ABIM Revision Questions With Answers
2024
ASCVD - Answer - <5% = Low Risk
5-7.5% = Intermediate
>7.5% = Severe
If indetermediate, consider:
- Coronary Artery Calcium score greater than 300 or greater than 75% for age
- C-reactive protein level (hsCRP) above 2 mg/L
- Ankle-brachial index below 0.90
- LDL cholesterol level 160 mg/dL
- Family history
- HIGH intensity statin for LDL > 190 regardless of risk
Abdominal Aortic Aneurysm - Answer - <4cm low risk, US every 2-3 years
4cm-5.4cm need 6-12 month monitoring
Over 5.5cm = SURGERY
HIGH RISK surgery so need cardiac evaluation with AT LEAST chemical stress test if
sedentary and angio if indicated...elective procedure so if myocardium at risk, DEFER
surgery
If symptomatic over 5cm in men or 4.5cm in women = SURGERY
- Cholesterol atheroemboli are high risk after any vascular procedures esp those with
comorbidities
- differentiate from renal embolization which is due to A fib and can present like
pyelonephritis (but with increased LDH)
- screen MALE smokers over 65
Abdominal compartment syndrome - Answer - - oliguria or increasing serum creatinine
levels who have had abdominal surgery, who have received massive fluid resuscitation,
who have a tense abdomen, or who have liver or pancreatic disease with ascites
- measure abdominal pressure or bladder pressure for diagnosis
- treatment is surgical decompression
Acanthocytes (spur cells) - Answer - - chronic liver disease
- chronic alcoholism
- less projections compared to burr cells (often related to acid base and electrolyte
disturbances associated with uremia and glomerulonephritis)
,ABIM Revision Questions With Answers
2024
ACANTHOSIS NIGRICANS - Answer - - of course with insulin resistance but heavily
associated with STOMACH ADENOCARCINOMA
Acetominophen Toxicity - Answer - - MCC of fulminant liver failure in the US
- if rapid deterioration of liver function, AMS, coagulopathy and no hx of liver disease,
arrange for transfer for transplant
Acalculus Cholecystitis - Answer - - in critically ill patients, GB wall thickening with no
stones
- can be diagnosed on HIDA scan which shows non-visualization of the gallbladder
- Tx: Surgery is a good option but in critically ill patients we usually ask IR to place
catheter to drain the fluid to give some initial improvement as patient recovers, then
surgery at a more oppurtune or stable time
Achalasia - Answer - - associated with squamous cell carcinoma
Barrett's = adenocarcinoma
Tx: First try botulinium toxin
- if considering surgery, laparoscopic myotomy is the first choice
Acne - Answer - - 1st line is topical retinoid
- 2nd abx
- 3rd isotretinoin (for CYSTIC acne)
ISOTRETINOIN can cause ELEVATE TRIGLYCERIDES and lead to pancreatitis so
treat with Fenofibrate as well
NON INFLAMMATORY ACNE
- open and closed comedones
- Tx: topical retinoid is the best
INFLAMMATORY ACNE
- papules, pustules, nodules, cysts
Pregnant patients should be off for ONE MONTH before conceiving
Acquired cystic kidney disease (ACKD) - Answer - - no family history
- small kidneys, cysts in the renal parenchyma
- once ESRD, patient at significantly increased risk of renal cell carcinoma
Acromegaly - Answer - - also associated with hyperglycemia, skin tags, colon polyps
- Dx: serum IGF-1 level
- Tx: transsphenoidal pituitary surgery for removal of adenoma
,ABIM Revision Questions With Answers
2024
- might not completely remove tumor but surgery can effectively debulk the tumor and
preserve vision in addition to significantly decreasing GH secretion as measured by
IGF-1 levels
- radiation therapy afterward may continue to work on the tumor if symptoms don't
improve with surgery
Acute angle closure glaucoma - Answer - - pain, n/n
- colorful halos, decreased vision
- ophthalmic emergency, gonioscopy
Acute Intermittent Porphyria - Answer - - deficiencies in particular enzymes of the
heme biosynthetic pathway
- neuro symptoms, abdominal pain, psych manifestations
- Dx: Urine studies during acute attack
Acute Liver Failure - Answer - - non alcoholic, non acetaminophen induced, non
infectious: N-acetylcysteine IV is beneficial as we wait for transplant, REGARDLESS of
tylenol use or not!! wtf!!
- Acetominophen toxicity is MCC
- if rapid deterioration of LFTs with coagulopathy, AMS and no hx of liver disease, go
ahead and call transplant center for arrangements
ALCOHOLIC HEPATITIS
- can benefit from steroids depending on score
Acute MI - Answer - Ventricular Septal Rupture
- VSD manifests as hemodynamic compromise in the setting of a new HOLOSYSTOLIC
murmur AT LEFT STERNAL BORDER 3 to 7 days after an initial myocardial infarction.
- Patient has symptoms of CARDIOGENIC SHOCK, SYNCOPE and CHF, echo
showing left to right blood flow. Emergency condition requiring EMERGENT SURGERY
- reduce afterload with vasodilators and help with ionotropic agents in the meantime
Papillary Muscle Rupture w MR
- similar to ventricular septal rupture but murmur is different
- MIDSYSTOLIC murmur at the APEX
- acute mitral regurg requiring EMERGENT SURGERY
- no syncope reported and murmur usually at apex, though it can also be left sternal too
-___-
- reduce afterload with vasodilators and help with ionotropic agents in the meantime
- if chest pain and new LBBB or 3rd degree block, go straight to cath (or tPA if unable)
as this indicated the MOST MYOCARDIUM is damaged
- Anterior infarct benefits less, Inferior infarct benefits even lesser
, ABIM Revision Questions With Answers
2024
- if over 50 and typical angina presentation, then GREATER THAN 90% chance of CAD
- Patient's who we start on medical therapy can have adverse effects, for example BB
can lead to heart block so monitor and titrate dose
- as we await cath, start antiplatelet therapy and heparin
- please note, Bivalirudin is an anticoagulant that can be in place of Heparin :-<
- please note, in NSTEMI, Ticagrelor is preferred over Plavix for DAPT
- please note, in NSTEMI, Prasugrel can ONLY be used if initiated AT THE TIME of PCI
**Prasugrel CONTRAINDICATED with stroke patients**
- If stable then sudden chest pain, think RV infarct with acute right HF. Patient cannot
perfuse left heart and ultimately rest of the body...these patients are PRELOAD
dependent in order to keep cardiac output up. PCWP is LOW, but PA and RA is high
- Biventricular failure you get low CO
Acute renal failure - Answer - - if hyperkalemia and EKG changes:
1) Calcium Gluconate
2) Insulin and d50
3) Dialysis
- rhabdo can even cause ARF
PRERENAL AZOTEMIA
- common with NSAIDS
- improved w fluids
- hyaline casts
- FeNA < 1
ACUTE TUBULAR NECROSIS
- muddy brown granular casts
- FeNA > 1
- in the context of sepsis, due to prerenal BUT does NOT improve initially w fluids, can
sometimes take 1 week sometimes several months
ACUTE INTERSTITIAL NEPHRITIS
- WBC casts, fevers, maculopapular rash, Cr increase, recent antibiotic use, eosinophils
Acute Spinal Cord Injury - Answer - - First step is IV STERIODS within 8 hours
- Confirmatory MRI is appropriate, but do not delay steroids if still in the 8 hour window
Acute Trauma - Answer - - NSAIDS may increase risk of further BLEEDING into area
of blunt or penetrating trauma
2024
ASCVD - Answer - <5% = Low Risk
5-7.5% = Intermediate
>7.5% = Severe
If indetermediate, consider:
- Coronary Artery Calcium score greater than 300 or greater than 75% for age
- C-reactive protein level (hsCRP) above 2 mg/L
- Ankle-brachial index below 0.90
- LDL cholesterol level 160 mg/dL
- Family history
- HIGH intensity statin for LDL > 190 regardless of risk
Abdominal Aortic Aneurysm - Answer - <4cm low risk, US every 2-3 years
4cm-5.4cm need 6-12 month monitoring
Over 5.5cm = SURGERY
HIGH RISK surgery so need cardiac evaluation with AT LEAST chemical stress test if
sedentary and angio if indicated...elective procedure so if myocardium at risk, DEFER
surgery
If symptomatic over 5cm in men or 4.5cm in women = SURGERY
- Cholesterol atheroemboli are high risk after any vascular procedures esp those with
comorbidities
- differentiate from renal embolization which is due to A fib and can present like
pyelonephritis (but with increased LDH)
- screen MALE smokers over 65
Abdominal compartment syndrome - Answer - - oliguria or increasing serum creatinine
levels who have had abdominal surgery, who have received massive fluid resuscitation,
who have a tense abdomen, or who have liver or pancreatic disease with ascites
- measure abdominal pressure or bladder pressure for diagnosis
- treatment is surgical decompression
Acanthocytes (spur cells) - Answer - - chronic liver disease
- chronic alcoholism
- less projections compared to burr cells (often related to acid base and electrolyte
disturbances associated with uremia and glomerulonephritis)
,ABIM Revision Questions With Answers
2024
ACANTHOSIS NIGRICANS - Answer - - of course with insulin resistance but heavily
associated with STOMACH ADENOCARCINOMA
Acetominophen Toxicity - Answer - - MCC of fulminant liver failure in the US
- if rapid deterioration of liver function, AMS, coagulopathy and no hx of liver disease,
arrange for transfer for transplant
Acalculus Cholecystitis - Answer - - in critically ill patients, GB wall thickening with no
stones
- can be diagnosed on HIDA scan which shows non-visualization of the gallbladder
- Tx: Surgery is a good option but in critically ill patients we usually ask IR to place
catheter to drain the fluid to give some initial improvement as patient recovers, then
surgery at a more oppurtune or stable time
Achalasia - Answer - - associated with squamous cell carcinoma
Barrett's = adenocarcinoma
Tx: First try botulinium toxin
- if considering surgery, laparoscopic myotomy is the first choice
Acne - Answer - - 1st line is topical retinoid
- 2nd abx
- 3rd isotretinoin (for CYSTIC acne)
ISOTRETINOIN can cause ELEVATE TRIGLYCERIDES and lead to pancreatitis so
treat with Fenofibrate as well
NON INFLAMMATORY ACNE
- open and closed comedones
- Tx: topical retinoid is the best
INFLAMMATORY ACNE
- papules, pustules, nodules, cysts
Pregnant patients should be off for ONE MONTH before conceiving
Acquired cystic kidney disease (ACKD) - Answer - - no family history
- small kidneys, cysts in the renal parenchyma
- once ESRD, patient at significantly increased risk of renal cell carcinoma
Acromegaly - Answer - - also associated with hyperglycemia, skin tags, colon polyps
- Dx: serum IGF-1 level
- Tx: transsphenoidal pituitary surgery for removal of adenoma
,ABIM Revision Questions With Answers
2024
- might not completely remove tumor but surgery can effectively debulk the tumor and
preserve vision in addition to significantly decreasing GH secretion as measured by
IGF-1 levels
- radiation therapy afterward may continue to work on the tumor if symptoms don't
improve with surgery
Acute angle closure glaucoma - Answer - - pain, n/n
- colorful halos, decreased vision
- ophthalmic emergency, gonioscopy
Acute Intermittent Porphyria - Answer - - deficiencies in particular enzymes of the
heme biosynthetic pathway
- neuro symptoms, abdominal pain, psych manifestations
- Dx: Urine studies during acute attack
Acute Liver Failure - Answer - - non alcoholic, non acetaminophen induced, non
infectious: N-acetylcysteine IV is beneficial as we wait for transplant, REGARDLESS of
tylenol use or not!! wtf!!
- Acetominophen toxicity is MCC
- if rapid deterioration of LFTs with coagulopathy, AMS and no hx of liver disease, go
ahead and call transplant center for arrangements
ALCOHOLIC HEPATITIS
- can benefit from steroids depending on score
Acute MI - Answer - Ventricular Septal Rupture
- VSD manifests as hemodynamic compromise in the setting of a new HOLOSYSTOLIC
murmur AT LEFT STERNAL BORDER 3 to 7 days after an initial myocardial infarction.
- Patient has symptoms of CARDIOGENIC SHOCK, SYNCOPE and CHF, echo
showing left to right blood flow. Emergency condition requiring EMERGENT SURGERY
- reduce afterload with vasodilators and help with ionotropic agents in the meantime
Papillary Muscle Rupture w MR
- similar to ventricular septal rupture but murmur is different
- MIDSYSTOLIC murmur at the APEX
- acute mitral regurg requiring EMERGENT SURGERY
- no syncope reported and murmur usually at apex, though it can also be left sternal too
-___-
- reduce afterload with vasodilators and help with ionotropic agents in the meantime
- if chest pain and new LBBB or 3rd degree block, go straight to cath (or tPA if unable)
as this indicated the MOST MYOCARDIUM is damaged
- Anterior infarct benefits less, Inferior infarct benefits even lesser
, ABIM Revision Questions With Answers
2024
- if over 50 and typical angina presentation, then GREATER THAN 90% chance of CAD
- Patient's who we start on medical therapy can have adverse effects, for example BB
can lead to heart block so monitor and titrate dose
- as we await cath, start antiplatelet therapy and heparin
- please note, Bivalirudin is an anticoagulant that can be in place of Heparin :-<
- please note, in NSTEMI, Ticagrelor is preferred over Plavix for DAPT
- please note, in NSTEMI, Prasugrel can ONLY be used if initiated AT THE TIME of PCI
**Prasugrel CONTRAINDICATED with stroke patients**
- If stable then sudden chest pain, think RV infarct with acute right HF. Patient cannot
perfuse left heart and ultimately rest of the body...these patients are PRELOAD
dependent in order to keep cardiac output up. PCWP is LOW, but PA and RA is high
- Biventricular failure you get low CO
Acute renal failure - Answer - - if hyperkalemia and EKG changes:
1) Calcium Gluconate
2) Insulin and d50
3) Dialysis
- rhabdo can even cause ARF
PRERENAL AZOTEMIA
- common with NSAIDS
- improved w fluids
- hyaline casts
- FeNA < 1
ACUTE TUBULAR NECROSIS
- muddy brown granular casts
- FeNA > 1
- in the context of sepsis, due to prerenal BUT does NOT improve initially w fluids, can
sometimes take 1 week sometimes several months
ACUTE INTERSTITIAL NEPHRITIS
- WBC casts, fevers, maculopapular rash, Cr increase, recent antibiotic use, eosinophils
Acute Spinal Cord Injury - Answer - - First step is IV STERIODS within 8 hours
- Confirmatory MRI is appropriate, but do not delay steroids if still in the 8 hour window
Acute Trauma - Answer - - NSAIDS may increase risk of further BLEEDING into area
of blunt or penetrating trauma
