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
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).
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.
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
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.