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 1. Internal Medicine Essentials For Clerkship Students 2
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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


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