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AMERICAN COLLEGE OF PHYSICIANSCLERKSHIP DIRECTORS IN INTERNAL MEDICINEAC PINTERNAL MEDICINEEssentialsforClerkshipStudents2Patrick C. Alguire, MD, FACPDIRECTOREDUCATION AND CAREER DEVELOPMENTAMERICAN COLLEGE OF PHYSICIANSEDITOR-IN-CHIEFINTERNALMEDICINEEssentialsforClerkshipStudents2Associate Publisher and Manager, Books Publishing: Tom HartmanProduction Supervisor: Allan S. KleinbergSenior Production Editor: Karen C. NolanEditorial Coordinator: Angela GabellaDesign: Michael E. RipcaCopyright © 2009 by the American College of Physicians. All rights reserved. No part ofthis publication may be reproduced in any form by any means (electronic, mechanical,xerographic, or other) or held in any information storage or retrieval systems withoutwritten permission from the College.Printed in the United States of AmericaPrinted by Sheridan BooksComposition by Scribe, Inc. (www.scribenet.com)ISBN: 978-1-934465-13-4The authors and publisher have exerted every effort to ensure that the drug selectionand dosages set forth in this book are in accordance with current recommendations andpractice at the time of publication. In view of ongoing research, occasional changes ingovernment regulations, and the constant flow of information relating to drug therapyand drug reactions, however, the reader is urged to check the package insert for eachdrug for any change in indications and dosage and for added warnings and precautions.This care is particularly important when the recommended agent is a new or infrequentlyused drug.0910111213 / 10987654321Section EditorsThomas M. DeFer, MD, FACPClerkship Director Division of Medical Education Department of Internal MedicineWashington University School of MedicineSt Louis, MissouriD. Michael Elnicki, MD, FACPDirector, Ambulatory Medicine ClerkshipDirector, Section of General Internal MedicineUniversity of Pittsburgh School of Medicine UPMC ShadysidePittsburgh, PennsylvaniaMark J. Fagan, MD Clerkship Director Department of MedicineAlpert Medical School of Brown UniversityProvidence, Rhode IslandSara B. Fazio, MDAssistant Professor, Harvard Medical SchoolDirector, Core I Medicine ClerkshipDivision of General Internal MedicineBeth Israel Deaconess Medical CenterBoston, MassachusettsJames L. Sebastian, MD, FACPDirector of Student Teaching Programs Department of MedicineMedical College of Wisconsin Clement J. Zablocki Veterans Affairs Medical CenterMilwaukee, WisconsinvArlina Ahluwalia, MDClinical Assistant Professor of MedicineStanford University School of MedicineClerkship Site DirectorPalo Alto VAHCSPalo Alto, California Eyad Al-Hihi, MD, FACPAssociate Professor of MedicineClerkship Director, Ambulatory Medicine Section Chief, Division of General InternalMedicine Medical Director, InternalMedicine ClinicsTruman Medical Center-Hospital Hill University of Missouri-Kansas City School of MedicineKansas City, MissouriErik K. Alexander, MD, FACPDirector, Medical Student Education Brigham & Women’s HospitalAssistant Professor of MedicineHarvard Medical SchoolBoston, MassachusettsIrene Alexandraki, MD, FACPAssistant Professor of MedicineUniversity of Florida College of MedicineJacksonville, FloridaMark R. Allee, MD, FACPAssistant Professor of Medicine Department of Internal MedicineUniversity of Oklahoma College of MedicineOklahoma City, OklahomaHugo A. Alvarez, MD, FACPAssociate Professor of MedicineSub-Internship DirectorClerkship Site Director, Department of MedicineRosalind Franklin University of Medicine and ScienceMount Sinai HospitalChicago, IllinoisAlpesh N. Amin, MD, MBA, FACPMedicine Clerkship DirectorAssociate Program Director, IM ResidencyUniversity of California, IrvineIrvine, CaliforniaMary Jane Barchman, MD, FACP, FASNAssociate Professor of MedicineSection of Nephrology and HypertensionDirector, Introduction to Medicine CourseClerkship Director, Internal MedicineBrody School of Medicine at East Carolina UniversityGreenville, North CarolinaSeth Mark Berney, MD, FACPProfessor of MedicineChief, Section of RheumatologyDirector, Center of Excellence for Arthritis and RheumatologyHealth Sciences CenterLouisiana State University School of MedicineShreveport, LouisianaContributorsCynthia A. Burns, MDAssistant ProfessorClerkship Director, Inpatient Internal MedicineSection of Endocrinology and MetabolismDepartment of Internal MedicineWake Forest University School of MedicineWinston-Salem, North CarolinaAmanda Cooper, MDAssistant Professor of MedicineUniversity of Pittsburgh School of MedicineUniversity of Pittsburgh Medical CenterPittsburgh, Pennsylvania Nicole M. Cotter, MDFellow, Section of RheumatologyCenter of Excellence for Arthritis and RheumatologyHealth Sciences CenterLouisiana State University School of MedicineShreveport, LouisianaReed E. Drews, MD, FACPProgram DirectorHematology-Oncology Fellowship Co-Director, Core Medicine 1 ClerkshipBeth Israel Deaconess Medical CenterHarvard Medical SchoolBoston, MassachusettsSteven J. Durning, MD, FACPMajor, Medical Corps, US Air ForceAssociate Professor of Medicine Co-Director, Intro to Clinical Reasoning CourseUniformed Services University of the Health SciencesBethesda, MarylandRichard S. Eisenstaedt, MD, FACPChair, Department of MedicineAbington Memorial HospitalProfessor of MedicineTemple University School of MedicinePhiladelphia, PennsylvaniaJ. Michael Finley, DO, FACP, FACOIAssociate Professor and Chair of MedicineDepartment of MedicineWestern University College of Osteopathic MedicinePomona, CaliforniaJanine M. Frank, MDAssistant Professor of MedicineUniversity of Pittsburgh Medical CenterUniversity of Pittsburgh School of MedicinePittsburgh, PennsylvaniaJane P. Gagliardi, MDAssistant Clinical ProfessorDepartment of Internal MedicineDepartment of Psychiatry and Behavioral SciencesDuke University School of MedicineDurham, North CarolinaPeter Gliatto, MDAssistant Professor of MedicineDirector, Medical ClerkshipsMount Sinai School of MedicineNew York, New YorkEric H. Green, MD, MScCourse Director, Patients, Doctors, and CommunitiesAssistant Professor of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineBronx, New YorkMark C. Haigney, MDProfessor of MedicineDirector of CardiologyUniformed Services University of the Health SciencesBethesda, MarylandCharin L. Hanlon, MD, FACPAssistant Professor of Internal MedicineClerkship Director, Internal MedicineWest Virginia University-Charleston DivisionCharleston, West VirginiaWarren Y. Hershman, MDDirector of Student EducationDepartment of MedicineBoston University School of MedicineBoston, MassachusettsMark D. Holden, MD, FACPEagle’s Trace Medical Director Erickson Retirement CommunitiesHouston, Texasvi • ContributorsIvonne Z. Jiménez-Velázquez, MD, FACPProfessor and Vice-Chair for EducationGeriatrics Program DirectorClerkship Director, InternalMedicine DepartmentUniversity of Puerto Rico School of MedicineSan Juan, Puerto Rico Lawrence I. Kaplan, MD, FACPProfessor of Medicine Section Chief, General Internal MedicineInternal MedicineClerkship DirectorTemple University School of MedicinePhiladelphia, PennsylvaniaAsra R. Khan, MDAssistant Professor of Clinical MedicineAssociate Program Director, InternalMedicine ResidencyMedicine Clerkship DirectorUniversity of Illinois College of Medicine Chicago, IllinoisSarang Kim, MDAssistant Professor of Medicine Division of General Internal MedicineUniversity of Medicine and Dentistry of New JerseyRobert Wood Johnson Medical SchoolNew Brunswick, New JerseyChristopher A. Klipstein, MDClerkship Director of Internal MedicineAssociate Professor Department of MedicineUniversity of North Carolina School of MedicineChapel Hill, North CarolinaCynthia H. Ledford, MDClerkship Director of Internal MedicineOhio State University College of MedicineColumbus, OhioBruce Leff, MD, FACPAssociate Professor of MedicineMedicine Clerkship DirectorJohns Hopkins University School of MedicineBaltimore, MarylandFred A. Lopez, MD, FACPAssociate Professor and Vice Chair Department of MedicineLouisiana State University Health Sciences CenterAssistant Dean for Student AffairsLSU School of MedicineNew Orleans, LouisianaAnna C. Maio, MD, FACPDivision Chief and Associate ProfessorDivision of General InternalMedicine Department of Internal MedicineCreighton University School of MedicineOmaha, Nebraska Brown J. McCallum, MD, FACPAssistant ProfessorCo-Clerkship Director Department of Internal MedicineUniversity of South Carolina School of MedicineColumbia, South CarolinaKevin M. McKown, MD, FACPAssociate Professor of MedicineCo-Chief, Section of RheumatologyProgram Director, Rheumatology FellowshipCo-Clerkship DirectorDepartment of MedicineUniversity of Wisconsin School of Medicine and Public Health Madison, WisconsinMelissa A. McNeil, MD, MPHProfessor of Medicine and Obstetrics, Gynecology & Reproductive SciencesChief, Section of Women’s HealthDivision of General MedicineUniversity of PittsburghPittsburgh, PennsylvaniaJanet N. Myers, MD, FACP, FCCPAssociate Professor of MedicineDeputy Clerkship Director, Department of MedicineUniformed Services University of the Health SciencesBethesda, MarylandContributors • viiKathryn A. Naus, MDChief Fellow, Section of RheumatologyCenter of Excellence for Arthritis and RheumatologyHealth Sciences CenterLouisiana State University School of MedicineShreveport, LouisianaRobert W. Neilson Jr., MDAssistant ProfessorClerkship DirectorDepartment of Internal MedicineDivision of General Internal MedicineTexas Tech University Health Sciences CenterLubbock, TexasKatherine Nickerson, MDVice Chair Department of MedicineAssociate Professor of Clinical MedicineClerkship DirectorColumbia University, P & SNew York, New YorkL. James Nixon, MDClerkship Director Division of General Internal MedicineUniversity of Minnesota Medical SchoolUniversity of Minnesota Medical Center, FairviewMinneapolis, MinnesotaCarlos Palacio, MD, MPH, FACPClerkship Director Assistant Professor of Medicine University of Florida College of MedicineJacksonville, FloridaHanah Polotsky, MDAssistant Professor of MedicineClerkship DirectorMontefiore Medical CenterAlbert Einstein College of MedicineBronx, New YorkNora L. Porter, MDCo-Director, InternalMedicineClerkship St. Louis University School of MedicineSt. Louis, MissouriPriya Radhakrishnan, MDClinical Assistant Professor University of Arizona College of MedicineClerkship Director and Associate Program Director Department of Internal MedicineSt. Joseph Hospital & Medical Center Phoenix, ArizonaJoseph Rencic, MD, FACPAssistant Professor of MedicineClerkship Site Director, Associate Program DirectorDepartment of Internal MedicineTufts-New England Medical CenterBoston, MassachusettsKathleen F. Ryan, MD Associate Professor of MedicineClerkship Director Division of General InternalMedicine Department of InternalMedicine Drexel University College of MedicinePhiladelphia, PennsylvaniaBrijen J. Shah, MDChief Medical Resident, Department of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBoston, MassachusettsPatricia Short, MDMajor, Medical Corps, US ArmyAssociate Professor and Associate Clerkship Director Department of MedicineUniformed Services University of the Health SciencesBethesda, MarylandMadigan Army Medical CenterTacoma, WashingtonDiane C. Sliwka, MDInstructor of MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBoston, Massachusettsviii • ContributorsHarold M. Szerlip, MD, FACP, FCCPProfessor and Vice-Chairman Department of MedicineMedical College of GeorgiaAugusta, GeorgiaGary Tabas, MD, FACPAssociate Professor of MedicineUniversity of Pittsburgh School of MedicinePittsburgh, PennsylvaniaTomoko Tanabe, MD, FACPAssistant Professor of MedicineAssociate Clerkship DirectorUniversity of California, San DiegoSan Diego, CaliforniaDavid C. Tompkins, MDAssociate ChairDepartment of MedicineSUNY Stony Brook Health Sciences CenterStony Brook, New YorkDario M. Torre, MD, MPH, FACPClerkship Director Department of MedicineMedical College of WisconsinMilwaukee, WisconsinMark M. Udden, MD, FACPProfessor of MedicineDepartment of Internal MedicineBaylor College of MedicineHouston, TexasH. Douglas Walden, MD, MPH, FACPCo-Director, InternalMedicine ClerkshipSt. Louis University School of MedicineSt. Louis, MissouriJoseph T. Wayne, MD, MPH, FACPAssociate Professor of MedicineAssociate Professor of PediatricsClerkship Director, Internal MedicineAlbany Medical CollegeAlbany, New YorkJohn Jason White, MDAssistant Professor of Medicine Nephrology SectionDepartment of MedicineMedical College of GeorgiaAugusta, GeorgiaKevin D. Whittle, MDAssistant Professor Third Year Clerkship Director, Internal MedicineSanford Medical School of the University of South DakotaSioux Falls, South DakotaContributors • ixxiFOREWORD xvACKNOWLEDGMENTS xviiI Cardiovascular Medicine1 Approach to Chest Pain 3Dario M. Torre2 Chronic Stable Angina 7Anna C. Maio3 Acute Coronary Syndrome 11Patrick C. Alguire4 Supraventricular Arrhythmias 15Charin L. Hanlon5 Ventricular Arrhythmias 20Steven J. Durning and Mark C. Haigney6 Heart Failure 24James L. Sebastian7 Valvular Heart Disease 28H. Douglas WaldenII Endocrinology and Metabolism8 Diabetes Mellitus and Diabetic Ketoacidosis 37Erik K. Alexander9 Dyslipidemia 41D. Michael Elnicki and Gary Tabas10 Thryoid Disease 44Erik K. Alexander11 Adrenal Disease 48Cynthia A. Burns12 Osteoporosis 52Melissa A. McNeil and Janine M. FrankIII Gastroenterology and Hepatology13 Approach to Abdominal Pain 57Priya Radhakrishnan14 Approach to Diarrhea 61Sarang Kim15 Diseases of the Gallbladder and Bile Ducts 64Nora L. Porter16 Acute Pancreatitis 67Nora L. Porter17 Gastroesophageal Reflux Disease 70Brown J. McCallum18 Peptic Ulcer Disease 72Brown J. McCallum19 Dyspepsia 74Brown J. McCallum20 Approach to Gastrointestinal Bleeding 76Warren Y. Hershman21 Viral Hepatitis 80Carlos Palacio22 Cirrhosis 83Mark J. Fagan23 Inflammatory Bowel Disease 87Brown J. McCallumIV General Internal Medicine24 Test Interpretation 93D. Michael Elnicki25 Health Promotion, Screening, and Prevention 96L. James Nixon26 Approach to Syncope 100Lawrence I. KaplanContents[..].. Society for General InternalMedicine A collaboration of 66 authors, all of whom are either internalmedicineclerkship directors or clerkship faculty, representing 45 different medical schools, IM Essentials2 is unique in that it is created by faculty who helped design the internalmedicine curriculum and who are actively involved in teaching and advising students on the internalmedicine clerkship. . Cancer 26 2 Eric H Green 71 Cervical Cancer 26 5 Asra R Khan 72 Skin Cancer 26 8 Cynthia H Ledford 73 Pain Management 27 1 Patrick C Alguire X Pulmonary Medicine 74 Approach to Dyspnea 27 5 Mark D Holden 75 Pleural Effusion 27 8 Dario M Torre 76 Asthma 28 2 Patricia Short 77 Chronic Obstructive Pulmonary Disease 28 6 Carlos Palacio 78 Obstructive Sleep Apnea 29 0 Arlina.. the internalmedicineclerkship I nternal MedicineEssentialsforClerkshipStudents is a collaborative project of the American College of Physicians (ACP) and the Clerkship Directors in InternalMedicine (CDIM), the organization of individuals responsible for teaching internalmedicine to medical students The purpose of IM Essentials is to provide medical students with an authoritative educational.. The Clerkship Directors in InternalMedicine is the national organization of individuals responsible for teaching internal medicineto medical students Founded in 1989, CDIM promotes excellence in the education of medical students in internal medicineCDIM serves internal medicinefaculty and staff by: providing a forum to share ideas, generate solutions to common problems, and create opportunities for. . of the Clerkship Directors in InternalMedicine and the Education Committee and the Council of Student Members of the American College of Physicians Patrick C Alguire, MD, FACP Editor-in-Chief Acknowledgments The American College of Physicians and the Clerkship Directors in InternalMedicine gratefully acknowledge the special contributions to InternalMedicineEssentialsforClerkshipStudents2 of Nicole.. 7-9 in the Cardiovascular Medicine section Bibliography American College of Physicians Medical Knowledge Self-Assessment Program 14 Philadelphia: American College of Physicians; 20 06 Klompas M Does this patient have an acute thoracic aortic dissection? JAMA 20 02; 287 :22 62- 72 [PMID: 11980 527 ] Lee TH, Goldman L Evaluation of the patient with acute chest pain N Engl J Med 20 00;3 42: 1187-95 [PMID: 10770985].. bibliography We recommend that students first read the appropriate chapter in IM Essentials, then assess their understanding by answering the designated questions in MKSAP for Students4 The content of IM Essentials is based upon The Core MedicineClerkship Curriculum Guide (available at www.im.org/CDIM), a nationally recognized curriculum for the required third-year internalmedicine clerkship, created and.. 62 Headache 23 4 Eyad Al-Hihi 63 Dementia 23 7 Mark Allee 64 Approach to Meningitis and Encephalitis 24 0 Fred A Lopez 65 Stroke and Transient Ischemic Attack 24 4 Jane P Gagliardi 66 Peripheral Neuropathy 24 7 Christopher A Klipstein IX Oncology 67 Breast Cancer 25 3 Kathleen F Ryan 68 Colon Cancer 25 6 Kathleen F Ryan Contents • xiii 69 Lung Cancer 25 9 Cynthia H Ledford.. 20 0 Fred A Lopez 55 Osteomyelitis 20 3 David C Tompkins VII Nephrology 56 Acute Kidney Injury 20 9 Harold M Szerlip 57 Chronic Kidney Disease 21 3 John Jason White 58 Acid-Base Disorders 21 7 Tomoko Tanabe 59 Fluid and Electrolyte Disorders 22 0 Mary Jane Barchman 60 Calcium and Phosphorus Metabolism 22 5 Mary Jane Barchman VIII Neurology 61 Approach to the Altered Mental State 23 1.. electrocardiography interpretation In MKSAP for Students4, assess yourself with items 23 29 in the Cardiovascular Medicine section Bibliography Delacrétaz E Clinical practice Supraventricular tachycardia N Engl J Med 20 06;354:1039-51 [PMID: 16 525 141] Ferrari VA, Callans D, Wiegers S Atrial Fibrillation http://pier.acponline org/physicians/diseases/d 027 [Date accessed: 20 08 Jan 23 ] In: PIER [online database] Philadelphia: . AMERICAN COLLEGE OF PHYSICIANS CLERKSHIP DIRECTORS IN INTERNAL MEDICINE AC P INTERNAL MEDICINE Essentials for Clerkship Students 2 Patrick C. Alguire, MD, FACPDIRECTOREDUCATION. contributions to Internal Medicine Essentials for Clerkship Students 2 of Nicole V. Baptista, CDIM PolicyCoordinator, Clerkship Directors in Internal Medicine; Sheila
Internal Medicine Essentials For Clerkship Students 2
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