Paul Testa, MD. There are so many resources out there to prepare for the initial certification exam, just picking one can be stressful. I went with Rosh Review and was extremely satisfied. It is all you need. I did not attend a course or buy any other books. And yes, I Peter Rosen, MD. Rosh Review is going to help you improve your knowledge and self-confidence as you approach board Matthew DeAugustinis, MD.
Just wanted to send you a heartfelt thanks! Just received my comfortably above passing score on the Initial Certification exam and I have you and your company to thank. Based on the American Board of Internal Medicine format. In order for a test question to be high quality, it must satisfy two basic criteria: Must address important content Must be well structured. Our Answer Choices Building difficulty into the question.
Meet the Challenge. This patient has alpha-1 antitrypsin deficiency, an inherited disorder that affects the lungs and liver.
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Alpha-1 antitrypsin is a protease inhibitor of elastase. In the lungs, alpha-1 antitrypsin deficiency causes COPD emphysema and bronchiectasis due to an imbalance between neutrophil elastase, which destroys elastase, and alpha-1 antitrypsin. This results in uninhibited elastase and decreased elastic tissue. In the liver, unsecreted variant alpha-1 antitrypsin proteins aggregate and polymerize within the endoplasmic reticulum of hepatocytes, causing cirrhosis. Alpha-1 antitrypsin deficiency is an autosomal codominant disorder.
Heterozygous individuals are generally asymptomatic but have an increased risk of COPD, are encouraged not to smoke, and often have decreased levels of alpha-1 antitrypsin in the blood.
Patient-Centered Medical Home in chronic obstructive pulmonary disease
Clinical manifestations of alpha-1 antitrypsin deficiency involve the lung early-onset panacinar emphysema and bronchiectasis and liver cirrhosis. Pulmonary function testing demonstrates obstruction of airflow with increased total lung capacity and decreased forced expiratory volume in one second to forced vital capacity ratio. Chest X-ray reveals bullous changes that are more prominent at the lung bases. Elevated liver enzymes are also commonly seen. Treatment of alpha-1 antitrypsin deficiency involves encouraging patients to avoid tobacco and passive cigarette smoke exposure.
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Pulmonary function tests are used to monitor lung functions. Pulmonary rehabilitation, nutritional support, supplemental oxygen, preventive vaccinations, and prompt treatment of respiratory infections are all important for these patients. Some patients receive intravenous augmentation with pooled human alpha-1 antitrypsin. Lung and liver transplantation are needed when severe emphysema and end-stage liver disease develop. Enhanced learning Explanations contain integrated audio and visual content to further clarify meaning of the core concept. By representing information using audio cues and spatially with images, you are able to focus on meaning, reorganize and group similar ideas easily and make better use of your audio and visual memory.
More than just a question Advanced reinforcement To optimize recall and understanding of a topic we link concepts to help you express knowledge, thoughts and ideas and build relationships between them. Who are all these people? What training do they have? Which one is best for you? See our guide to healthcare providers , below. The truth is, you may not always need a traditional physician—and may have a difficult time finding one.
The U. We now have fewer primary care physicians per person than many other developed nations. Canada, for example, has 1. The average wait time for a new patient in a big city to see a family-medicine physician, for example, is now 29 days, compared with At the same time, doctors today are feeling pressure to work faster.
Because of competitive forces in the marketplace, including many hospitals buying up physician practices, doctors are now more likely to work for large networks than for themselves. And those employers often set daily patient quotas—16 to 25 per day is typical—that can limit your time with a doctor. That time crunch, combined with growing demands to document all their encounters in often cumbersome electronic health records, is taking a toll on doctors. More than half of primary care doctors report feeling burned out, according to a Medscape survey.
And that could undermine the care they provide, make them less willing to work collaboratively with patients, and drive even more out of the profession. Source: Bureau of Labor Statistics N. And their ranks are growing fast. The share of physicians with these clinicians on their team has risen from 25 percent in to more than 60 percent now.
But is seeing one of them as good as seeing a medical doctor? In most cases, yes, says Ateev Mehrotra, M. His January study in the journal Medical Care found that practices with more N. The team approach is also efficient, allowing each clinician to focus on what he or she does best. And it can mean shorter wait times and better patient education, according to a analysis by the Agency for Healthcare Research and Quality.
In addition to N. They include reputable ones, such as doctors of osteopathic medicine D. Their education is similar to an M. But you may also encounter some more controversial providers, such as naturopathic doctors, or N. For a routine office visit these days, you might not ever see an M. A case of the flu, for example, might be handled by a physician assistant P. And that can be just fine: Practices with advanced practice providers have outcomes at least as good as those that rely mainly on M.
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Training: Earning this degree requires four years of medical school—typically with two years studying biomedical science and basic clinical skill and two more rotating through a broad variety of specialties. Strengths: M. Limitations: Primary care docs are in short supply, so it might be difficult to find one accepting new patients, and he or she might not be able to spend as much time with you as you like.
Lipman, M. Training: The four years of medical education for D.
These doctors participate in many of the same residency programs as M. One of four U. They provide a full range of medical care for all types of diseases and health problems, but they may be especially good at treating musculoskeletal conditions such as lower back pain and less likely to prescribe drugs for that problem, according to a study in the Journal of the American Osteopathic Association. Limitations: Like M.
The average osteopathic visit is actually a couple of minutes shorter than the average visit with an M. More than half of them practice family medicine or pediatrics. And by seeing a D. Training: Before someone can become an N.
Exacerbations of Chronic Obstructive Pulmonary Disease
Strengths: N. One study found that patients tend to be more satisfied after a visit with an N. In some states, N.