Table Of ContentTHE ULTIMATE CRUNC RESOURCE
THE ULTIMATE CRUNC RESOURCE
Brennan Spiegel, MD, MSHS
Director of Health Services Research
Cedars-Sinai Health System
Director
Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
Professor of Medicine and Public Health
David Geffen School of Medicine at UCLA
Los Angeles, California
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Library of Congress Cataloging-in-Publication Data
Spiegel, Brennan M. R., 1972- , author.
Acing the GI board exam : the ultimate crunch-time resource / Brennan M.R. Spiegel. -- Second edition.
p. ; cm.
Includes bibliographical references and indexes.
I. Title.
[DNLM: 1. Gastrointestinal Diseases--Examination Questions. WI 18.2]
RC801
616.3’30076--dc23
2014036272
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D
EDICATION
To my wife, Tracy, and children, Kaelen and Shane. Without them I’d be lost and confused.
With them I am whole and sustained.
C
ONTENTS
Dedication .................................................................................................................................................v
Acknowledgments ....................................................................................................................................ix
About the Author ....................................................................................................................................xi
Note About the Second Edition .......................................................................................................xiii
Preface ......................................................................................................................................................xv
Chapter 1 A Compilation of Lessons Learned From Taking the GI Boards .......................1
Chapter 2 Pearls of Wisdom for Board Preparation and Earning MOC Points .................9
Chapter 3 “Tough Stuff” Vignettes ..........................................................................................13
Chapter 4 Board Review “Clinical Threshold Values” ........................................................209
Chapter 5 “Crunch-Time” Self-Test—Time to Get Your Game On ...................................215
Appendix A Answers to “Crunch-Time” Self-Test .....................................................................235
Appendix B “Crunch-Time” Self-Test Scoring Guide ................................................................241
Bibliography..............................................................................................................................................243
Subject Index.........................................................................................................................................247
A
CKNOWLEDGMENTS
This book was greatly enhanced by the feedback and input from current and former GI fel-
lows at Cedars-Sinai Medical Center. I am especially grateful to Benjamin Weinberg, who helped
develop the title. I’d also like to acknowledge Hetal Karsan, who provided important feed-
back. I want to credit Stephan Targan, a master teacher and pioneer in our field, for building an
amazing and supportive GI department at Cedars-Sinai. Steph Targan’s vision is truly remarkable,
and his beneficence is felt by all of us at Cedars who try to live up to his achievements. I could not
do what I do without the support from Cedars-Sinai and its top-notch GI division. I must also
thank Fred Weinstein, the best role model a student could ever have, who allowed me to teach
“Board review” to our fellows year after year, despite his valid insistence that “Board review” is
a concept that has little place in an academic program. His stance has colored my own approach
to this area, and helped me to remember that, after all, we’re taking care of patients—not just
trying to ace an exam.
A A
BOUT THE UTHOR
Brennan Spiegel, MD, MSHS is Professor of Medicine and Public Health and Director of Health
Services Research at Cedars-Sinai Health System in Los Angeles, California. In addition to prac-
ticing general gastroenterology, he has a clinical and academic focus in irritable bowel syndrome,
acid reflux disease, dyspepsia, and other functional gastrointestinal disorders. In addition to
authoring the Acing series of Board review textbooks, Dr. Spiegel has published numerous book
chapters, abstracts, editorials, and more than 130 articles in peer-reviewed journals. He serves
on the Advisory Board of Editors for Clinical Gastroenterology and Hepatology and the Editorial
Board for Alimentary Pharmacology & Therapeutics, and he is associate editor for the American
Journal of Gastroenterology.
In addition to his focus on digestive disorders, Dr. Spiegel studies how digital innovations can
improve the value of health care by strengthening patient-doctor bonds and bringing greater effi-
ciency to the delivery of clinical services. His team of investigators at the Cedars-Sinai Center for
Outcomes Research and Education (CS-CORE) seeks to transform the way patients, doctors, and
hospitals communicate through wearable biosensors that track patients’ vital signs and activities
both in the hospital and at home, transmitting data to electronic medical records. His team devel-
ops computer programs and mobile health applications that allow patients to explain their medical
histories online at home, saving time and providing up-to-date information for doctors. The team
also explores social media and telemedicine as clinical communication tools.
Dr. Spiegel is a member of several professional organizations and is a fellow of the American
College of Gastroenterology, the American Gastroenterological Association, and the Rome
Foundation.
N A
OTE BOUT THE
S E
ECOND DITION
When I published the first edition of Acing the GI Board Exam: The Ultimate Crunch-Time
Resource in 2009, I wondered if anyone other than my immediate family and friends would read
the book, much less whether it would evolve into a second edition. Yet, somehow, the book has
gained in popularity over the years, spawned an expanded series of texts (there are now liver and
IBD versions of the Acing books, with a pancreaticobiliary version to come), and served as last-
minute Board review material for a half decade’s worth of graduating GI fellows and recertifying
physicians. In fact, this year I had to retake the Boards, so I found myself reading and critiquing
my own book. What better timing to write an update? Although Board material pretty much
stands the test of time, there are always opportunities to make improvements, write better ques-
tions, and correct errors.
I’ve been fortunate to receive extensive and exceptional feedback from hundreds of readers
over the past 5 years, and I have tried to incorporate their responses into this new, updated ver-
sion of the book. I removed many vignettes that were either marred by errors, grew a little stale
over the years, or simply became outdated. I’ve replaced the deleted content with more than
40 new vignettes that expand the breadth and depth of the offerings while slightly increasing the
size of the book (yet keeping it true to its succinct predecessor). Much of the book is the same as
the original, by design, because “if it ain’t broke, don’t fix it!” But I’ve cleaned up some entries,
shortened text here and there, and corrected little errors throughout. By popular demand, I also
included several new questions about evidence-based medicine (EBM) and epidemiology, because
the Boards always include questions on these pesky topics. I’ve selected some of the key EBM topics
that cause perennial perplexion, like interpreting 2x2 tables, calculating sensitivity and specific-
ity, and reading publication bias plots. I try to serve the material up in a relatively painless way.
Finally, I added a short new chapter on pearls for Board preparation and earning Maintenance of
Certification (MOC) points.
I hope this new version is worth your time to read. Time will tell. Please contact me if you
find any residual errors, inaccuracies, or if you have some ideas for great questions in future
versions of the book.
—Brennan Spiegel, MD, MSHS
Cedars-Sinai Medical Center
Los Angeles, California
October 2014
P
REFACE
At this point in your career you know a lot. It’s been a hard-won battle, but after years of read-
ing books, sitting through lectures, and working with patients, you now have a pretty good sense
of what’s important and what’s, well, less important. You’re also busy, and your time is limited. So
now that you have to study for Boards or prepare for a clerkship, your goal is to learn the stuff you
don’t know, not review the stuff you already do know.
Yet, for some reason, we all continue to practice an inefficient approach to studying for Board
exams. This usually consists of comprehensively reviewing the entirety of a topic area without
thinking about (a) whether we’re adding incremental information to our preexisting storehouse
of knowledge, and (b) whether we’re learning things that are actually on the examination.
Presumably you’ve already done the painstaking work of learning the basics of your trade. Now
you’ve got to get to business and ace a test. Those are 2 very different activities.
The inefficient approach to Board review is perennially fostered by traditional “Board review”
textbooks, in which content areas are laid out in chapter-by-chapter (and verse) detail, fully laden
with facts both high and low yield—both relevant and irrelevant to actual examinations. There’s
a time and place for the chapter-and-verse approach to learning your trade, but Board review
crunch time probably isn’t it. Yet, when I look back at my own efforts to study for Boards, I see
page markings like this:
I mean, you’ve got to be kidding! At the time I read that passage, I had already known that
stuff since practically being in the womb—or, at least, since the second year of medical school. Yet
there is something self-gratifying about rereading information that we already know and recon-
quering content with a barrage of self-affirming scribbles, circles, stars, and highlights. Don’t get
