American Board of Internal Medicine Certification (ABIM Board Certification) General Internal Medicine, Neurology & Geriatrics Syllabus

What are first-line acute and preventive treatments for migraine?

Acute: triptans (or NSAIDs, gepants). Preventive (≥4 headache days/month): beta-blockers (propranolol), topiramate, amitriptyline, candesartan, or CGRP monoclonal antibodies.

What clinical features of a headache are red flags warranting urgent neuroimaging?

Thunderclap (worst-ever) onset, new headache after age 50, fever/neck stiffness, papilledema, focal neuro deficits, immunosuppression/cancer, positional worsening, or pattern change (SNOOP mnemonic).

How is status epilepticus defined, and what is the first-line pharmacologic treatment?

≥5 minutes of continuous seizure or ≥2 seizures without recovery of consciousness. First-line: IV benzodiazepine (lorazepam or diazepam), then a second agent like fosphenytoin, valproate, or levetiracetam.

After a first unprovoked seizure, what findings indicate starting an antiepileptic drug?

Abnormal EEG (epileptiform discharges), structural brain lesion on imaging, abnormal neuro exam, or nocturnal seizure—because these raise recurrence risk substantially.

What are the core clinical features and pathology of Parkinson disease?

Bradykinesia plus resting tremor and/or rigidity (often asymmetric), with postural instability later. Pathology: loss of dopaminergic neurons in the substantia nigra with Lewy bodies (alpha-synuclein).

How is Alzheimer disease distinguished clinically from vascular and Lewy body dementia?

Alzheimer: gradual memory loss first. Vascular: stepwise decline with vascular risk/strokes. Lewy body: fluctuating cognition, visual hallucinations, parkinsonism, REM sleep behavior disorder, neuroleptic sensitivity.

What distinguishes a demyelinating from an axonal peripheral neuropathy on nerve conduction studies?

Demyelinating: slowed conduction velocity, prolonged latencies, conduction block. Axonal: reduced amplitudes with relatively preserved velocity.

What is the classic clinical and CSF finding in Guillain-Barré syndrome?

Acute ascending symmetric weakness with areflexia following infection; CSF shows albuminocytologic dissociation (elevated protein with normal cell count). Treat with IVIG or plasmapheresis.

What distinguishes myasthenia gravis from Lambert-Eaton myasthenic syndrome?

MG: fatigable weakness worsening with use, ocular/bulbar onset, anti-AChR antibodies. LEMS: proximal weakness that improves with repetitive use, autonomic symptoms, anti-VGCC antibodies, often with small-cell lung cancer.

Name the components of a comprehensive geriatric assessment of the "5 M's" framework.

Mind (cognition, mood), Mobility (gait, falls), Medications (polypharmacy), Multicomplexity (multimorbidity), and what Matters Most (goals/preferences).

What interventions reduce fall risk in community-dwelling older adults?

Exercise (balance/strength, e.g., tai chi), medication review (reduce sedatives/anticholinergics), vitamin D if deficient, vision correction, home hazard modification, and gait/assistive-device assessment.

What are the diagnostic features of delirium and how is it distinguished from dementia?

Delirium: acute onset, fluctuating course, inattention, altered consciousness, often reversible (CAM criteria). Dementia: chronic, progressive, stable level of consciousness. Delirium is frequently superimposed on dementia.

What are commonly used brief cognitive screening tools and a notable strength of the MoCA over the MMSE?

Mini-Cog, MMSE, and MoCA. The MoCA is more sensitive for mild cognitive impairment and detects executive/visuospatial deficits that the MMSE may miss.

What is the first-line opioid for moderate-to-severe cancer pain, and how should breakthrough dosing be calculated?

Morphine (or oxycodone/hydromorphone). Breakthrough dose ≈ 10-15% of the total 24-hour oral morphine equivalent, given as needed.

What are the recommended treatments for terminal dyspnea and "death rattle" in end-of-life care?

Dyspnea: low-dose opioids (morphine) ± oxygen; benzodiazepines for associated anxiety. Death rattle (secretions): repositioning and antimuscarinics (glycopyrrolate, scopolamine, atropine).

What is the difference between a living will, a durable power of attorney for health care, and a POLST?

Living will: written treatment preferences if incapacitated. DPOA-HC: appoints a surrogate decision-maker. POLST: actionable medical orders (e.g., DNR, intubation) signed by a clinician for seriously ill patients.

What screening tool is used for depression in primary care, and what defines a major depressive episode?

PHQ-9 (or PHQ-2 first). Major depressive episode: ≥5 of 9 symptoms (including depressed mood or anhedonia) for ≥2 weeks (SIGECAPS), causing functional impairment.

What are first-line pharmacologic and psychotherapy treatments for generalized anxiety disorder?

First-line: SSRIs or SNRIs plus cognitive behavioral therapy. Avoid chronic benzodiazepines; buspirone is an option.

How does somatic symptom disorder differ from illness anxiety disorder?

Somatic symptom disorder: ≥1 distressing physical symptom with excessive thoughts/anxiety about it. Illness anxiety disorder: preoccupation with having/acquiring a serious illness with minimal or no somatic symptoms.

What are the four core principles of medical ethics?

Autonomy (respect patient self-determination), Beneficence (act in the patient's best interest), Nonmaleficence (do no harm), and Justice (fair distribution of resources).

What is the hierarchy for surrogate medical decision-making when a patient lacks capacity and has no advance directive?

Use the patient's previously stated wishes (substituted judgment); if unknown, apply the best-interest standard. Default surrogate order: spouse, adult children, parents, siblings (varies by state).

What four abilities must a patient demonstrate to have decision-making capacity?

Communicate a choice, Understand relevant information, Appreciate the situation and consequences, and Reason about treatment options.

What are the components of the IHI "Swiss cheese model" concept and the classification of patient safety errors?

Swiss cheese model: latent and active failures align through gaps in defensive layers to cause harm. Errors: active errors (sharp end, frontline) vs latent errors (blunt end, system design).

In quality improvement, what does the PDSA cycle stand for?

Plan (objective and prediction), Do (test the change), Study (analyze results), Act (adopt, adapt, or abandon)—an iterative model for small-scale improvement testing.

Define sensitivity, specificity, PPV, and NPV.

Sensitivity = TP/(TP+FN), ability to detect disease. Specificity = TN/(TN+FP), ability to exclude disease. PPV = TP/(TP+FP), probability of disease given a positive test. NPV = TN/(TN+FN). PPV/NPV depend on prevalence.

What is the relationship between likelihood ratios and pretest/posttest probability?

LR+ = sensitivity/(1-specificity); LR− = (1-sensitivity)/specificity. Posttest odds = pretest odds × LR. LR+ >10 and LR− <0.1 significantly change probability of disease.

How is the number needed to treat (NNT) calculated, and what does it represent?

NNT = 1/absolute risk reduction (ARR). It is the number of patients needed to treat to prevent one additional bad outcome. Lower NNT means greater treatment effect.

What is the difference between relative risk, odds ratio, and a hazard ratio?

Relative risk: ratio of incidence in exposed vs unexposed (cohort studies). Odds ratio: ratio of odds (case-control studies, approximates RR when disease is rare). Hazard ratio: relative risk of an event over time (survival analysis).

What does a 95% confidence interval crossing 1.0 (for a ratio) or 0 (for a difference) indicate?

The result is not statistically significant—the true effect could plausibly be no effect (RR/OR of 1.0 or risk difference of 0).

What are the USPSTF recommendations for osteoporosis screening (women) and the role of FRAX?

DEXA screening for all women ≥65, and younger postmenopausal women at increased risk. FRAX estimates 10-year fracture risk; treat if hip fracture risk ≥3% or major osteoporotic fracture risk ≥20%.

What is the recommended screening for chlamydia/gonorrhea in women and screening for testosterone deficiency criteria in men?

Screen all sexually active women ≤24 (and older at-risk) for chlamydia and gonorrhea annually. Diagnose male hypogonadism with consistent symptoms plus two low morning total testosterone levels.