ANA → screening test for SLE. Most specific for SLE is anti-Smith, followed by anti-
dsDNA.
Anti-dsDNA is often seen in patients with lupus nephritis.
Anti-histone → Drug induced lupus (most common drugs are Procainamide,
Hydralazine, INH, PTU, Minocycline, and Methyl-Dopa)
Anti-CCP → most specific antibody for Rheumatoid Arthritis
Anti- SSA (Ro) and Anti SSB (La) → commonly seen in Sjogren’s Syndrome. NOTE:
Anti-SSA (Ro) can lead to a newborn having complete heart block
Diffuse systemic sclerosis (Scleroderma) → anti-SCL 70 (anti-topoisomerase 1)
CREST syndrome → anti-centromere
Polymyositis/Dermatomyositis → anti Jo-1
Mixed Connective Tissue Disease → anti RNP
Pearl # 4: Interpretation of joint effusion plays a critical role in establishing diagnosis
WBC of 200-2000 in joint effusion-non-inflammatory conditions like Osteoarthritis
WBC of 5000-50,000 in joint effusions-inflammatory conditions like RA, gout,
pseudogout, or trauma
WBC >50,000 → likely septic arthritis
With gout, inflammatory joint effusion will be seen. Additionally, monosodium urate
crystals will be present and negative birefringence is present
With pseudogout, inflammatory joint effusion will be suspected. Calcium
pyrophosphate crystals will be seen and positive birefringence will be present
With septic arthritis, if patient is less than 40 years of age, the likely causative agent is
Neisseria gonorrhea and treatment is with Ceftriaxone. In patients more than 40 years
of age, likely causative agent is Staph aureus and treatment is with Nafcillin for MSSA
or Vancomycin for MRSA.
NOTE: Never start uric acid lowering agent in an acute gouty attack AND never
discontinue uric acid lowering agent if patient already on a uric acid lowering agent in
an acute attack.
Goal uric acid level to prevent further attacks of gout should be less than 6 mg/dl.
70 | P a g e
K N O W M E D G E
In an acute attack, checking a uric acid level has no diagnostic value.
Pearl # 5: Seronegative Spondyloarthropathies (HLA B27+ and Rh factor negative)
HLA B27 is NEVER used in the diagnosis of the seronegative spondyloarthropathies
Mnemonic to remember the different seronegative spondyloarthropathies is “PEARR”
o P – Psoriatic arthritis
o E – Enteropathic arthritis
o A – Ankylosing Spondylitis
o R – Reactive arthritis
o R – Reiter Syndrome → causative agent is Chlamydia. Triad of urethritis, uveitis,
and arthritis (Can’t pee, can’t see, can’t climb a tree)
71 | P a g e
K N O W M E D G E
Bonus: How to study for and pass the ABIM board exam
By: Dr. Ravi Bhatia
As the ABIM internal medicine certification exam approached, we received a large number of
emails from our subscribers asking for suggestions on the best way to study for the boards.
The truth is there is no one path to success though there are certainly ways to increase your
likelihood of passing. Regardless of whether you are preparing for board certification or trying
to achieve maintenance of certification (MOC), the best tried and true overall method is to
“study early and study often.” Below we lay out possible strategies and tactics (in no particular
order) for passing the ABIM board exam:
1. Know the basics of the Internal Medicine board exam
It may seem obvious but a lot of people simply don’t review this prior to starting their exam
preparation and instead rely on their ABIM study source of choice to provide the information.
Review the ABIM exam blueprint and understand the topics covered on the exam
A large percentage (33%) of the exam is comprised of Cardiovascular Disease,
Gastroenterology, and Pulmonary Disease
Over 75 percent are based on patient presentations – most take place in an outpatient
or emergency department; others are primarily in inpatient settings such as the
intensive care unit or a nursing home.
While it’s not a big part of the exam, be prepared and expect to interpret some pictorial
information such as electrocardiograms, radiographs, and photomicrographs (e.g.,
blood films, Gram stains, urine sediments).
2. Use the in-training exam as a starting gauge
If you are a resident, the Internal Medicine in-training exam is a good starting point to see
where you stand. It’s simply that – a barometer of where you stand. It will give you an idea
where you may be weak and where you may be pretty strong. It will also give you an idea of
how you compare with your peers. Don’t alter your ABIM study plan simply based on it but it
does give you an early metric of the areas you need to focus on.
72 | P a g e
K N O W M E D G E
3. Get a study guide to prepare for the ABIM exam
It’s important to have a good study guide that is tailored for the exam. Some of the more
popular and effective guides we’ve come across are the MedStudy Internal Medicine Board
Review books and Harrison’s Principles of Internal Medicine Board Review.