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MKSAP 19 - Errata and Revisions

 

(Updated March 2022)

 

Invalidated MKSAP 19 Questions

The following questions have been invalidated as a result of postpublication analysis and/or new data that are relevant to the question: Item 31 from Cardiovascular Medicine; Item 42 and Item 79 from Endocrinology and Metabolism; Item 88 from General Internal Medicine 1; Item 50 and Item 52 from Nephrology.

 

Cardiovascular Medicine

 

Epidemiology and Risk Factors

Pages 1-3: The text has been revised to acknowledge that the significant racial and ethnic disparities in the prevalence of cardiovascular disease in the United States are driven by multiple factors, including structural social factors and inequitable access to care. Many calculators of cardiovascular risk, including the Pooled Cohort Equations recommended by the U.S. Preventive Services Task Force, the Society of Thoracic Surgeons Adult Cardiac Surgery Risk Calculator, and the Multi-Ethnic Study of Atherosclerosis risk score, include race as a variable in estimating cardiovascular risk. The inclusion of race as a predictor of risk is problematic, and guidelines are likely to evolve to better reflect individualized risk.

In addition, the text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Heart Failure

Page 30: Screening. The text has been revised to acknowledge that inclusion of race as a variable in calculating risk for heart failure is likely a flawed approach. (Added March 2022)

Pages 32-35: Heart Failure With Reduced Ejection Fraction. The text, including the Figure 13 legend, has been revised to acknowledge that race-based heart failure treatment recommendations are under scrutiny. (Added March 2022)

Page 41: Black Patients. The text has been revised to remove race-based treatment recommendations that are under scrutiny. (Added March 2022)

 

Valvular Heart Disease

Page 63: Clinical Presentation and Evaluation. In the last sentence of the first paragraph, "non-Hodgkin" was changed to "Hodgkin." (Added January 2022)

 

Pregnancy and Cardiovascular Disease

Pages 115-116: Peripartum Cardiomyopathy. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Questions

 

Pages 125 and 155, Question 1: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. Option A has been changed from "Add isosorbide dinitrate–hydralazine" to "Add digoxin." In addition, the second paragraph of the critique has been revised to remove race-based treatment recommendations that are under scrutiny. (Added March 2022)

 

Pages 127 and 160, Question 10: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. Option D has been changed from "Isosorbide dinitrate–hydralazine" to "Ivabradine." In addition, the fourth paragraph of the critique has been revised to remove race-based treatment recommendations that are under scrutiny. (Added March 2022)

 

Page 132, Question 31: This question has been invalidated as a result of postpublication analysis and/or new data that are relevant to the question. Please select answer B to earn CME/MOC credit for this question. The item has been excluded because the guideline recommendations on which it was based included racial variables that are under scrutiny. (Added March 2022)

 

Page 158, Question 7: The first paragraph of the critique was revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Page 164, Question 19: The first paragraph of the critique was revised to acknowledge that the inclusion of race as a predictor of cardiovascular risk is problematic and that the guidelines are likely to evolve to better reflect individualized risk. (Added March 2022)

 

Endocrinology and Metabolism

 

Disorders of Glucose Metabolism

Page 3: Idiopathic Type 1 Diabetes Mellitus. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Page 12: Therapy for Type 2 Diabetes Mellitus. In the sixth paragraph, the following text has been added after the third sentence: “Renal dose adjustment is required for all SGLT2 inhibitors. The GLP-1 RAs exenatide and lixisenatide should be avoided in patients with an eGFR less than 30 mL/min/1.73 m2.” (Added January 2022)

Page 24: Hypoglycemia in Patients With Diabetes Mellitus. The third paragraph has been changed to: "Hypoglycemia can also occur with the use of oral antidiabetic agents (especially sulfonylureas or meglitinides) because of incorrect dosages, drug-drug interactions, and intercurrent illnesses that alter the metabolism or excretion of drugs." (Added January 2022)

 

Reproductive Disorders

Page 67: Management. In the second paragraph, the following information has been added to clarify the risk for cardiovascular events in men receiving certain testosterone therapies: "However, two products (oral testosterone undecanoate and subcutaneous testosterone enanthate) have boxed warnings regarding the potential for increased blood pressure, which can increase the risk for major adverse cardiovascular events." (Added March 2022)

Page 69: Table 42. Recommended Testosterone Replacement Therapy. This table has been updated to add information on testosterone undecanoate. (Added March 2022)

 

Calcium and Bone Disorders

Page 77: Pathophysiology. A second paragraph has been added, as follows: "Glucocorticoids are a well-recognized cause of significant bone loss, and risk is increased in older patients, larger doses, and longer duration of therapy. Patients taking glucocorticoids should be on the lowest dose possible for the shortest duration necessary." (Added January 2022)

Questions

 

Pages 92 and 116, Question 18: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. Option D has been changed from "Order dual-energy x-ray absorptiometry scan" to "Discontinue teriparatide, start abaloparatide." In addition, the fourth paragraph of the critique has been removed. (Added March 2022)

 

Page 97, Item 42: This question has been invalidated as a result of postpublication analysis and/or new data that are relevant to the question. Please select answer B to earn CME/MOC credit for this question. This item has been excluded because option C (Adrenocorticotropin hormone stimulation test) is a logical step next in the evaluation of this patient and is therefore a correct answer. (Added March 2022)

 

Page 149, Item 79: This question has been invalidated as a result of postpublication analysis and/or new data that are relevant to the question. Please select answer D to earn CME/MOC credit for this question.

This item has been excluded because the best pharmacologic agent to treat type 2 diabetes mellitus in this patient with stage 4 chronic kidney disease, a glucagon-like peptide 1 receptor agonist (GLP-1 RA) such as liraglutide, was not included in the option list. GLP-1 RAs improve cardiovascular outcomes and reduce albuminuria. The dosage of these agents can be adjusted in patients with chronic kidney disease, although exenatide and lixisenatide should be avoided in patients with an estimated glomerular filtration rate less than 30 mL/min/1.73 m2. (Added January 2022)

 

Gastroenterology

 

Disorders of the Small and Large Bowel

Page 27: History and Physical Examination. In the last sentence of the second paragraph, "age 50 years" has been changed to "age 45 years" based on updated USPSTF guidance on colorectal cancer risk and screening. (Added January 2022)

Page 28: Additional Testing. In the last sentence of the sixth paragraph, "age older than 50 years" has been changed to "age older than 45 years" based on updated USPSTF guidance on colorectal cancer risk and screening. (Added January 2022)

Page 37: Evaluation. In the third sentence of the first paragraph, "age older than 50 years" has been changed to "age older than 45 years" based on updated USPSTF guidance on colorectal cancer risk and screening. (Added January 2022)

Page 42: Perianal Disorders. In the last sentence of the first paragraph, "age older than 50 years" has been changed to "age older than 45 years" based on updated USPSTF guidance on colorectal cancer risk and screening. (Added January 2022)

 

Colorectal Neoplasia

Page 45: : Risk Factors. In the first sentence of the first paragraph, the "≥50 years" has been changed to "≥45 years" based on updated USPSTF guidance on colorectal cancer risk and screening. The same change has been made in the related key point. (Added January 2022)

Page 45: Risk Factors. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Disorders of the Liver

Page 59: Drug-Induced Liver Injury. In the first paragraph, the last sentence has been changed to "Use of the Web-based tool LiverTox (www.ncbi.nlm.nih.gov/books/NBK547852/) from the National Institutes of Health can help assess risk for hepatotoxicity." (Added August 2021)

 

Gastrointestinal Bleeding

Page 81: Table 43. In the fifth row, ">50" in the "Patient Age" column has been changed to ">45" based on updated USPSTF guidance on colorectal cancer risk and screening. (Added January 2022)

Questions

 

Page 87, Question 4: Under "Laboratory studies" in the question stem, "Hepatitis E antigen" and "Hepatitis E IgG antibody" have been changed to "Hepatitis B e antigen" and "Hepatitis B e IgG antibody," respectively. (Added January 2022)

 

Page 88, Question 9: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. The total IgA level in the question stem has been changed to “less than 5 mg/dL (0.05 g/L).” (Added January 2022)

 

Page 107, Question 2: In the first paragraph of the critique, the second sentence has been revised as follows: "This patient most likely has primary biliary cholangitis (PBC), a diagnosis that is best established by imaging with ultrasound or magnetic resonance cholangiopancreatography to exclude extrahepatic obstruction and by positive results for AMA." (Added January 2022)

 

Page 114, Question 14: In the first paragraph of the critique and in the related key point, "age older than 50 years" has been changed to "age older than 45 years" based on updated USPSTF guidance on colorectal cancer risk and screening. (Added January 2022)

 

Page 137, Question 59: In the second paragraph of the critique, "age 50 years or older" has been changed to "age 45 years or older" based on updated USPSTF guidance on colorectal cancer risk and screening. (Added January 2022)

 

Page 146, Question 76: : In the first paragraph of the critique, text was revised to better reflect the risk factors for gastric cancer identified by the American Gastroenterological Association. (Added March 2022)

 

Page 149, Question 83: In the first sentence of the second paragraph of the critique, “cholecystitis” has been changed to “cholangitis.” The sentence now reads, “Surgical drainage of the biliary tree, either open or laparoscopic (Option A), is reserved for patients with acute cholangitis who cannot undergo ERCP or in whom ERCP has failed.” (Added January 2022)

 

General Internal Medicine 1

 

Common Symptoms

Page 19: Acute Cough. In the third sentence of the third paragraph, the phrase "the most current" was changed to "additional." The sentence now reads, "For additional information on SARS-CoV-2, see COVID-19: An ACP Physician's Guide (https://www.acponline.org/clinical-information/clinical-resources-products/coronavirus-disease-2019-covid-19-information-for-internists)." (Added January 2022)

Page 28: Evaluation. The first sentence in the second to last paragraph was revised to read: “Although the pathophysiology of SEID remains unclear, central sensitization may contribute.” The following sentence was added to the last paragraph: “Comorbid conditions, such as fibromyalgia, irritable bowel syndrome, and interstitial cystitis, are common.” (Added March 2022)

Page 29: Management. The second sentence in the first paragraph was changed to: “In patients with SEID, treatment is supportive and focuses on treatment of symptoms and comorbid conditions.” The sentence “Cognitive behavioral therapy (CBT) may decrease fatigue and improve function” was deleted. The second sentence in the second paragraph was changed to: “Medical therapy is therefore typically limited to the treatment of symptoms and comorbid conditions.” The second sentence in the last paragraph was changed to: “It depends on many factors, including patient age, formal education level, severity and duration of symptoms, decline in functional status relative to premorbid level of functioning, presence of other symptoms, comorbid conditions, and availability of resources.” (Added March 2022)

Page 29: Management. In the fourth sentence of the first paragraph, the phrases "and graded exercise therapy" and "and these therapies should be offered to all patients" were deleted. The sentence now reads, "Cognitive behavioral therapy (CBT) may decrease fatigue and improve function." In the second key point, the phrase "cognitive behavioral therapy and graded exercise therapy may decrease fatigue and improve function and should be offered to all patients" was deleted. The key point now states, "Patients with systemic exertion intolerance disease benefit most from a structured, multimodal approach that includes regularly scheduled office visits." (Added January 2022)

Questions

 

Page 118, Item 42: In the second paragraph of the stem, the fourth sentence was corrected to state that the patient’s left leg calf is 4 cm larger than the right. (Added January 2022)

 

Page 119, Item 46: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. The first paragraph of the stem was revised to convey that the patient's race is reported for the purposes of calculating risk for atherosclerotic cardiovascular disease. (Added March 2022)

 

Page 124, Item 72: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. The first paragraph of the stem was revised to convey that the patient's race is reported for the purposes of calculating risk for atherosclerotic cardiovascular disease. (Added March 2022)

 

Page 124, Item 74: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. In the lead-in question, “another overdose” was changed to “an overdose-related death.” (Added March 2022)

 

Page 127, Item 88: This question has been invalidated as a result of postpublication analysis and/or new data that are relevant to the question. Please select answer A to earn CME/MOC credit for this question.

This item has been excluded because there is more than one correct answer. Option B (knee strengthening exercises) is not an unreasonable answer for this patient who also has limiting knee osteoarthritis. (Added January 2022)

 

Page 127, Item 91: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. Option A has been changed from "Graded exercise program" to "Pacing strategies." (Added March 2022)

 

Page 142, Item 19: The reference was updated to: Fowler JR, Hughes TB. Scaphoid fractures. Clin Sports Med. 2015;34:37-50. [PMID: 25455395] doi:10.1016/j.csm.2014.09.011. The previous reference--Mawdsley MJ, Harrison J. Conservative interventions for treating scaphoid fractures in adults. Cochrane Database Syst Rev. 2018;2018:CD010713. doi:10.1002/14651858.CD010713.pub2—was removed from the Cochrane Library and is no longer accessible. (Added March 2022)

 

Page 170, Item 74: In the next to last sentence in paragraph 1 of the critique, “ways to prevent overdose” was changed to “ways to reverse overdose and prevent overdose death.” (Added March 2022)

 

Page 178, Item 91: The critique and key point have been revised to reflect the current evidence for systemic exertion intolerance disease therapies. (Added March 2022)

 

General Internal Medicine 2

 

Routine Care of the Healthy Patient

Pages 5-6: Screening for Chronic Diseases. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Obesity

Page 43: Screening and Evaluation. The first sentence of the first paragraph was revised to, "Multiple organizations, including the American College of Cardiology, American Heart Association, and The Obesity Society, recommend annual screening of adults with BMI and waist circumference measurements." (Added March 2022)

 

Women's Health

Page 56: Contraception. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Eye Disorders

Page 72: Glaucoma. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Ear, Nose, Mouth, and Throat Disorders

Page 79: Upper Respiratory Tract Infection/Sinusitis. Sentence three in paragraph one was revised to, “It is usually self-limited; therapies that may relieve symptoms include systemic decongestants, saline nasal irrigation, and intranasal glucocorticoids, all targeted to the patient's specific symptoms.” (Added March 2022)

Page 82: Legend for Figure 30: In the first sentence, “loss or diminution of the interdental papilla, and necrotic sloughing of the gingiva” was revised to “loss or diminution of the interdental papilla (green arrow), and necrotic sloughing of the gingiva (blue arrow).” (Added January 2022)

 

Dermatologic Disorders

Page 97: Table 74. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Questions

 

Page 168, Item 7: The critique of this question has been updated to remove epidemiologic information that is irrelevant to the question. (Added March 2022)

 

Page 185, Item 37: The critique of this question has been updated to remove epidemiologic information that is irrelevant to the question. (Added March 2022)

 

Page 196, Item 55: The critique of this question has been updated to remove epidemiologic information that is irrelevant to the question. (Added March 2022)

 

Page 224, Item 106: The critique of this question has been updated to remove epidemiologic information that is irrelevant to the question. (Added March 2022)

 

Hematology

 

Approach to Nonmalignant Leukopenia and Leukocytosis

Page 1: Lymphopenia and Neutropenia. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Erythrocyte Disorders

Page 24: α-Thalassemia. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Page 28: Sickle Cell Syndromes. The discussion has been revised to clarify that sickle cell disease is most common in patients from sub-Saharan Africa, India, the Middle East, the Caribbean, and Central and South America. (Added March 2022)

 

Iron Overload Syndromes

Page 34: Primary/Hereditary Hemochromatosis. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Thrombotic Disorders

Pages 51-53: Inherited Thrombophilias. The discussion has been revised to clarify that some inherited thrombophilias (heterozygous factor V Leiden, prothrombin G20210A mutation, and heterozygous methylene tetrahydrofolate reductase polymorphisms) are most commonly found in patients of European ancestry. (Added March 2022)

Questions

 

Page 104, Item 29: The Critique has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Page 112, Item 45: The third Critique paragraph has been revised to clarify that heterozygous factor V Leiden is most commonly found in patients of European ancestry. (Added March 2022)

 

Page 121, Item 63: The epidemiologic information regarding hereditary hemochromatosis in the first Critique paragraph has been revised. (Added March 2022)

 

Page 126, Item 73: The epidemiologic information regarding glucose-6-phosphate dehydrogenase deficiency in the first Critique paragraph has been revised. (Added March 2022)

 

Infectious Disease

 

Central Nervous System Infection

Page 3: Table 2. Under "Empiric Antibiotic Regimen" for patients >50 years or with altered cell-mediated immunity, the phrase “or cefotaxime” has been added as an alternative treatment instead of ceftriaxone. “In countries with ceftriaxone resistance rate >1%, such as the United States” has been moved to the footnotes section. (Added January 2022)

 

Community-Acquired Pneumonia

Page 21: Complications. In the final paragraph, the word "without" should be "with." The sentence should read, "Glucocorticoids are not routinely recommended and should be reserved for patients with documented adrenal insufficiency or refractory septic shock." (Added January 2022)

 

Tick-Borne Diseases

Page 23: Early Disseminated Disease. In the paragraph beginning, "Neurologic infection occurs…," the sentence on lumbar puncture has been revised to, "Serum antibody testing, rather than polymerase chain reaction or culture of either cerebrospinal fluid or serum, is recommended for the diagnosis of Lyme disease involving the peripheral or central nervous system." This change makes the content more consistent with current guidelines. (Added January 2022)

 

Mycobacterium tuberculosis Infection

Page 37: Management, Drug-Resistant Tuberculosis. The last sentence and the Key Point box have been clarified concerning treatment duration and culture conversion. Both sentences now state, "…the recommendation is to use five drugs in the intensive phase of treatment and four drugs in the continuation phase of treatment. The recommended intensive-phase duration is between 5 and 7 months after culture conversion, with the total duration between 15 and 21 months after culture conversion." (Added January 2022)

 

Nontuberculous Mycobacterial Infection

Page 38: Mycobacterium avium Complex Infection. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Fungal Infections

Page 43: Coccidioidomycosis. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Questions

 

Pages 115-116, Item 14: The patient's history has been revised to indicate meningococcal meningitis as a child; the family history has been removed. (Added March 2022)

 

Page 154, Item 30: The first Critique paragraph has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Page 160, Item 41: In the final Critique paragraph, the first sentence, "Hepatitis B vaccination and immune globulin are used to prevent HBV infection in nonimmune persons (negative surface antigen and positive surface antibody)," the parenthetical note should indicate "negative surface antigen and negative surface antibody." (Added March 2022)

 

Page 163, Item 48: In the first Critique paragraph, following the sentence that reads, "In countries such as the United States with a prevalence of greater than 1% of ceftriaxone-resistant pneumococcus, …provide coverage for possible Listeria monocytogenes (Option A)," a sentence has been added, indicating, "Cefotaxime is also effective against pneumococcus and may be given instead of ceftriaxone." The first Key Point has also been revised to state, "Empiric therapy for bacterial meningitis should include vancomycin, ceftriaxone or cefotaxime, and ampicillin in adult patients older than 50 years." (Added January 2022)

 

Page 166, Item 53: In the last sentence in the first paragraph of the Critique, "oral" has been removed. The sentence should read, "Ertapenem has an advantage over the other carbapenems with once-daily dosing, but some ESBL-producing organisms are resistant to it." Ertapenem does not have oral dosing. (Added March 2022)

 

Page 174, Item 70: In the first sentence of the Critique, Heartland virus is classified as a Phlebovirus. The taxonomy of Heartland virus was recently revised, and the virus is now classified as part of the new genus Bandavirus. (Added January 2022)

 

Page 189, Item 98: The last Critique paragraph has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Nephrology

 

Clinical Evaluation of Kidney Function

Page 1: Assessment of Kidney Function. The text has been revised to acknowledge that inclusion of race in glomerular filtration rate (GFR) calculation may lead to inaccurately higher GFR estimates for Black patients, which could subsequently translate into delayed or inequitable care in some cases. In addition, epidemiologic information that is irrelevant to the discussion has been removed. (Added February 2022)

Page 1: Estimation of Glomerular Filtration Rate. In September 2021, the Task Force of the National Kidney Foundation and the American Society of Nephrology recommended the immediate adoption of a new 2021 Chronic Kidney Disease Epidemiology (CKD-EPI) Creatinine Equation, which has been refit to estimate glomerular filtration rate without a race variable. Based on this recommendation, the following revisions have been made:

In the first paragraph, sentence 2, "These formulas take into account" has been replaced with "These formulas may take into account."

In the second paragraph, sentence 2 has been replaced with: "To estimate GFR, the National Kidney Foundation and the American Society of Nephrology recommend using the CKD-EPI Creatinine Equation (2021) (www.kidney.org/professionals/kdoqi/gfr_calculator), which has been refit to estimate kidney function without a race variable (see Table 1). CKD-EPI equations presume standard body surface area and therefore require adjustment for very large or small persons. Combining filtration markers (creatinine and cystatin C) into the CKD-EPI creatinine-cystatin C equation is more accurate and informs clinical decision making better than either marker alone." (Added October 2021)

Page 2: Estimation of Glomerular Filtration Rate, Table 1. Methods for Estimating Kidney Function. To reflect the Task Force of the National Kidney Foundation and the American Society of Nephrology recommendation for the immediate adoption of a new 2021 Chronic Kidney Disease Epidemiology (CKD-EPI) Creatinine Equation, which has been refit to estimate glomerular filtration rate without a race variable, Table 1 was revised as follows:

  • Row 3, column 1. Column heading was revised to "CKD-EPI Creatinine (2021)." In sentence 1, the term "race" was deleted.
  • Row 3, column 3. Sentence 2 was deleted.
  • Row 5, column 3. "The most accurate formula for estimating GFR in most situations" was added.
  • (Added October 2021)

Page 3: Estimation of Glomerular Filtration Rate, Key Points. To reflect the Task Force of the National Kidney Foundation and the American Society of Nephrology recommendation for the immediate adoption of a new 2021 Chronic Kidney Disease Epidemiology (CKD-EPI) Creatinine Equation, which has been refit to estimate glomerular filtration rate without a race variable, the second Key Point was revised to, "To estimate glomerular filtration rate, the National Kidney Foundation and the American Society of Nephrology recommend using Chronic Kidney Disease Epidemiology (CKD-EPI) Creatinine Equation (2021), which has been refit to estimate kidney function without a race variable." (Added October 2021)

 

Hypertension

Pages 26-41: The text has been revised to acknowledge that race-based antihypertensive prescribing recommendations are under scrutiny. In addition, epidemiologic information that is irrelevant to the discussion has been removed. (Added February 2022)

 

Glomerular Diseases

Pages 44-55: The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added February 2022)

 

Genetic Disorders and Kidney Disease

Page 60: Apolipoprotein L1 Nephropathy. The text has been revised to acknowledge the multifactorial reasons for disparities in the incidence of kidney failure. (Added February 2022)

 

Kidney Stones

Page 70: Overview. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added February 2022)

 

Chronic Kidney Disease

Page 76: Diagnosis. To reflect the Task Force of the National Kidney Foundation and the American Society of Nephrology recommendation for the immediate adoption of a new 2021 Chronic Kidney Disease Epidemiology (CKD-EPI) Creatinine Equation, which has been refit to estimate glomerular filtration rate without a race variable, the equation in sentence 1 has been revised to "Chronic Kidney Disease Epidemiology (CKD-EPI) Creatinine Equation (2021)." (Added October 2021)

Page 85: Non-Dialytic Palliative Therapy. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added February 2022)

Questions

 

Page 99, Item 22: This question has been revised to exclude mention of race-based antihypertensive prescribing recommendations that are under scrutiny. (Added February 2022)

 

Page 106, Item 50: This question has been invalidated as a result of postpublication analysis and/or new data that are relevant to the question. Please select answer A to earn CME/MOC credit for this question. The item has been excluded because the guideline recommendations on which it was based included racial variables that are under scrutiny. (Added February 2022)

 

Page 107, Item 52: This question has been invalidated as a result of postpublication analysis and/or new data that are relevant to the question. Please select answer B to earn CME/MOC credit for this question. The item has been excluded because the guideline recommendations on which it was based included racial variables that are under scrutiny. (Added February 2022)

 

Page 139, Item 36: The critique of this question has been updated to remove epidemiologic information that is irrelevant to the question. (Added February 2022)

 

Page 140, Item 39: The critique of this question has been updated to exclude mention of race-based antihypertensive prescribing recommendations that are under scrutiny. (Added February 2022)

 

Page 166, Item 91: The critique of this question has been updated to exclude mention of race-based antihypertensive prescribing recommendations that are under scrutiny. (Added February 2022)

 

Neurology

 

Stroke

Page 36: Primary Prevention. In the first sentence of the first paragraph, the cross-reference should be: MKSAP 19 General Internal Medicine 2. (Added August 2021)

 

Neuromuscular Disorders

Page 83: Paraproteinemic Neuropathy. The cross-reference at the end of the third sentence of this paragraph should be: (See MKSAP 19 Hematology.) (Added August 2021)

Questions

 

Page 101, Question 20: This question has been updated as a result of postpublication analysis and/or new data that are relevant to the question. The fifth sentence of the first paragraph of the question stem has been revised to read as follows: "Her sister, brother, mother, and maternal aunt have similar muscle, neurologic, and multiorgan symptoms, but her father and a second brother do not." (Added March 2022)

 

Page 111, Question 72: In the question stem, the second sentence of the second paragraph should read: "She has right facial weakness, dysarthria, and right arm and leg weakness with a downward drift, with the leg not touching the examination table." (Added August 2021)

 

Page 126, Question 20: After the third sentence of the first paragraph of the critique, the following text was inserted: “Offspring of affected fathers do not inherit these diseases, but all offspring regardless of sex are at equal risk for inheriting the disease when a mother possesses the mutation. Each cell carries multiple copies of the mitochondrial genome and deleterious mutations usually affect some but not all copies of the mitochondrial genome. The expression of disease due to mitochondrial DNA depends on the relative proportions of normal and abnormal mitochondrial DNA. This means that there can be substantial variation in the likelihood of developing the disease and the disease severity. In this case, three of the offspring are affected because of this variable expression of disease. ” In addition, the last sentence of the first paragraph should read: “In this patient, fluctuating weakness, ophthalmoplegia, multiorgan symptoms, and family history should prompt consideration of mitochondrial myopathy.” Finally, the Key Point should read: “Mitochondrial myopathy is associated with fluctuating weakness, ophthalmoplegia, multiorgan symptoms, and maternal inheritance.” (Added March 2022)

 

Page 133, Question 35: The third sentence of the first paragraph of the critique should read: "He is receiving the most appropriate medical therapy, including aspirin and a high-intensity statin." (Added January 2022)

 

Page 144, Question 56: In the first paragraph of the critique, after the 11th sentence, the following text was added: "The Infectious Disease Society of America recommends careful observation rather than antimicrobial treatment in older patients with functional and/or cognitive impairment with bacteriuria and delirium and without local genitourinary symptoms or other systemic signs of infection (strong recommendation, very low-quality evidence). The next sentence should read “In this patient who cannot give a symptom history, a urinalysis seems a reasonable initial management step." (Added January 2022)

 

Oncology

 

Breast Cancer

Page 9: Ductal Carcinoma in Situ: The last sentence of the third paragraph should read: "Following bilateral mastectomy, adjuvant endocrine therapy is not indicated." (Added January 2022)

Page 10: Adjuvant Endocrine Therapy. The second sentence in the third paragraph should read: “Extended aromatase therapy up to 10 years increases disease-free survival in patients with high-risk features but does not have an impact on overall survival.” (Added March 2022)

 

Gastroenterological Malignancies

Page 18: Colon Cancer: The fourth key point should read: "Patients with stage II colon cancer that is microsatellite stable and lacks high-risk features are unlikely to benefit from adjuvant chemotherapy." (Added January 2022)

 

Genitourinary Cancer

Page 26: Epidemiology and Risk Factors. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Questions

 

Page 60, Question 40: The first sentence of the stem should read: "A 50-year-old woman is evaluated for heaviness and swelling of her right breast of 3 weeks' duration." (Added March 2022)

 

Pulmonary and Critical Care Medicine

 

Pulmonary Diagnostic Tests

Page 1: Pulmonary Function Testing. The text has been updated to acknowledge that the use of race as a variable in establishing predicted values for pulmonary function tests is inappropriate and that alternate means of describing norms have been proposed. (Added March 2022)

 

Airways Disease

Pages 5 and 7: Epidemiology and Natural History. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Page 14: Controller Medications: In the first full sentence at the top of page 14, the eosinophil counts given in SI units in parentheses have been corrected from "0.15 x 109/L" and "0.4 x 109/L" to "0.15 x 109/L" and "0.4 x 109/L." (Added January 2022)

Page 20: Other Agents. In the first sentence of the first paragraph, the word "inflammatory" has been changed to "anti-inflammatory." (Added March 2022)

 

Diffuse Parenchymal Lung Disease

Page 31: Sarcoidosis. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

 

Common ICU Conditions

Page 78: Epidemiology of Sepsis. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Page 78: Management of Sepsis: In the first paragraph, "time-based metrics" has been changed to "the development of separately created time-based performance improvement metrics." The fourth sentence has been revised to read as follows: "In 2018, the 3- and 6-hour bundles were combined into a single 1-hour performance improvement bundle." Under the subheading "Initial Resuscitation," the first two sentences of the second paragraph have been revised to read as follows: "The Surviving Sepsis Campaign guidelines recommend early and aggressive fluid resuscitation for sepsis-induced hypoperfusion or shock with an initial bolus of 30 mL/kg of crystalloid fluid given within the first 3 hours of resuscitation. The 1-hour performance improvement bundle indicates that fluid bolus should be initiated within the first hour of presentation." (Added January 2022)

Questions

 

Page 102, Item 36: In the fourth sentence of the first paragraph of the stem, "21-pack-year history" has been changed to "15-pack-year history." (Added March 2022)

 

Page 155, Item 68: In the first sentence of the fourth paragraph of the critique, the word "performed" has been changed to "initiated." (Added January 2022)

 

Board Basics

Cardiovascular Medicine

Page 8: Study Table: Treatment of HFrEF. Some table content has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

General Internal Medicine

Page 120: Systemic Exertion Intolerance Disease, Diagnosis & Treatment. The first sentence under "Diagnosis" has been revised to state, "Systemic exertion intolerance disease (SEID) is defined as an impairment or reduction in the ability to engage in pre-illness activities lasting more than 6 consecutive months that is accompanied by fatigue and not alleviated by rest." The second sentence under "Treatment" has been revised to state, "Patients with SEID benefit most from a structured, multimodal approach that includes regularly scheduled office visits and that focuses on symptom and comorbid disease management." (Added March 2022)

Hematology

Page 217: Thrombophilia, Inherited Thrombophilia. The discussion has been revised to clarify that factor V Leiden mutation is the most common hereditary thrombophilia in those of European ancestry. (Added March 2022)

Nephrology

Page 269: Study Table: Presentation and Treatment of Alcohol Poisoning. For the row on "Ethanol," the Anion Gap should indicate "Possible" rather than "No." (Added March 2022)

Pages 271-272: Hypertension, Treatment. The text has been revised to acknowledge that race-based antihypertensive prescribing recommendations are under scrutiny. (Added February 2022)

Page 274: Study Table: Common Causes of the Nephrotic Syndrome. The table has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added February 2022)

Rheumatology

Page 389: Study Table: Vasculitis Diagnosis. Some table content has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)

Page 391: Vasculitis, Test Yourself. The text has been revised to remove epidemiologic information that is irrelevant to the discussion. (Added March 2022)