Daily post abim2019
This worked for me in step 1 writing ✍️ few educational objective of questions everyday
Will post regularly
If not my regular resources
Just 1 MKSAP topic question of patient I saw at least
Have performed well during mark exams , hoping to do same on boards as well
Persistence marathon begins
Join me in my journey
Thank you
Done with last night float of residency.
Starting board review while aboard on flight for my outside elective in sunny california
Resources:
+ve
FA-Medquest ABIM Videos 92 videos /35 hours 53 minutes 17 seconds
questions MKSAP 1200/Flash cards
UWORLD ABIM 1282 Q
Sleep -Awesome Review 2 Long Weekends April 19-21 and 26-28, 2019
Rheumatology
Rheumatology 1 - Rheumatoid Arthritis, Parvovirus 35:49
Rheumatology 2 - Sjögren's Syndrome, Crest Syndrome 31:46
Rheumatology 3 - SLE, Still's Disease, Bechet's, Bursitis 36:34
Rheumatology 4 - Ankylosing Spondylitis, Psoriatic Arthritis 22:12
Rheumatology 5 - Vasculitis, Henoch-Schonlein Purpura 21:21
Rheumatology 6 - Gout, CPPD & Osteoarthritis 23:17
Rheumatology 7 - Tendon, Ligament & Bursa Disorders, Pm/dm Carpal Tunnel 34:42
03-11
03-12: UW Rheumatology/Orthopedics & Sports 98
MKSAP 46/96 Answered
April 19, 2019 S2: Rheumatology
edited by on 3/11/2019
edited by on 3/14/2019
Off to sleep
Today Did mksap flash cards today
questions
Patient with antigbm disease
anca vasculitis
Adrenal insufficiency
Pmr patient
Takayasu disease
Hey rahul..
When is ur ABIM exam date?
August 16th
Saw patient with Lupus Nephritis III, Anemia
MKSAP Rheumatology
1: Approach
-exam >periarticular-active ROM affected
Pattern: mono, oligo, poly
Extraritcular-constitution, dermatological, eye , internal oragan
q31- scleritis -think of vasculitiis-wegners
LAbs-ESR
q94 PMR patient ESR not reliable -can be increased with patient taking prednisone -as diabetes may cause increase
Imagin, joint aspiration
q96-more than 2k inflammatory arthiritis, crystal culture, gram stain
Ch 2Principles thearupetics
NSAID
q68-above 75 switch to topical NSAIDS
RA
q75 -Hepatitis due to leflunomide-cholestyramine can be usd
q90-cystoscopy for wegner patient treated with cont cyclophosphamide alkylating agent to r/o bladder cancer
Apremilast-psoriatic arhitiritis
q8 Add non biologic lefluonimide ARAVA if already of Tnf alfa
q16 Lipid profile for patient on tofacinimib as early as 1 month
q18-IGRA quantiferon before starting medication
Urate lowering therapy
q16-t2t <6 goal or <5 if tophi
q1 febuxostat Start
q76 contraindicated in patients using Azathiprine for Inlfammatory bowerl disease, also colchicine levels in patient iwth cardizem
q86-IV syntheric uricase,, pegloticase however immunity , contraindicated in renal failure
q78 Stop mycophenolate 3 months ago 0cellcept though better in SLE-flared ip in pregnancy 1/3rd of patient -continue Plaquineil and low dose prednisone
Chapter 3 RA
q3-RF and ccp, 40 percent patient can have ANA
q69-seronegative RA , mostly men not serology -if IP, MCP, ankle morning stiffness X ray finding of marginal erosion, periarticular osteopenia
q95-perciarditis , acc athero in RA patient
q54-erosive disease start Methotrexate early, if non erosive-mild disease only then HCQ
q46-mtx now at 25 weekly dose -start etanercenpt 20 percent improvement in 1/2 patient within week also dec CV risk
q50 -like q78 stop 3 months if expecting, leflunomide, prednisone first 14 weeks not give -risk of cleft palate, GDM and HTN
can give Sulfasalazine HCQ
Chapter 7 SLE
q2-jaccouds reducible subluxation, swan neck and ulnal deviation
q61-MRI hip osteonecrosis limited motion, 37 percent patient 10 percent symptomatic q
q84->500mg , class 3/4 progressive 50-70 percent patient within 5 years , do not wait for more labs start treatment
q80-EMG/NCS 14 percent patient with mono neuritis multiplex
q56-DAH-do BAL/Biopsy , only 50 percent with have hemoptysis, may sow up as dropping H^H , Pericardititis most coomon
q87-ds dna -suggestive of flare
q35 Minocycline for acne-ANA-Panca Drug induced, also agents TNF alfa influximab, etanecerpt
q41-add HCQ if pt on prednisone for mild disease
q10-CHB 2 percent >subsequent p9nancy 12 percent ssa ro, 6 months quescent , else miscarr, stillb, premat 2X, IUGR 8X more common
Am lecture on cppd
Did mksap chapter 4 osteoarthritis
q64 Meniscus removal -132X more changes of OA
q52-Erosive OA: 3 percent-10 percent -Inflammatory, flares polyarticular-central erosions, v/s gout with overhanging bones, RA with Marginal erosions
q11-Transferrin Saturation Metacarpal 2nd and 3rd of wrist, 60 percent in Male/50 female-Hemachromatosis CPPD
q29-DISHyperostosis, stiffness dec ROM, Osteophytes in 4+ continuous vertebra, preserved disc spaces rule out inflammatory apophyseal and sacro iliac involvement
q43 -Clinical diagnosis OA not radiological pain inc with use, dec with rest, MS<30 mins, CMC thumb with boxing
q37-Standing plain X ray , proxical Wrist-RA can have as well-imaging , RF positive is low specificity though, Imaging can also help with rule out Osteonecrosis, Avascular , Fracture
q23-Duloxertine SNRI better for OA, hyaluronate expensive, glucocorticosteroids, Narcotic has risk of falls in elderly
q72-Acetaminophen 3-4 gram/day moderate effect
q89-NSAIDS if acetaminophen not effect, hydrocodone or tramodol with SSRI effect
q5-Intraarticular Glucocorticosteroid, however expensive Hyaluronate with 3 series weekly effect
Ch5 fibromyalgia
q9-Pain -Wide spread>3 months, Wake unrefreshed, ALlodynia-Pain/tender while pressing muscles, Fatigue Irritable bowel and other syndrome-get ESR, TSH, CBC, BMPP not ANA ulsess other features
ET overdoes-symptoms carry on
q670Aerobic exercise0Non pharmacological>increase gradually to 30 minutes, pregabalin, duloxertine and milnaciprine effective
Ch6 spondyloarthiritis
q81-HIV with severe flare of Psoriatic arthiritis
q19 AS>3 months in <45 yo, Morning stiffness>1 hour worse with immobility so night and AM symtoms improving
q26-Psoriatric Nail pitting, CAspar crietaria
q58 Reactive 20 percent polyarticular-assymetrical enthesitis, dactylitis
q21-HLA b27 percent of general population , however aids in diagnosis in cases diagnosis mri
q45-DNA amplification for chlamydia fi keroderma blenorrhagicum vesicles, palms , soles, dactylitis toes foot
q12-MRI of Sacro iliac -if negative x ray: as n eed life long monitoring , CVascular rule out
q33-no imaging to monitor if <2 years
q60-Adalimumam within 6 weeks help , if NSAID naproxen indomethacin not helpful to prevent Axial fusion from kyphosis , nees muscle strengthening, Not MTX -help with peripheral joints
Ch 8 Sjögren
q20-LymphOMA-node biopsy-MAltoma and diffuse B cell : not skin biopsy for palpable purpura as 44X more reisk-c/f B symtpoms , spleen , Cervial LN, enlarge, complement , cryoglobulin
q38-cyclosporine eye drops-dry cornea-visioni impairment-puctal blockage
not tnf alfa-cetolu0xiliza
edited by on 3/20/2019
Saw patient with PM/Dermatomyositis and raynauds improving with viagra
Cervical radiculopathy with DJD-happens to be sculpture with AM stiffness as does not feels pain when working/artist
Chapter 9 MCTZ
q55 u1rnp 3/5 raynauds/edema/sclerodactyly(ssc) -synovitis/myositis(PM) Pulmonary hypertension
not undiffrentiated, sle negative dns0dna ,
Ch 10 Crystal
q25 joint aspiration diagnose first and rule out infection
not treat with colchicine, also is c4p3ay metabolised inhibition by clarithromycin, so pneumonia treted patient with flare careful
q6 Intraarticulo corticosteroid for monoarticular, Not NSAID if ckd
q42 start allopurinol and continue with colchicine, do not discontinue
renal stone increased by probenevid
2016 acp reports lack of evifency , tret to avoid , however eular and acp treat to target
q59 continue colchicine, continue, if tophi for 6 months, 3 months if no tophi
q66 low fat dairy, no green leafy has purine
also decrease fructose soft drink--obesity itself is risk factor
q85 losartan 0.81, CCB .87 (74 percent have hypertension comorbidity) 25k/50k
q93-CPPD like OA w activitiy however non traditional-like wrist and shoulder, negative rf, esr, crp
Effusion and chondrocacinosis
Q48 basic cppd deposition-miluwakee alizarid red, positive blood, wbc negative crystal negative bifriengent negative LM, negative polarized, calcification of cartilatge/erosis, h head decreased narrowing glenohumeral, 77female rotator injury-upward subluxation
11 Infectious arthiritis
Q49 synovial fluid negative, blood culture, cervical culture, throat and skin and diffuse gonorrhea 4 percent ,
Dermatitis-vesicular pustular hem,
Tenosynovitis-non purulent arthiritis
Q34 serology lyme , nalso negative synovial fluid, stiffness, negative joint pain ,,spare axial
q79-OA like non specific, TB hip erosive knee , patient started on tnf alfa blocker reactivation
Q30 hepatitis B -hand arthiritis symmetric, rapid, core and surgace antigen also has rash , |
has liver function change npt in PBC and autoimmune
q19-NSAID ibuprofen sufficient for b19 parvo virus
Q65 synovial culture either OR surgical intervention or needle /blood culture even without fever in prosthetic joint
12 Inflammatory myopathy
Q4 amyopathic-no weakness dermato -helitrope eye , LE skin between joint extensor gotton, light sensitive eruption poikilo shawl
Q14 anti jo1 -get cxr t rna synthetase-monitor for ild pah poor prognosis not leave alone if aymptomatic
Q63 Transvaginal pelvic ultrasound 10.5 ovarian ca , vasculitis, lung , cervical , pancreast first 2 years
Q36 LFT AST increase IBM 0distal grip along with proximal -insidious in old male compare to sub/acute EMG changes, Diffrence CK normal no extrain 15 percent aymptomatic
Q28 prednisone even without 1mg/kg/day
edited by on 3/25/2019
patient with
Fibromyalgia Sibo malabsobtion had truncal vagotomy such fancy procedure
Ehler danlos- Ent doing some simulator
Hemochromatosis patient h63d with migraine Hypermobility
Long qtc psoriasis
Xlimelts cppd Sjögren oa patirnf
13 vasculitis
q17 prednisone 60mg 1mg/dau if jaw pain with PMR symptoms , 2 weeks can wait with good yield
q44 15mg 10-20 mg for PMR 1-3 yrs may need slow taper
q77 aortic arteriography takayasu febrile illness, arm pain with use, walking, abdominal aorta bruit
q64 PAN hepatitis B , Mono neuritis , testicular pain
bruits also
Fever, Renal artery blood flow-creatitine with
no urine sediment difference HSP and glomerulonephritis wegner and GPA
q75 -intra angiography and biopsy for PACNS with recurrent headaches, negative CVA and encephalomalacia
only then treat with cyclophosphamide
Q83 Negative MPO , 3 protienase
Q27 EGPA , Eosinphillic granulomatous, ESR [psotove, WBC positive fever 100.4
40 percent negative ANCA, positive for neurological, positive rash , decrease weakness, PP, Lungs
Q47 cryoglobulinema, ear infreaction, fingertip, Urine, monoclonal SPEP, C4 decrease, positive neuro Wrist-strength, drecreas
Q7 prednisone for HSP in Adults severe with organ system abdominal tenderness worsens , UA with casts , GI occult blood positive,only if mild treat with dapsone
Q40 discontinue bactrim TMP Smx for uti if Hypersensitivity vasculitis
Do not biopsy leukocytoclastic vasculitis
Chapter 14
Systemic sclerosis
Q53 Limited Lsc Face neck , nodule 10-25 percent have negative ana , centromere 15-40 percent
PAH ,
Diffuse sclreoderma 15-40 percent prevalence, topoisomerase if negative rna polymerase
U3 rnp male black patient , pmscl and th
MSK-joint erosion-overlap with RA-mtx arava, Has myositis
Vacular-ccb, topical , endothelin
Q73 just for raynauds observation, derm no ANA , 30 percent white
GI 70 percent proximal dysphagia esophagus, stomach , angiodyspasia-uuper end gast vasogenic ecstasis, anemia watermelon stomach
Hydrogen breath test-small bowel not in colonoscopy
Bloating-loos stool
Q88 Kidney 50percent protein uria headache vision changes, nausea , scleroderma renal crisisi captopril
Encephalopathy-propt treatment of mild hypertension, unexplained creatitine
Urine protein/creatitis AKI MAHA hemlytic anemia, thrombocytipenia and pulmonary edema , oligo uric
Q24 NSIP-pUlmonary biopsy -oxygen 6 minute walk test 70 percent pulmonary >>IV or oral cyclosporine / azathiopurine
RHC >treat with PDE5 sidenafil or endothelin blocker like bosentan or prostacyclin apoprostes, epoprostenosl, trep
Q13 fatigue >anca PAH -Dopper ECHo before RHC , vq scan , sleep study
Q91-cardiomyopathy ssc with coronary vasospasm-pathchy areas, 75 percent mortality in 5 years
edited by on 3/25/2019
Saw patient with GCA possible , shoulder hip pathology
-SLE 2 with nephrotic-AKI
my pt with Diffuse Ssc now with AKI
6 more questions left for mksap completion
Others
q71 bechet recurrent oral ulcer PAINFUL q1-3 weeks +eye with hyppyon, posterior uveitis, life threatening reinal vasculitis, SKIN with acneiform-pathergy
not reactive -less-pain , genital ulcer keratotic not ulcerative
Q70 AOSD stills disease -tamaguchi-fever -join, rash maculopapular-MAJOR needs 2 and
3 minor-speen/LN and LFT changes-high Nuetrophill to 30k rule out malignancy and infection,-ferritin-macropages
q22 cochicine for FHF-Mutation in MEF1 gene-recurrent abdominal pain (polyserosisitis) q3 months, fever , arthiritis, nee with weeks-ESR 84 WBC 16 w neutrophills
also rash-eryspeiloid-foot cellulitis
after cochicine-inflammasome-AA amylodosis risk IL1 related-Anakinra is second line
Q57 Lofgren-Naproxen and >>low dose steroid colchicine
not high dose steroid
Triad 95 perspecific, other not needed-Hilar LN, Erythema nododsum and
Ankle-periarhthiritis, sof tissue enthesitis, Tenosynovitis
Q29 ECHO aortic root evalation-dilation-regurgitation for initial marfan
q6 months or if >4.5 cm
Q51 igg4 plasma>LN lacrimal gland-sailvary below jaw, Male>50 mostly , Orbital Proptosis-pseudodumour or perioartic biopsy- Fibprosis storiform obliterateive phlebitis only 70 percent ig g4 antibody positive
26 - saw pt with trigemminal neuralgia ?gca
Multiple myeloma in family member did 3 hem q and video
Followed up my rotator cuff / hip pain patient with jaw locking ? Gca pt neg temp biopsy pmr ??
Saw pt with Sjögren, sle avn versus chronic osteomyelitis , mycobacterium given rituximab
Clinic saw sle lupus cerebritis 5 proteinuria on cytoxane patient
On q7 of uw qbank rheum of 96 q
Did
edited by on 3/27/2019
1 Did joint tap /Melanoma/ polygammapathy, LN Igg4
ANA 2008 negative then positive for anti DNA 117 95 dsdna
2 psoriatic methotrexate embrel
3 rf ccp -plaquenil mtx
4 hypermobility patient , oa healthcare
5 ild with rf ana rnp pft for immunosupression
6 sle with celiac disease Anti-RNP-70 240 Anti-U1RNP 240 nodules patient said thanks , ur welcome>any significance with RF asked as family history
ip7 avn short visit rituximab mycobaterium infection chronic osteomyelitis
ip 8 f/u RA patient flare with rotator cuff tear Gluteal tendonitis
ip9 Complex regional pain triple-phase bone scintigraphy which is possibly psoriatic enthesopathy and autoimmune change
dry mouth Raynaud adrenal fatigue recurrent labial rash,Gluteral area nodule, PIP, DIP diarrhea, abdominal pain, nausea vomitting staph antibiotics 3 weeks foot ankle foot drop upper motor neuron PAN MR head, spine and EMG
2 lyme positive, C4 Complement (3/9/12): 14.6 (Low) CT angio PAN- EMG to rule out mononeuritis multiplex of Rt leg- celiac disease serology leukopenia and TCPenia
edited by on 3/29/2019
Saw Patient with antisynthetase syndrome antijo1
Pulmonary hypertension on Letairis, Riociguat
Eosinophillia?Aspergillosis
05/07 starting my board prep again
Done with awesome review course
Will start updating again
Endocrinology now
Endocrine 1 - Pituitary 40:07
Endocrine 2 - Calcium & Bone 32:40
Endocrine 3 - Adrenal 26:21
Endocrine 4 - Thyroid 22:35
Endocrine 5 - Diabetes 25:38
Endocrine 6 - Reproductive 15:55
MKSAP 84 Answered
UW Endocrine, Diabetes & Metabolism 104
April 20, 2019 S1: Endocrinology
Even though it was 30 mins- did calcium disorders and then spent more 30 mins doing thyroid disorders
Today am short call intend on studying more , will keep updating till test day
Done with residency, have to be done by aug 16th abim so can start my job aug 19th
doing awesome review
Goal this week endocrine,rheumatology and hematology
Doing awesome review Thyroid Disorders
update Vitamin D PTH d/o
edited by on 7/6/2019
Doing Uworld Endocrine, Will complete both blocks and Mksap board basics today
Will start posting Videos on youtube , Every King started somewhere
Today would be last day of Endocrine
Thyroid D/o
Bone d/o
Hormone d/o
left
Will start
Done with Endocrine y;day , submitted hard work in hopes of some acknowledgement
Started Hem/Onc
Will do UW q's Today
Doing Awesome review hematology first and then do UW Hem Onc Q's
1 month to exam, today at stanford. Will complete oncology from Awesome review and start w UW Oncology
Studying Hematology , Hopefully be able to finish >Done w Awesome, Done w Medquest
Running behind schedule Rheum/Cardiology this week
Trying my best >Start UW now
At Stanford , starting new day w UW Hem/Onc questions. Hoping to be done w everything today and start Rheum v/s Cardio tomorrow
doing hem onc still, many questions to go >probably will get done today
I am very slow, taking forever
Still many topics left
will skip rheum and start cardiology
Focus on self
Starting Cardiology today
Awesome review Videos
Medquest videos
UW
pages:
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