2015 Internal Medicine

In-Training Examination
Educational Objectives
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2015 Internal Medicine In-Training Examination

Content Area

Number of Items

Percentage of Total Items

Cardiology

35

13.5

Endocrinology

18

6.9

Gastroenterology

24

9.2

General Internal Medicine*

40

15.4

Geriatric Medicine

16

6.2

Hematology and Oncology

30

11.5

Infectious Diseases

22

8.5

Nephrology

16

6.2

Neurology

10

3.8

Pulmonary and Critical Care Medicine

26

10.0

Rheumatology

23

8.8

High Value Care (HVC)**

43

16.5

TOTAL

260

100

*This content area includes, but is not limited to, adolescent medicine, allergy and immunology,
complementary and alternative medicine, dermatology, ethics, genetics, literature interpretation, nutrition,
ophthalmology, preventive care, psychiatry, sports medicine, statistics, and womens health. Items associated
with the content area High Value Care (HVC)** may appear in other content areas. These items are identified
with a double asterisk.

The following pages list examination educational objectives grouped by content area. One educational
objective is provided for each item.

2015 Internal Medicine In-Training Examination

Educational Objectives

Cardiology
** Assess a patient for cardiovascular risk before noncardiac surgery.
Diagnose a venous stasis ulcer.
Diagnose an atrial septal defect.
Diagnose cardiac tamponade.
Diagnose critical aortic stenosis on the basis of physical findings.
Diagnose Eisenmenger syndrome.
Diagnose hypertrophic cardiomyopathy on the basis of physical findings.
Diagnose ischemia-induced papillary muscle dysfunction.
Diagnose mitral valve prolapse.
Diagnose pericardial effusion.
Evaluate the risk of cardiomyopathy caused by chemotherapy.
Identify high-risk patients requiring coronary angiography.
Manage an idioventricular rhythm.
Manage antiplatelet therapy in the setting of a dental procedure.
Manage aortic dissection.
**Manage asymptomatic left ventricular dysfunction.
**Manage atrioventricular nodal block after an acute inferior myocardial infarction.
Manage cardiogenic shock.
Manage chest pain in the setting of left bundle branch block.
Manage high-risk coronary disease.
**Manage Mobitz I second-degree heart block.
Manage peripheral artery disease.
Manage recurrent atrial flutter.
**Manage undifferentiated chest pain.
Perform cardiac testing in a patient with a cardiac pacemaker and an intermediate pretest probability.
Prevent sudden cardiac death.
Select stroke prophylaxis in atrial fibrillation.
Select the appropriate endocarditis prophylaxis.

Treat a right ventricular infarction.

Treat atrial fibrillation with warfarin.
Treat digoxin toxicity.
Treat symptomatic hypertrophic cardiomyopathy.
Treat symptomatic nonsustained ventricular tachycardia.
Treat venous insufficiency.
Treat ventricular arrhythmias in a patient with an implantable cardioverter-defibrillator.

Endocrinology
Diagnose hyperprolactinemia in a patient with secondary amenorrhea.
Diagnose multiple endocrine neoplasia type 1.
Diagnose sarcoidosis in a patient with metabolic complications.
Diagnose secondary amenorrhea.
Manage a prolactinoma.
Manage asymptomatic primary hyperparathyroidism.
Manage primary adrenal insufficiency.
Manage primary hyperparathyroidism.
**Manage primary hypothyroidism.
Manage secondary hypertension.
Manage secondary hypogonadism.
**Manage thyroid nodularity.
Manage thyroid storm in the setting of Graves disease.
Recommend insulin adjustment during strenuous activity.
Treat a prolactinoma.
Treat myxedema coma.
Treat thyrotoxicosis secondary to thyroiditis.
Treat type 2 diabetes mellitus, minimizing weight gain.

Gastroenterology
Diagnose a Mallory-Weiss tear.
Diagnose a pill-induced esophageal ulcer.
Diagnose acute hepatitis C.
Diagnose alcoholic hepatitis.
Diagnose cholangiocarcinoma.
Diagnose Crohn disease.
Diagnose drug-induced cholestasis.
Diagnose eosinophilic esophagitis.
Diagnose gluten ingestion in a patient with recurrent symptoms of celiac disease.
Diagnose ischemic colitis.
Diagnose laxative abuse.
Diagnose microscopic colitis with celiac disease.
Diagnose primary biliary cirrhosis.
Diagnose Zollinger-Ellison syndrome.
Evaluate new-onset ascites.
Evaluate painless jaundice.
**Manage acute pancreatitis.
**Manage bleeding from uncomplicated peptic ulcer disease.
Manage bleeding in a patient with portal hypertension.
Manage dyspepsia in a patient with alarm features.
**Manage Gilbert syndrome.
**Manage irritable bowel syndrome.
Manage recent colorectal cancer.
Treat spontaneous bacterial peritonitis.

General Internal Medicine

Administer appropriate vaccines to an older patient.
**Calculate the number needed to treat to achieve reduction of one clinical event.
Determine colon cancer screening interval in a patient with a family history of colon cancer.
Diagnose at-risk drinking patterns.
Diagnose carpal tunnel syndrome.
Diagnose cervical radiculopathy.
Diagnose deep venous thrombosis.
Diagnose domestic abuse.
Diagnose Meniere disease.
**Diagnose panic disorder.
Diagnose the cause of oral ulcers.
**Diagnose the cause of urinary frequency.
Interpret odds ratios.
Manage acute rotator cuff injury.
Manage allergic conjunctivitis.
**Manage benign eye conditions.
**Manage epistaxis.
Manage hepatitis B virus immunization.
**Manage mechanical low back pain.
**Manage pharyngitis.
**Manage pityriasis rosea.
**Manage pubertal gynecomastia.
**Manage trochanteric bursitis.
**Manage vasovagal syncope.
**Manage venous stasis dermatitis.
**Manage viral conjunctivitis.
Order appropriate immunizations in an adolescent.
**Perform appropriate preoperative laboratory testing.
Prevent urinary tract infection.
Recognize patient autonomy in medical decision making.
Recommend appropriate vaccinations in a pregnant woman.
Screen a patient for alcohol misuse.

Screen for cervical cancer.

**Treat a wasp sting.
Treat contact dermatitis.
Treat failure to respond to initial therapy for depression.
**Treat symptoms of pharyngitis.
Treat vasomotor rhinitis.
Treat vitamin B12 deficiency.
Use root cause analysis to address a problem in health care.

Geriatric Medicine
Diagnose bullous skin disease.
Diagnose drug-related hearing loss.
Diagnose mild cognitive impairment.
**Diagnose postprandial hypotension.
Identify decisional capacity.
**Manage a gait abnormality.
**Manage a heel pressure ulcer.
Manage advanced dementia with hospice care.
Manage diabetes mellitus in older adults with comorbid conditions.
Manage dysphagia in an older patient.
**Manage low testosterone levels in an older man.
Recommend age-appropriate health screening.
Recommend the appropriate intervention regarding driving in an older patient with cognitive impairment.
Screen for breast cancer.
Treat an infected stage 3 necrotic pressure ulcer.
Treat dry macular degeneration.

Hematology and Oncology

Anticipate infectious complications of biologic therapy in lymphoma.
Diagnose acute promyelocytic leukemia.
Diagnose a-thalassemia.
Diagnose autoimmune hemolytic anemia.
Diagnose Burkitt lymphoma.
Diagnose chronic lymphocytic leukemia.
Diagnose multiple myeloma.
Diagnose myelodysplasia.
Diagnose myelodysplastic syndrome.
Diagnose myelofibrosis.
Diagnose porphyria cutanea tarda.
**Diagnose pseudothrombocytopenia.
Diagnose secondary polycythemia.
Diagnose superior vena cava syndrome.
Diagnose von Willebrand disease.
Identify the cause of oropharyngeal cancer in a nonsmoker.
Manage a transfusion reaction.
Manage testicular cancer.
Manage testicular cancer.
Treat a patient who has undergone breast-conserving surgery.
Treat colon cancer in a patient with positive lymph nodes.
**Treat early-stage colorectal cancer.
Treat early-stage lung cancer.
Treat neutropenic fever.
Treat newly diagnosed breast cancer.
Treat opioid-induced constipation.
Treat pain in malignancy.
**Treat postchemotherapy cytopenia.
Treat recurrent, unprovoked deep venous thrombosis.
Treat thrombotic thrombocytopenic purpura.

Infectious Diseases
Diagnose babesiosis.
Diagnose dengue in a returning traveler.
**Diagnose erythema migrans.
Diagnose Lemierre syndrome caused by Fusobacterium necrophorum.
Diagnose Listeria monocytogenes meningitis.
Diagnose nonmenstrual toxic shock syndrome.
Diagnose the cause of short-incubation, food-borne gastroenteritis.
Diagnose trimethoprim-sulfamethoxazoleassociated hyperkalemia on the basis of an electrocardiogram.
Institute appropriate isolation in health care settings.
Manage a brain mass in a patient with HIV.
**Manage asymptomatic bacteriuria.
**Manage vancomycin-resistant enterococci colonization of the stool.
Treat a severe diabetic foot infection.
Treat an HIV-infected patient with cryptococcal meningitis.
Treat Aspergillus-associated pneumonia.
Treat neurosyphilis.
Treat pertussis.
Treat pneumococcal meningitis in an adult.
Treat prosthetic valve endocarditis.
Treat severe Clostridium difficileassociated colitis.
Treat suspected community-acquired methicillin-resistant Staphylococcus aureus soft-tissue infection.
Treat uncomplicated cystitis.

Nephrology
Diagnose acute interstitial nephritis.
Diagnose acyclovir-induced nephropathy.
Diagnose IgA nephropathy.
Diagnose nephrogenic diabetes insipidus.
Diagnose propylene glycolinduced lactic acidosis.
Diagnose psychogenic polydipsia.
Manage bleeding in a patient with stage 5 chronic kidney disease.
Manage cystinuria.
Manage hypertension.
Predict the composition of kidney stones in the setting of chronic urinary tract infection.
Prevent contrast-induced nephropathy.
Recognize the association of hypomagnesemia and the use of proton pump inhibitors.
Treat hypertension.
Treat obstructive uropathy.
Treat statin-induced rhabdomyolysis.
**Use ACE inhibitors appropriately in chronic kidney disease.

Neurology
Diagnose a drug-related movement disorder.
Diagnose basilar artery stroke.
Diagnose dementia.
Diagnose meralgia paresthetica.
Evaluate new-onset seizure activity.
Initiate treatment for dementia.
**Manage asymptomatic carotid artery stenosis in an older patient.
Manage essential tremor.
**Treat medication overuse headache.
Treat myasthenia gravis.

Pulmonary and Critical Care Medicine

Diagnose cystic fibrosis in an adult.
Diagnose exercise-induced asthma.
Diagnose extrathoracic airway obstruction on the basis of a flow volume loop.
Diagnose iatrogenic hyperventilation.
Diagnose interstitial lung disease.
Diagnose nocturnal hypoxemia in COPD.
Diagnose pneumonia on the basis of physical examination findings.
Diagnose pulmonary hypertension.
Diagnose respiratory failure in the setting of restrictive lung disease.
Diagnose sarcoidosis.
Diagnose the cause of a pleural effusion with a high amylase level.
**Manage a solitary pulmonary nodule.
Manage fluids in acute respiratory distress syndrome.
Manage hemoptysis.
Manage respiratory alkalosis secondary to pain.
Prevent vascular catheterrelated infections.
Prevent ventilator-associated pneumonia.
**Treat a parapneumonic effusion.
Treat a patient with COPD.
Treat anaphylaxis.
Treat asthma during pregnancy.
Treat hypercapnic respiratory failure.
Treat hypothermia-related bradycardia.
Treat pulmonary edema.
Treat transfusion-related acute lung injury.
Use D-dimer measurement to exclude pulmonary embolism.

Rheumatology
Diagnose adhesive capsulitis.
Diagnose anserine bursitis.
Diagnose fibromyalgia.
Diagnose hemochromatosis.
Diagnose hypertrophic osteoarthropathy.
Diagnose limited cutaneous systemic sclerosis with the appropriate antibody.
Diagnose osteoarthritis of the hip.
Diagnose osteonecrosis of the hip.
Diagnose reactive arthritis.
Diagnose reactive arthritis.
Diagnose rheumatoid arthritis.
Diagnose rheumatoid arthritis.
Diagnose rotator cuff tendinopathy.
Diagnose statin-induced myopathy.
Diagnose subacute cutaneous lupus erythematosus.
Manage giant cell arteritis.
Manage glucocorticoid-induced myopathy.
**Treat osteoarthritis of the hip.
Treat polyarticular gout.
Treat polymyalgia rheumatica.
Treat pseudogout in a patient with chronic kidney disease.
Treat psoriatic arthritis.
Treat systemic lupus erythematosus.