal Medicine Practice Questions), you can still do so! It’s also available for iTunes, Google Play, and Kindle.

High Yield Internal Medicine Board Exam Pearls by Knowmedge

Sunday, December 1, 2013

5 High-Yield Cardiology Pearls to Help Pass the Internal Medicine Boards

NOVEMBER 23, 2013 / SALIM REZAIE

Whether studying for emergency medicine, internal medicine, or USMLE board examinations, cardiovascular diseases are by far and away one of the biggest organ systems of which questions get asked. If you pay attention, the first three pearls are all on physical exam findings and the last two pearls are on disease processes with high morbidity and mortality. I have attached a review table for each pearl to help simplify the concepts and buzz phrases.

Pearl #1: Know what the maneuvers are that increase and decrease heart murmurs.

In general, you should know all the different maneuvers, their effect, and how they would affect valve abnormalities. It is helpful to walk yourself through each valve abnormality, and try and explain why murmurs are increased or decreased, instead of just memorizing a table, which you will forget in 1 – 2 weeks. That being said, common murmurs that seem to get the most questions are: HOCM, AS, MVP, and MR.

Cardiac Maneuvers - ABIM Internal Medicine Board Exam

Cardiac Maneuvers for the Internal Medicine Board Exam

Pearl #2: Know the abnormal arterial pulsations and the disease state with which they are commonly associated.

Arterial pulsations is another physical exam finding that can be very high-yield. Recognizing the buzz phrase (arterial pulse description) and its association to what disorder it is commonly associated can help save you time on questions, which allows you more time on other questions. This is too easy to not know these terms.

ABIM Exam / NBME Internal Shelf Exam - Pulses

Heart Pulses

Pearl #3: Know your normal and abnormal heart sounds.

Heart sounds such as S1 and S2 is also a big part of the cardiovascular physical exam on boards. Know what happens with inspiration/expiration as well as other pathologies. Don’t forget about S3 and S4. Remember, sometimes an S3 can be normal (i.e. pregnancy and children).

Heart Sounds - Internal Medicine Board Exam

Heart Sounds to know for the Internal Medicine Boards

Pearl #4: The number one killer in the world is ischemic heart disease, so know what medications improve morbidity and mortality.

First and foremost, be sure to fix modifiable coronary artery disease risk factors such as diabetes mellitus, hypertension, hyperlipidemia, and smoking. Next know what medications decrease mortality in ischemic heart disease and acute coronary syndrome. Also be sure to know the contraindications for lytics in STEMI.

High-Yield Information - CAD ACS Therapy Internal Medicine Boards

CAD ACS Therapy Table for the Internal Medicine Boards – Part I

Internal Medicine Board Exam - CAD ACS Therapy

CAD ACS Therapy Table for the Internal Medicine Boards – Part II

Contraindications – Thrombolytics

Pearl #5: Congestive Heart Failure (CHF) is common, so know which medications affect mortality

CHF is a common disease process seen in hospitalized, elderly patients due to improvements in revascularization techniques. 40% of these patients die from arrhythmias and sudden cardiac death; therefore knowing what medications can improve mortality is something you should know.

CHF – Medications

If you remember nothing else, KNOW THE PHYSICAL EXAM FINDINGS FOR CARDIOVASCULAR DISEASES!!! The cardiovascular physical exam is the largest portion of information that board questions in this section are derived. Each pearl has one to two charts to help simplify these concepts.