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FOCUSED PRACTICE in HOSPITAL MEDICINE Maintenance of Certification (MOC) Examination Blueprint
® FOCUSED PRACTICE IN HOSPITAL MEDICINE Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Purpose of the Hospital Medicine MOC exam Hospital Medicine MOC exam blueprint The MOC exam is designed to evaluate the knowledge, Based on feedback from physicians that MOC assessments diagnostic reasoning, and clinical judgment skills expected of should better reflect what they see in practice, in 2016 the the certified hospitalist in the broad domain of the discipline. American Board of Internal Medicine (ABIM) invited all certified The exam emphasizes diagnosis and management of prevalent hospitalists and those enrolled in the focused practice program conditions, particularly in areas where practice has changed to provide ratings of the relative frequency and importance of in recent years. As a result of the blueprint review by ABIM blueprint topics in practice. diplomates, the MOC exam places less emphasis on rare This review process, which resulted in a new MOC exam conditions and focuses more on situations in which physician blueprint, will be used on an ongoing basis to inform and intervention can have important consequences for patients. update all MOC assessments created by ABIM. No matter For conditions that are usually managed by other specialists, what form ABIM’s assessments ultimately take, they will need the focus is on recognition rather than on management. The to be informed by front-line clinicians sharing their perspective exam is developed jointly by the ABIM and the American on what is important to know. Board of Family Medicine. A sample of over 100 hospitalists, similar to the total invited Exam format population of hospitalists in age, gender, geographic region, and time spent in direct patient care, provided the blueprint The traditional 10-year MOC exam is composed of 220 single- topic ratings. -
Pilonidal Disease
Pilonidal Disease What is pilonidal disease and what causes it? Pilonidal disease is a chronic infection of the skin in the region of the buttock crease (Figure 1). The condition results from a reaction to hairs embedded in the skin, commonly occurring in the cleft between the buttocks. The disease is more common in men than women and frequently occurs between puberty and age 40. It is also common in obese people and those with thick, stiff body hair. Figure 1: Pilonidal disease is a chronic skin infection in the buttock crease area. Two small openings are shown (A). What are the symptoms? Symptoms vary from a small dimple to a large painful mass. Often the area will drain fluid that may be clear, cloudy or bloody. With infection, the area becomes red, tender, and the drainage (pus) will have a foul odor. The infection may also cause fever, malaise, or nausea. There are several common patterns of this disease. Nearly all patients have an episode of an acute abscess (the area is swollen, tender, and may drain pus). After the abscess resolves, either by itself or with medical assistance, many patients develop a pilonidal sinus. The sinus is a cavity below the skin surface that connects to the surface with one or more small openings or tracts. Although a few of these sinus tracts may resolve without therapy, most patients need a small operation to eliminate them. A small number of patients develop recurrent infections and inflammation of these sinus tracts. The chronic disease causes episodes of swelling, pain, and drainage. -
Consultative Comanagement (15%)
Consultative Comanagement (15%) Focused Practice in Hospital Medicine (FPHM) Where Can I Find this topic Blueprint Topic: covered in MKSAP 17? Perioperative Medicine (12.5%) Cardiology Endocarditis prophylaxis MKSAP 17 Cardiovascular Medicine Perioperative risk-stratification MKSAP 17 General Internal Medicine Perioperative arrhythmias MKSAP 17 Cardiovascular Medicine; MKSAP 17 General Internal Medicine Pulmonology Perioperative asthma management MKSAP 17 Pulmonary and Critical Care Medicine; MKSAP 17 General Internal Medicine Perioperative chronic obstructive pulmonary disease MKSAP 17 Pulmonary and Critical Care management Medicine Postoperative hypoxia MKSAP 17 Pulmonary and Critical Care Medicine Hematology Perioperative anticoagulation and antiplatelet therapy MKSAP 17 General Internal Medicine Perioperative deep venous thrombosis prophylaxis MKSAP 17 General Internal Medicine Endocrinology Perioperative diabetes mellitus management MKSAP 17 General Internal Medicine Perioperative stress-dose corticosteroid management MKSAP 17 General Internal Medicine Perioperative thyroid management and thyroid storm MKSAP 17 General Internal Medicine; MKSAP 17 Endocrinology and Metabolism Perioperative and postoperative infections MKSAP 17 Infectious Disease Neurology Postoperative delirium MKSAP 17 Neurology Compressive neuropathies MKSAP 17 Neurology Pregnancy (2.5%) Hypertension in pregnancy (pre-eclampsia and eclampsia) MKSAP 17 Nephrology MKSAP 17 Pulmonary and Critical Care Asthma and pregnancy Medicine Hyperthyroidism during pregnancy or -
For Sexual Health Care of Clinical
Clinical Guidelines for Sexual Health Care of Men Who Have Sex with Men Clinical ...for Sexual Health Care of IUSTI Asia Pacific Branch The Asia Pacific Branch of IUSTI is pleased to introduce a set of clinical guidelines for sexual health care of Men who have Sex with Men. This guideline consists of three types of materials as follows: 1. The Clinical Guidelines for Sexual Health Care of Men who Have Sex with Men (MSM) 2. 12 Patient information leaflets (Also made as annex of item 1 above) o Male Anogenital Anatomy o Gender Reassignment or Genital Surgery o Anogenital Ulcer o Genital Warts o What Infections Am I At Risk Of When Having Sex? o Hormone Therapy for Male To Female Transgender o How To Put On A Condom o Proctitis o What Can Happen To Me If I Am Raped? o Scrotal Swelling o What Does An STI & HIV Check Up Involve? o Urethral Discharge 3. Flip Charts for Clinical Management of Sexual Health Care of Men Who Have Sex with Men (Also made as an annex of item 1 above) The guidelines mentioned above were developed to assist the following health professionals in Asia and the Pacific in providing health care services for MSM: • Clinicians and HIV counselors who work in hospital outpatient departments, sexually transmitted infection (STI) clinics, non-government organizations, or private clinics. • HIV counselors and other health care workers, especially doctors, nurses and counselors who care for MSM. • Pharmacists, general hospital staff and traditional healers. If you would like hard copies of the set of clinical guidelines for sexual health care of Men who have Sex with Men, please contact Dr. -
Practice Parameters for the Management of Pilonidal Disease Scott R
PRACTICE PARAMETERS Practice Parameters for the Management of Pilonidal Disease Scott R. Steele, M.D. • W. Brian Perry, U.S.A.F., M.C. • Steven Mills, M.D. W. Donald Buie, M.D. Prepared by the Standards Practice Task Force of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Surgeons were also performed in selected circumstances. Although is dedicated to ensuring high-quality patient care not exclusionary, primary authors focused on all English Tby advancing the science, prevention, and man- language manuscripts and studies of adults. Recommen- agement of disorders and diseases of the colon, rectum, dations were formulated by the primary authors and re- and anus. The Standards Committee is composed of So- viewed by the entire Standards Committee. The final grade ciety members who are chosen because they have dem- of recommendation was performed by using the Grades of onstrated expertise in the specialty of colon and rectal Recommendation, Assessment, Development, and Evalua- surgery. This Committee was created to lead internation- tion (GRADE) system (Table 1).1 al efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best STATEMENT OF THE PROBLEM available evidence. These guidelines are inclusive, and Pilonidal disease is a potentially debilitating condition not prescriptive. Their purpose is to provide information affecting 70,000 patients annually in the United States on which decisions -
Peritonsillar Abscess NICHOLAS J
Peritonsillar Abscess NICHOLAS J. GALIOTO, MD, Broadlawns Medical Center, Des Moines, Iowa Peritonsillar abscess is the most common deep infection of the head and neck, occurring primarily in young adults. Diagnosis is usually made on the basis of clinical presentation and examination. Symptoms and findings generally include fever, sore throat, dysphagia, trismus, and a “hot potato” voice. Drainage of the abscess, antibiotic therapy, and supportive therapy for maintaining hydration and pain control are the cornerstones of treatment. Most patients can be managed in the outpatient setting. Peritonsillar abscesses are polymicrobial infections, and antibiotics effec- tive against group A streptococcus and oral anaerobes should be first-line therapy. Corticosteroids may be helpful in reducing symptoms and speeding recovery. Promptly recognizing the infection and initiating therapy are important to avoid potentially serious complications, such as airway obstruction, aspiration, or extension of infection into deep neck tissues. Patients with peritonsillar abscess are usually first encountered in the primary care outpatient setting or in the emergency department. Family physicians with appropriate training and experience can diagnose and treat most patients with peritonsillar abscess. (Am Fam Physician. 2017;95(8):501-506. Copyright © 2017 American Acad- emy of Family Physicians.) CME This clinical content eritonsillar abscess is the most Etiology conforms to AAFP criteria common deep infection of the Peritonsillar abscess has traditionally been for continuing medical education (CME). See head and neck, with an annual regarded as the last stage of a continuum CME Quiz Questions on incidence of 30 cases per 100,000 that begins as an acute exudative tonsil- page 483. Ppersons in the United States.1-3 This infec- litis, which progresses to a cellulitis and Author disclosure: No rel- tion can occur in all age groups, but the eventually abscess formation. -
Horseshoe Abscesses in Primary Care
CASE REPORT Horseshoe abscesses in primary care Jeremy Rezmovitz MSc MD CCFP Ian MacPhee MD PhD FCFP Graeme Schwindt MD PhD CCFP norectal abscesses are a common presentation in metformin, gliclazide, atorvastatin, and low-dose primary care. While most abscesses are mild and acetylsalicylic acid. can be treated effectively with incision and drain- On physical examination, the patient was in no Aage, unrecognized anorectal abscesses might cause sep- distress. He was obese (body mass index of 35 kg/m2) sis and ultimately require surgery if left untreated.1-4 In this and afebrile, his blood pressure was 143/75 mm Hg, case, we demonstrate the importance of recognizing the and his heart rate was 99 beats/min and regular. evolution of symptoms in the face of an unusual presenta- Findings of a digital rectal examination (DRE) dem- tion of perianal pain not responding to medical treatment. onstrated multiple nonthrombosed external hemor- rhoids and a normal-sized but exquisitely tender Case prostate. He was diagnosed clinically with prostati- A 68-year-old man presented to his family physician tis. Investigations were ordered, including complete with a 3-day history of gradual difficulty in passing blood count and urine testing for culture, gonorrhea, urine and stool. While the patient was able to pass and chlamydia; the results showed no abnormality gas, he was finding it painful to walk owing to rectal except a white blood cell count (WBC) of 9.2 × 109/L, discomfort and reported 1 day of “chills.” He denied the upper limit of normal. A 14-day course of sulfa- hematuria, hematochezia, dysuria, nausea, vomiting, methoxazole (800 mg) and trimethoprim (160 mg) or fever, and had no history of sexually transmitted was prescribed, and the patient was asked to return infections. -
Evidence-Based Management of Skin and Soft-Tissue Infections In
VISIT US AT BOOTH # 203 AT THE ACEP PEDIATRIC ASSEMBLY IN NEW YORK, NY, MARCH 24-25, 2015 February 2015 Evidence-Based Management Volume 12, Number 2 Authors Of Skin And Soft-Tissue Jennifer E. Sanders, MD Pediatric Emergency Medicine Fellow, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Infections In Pediatric Patients New York, NY Sylvia E. Garcia, MD Assistant Professor of Pediatrics and Pediatric Emergency In The Emergency Department Medicine, Icahn School of Medicine at Mount Sinai, New York, NY Abstract Peer Reviewers Jeffrey Bullard-Berent, MD, FAAP, FACEP Skin and soft-tissue infections are among the most common condi- Health Sciences Professor, Emergency Medicine and Pediatrics, University of California – San Francisco, Benioff tions seen in children in the emergency department. Emergency de- Children’s Hospital, San Francisco, CA partment visits for these infections more than doubled between 1993 Carla Laos, MD, FAAP and 2005, and they currently account for approximately 2% of all Pediatric Emergency Medicine Physician, Dell Children’s Hospital, Austin, TX emergency department visits in the United States. This rapid increase CME Objectives in patient visits can be attributed largely to the pervasiveness of community-acquired methicillin-resistant Staphylococcus aureus. The Upon completion of this article, you should be able to: 1. Describe the pathophysiology of community-acquired emergence of this disease entity has created a great deal of controver- methicillin-resistant Staphylococcus aureus. sy regarding treatment regimens for skin and soft-tissue infections. 2. Differentiate the clinical presentation of common skin and soft-tissue infections. This issue of Pediatric Emergency Medicine Practice will focus on the 3. -
Peritonsillar Abscess
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of Missouri: MOspace Peritonsillar Abscess Background 1. Definition o Extension of tonsillar infection beyond the capsule with abscess formation usually above and behind the tonsil 2. Almost always a complication of acute tonsillitis 3. Most common deep head/neck infection (50%) 4. Also known as "Quinsy" 5. Peritonsillar cellulitis o Extension of tonsillar infection beyond the capsule without abscess Pathophysiology 1. Pathology of disease o Infection that starts as acute tonsillitis and results in abscess o Most often Group A Strep1 o Cultures of abscesses often grow anaerobes (Fusobacterium, Prevotella, Veillonella spp)1 o H. flu, S. aureus occasionally cultured alone o Inflamed areas . Supratonsillar space of soft palate Just above superior pole of tonsil . Surrounding muscles Esp. internal pterygoids o Pus collects between fibrous capsule of tonsil and superior pharyngeal constrictor muscle 2. Incidence, prevalence o Most commonly seen in adults age 15-30 o Estimated incidence in USA: 30/ 100,000 people/ year 3. Risk factors o Tonsillitis o Acute or chronic oropharyngeal infection o 15% with antecedent Infectious Mono, seen by monospot test2 o Prior tonsillar infection 36% o Smoking 4. Morbidity/ mortality o Airway obstruction o Septicemia o Thrombophlebitis (Lemierre's Syndrome) - spread of infection to carotid sheath which may lead to spread of infection to lungs, mediastinum o Aspiration pneumonia subsequent to rupture of abscess into an airway Diagnosis 1. History o Headache, malaise o Severe sore throat . Worsens, becomes unilateral o Dysphagia Peritonsillar Abscess Page 1 of 6 10.26.09 o "Hot potato" muffled voice o Trouble fully opening mouth o Neck pain / swelling . -
Pilonidal Sinus Disease - a Literature Review
Review Article World Journal of Surgery and Surgical Research Published: 10 Apr, 2019 Pilonidal Sinus Disease - A Literature Review Lim J and Shabbir J* Department of Colorectal Surgery, University Hospital Bristol, UK Abstract Pilonidal Sinus Disease (PSD) is a common condition that has had controversies surrounding its aetiology and treatment since its first description in the mid-19th century. The prevalence in the UK has been estimated at 0.7% with peak age of incidence at 16 years to 25 years. Males are more commonly affected than females and risk factors include stiff body hair, obesity, and a bathing habit of less than two times a week, and a sedentary occupation or lifestyle (i.e. those who sit for more than six hours a day). Pilonidal sinus disease is best managed by specialists with an interest in the disease such as a colorectal or plastic surgeon experienced in treating recurrent cases. Emergency treatment should primarily consist of off-midline incision and drainage with subsequent referral to a specialist should the condition recur. The aim of this article is to summaries the current practice for treatment of pilonidal sinus disease including difficult modalities used and their limitations. Introduction Pilonidal Sinus Disease (PSD) was previously referred to as Jeep disease when it was noticed amongst American soldiers driving the eponymous vehicles in World War II [1]. It is a common condition that has had controversies surrounding its aetiology and treatment since its first description in the mid-19th century [2]. Due to its high recurrence rate, PSD has previously been ascribed to a congenital origin such as a caudal remnant of the neural tubeor sequestered ectodermal tissue during development [3,4]. -
Pediatrics CAQ Blueprint
Pediatrics CAQ Blueprint Content Area Percentage 1. Health Maintenance 10 2. Cardiovascular Disorders 6 3. Pulmonary Disorders 6 4. Endocrine Disorders 5 5. Eyes, Ears, Nose, and Throat 7 6. Gastrointestinal/Nutrition Disorders 7 7. Renal Disorders 3 8. Genitourinary/Reproductive Disorders 3 9. Musculoskeletal Disorders 4 10. Sports Medicine 3 11. Neurologic Disorders 5 12. Psychiatry and Behavioral Medicine 6 13. Abuse and Neglect 2 14. Dermatologic Disorders 6 15. Hematology/Oncology 4 16. Infectious Diseases 12 17. Allergy and Immunology 3 18. Congenital Anomalies and Genetic Disorders 2 19. Neonatal/Newborn Medicine 4 20. Emergency Medicine and Critical Care 2 1. HEALTH MAINTENANCE (10%) 2. CARDIOVASCULAR DISORDERS (6%) A. Growth and development A. Congenital heart disease/defects • Constitutional growth delay • Acyanotic heart disease • Developmental delay • Cardiomyopathy • Failure to thrive • Cyanotic heart disease • Normal growth and development • Marfan syndrome • Obesity • Pulmonary hypertension • Puberty • Vascular malformation • Short stature B. Heart murmurs B. Nutrition C. Heart rhythm disorders • Infancy • Arrhythmia • Childhood • Long QT syndrome • Adolescence • Supraventricular tachycardia C. Preventive pediatrics • Wolff-Parkinson-White syndrome • Accident/injury prevention D. Syncope • Anticipatory guidance E. Hyperlipidemia • Colic • Hypercholesterolemia • Immunizations F. Infection • Oral health • Endocarditis • Pregnancy and contraception • Kawasaki disease • Routine screening guidelines • Myocarditis • Sleep hygiene -
A Review of Pilonidal Sinus Lesions and a Method Oftreatment
Postgrad Med J: first published as 10.1136/pgmj.43.499.353 on 1 May 1967. Downloaded from Postgrad. med. J. (May 1967) 43, 353-358. A review of pilonidal sinus lesions and a method of treatment B. P. FLANNERY H. A. KIDD F.R.C.S. F.R.C.S.E. St Helier Hospital, Carshalton, Surrey Introduction barbers has been reported by Patey & Scarff (1946, This paper on pilonidal lesions is presented with 1948, 1955). Lesions have also been found in the the object of reviewing the disease and describing anterior perineum (Smith, 1948), axilla and a method of treatment introduced by Jacobsen umbilicus (Aird, 1952) and also in an amputation (1959). stump (Shoesmith, 1953. From a review of umbilical A pilonidal sinus is an anomalous condition, in sinuses and fistulae (Steck & Helwig, 1965) thirty- which there may be found a nidus of epithelial and eight sinuses have been histologically identified as hair cells submerged in the cutaneous tissues of the pilonidal. intergluteal cleft. These elements under certain conditions give rise to symptoms or signs. Their Aetiology presence is indicated by a number of fine circular The cause of pilonidal sinuses has during the last pits, which are aligned vertically and are of four to five decades been in doubt. For some time, variable orifice-diameter. They are usually two or two beliefs supporting a congenital theory of origin thiree in number, although larger numbers have were held: (a) remnants of the neural canal be- copyright. been described. They extend to the caudal end of came separated off and isolated, thus leading to a the anal cleft, superior to the posterior anal verge sinus tract; and (b) malfusion of the body halves beyond which they are not seen.