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NEJM Knowledge+ Strategies for Working Through ABIM Board Questions

May 31, 2014

The complex questions that appear on medical board exams pose challenges for every test taker, even those who are highly experienced. There are up to 70 questions in each 2-hour segment of an ABIM internal medicine exam, so you need to make the most of your time and knowledge. This post will help you sharpen your approach to do just that.

Most medical certification exams, and all ABIM exams, are made up of multiple-choice questions. The majority are case-based scenarios that require reasoning and decision making. Each question has three distinct parts:

  • The patient vignette or question scenario
  • The lead-in or the question itself
  • The answer options, which include one correct answer and several distractors

- See more at: http://knowledgeplus.nejm.org/strategies-working-abim-board-questions/#sthash.a26Hznn4.dpuf

NEJM Knowledge+ Strategies for Working Through ABIM Board Questions.

Low-Dose Estrogen and Venlafaxine Similarly Effective for Menopausal Symptoms

May 31, 2014

Low-dose estradiol and venlafaxine are both effective treatments for vasomotor symptoms in menopausal women, a JAMA Internal Medicine study finds.

Some 340 peri- or postmenopausal women with bothersome vasomotor symptoms (hot flashes, night sweats) were randomized to receive low-dose estradiol (0.5 mg/day), low-dose venlafaxine (a serotonin-norepinephrine reuptake inhibitor; 75 mg/day), or placebo daily for 8 weeks.

Symptom frequency was reduced significantly more with estradiol (by 53%) and with venlafaxine (48%) than with placebo (29%). Both active treatments were well tolerated, although estradiol was more often associated with abnormal vaginal bleeding and venlafaxine with blood pressure increases.

The researchers note that “while the efficacy of low-dose estradiol may be slightly superior to that of venlafaxine, the difference is small and of uncertain clinical relevance.” They conclude: “Treatment decisions should weigh the risk profile of each agent for each individual woman, taking into account her risk factor status and personal preferences regarding treatment options.”

See more at: http://www.jwatch.org/fw108875/2014/05/27/low-dose-estrogen-and-venlafaxine-similarly-effective#sthash.6Pz6evr6.dpuf

Low-Dose Estrogen and Venlafaxine Similarly Effective for Menopausal Symptoms — Physician’s First Watch.

AFP Screening in Patients with Hepatitis C

April 24, 2014
tags: ,

Positive predictive value for hepatocellular cancer was low; AFP screening is not recommended.

Recent guidelines recommend against serum α-fetoprotein (AFP) testing to screen for hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (Hepatology 2011; 53:1020). Nevertheless, I still encounter cases in which clinicians have conducted AFP screening. In this study of 855 patients with histologically advanced chronic hepatitis C, researchers measured levels of AFP and two other biomarkers (AFP-L3 and des-γ-carboxy prothrombin [DCP]) every 3 months for 4 years. Patients also underwent yearly screening ultrasound imaging. HCC developed in 46 patients (5% of the cohort).

α-Fetoprotein Screening in Patients with Hepatitis C – NEJM Journal Watch.

 

Malingering vs Factitious Disorder

August 1, 2013

Malingering → siMulation of Sx for secondary gain (Money, drugs, absents of work,”cold feet” = afraid to get Married). It’s not a disorder.

FAKtitious disorder → FAKing of Sx w/o secondary gain. These patients just want to be sick (they love the sick role and the attentions they got in a hospital). It’s a disorder, as the name shows.

#QOTD 3

July 16, 2013

A 62-year-old woman is evaluated in the stroke unit for a 2-day history of difficulty speaking and right arm weakness. She has a history of hypertension and dyslipidemia and a 35-pack-year smoking history. Medications are lisinopril, atenolol, simvastatin, and aspirin.

On physical examination, blood pressure is 148/78 mm Hg, pulse rate is 84/min and regular, and respiration rate is 12/min. Other general medical examination findings are normal. Neurologic examination shows mild sensory aphasia and right arm drift.

An MRI of the brain shows an acute infarct in the left middle cerebral artery distribution that appears embolic. A magnetic resonance angiogram of the head and neck is normal. An electrocardiogram shows sinus rhythm and is normal. Telemetry performed over the next 3 days shows occasional premature ventricular complexes. A transesophageal echocardiogram shows no intracardiac thrombus, normal left atrial appendage velocities, and a patent foramen ovale with an atrial septal aneurysm. No evidence of deep venous thrombosis is found.

Which of the following is the most appropriate next step in management?

A Percutaneous patent foramen ovale closure

B Prolonged cardiac rhythm monitoring

C Surgical closure of the patent foramen ovale

D Warfarin

Read more…

QOTD #2

July 13, 2013

An 82-year-old man is evaluated for recurrent obscure gastrointestinal bleeding. He has experienced four episodes of melena in the past 6 months. Results of a colonoscopy and upper endoscopy 3 months ago were unremarkable. There is no family history of bleeding diathesis. His only medication is iron sulfate for anemia.

On physical examination, vital signs are normal. BMI is 32. There is no abdominal tenderness. Digital rectal examination is normal.

Laboratory studies reveal a hemoglobin level of 10.1 g/dL (101 g/L); platelet count, complete metabolic panel, and INR are normal.

Which of the following is the most appropriate diagnostic test to perform next?

A Intraoperative endoscopy
B Repeat upper endoscopy
C Single-balloon enteroscopy
D Wireless capsule endoscopy

Question of the Day #1

July 10, 2013

A 32-year-old man is evaluated for significant blood glucose elevations associated with exercise. The patient has a 22-year history of type 1 diabetes mellitus. He reports that after a recent 6 AM five-mile run, his blood glucose level was 386 mg/dL (21.4 mmol/L); the level was 297 mg/dL (16.5 mmol/L) just before the run and 215 mg/dL (11.9 mmol/L) at bedtime the night before. He took no insulin and ate no food in the morning before his run. During the run, he felt slow and fatigued but was significantly better after drinking water and giving himself insulin. The patient had one episode of diabetic ketoacidosis 15 years ago. Medications are insulin detemir, 16 units/d in the morning, and insulin lispro, 4 to 6 units before each meal, depending on his preprandial blood glucose level and expected carbohydrate intake.  Physical examination findings, including vital signs, are normal.

Which of the following is the most likely cause of his postexercise hyperglycemia?

A Excess nocturnal carbohydrate intake

B Gastroparesis

C Inadequate insulin replacement

D Nocturnal hypoglycemia

Source: MKSAP 16

Read more…

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