American Board of Internal Medicine Certification (ABIM Board Certification) Infectious Disease, Rheumatology & Immunology Syllabus

Infectious Disease, Rheumatology & Immunology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Infectious Disease, Rheumatology & Immunology in American Board of Internal Medicine Certification (ABIM Board Certification), not a summary of it.

1. 1

   Common & Systemic Infections

   5 topics

   • Community and hospital-acquired pneumonia
   • Urinary tract and intra-abdominal infections
   • Skin and soft tissue infections
   • Sepsis, bacteremia, and endocarditis
   • Bone and joint infections
2. 2

   HIV & Opportunistic Infections

   3 topics

   • HIV diagnosis, staging, and antiretroviral therapy
   • Opportunistic infection prophylaxis and treatment
   • Pre-exposure prophylaxis and prevention
3. 3

   Specialized & Emerging Infections

   5 topics

   • Tuberculosis and nontuberculous mycobacteria
   • Fungal infections
   • Tick-borne and zoonotic diseases
   • Antimicrobial stewardship and resistance
   • Travel medicine and fever in the returning traveler
4. 4

   Systemic Rheumatic Diseases

   5 topics

   • Rheumatoid arthritis
     • Diagnosis and DMARD therapy
   • Systemic lupus erythematosus and antiphospholipid syndrome
   • Systemic sclerosis and inflammatory myopathies
   • Vasculitis syndromes
     • Large, medium, and small vessel vasculitis
   • Spondyloarthropathies and Sjogren syndrome
5. 5

   Joint, Crystal & Soft Tissue Disorders

   4 topics

   • Osteoarthritis
   • Crystal arthropathies (gout and CPPD)
   • Septic arthritis and approach to monoarticular complaints
   • Fibromyalgia and regional pain syndromes

Infectious Disease, Rheumatology & Immunology flashcards for American Board of Internal Medicine Certification (ABIM Board Certification)

25 of 53 cards from the Infectious Disease, Rheumatology & Immunology deck — real questions with worked answers.

1. What is the recommended empiric outpatient antibiotic regimen for community-acquired pneumonia (CAP) in a previously healthy adult with no comorbidities or risk factors for resistance?

   Amoxicillin (high-dose), OR doxycycline, OR a macrolide (azithromycin/clarithromycin) only where local pneumococcal macrolide resistance is <25%.

2. How does the IDSA/ATS define hospital-acquired pneumonia (HAP) versus ventilator-associated pneumonia (VAP)?

   HAP = pneumonia occurring >=48 hours after admission, not present at admission. VAP = pneumonia occurring >48 hours after endotracheal intubation.

3. What CURB-65 score components are used to assess CAP severity, and what total score generally favors hospitalization?

   Confusion, Urea >7 mmol/L (BUN >19), Respiratory rate >=30, Blood pressure (SBP <90 or DBP <=60), age >=65. Score >=2 favors hospitalization; >=3 consider ICU.

4. Which empiric antibiotics provide MRSA and antipseudomonal coverage when treating HAP/VAP in a patient at high risk for resistant organisms?

   MRSA: vancomycin or linezolid. Antipseudomonal: e.g., cefepime, piperacillin-tazobactam, meropenem, or ceftazidime (add a second antipseudomonal agent if high mortality risk/prior IV antibiotics).

5. In acute uncomplicated cystitis in a non-pregnant woman, what are the first-line antibiotic options?

   Nitrofurantoin x5 days, trimethoprim-sulfamethoxazole x3 days (if local resistance <20%), or fosfomycin single dose. Fluoroquinolones are reserved due to toxicity/resistance.

6. What distinguishes asymptomatic bacteriuria management, and in which two populations should it be treated?

   Asymptomatic bacteriuria is generally NOT treated. Treat only in pregnant women and in patients undergoing urologic procedures with anticipated mucosal bleeding.

7. What is the typical empiric antibiotic approach for community-acquired intra-abdominal infection (e.g., diverticulitis, perforated appendix)?

   Cover gram-negatives and anaerobes: e.g., ceftriaxone + metronidazole, or a fluoroquinolone + metronidazole, or piperacillin-tazobactam monotherapy. Source control is essential.

8. How do you differentiate purulent from nonpurulent skin and soft tissue infection (SSTI), and how does this guide therapy?

   Purulent (abscess/furuncle) suggests S. aureus including MRSA -> incision/drainage +/- anti-MRSA antibiotics. Nonpurulent (cellulitis/erysipelas) suggests beta-hemolytic streptococci -> beta-lactam (e.g., cephalexin).

9. What clinical features should raise concern for necrotizing fasciitis, and what is the cornerstone of treatment?

   Pain out of proportion, rapid progression, systemic toxicity, crepitus, bullae, skin necrosis. Treatment = urgent surgical debridement plus broad-spectrum antibiotics (e.g., vancomycin + piperacillin-tazobactam + clindamycin for toxin suppression).

10. What is the modified Duke criteria requirement for a definite clinical diagnosis of infective endocarditis?

    2 major, OR 1 major + 3 minor, OR 5 minor criteria. Major = positive blood cultures with typical organism (or persistent bacteremia) and endocardial involvement (echo evidence/new regurgitation).

11. Which organism is most associated with acute native-valve endocarditis, and which classically causes subacute endocarditis on previously damaged valves?

    Acute: Staphylococcus aureus. Subacute: viridans group streptococci (also Enterococcus, HACEK organisms).

12. What is the qSOFA score, and what threshold suggests increased risk of poor outcome in suspected sepsis?

    qSOFA: RR >=22, altered mentation (GCS <15), SBP <=100 mmHg. A score >=2 identifies patients at higher risk of mortality and prolonged ICU stay.

13. According to Surviving Sepsis guidelines, within what timeframe should broad-spectrum antibiotics and fluid resuscitation begin in septic shock, and what initial crystalloid dose is recommended?

    Antibiotics within 1 hour; begin resuscitation immediately with at least 30 mL/kg IV crystalloid within the first 3 hours; norepinephrine is the first-line vasopressor.

14. What is the empiric treatment and typical duration for acute hematogenous osteomyelitis in adults, and which imaging is most sensitive early?

    Empiric anti-staphylococcal coverage (often vancomycin +/- gram-negative coverage), tailored to cultures (ideally bone biopsy), for ~6 weeks. MRI is the most sensitive early imaging.

15. In a patient with diabetic foot osteomyelitis, what bedside finding strongly supports the diagnosis?

    A positive 'probe-to-bone' test (probing an ulcer reaches bone) has high specificity and supports underlying osteomyelitis; confirm with MRI and/or bone biopsy.

16. How is HIV infection diagnosed using the current laboratory testing algorithm?

    Begin with a 4th-generation HIV-1/2 antigen/antibody combination immunoassay (detects p24 antigen). If reactive, perform an HIV-1/2 antibody differentiation assay; if discordant, perform HIV-1 RNA (NAT).

17. What CD4 count defines AIDS, and what other criterion can define AIDS independent of CD4?

    CD4 <200 cells/microL defines AIDS; alternatively, presence of an AIDS-defining opportunistic illness (e.g., PCP, esophageal candidiasis, Kaposi sarcoma) regardless of CD4.

18. What is the preferred initial antiretroviral therapy (ART) backbone for most treatment-naive patients with HIV?

    An integrase strand transfer inhibitor (INSTI)-based regimen, e.g., bictegravir/tenofovir alafenamide/emtricitabine, or dolutegravir plus two NRTIs. ART is started in essentially all patients regardless of CD4.

19. At what CD4 thresholds is prophylaxis indicated for Pneumocystis jirovecii pneumonia (PCP) and for Mycobacterium avium complex (MAC) in HIV?

    PCP prophylaxis (TMP-SMX) when CD4 <200. MAC prophylaxis is no longer routinely recommended if patient starts effective ART; historically given (azithromycin) at CD4 <50.

20. What is the first-line treatment for Pneumocystis jirovecii pneumonia, and when are adjunctive corticosteroids indicated?

    TMP-SMX is first-line. Add corticosteroids if PaO2 <70 mmHg on room air or A-a gradient >=35 mmHg.

21. What is the prophylaxis threshold and agent for Toxoplasma gondii encephalitis in HIV, and which serology must be positive?

    TMP-SMX prophylaxis when CD4 <100 and Toxoplasma IgG is positive.

22. What are the recommended PrEP regimens for HIV prevention and the required baseline/monitoring testing?

    Oral TDF/FTC (or TAF/FTC) daily, or long-acting injectable cabotegravir. Requires confirmed HIV-negative status before start and periodic HIV testing (and renal function for oral regimens) every 3 months.

23. What is the recommended timeframe for initiating HIV post-exposure prophylaxis (PEP) after a high-risk exposure, and its duration?

    Start PEP as soon as possible, ideally within 72 hours of exposure; continue a 3-drug regimen for 28 days.

24. How is latent tuberculosis infection (LTBI) diagnosed and treated?

    Diagnosis: positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA) with no active disease on imaging/symptoms. Treatment options: 3 months isoniazid+rifapentine weekly (3HP), 4 months rifampin, or 9 months isoniazid.

25. What is the standard initial 4-drug regimen for active drug-susceptible pulmonary tuberculosis?

    RIPE: Rifampin, Isoniazid, Pyrazinamide, Ethambutol for 2 months (intensive phase), then rifampin + isoniazid for 4 months (continuation), total 6 months.

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