sunir-kumar

Sunir Kumar, MD

Dr. Sunir Kumar is a co-Founder of Knowmedge.com, a medical exam prep company. Sunir is a Board Certified Internist at the Cleveland Clinic in Cleveland, OH. Dr. Kumar graduated medical school from St. Matthews University and completed his internal medicine residency at the Mercy Hospital and Medical Center in Chicago, IL. Sunir can be reached at sunir@knowmedge.com or on twitter (@SunirMD)

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5 High-Yield Gastroenterology Pearls for the ABIM Board and Medical Clerkship Exams

As we mentioned in a previous blog post this week, Gastroenterology and Hepatology comprises about 9% of the ABIM Internal Medicine exam, making it one of the more critical subjects on the boards. Below, we review 5 High Yield Gastroenterology/Hepatology Pearls that may help you score a few extra points on your ABIM or Internal Medicine shelf examination.   1. Interpreting Hepatitis B markers seems like a pain but is worth remembering Start with these key points: o Hepatitis B surface Antigen (HbsAg) → active infection o Hepatitis B surface Antibody (HbsAb) → past infection or vaccination against hepatitis B o Hepatitis Be Antigen (HbeAg) → active replication of the virus o Anti Hepatitis B core IgM Antibody (Anti-HBc IgM) → acute infection o Anti Hepatitis B core IgG Antibody (Anti-HBc IgG) → chronic infection This table helps reinforce these rules: (Click above image to view larger size) As you see above: Along with the Cleared state, both Chronic and Carrier Hepatitis B patients will have positive HBsAg and Anti-HBc IgG. How can these two conditions be differentiated? Easily. Just look at the Liver function tests (LFTs) o Chronic → Increased LFTs o Carrier → Normal LFTs What about that Hepatitis D virus? o Hepatitis D can’t exist on its own. It requires Hepatitis B infection to be present o Anti-Hbc IgM + Hepatitis D virus → acute co-infection...

5 Endocrinology Pearls for the Internal Medicine Shelf and ABIM Board Exam

Endocrinology is an essential part of the Internal Medicine Medical Clerkship and ABIM Board exam. According to the ABIM exam blueprint, questions testing endocrinology topics comprise ~8% of the exam. Approximately ~5-10% of the NBME Clerkship exam is composed of endocrinology questions.   1. Don’t let thyroid nodules intimidate you. Check out the following post ABIM Exam Prep: How to Work Up a Thyroid Nodule This systematic approach will help you workup a thyroid nodule.   2. Workup of hirsutism is not as difficult as it seems. Follow this approach and you will be able to diagnose the cause of hirsutism. – Hirsutism is caused by either excessive testosterone or excessive 17-OH steroids (DHEA-S) production. – Excessive Testosterone production is seen in ovarian cancer or polycystic ovarian syndrome (PCOS)Ovarian cancer: worked up with trans-vaginal ultrasound to look for adnexal mass. In addition, CA-125 marker is usually elevated in ovarian cancer. – PCOS: Amenorrhea, insulin resistance, and LH:FSH ratio of greater than equal to 3:1 – Excessive DHEA-S production is seen in congenital adrenal hyperplasia (CAH), Cushing’s disease, or adrenal carcinoma – CAH: Usual cause is 21 beta hydroxylase deficiency, which is used to convert 17-OH progesterone to cortisol. Since this enzyme is deficient, 17-OH progesterone levels remain elevated. Decreased cortisol levels will cause an elevated ACTH level through a negative feedback mechanism. With increased ACTH, hyperpigmentation will also occur. – Cushing’s...

Know these 7 Vaccinations for the Boards and Shelf Exams, No Matter What Jenny McCarthy Says

While most of the ABIM Examination topics fall neatly into organ system categories, not all of them fit into this schematic. These include: primary care screening guidelines, substance abuse, vaccinations, etc. Here at Knowmedge, we’ve incorporated this important group of subject areas into General Internal Medicine, similar to the American College of Physicians’ Internal Medicine In-Training Exam Blueprint. Earlier this week, we reviewed the 5 key eye diseases seen on the ABIM board and NBME shelf exams. Today we explore the high-yield topic of vaccinations.   A comprehensive adult immunization schedule, by Vaccine and Age Group, can be found on the Centers for Disease Control and Prevention website (unlike other preventive health measures, vaccination guidelines are not released by the USPSTF). Fortunately, you don’t need to memorize the entire CDC chart. Instead, for the ACP Internal Medicine in-training exam, ABIM boards and NBME shelf exam, focus on these 7 vaccinations:  1. Tetanus, diphtheria, pertussis (Tdap) – Administer Tdap to all adults who have not previously received Tdap or whose vaccination status is unknown. – Boost with Td every 10 yrs.   2. Influenza – All individuals age 6 months and older should be vaccinated yearly since the targeted influenza strains changes on a yearly basis.   3. Herpes zoster (Shingles) – Adults 60 years of age and older should receive a single dose of the zoster vaccine. This is regardless of whether the patient has had...

5 Must-Know Eye Conditions for any Opthalmology Exam

While most of the ABIM Examination topics fall neatly into organ system categories, not all of them fit into this schematic. These include: ophthalmology, primary care screening guidelines, vaccinations, etc. Here at Knowmedge, we’ve incorporated this important group of subject areas into General Internal Medicine, similar to the American College of Physicians’ Internal Medicine In-Training Exam Blueprint. Today, in this first of a series of blogs, we review the key eye diseases: Conjunctivitis, Macular Degeneration, Glaucoma, Retinal Detachment, and Cataracts. The eyes may see only what the mind knows, but your mind should know these eye conditions for the ABIM exam. The exam is several months away so go ahead and bookmark this page so you can quickly review it once more in the days before you obtain your certification or recertification.   1. Conjunctivitis Conjunctivitis is broken down into viral, bacterial, and allergic conjunctivitis Viral • Usually caused by adenovirus • Having a preceding upper respiratory infection or recent exposure to a person with conjunctivitis are clues to aid in the diagnosis • Acute onset • Usually unilateral redness • Watery discharge is present • Highly contagious • Frequent hand washing must be performed to prevent spread of infection • Supportive treatment including cold compresses and artificial tears. NO role for antibiotic eye drops with viral conjunctivitis   Bacterial • Common causing agents are Staph aureus, Streptococcus pneumoniae,...