High -Yield Internal Medicine Board Exam Pearls by Knowmedge - HTML preview

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Ulcerative Colitis

o Presents with abdominal pain and bloody diarrhea that is chronic

o Problem starts in the rectum and spreads proximally (backwash ileitis)

o Pathology reveals superficial ulcers with crypt abscesses

o Some common extra-intestinal manifestations include:

 Aphthous ulcers

 Pyoderma gangrenosum

 Primary sclerosing cholangitis

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 Ankylosing spondylitis

 Arthritis (mirrors Ulcerative Colitis)

 Erythema nodosum (mirrors Ulcerative Colitis)

o Can show positive p-ANCA on labwork

o Colonoscopy should be performed 8 years after diagnosis and then every 1-2

years afterwards as patients with UC have an increased risk of colon cancer

 If dysplasia is seen on colonoscopy, total proctocolectomy should be

performed

Crohn’s Disease

o Rectum is spared with Crohn’s Disease. Crohn’s Disease occurs mainly in the

terminal ileum (Skip lesions are common)

o Common presentation is right lower quadrant mass, weight loss, and diarrhea

(can be bloody but can also be watery)

o Pathology will show deep ulcers with granuloma formation

o Not as common to see extra-intestinal manifestations with Crohn’s Disease as

is seen in patient with UC

o Colon cancer can occur but is more common in UC patients

o Can show positive ASCA (anti-Saccharomyces Cerevisiae antibodies) on

labwork

o Colonoscopy should be performed 8 years after diagnosis and then every 1-2

years

 If dysplasia is seen on colonoscopy, total protocolectomy should be

performed

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Gastroenterology Pearls: Digestive Tract in 7 Major Parts

By: Dr. Ruchi Bhatia

As previously mentioned, the Gastroenterology and Hepatology section of the ABIM Internal

Medicine exam comprises of about 9% of the entire exam - that means out of 240 total questions (4 sections of 60 questions each), we can expect about 20 questions to be geared

towards our liver and GI tract. For the Internal Medicine Shelf Exam, Gastroenterology comprises 7-13% of the exam.

Overall, the digestive system is fascinating (the liver itself is the largest organ in the body and

performs over 500 functions!) yet quite simple (think of it this way – food goes in to the mouth,

down the esophagus and in to the stomach, through 26 feet of small intestine in to the colon.

Then out.)

To simplify for the ABIM exam, let’s divide the digestive tract in to 7 major parts and discuss

a couple important topics in each – Esophagus, Stomach, Pancreas, Biliary Tract, Small

Bowel, Colon, and Liver.