INTERNAL MEDICINE Essentials for Clerkship Students 2 pdf

AMERICAN COLLEGE OF PHYSICIANS CLERKSHIP DIRECTORS IN INTERNAL MEDICINE AC P INTERNAL MEDICINE Essentials for Clerkship Students 2 Patrick C. Alguire, MD, FACP DIRECTOR EDUCATION AND CAREER DEVELOPMENT AMERICAN COLLEGE OF PHYSICIANS EDITOR-IN-CHIEF I NTERNAL M EDICINE Essentials for Clerkship Students 2 Associate Publisher and Manager, Books Publishing: Tom Hartman Production Supervisor: Allan S. Kleinberg Senior Production Editor: Karen C. Nolan Editorial Coordinator: Angela Gabella Design: Michael E. Ripca Copyright © 2009 by the American College of Physicians. All rights reserved. No part of this publication may be reproduced in any form by any means (electronic, mechanical, xerographic, or other) or held in any information storage or retrieval systems without written permission from the College. Printed in the United States of America Printed by Sheridan Books Composition by Scribe, Inc. (www.scribenet.com) ISBN: 978-1-934465-13-4 The authors and publisher have exerted every effort to ensure that the drug selection and dosages set forth in this book are in accordance with current recommendations and practice at the time of publication. In view of ongoing research, occasional changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, however, the reader is urged to check the package insert for each drug 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 infrequently used drug. 0910111213 / 10987654321 Section Editors Thomas M. DeFer, MD, FACP Clerkship Director Division of Medical Education Department of Internal Medicine Washington University School of Medicine St Louis, Missouri D. Michael Elnicki, MD, FACP Director, Ambulatory Medicine Clerkship Director, Section of General Internal Medicine University of Pittsburgh School of Medicine UPMC Shadyside Pittsburgh, Pennsylvania Mark J. Fagan, MD Clerkship Director Department of Medicine Alpert Medical School of Brown University Providence, Rhode Island Sara B. Fazio, MD Assistant Professor, Harvard Medical School Director, Core I Medicine Clerkship Division of General Internal Medicine Beth Israel Deaconess Medical Center Boston, Massachusetts James L. Sebastian, MD, FACP Director of Student Teaching Programs Department of Medicine Medical College of Wisconsin Clement J. Zablocki Veterans Affairs Medical Center Milwaukee, Wisconsin v Arlina Ahluwalia, MD Clinical Assistant Professor of Medicine Stanford University School of Medicine Clerkship Site Director Palo Alto VAHCS Palo Alto, California Eyad Al-Hihi, MD, FACP Associate Professor of Medicine Clerkship Director, Ambulatory Medicine Section Chief, Division of General Internal Medicine Medical Director, Internal Medicine Clinics Truman Medical Center-Hospital Hill University of Missouri-Kansas City School of Medicine Kansas City, Missouri Erik K. Alexander, MD, FACP Director, Medical Student Education Brigham & Women’s Hospital Assistant Professor of Medicine Harvard Medical School Boston, Massachusetts Irene Alexandraki, MD, FACP Assistant Professor of Medicine University of Florida College of Medicine Jacksonville, Florida Mark R. Allee, MD, FACP Assistant Professor of Medicine Department of Internal Medicine University of Oklahoma College of Medicine Oklahoma City, Oklahoma Hugo A. Alvarez, MD, FACP Associate Professor of Medicine Sub-Internship Director Clerkship Site Director, Department of Medicine Rosalind Franklin University of Medicine and Science Mount Sinai Hospital Chicago, Illinois Alpesh N. Amin, MD, MBA, FACP Medicine Clerkship Director Associate Program Director, IM Residency University of California, Irvine Irvine, California Mary Jane Barchman, MD, FACP, FASN Associate Professor of Medicine Section of Nephrology and Hypertension Director, Introduction to Medicine Course Clerkship Director, Internal Medicine Brody School of Medicine at East Carolina University Greenville, North Carolina Seth Mark Berney, MD, FACP Professor of Medicine Chief, Section of Rheumatology Director, Center of Excellence for Arthritis and Rheumatology Health Sciences Center Louisiana State University School of Medicine Shreveport, Louisiana Contributors Cynthia A. Burns, MD Assistant Professor Clerkship Director, Inpatient Internal Medicine Section of Endocrinology and Metabolism Department of Internal Medicine Wake Forest University School of Medicine Winston-Salem, North Carolina Amanda Cooper, MD Assistant Professor of Medicine University of Pittsburgh School of Medicine University of Pittsburgh Medical Center Pittsburgh, Pennsylvania Nicole M. Cotter, MD Fellow, Section of Rheumatology Center of Excellence for Arthritis and Rheumatology Health Sciences Center Louisiana State University School of Medicine Shreveport, Louisiana Reed E. Drews, MD, FACP Program Director Hematology-Oncology Fellowship Co-Director, Core Medicine 1 Clerkship Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts Steven J. Durning, MD, FACP Major, Medical Corps, US Air Force Associate Professor of Medicine Co-Director, Intro to Clinical Reasoning Course Uniformed Services University of the Health Sciences Bethesda, Maryland Richard S. Eisenstaedt, MD, FACP Chair, Department of Medicine Abington Memorial Hospital Professor of Medicine Temple University School of Medicine Philadelphia, Pennsylvania J. Michael Finley, DO, FACP, FACOI Associate Professor and Chair of Medicine Department of Medicine Western University College of Osteopathic Medicine Pomona, California Janine M. Frank, MD Assistant Professor of Medicine University of Pittsburgh Medical Center University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Jane P. Gagliardi, MD Assistant Clinical Professor Department of Internal Medicine Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham, North Carolina Peter Gliatto, MD Assistant Professor of Medicine Director, Medical Clerkships Mount Sinai School of Medicine New York, New York Eric H. Green, MD, MSc Course Director, Patients, Doctors, and Communities Assistant Professor of Medicine Montefiore Medical Center Albert Einstein College of Medicine Bronx, New York Mark C. Haigney, MD Professor of Medicine Director of Cardiology Uniformed Services University of the Health Sciences Bethesda, Maryland Charin L. Hanlon, MD, FACP Assistant Professor of Internal Medicine Clerkship Director, Internal Medicine West Virginia University-Charleston Division Charleston, West Virginia Warren Y. Hershman, MD Director of Student Education Department of Medicine Boston University School of Medicine Boston, Massachusetts Mark D. Holden, MD, FACP Eagle’s Trace Medical Director Erickson Retirement Communities Houston, Texas vi • Contributors Ivonne Z. Jiménez-Velázquez, MD, FACP Professor and Vice-Chair for Education Geriatrics Program Director Clerkship Director, Internal Medicine Department University of Puerto Rico School of Medicine San Juan, Puerto Rico Lawrence I. Kaplan, MD, FACP Professor of Medicine Section Chief, General Internal Medicine Internal Medicine Clerkship Director Temple University School of Medicine Philadelphia, Pennsylvania Asra R. Khan, MD Assistant Professor of Clinical Medicine Associate Program Director, Internal Medicine Residency Medicine Clerkship Director University of Illinois College of Medicine Chicago, Illinois Sarang Kim, MD Assistant Professor of Medicine Division of General Internal Medicine University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School New Brunswick, New Jersey Christopher A. Klipstein, MD Clerkship Director of Internal Medicine Associate Professor Department of Medicine University of North Carolina School of Medicine Chapel Hill, North Carolina Cynthia H. Ledford, MD Clerkship Director of Internal Medicine Ohio State University College of Medicine Columbus, Ohio Bruce Leff, MD, FACP Associate Professor of Medicine Medicine Clerkship Director Johns Hopkins University School of Medicine Baltimore, Maryland Fred A. Lopez, MD, FACP Associate Professor and Vice Chair Department of Medicine Louisiana State University Health Sciences Center Assistant Dean for Student Affairs LSU School of Medicine New Orleans, Louisiana Anna C. Maio, MD, FACP Division Chief and Associate Professor Division of General Internal Medicine Department of Internal Medicine Creighton University School of Medicine Omaha, Nebraska Brown J. McCallum, MD, FACP Assistant Professor Co-Clerkship Director Department of Internal Medicine University of South Carolina School of Medicine Columbia, South Carolina Kevin M. McKown, MD, FACP Associate Professor of Medicine Co-Chief, Section of Rheumatology Program Director, Rheumatology Fellowship Co-Clerkship Director Department of Medicine University of Wisconsin School of Medicine and Public Health Madison, Wisconsin Melissa A. McNeil, MD, MPH Professor of Medicine and Obstetrics, Gynecology & Reproductive Sciences Chief, Section of Women’s Health Division of General Medicine University of Pittsburgh Pittsburgh, Pennsylvania Janet N. Myers, MD, FACP, FCCP Associate Professor of Medicine Deputy Clerkship Director, Department of Medicine Uniformed Services University of the Health Sciences Bethesda, Maryland Contributors • vii Kathryn A. Naus, MD Chief Fellow, Section of Rheumatology Center of Excellence for Arthritis and Rheumatology Health Sciences Center Louisiana State University School of Medicine Shreveport, Louisiana Robert W. Neilson Jr., MD Assistant Professor Clerkship Director Department of Internal Medicine Division of General Internal Medicine Texas Tech University Health Sciences Center Lubbock, Texas Katherine Nickerson, MD Vice Chair Department of Medicine Associate Professor of Clinical Medicine Clerkship Director Columbia University, P & S New York, New York L. James Nixon, MD Clerkship Director Division of General Internal Medicine University of Minnesota Medical School University of Minnesota Medical Center, Fairview Minneapolis, Minnesota Carlos Palacio, MD, MPH, FACP Clerkship Director Assistant Professor of Medicine University of Florida College of Medicine Jacksonville, Florida Hanah Polotsky, MD Assistant Professor of Medicine Clerkship Director Montefiore Medical Center Albert Einstein College of Medicine Bronx, New York Nora L. Porter, MD Co-Director, Internal Medicine Clerkship St. Louis University School of Medicine St. Louis, Missouri Priya Radhakrishnan, MD Clinical Assistant Professor University of Arizona College of Medicine Clerkship Director and Associate Program Director Department of Internal Medicine St. Joseph Hospital & Medical Center Phoenix, Arizona Joseph Rencic, MD, FACP Assistant Professor of Medicine Clerkship Site Director, Associate Program Director Department of Internal Medicine Tufts-New England Medical Center Boston, Massachusetts Kathleen F. Ryan, MD Associate Professor of Medicine Clerkship Director Division of General Internal Medicine Department of Internal Medicine Drexel University College of Medicine Philadelphia, Pennsylvania Brijen J. Shah, MD Chief Medical Resident, Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts Patricia Short, MD Major, Medical Corps, US Army Associate Professor and Associate Clerkship Director Department of Medicine Uniformed Services University of the Health Sciences Bethesda, Maryland Madigan Army Medical Center Tacoma, Washington Diane C. Sliwka, MD Instructor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts viii • Contributors Harold M. Szerlip, MD, FACP, FCCP Professor and Vice-Chairman Department of Medicine Medical College of Georgia Augusta, Georgia Gary Tabas, MD, FACP Associate Professor of Medicine University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Tomoko Tanabe, MD, FACP Assistant Professor of Medicine Associate Clerkship Director University of California, San Diego San Diego, California David C. Tompkins, MD Associate Chair Department of Medicine SUNY Stony Brook Health Sciences Center Stony Brook, New York Dario M. Torre, MD, MPH, FACP Clerkship Director Department of Medicine Medical College of Wisconsin Milwaukee, Wisconsin Mark M. Udden, MD, FACP Professor of Medicine Department of Internal Medicine Baylor College of Medicine Houston, Texas H. Douglas Walden, MD, MPH, FACP Co-Director, Internal Medicine Clerkship St. Louis University School of Medicine St. Louis, Missouri Joseph T. Wayne, MD, MPH, FACP Associate Professor of Medicine Associate Professor of Pediatrics Clerkship Director, Internal Medicine Albany Medical College Albany, New York John Jason White, MD Assistant Professor of Medicine Nephrology Section Department of Medicine Medical College of Georgia Augusta, Georgia Kevin D. Whittle, MD Assistant Professor Third Year Clerkship Director, Internal Medicine Sanford Medical School of the University of South Dakota Sioux Falls, South Dakota Contributors • ix xi FOREWORD xv A CKNOWLEDGMENTS xvii I Cardiovascular Medicine 1 Approach to Chest Pain 3 Dario M. Torre 2 Chronic Stable Angina 7 Anna C. Maio 3 Acute Coronary Syndrome 11 Patrick C. Alguire 4 Supraventricular Arrhythmias 15 Charin L. Hanlon 5 Ventricular Arrhythmias 20 Steven J. Durning and Mark C. Haigney 6 Heart Failure 24 James L. Sebastian 7 Valvular Heart Disease 28 H. Douglas Walden II Endocrinology and Metabolism 8 Diabetes Mellitus and Diabetic Ketoacidosis 37 Erik K. Alexander 9 Dyslipidemia 41 D. Michael Elnicki and Gary Tabas 10 Thryoid Disease 44 Erik K. Alexander 11 Adrenal Disease 48 Cynthia A. Burns 12 Osteoporosis 52 Melissa A. McNeil and Janine M. Frank III Gastroenterology and Hepatology 13 Approach to Abdominal Pain 57 Priya Radhakrishnan 14 Approach to Diarrhea 61 Sarang Kim 15 Diseases of the Gallbladder and Bile Ducts 64 Nora L. Porter 16 Acute Pancreatitis 67 Nora L. Porter 17 Gastroesophageal Reflux Disease 70 Brown J. McCallum 18 Peptic Ulcer Disease 72 Brown J. McCallum 19 Dyspepsia 74 Brown J. McCallum 20 Approach to Gastrointestinal Bleeding 76 Warren Y. Hershman 21 Viral Hepatitis 80 Carlos Palacio 22 Cirrhosis 83 Mark J. Fagan 23 Inflammatory Bowel Disease 87 Brown J. McCallum IV General Internal Medicine 24 Test Interpretation 93 D. Michael Elnicki 25 Health Promotion, Screening, and Prevention 96 L. James Nixon 26 Approach to Syncope 100 Lawrence I. Kaplan Contents [...]... Society for General Internal Medicine A collaboration of 66 authors, all of whom are either internal medicine clerkship directors or clerkship faculty, representing 45 different medical schools, IM Essentials 2 is unique in that it is created by faculty who helped design the internal medicine curriculum and who are actively involved in teaching and advising students on the internal medicine 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 internal medicine clerkship I nternal Medicine Essentials for Clerkship Students is a collaborative project of the American College of Physicians (ACP) and the Clerkship Directors in Internal Medicine (CDIM), the organization of individuals responsible for teaching internal medicine to medical students The purpose of IM Essentials is to provide medical students with an authoritative educational... The Clerkship Directors in Internal Medicine is the national organization of individuals responsible for teaching internal medicine to medical students Founded in 1989, CDIM promotes excellence in the education of medical students in internal medicine CDIM serves internal medicine faculty and staff by: providing a forum to share ideas, generate solutions to common problems, and create opportunities for. .. of the Clerkship Directors in Internal Medicine 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 Internal Medicine gratefully acknowledge the special contributions to Internal Medicine Essentials for Clerkship Students 2 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 Students 4 The content of IM Essentials is based upon The Core Medicine Clerkship Curriculum Guide (available at www.im.org/CDIM), a nationally recognized curriculum for the required third-year internal medicine 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 Students 4, 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, FACP DIRECTOR EDUCATION. contributions to Internal Medicine Essentials for Clerkship Students 2 of Nicole V. Baptista, CDIM Policy Coordinator, Clerkship Directors in Internal Medicine; Sheila