Internal Medicine Essentials for Clerkship Students 2 PDF
Preview Internal Medicine Essentials for Clerkship Students 2
AMERICAN COLLEGE OF PHYSICIANS CLERKSHIP DIRECTORS IN INTERNAL MEDICINE ACP INTERNAL MEDICINE Essentials for Clerkship Students 2 INTERNAL MEDICINE Essentials for Clerkship Students 2 Patrick C. Alguire, MD, FACP DIRECTOR EDUCATION AND CAREER DEVELOPMENT AMERICAN COLLEGE OF PHYSICIANS EDITOR-IN-CHIEF 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. 09 10 11 12 13 / 10 9 8 7 6 5 4 3 2 1 Section Editors Thomas M. DeFer, MD, FACP Sara B. Fazio, MD Clerkship Director Assistant Professor, Harvard Medical School Division of Medical Education Director, Core I Medicine Clerkship Department of Internal Medicine Division of General Internal Medicine Washington University School of Medicine Beth Israel Deaconess Medical Center St Louis, Missouri Boston, Massachusetts D. Michael Elnicki, MD, FACP James L. Sebastian, MD, FACP Director, Ambulatory Medicine Clerkship Director of Student Teaching Programs Director, Section of General Internal Medicine Department of Medicine University of Pittsburgh School of Medicine Medical College of Wisconsin UPMC Shadyside Clement J. Zablocki Veterans Affairs Medical Center Pittsburgh, Pennsylvania Milwaukee, Wisconsin Mark J. Fagan, MD Clerkship Director Department of Medicine Alpert Medical School of Brown University Providence, Rhode Island Contributors Arlina Ahluwalia, MD Hugo A. Alvarez, MD, FACP Clinical Assistant Professor of Medicine Associate Professor of Medicine Stanford University School of Medicine Sub-Internship Director Clerkship Site Director Clerkship Site Director, Department of Medicine Palo Alto VAHCS Rosalind Franklin University of Medicine and Science Palo Alto, California Mount Sinai Hospital Chicago, Illinois Eyad Al-Hihi, MD, FACP Associate Professor of Medicine Alpesh N. Amin, MD, MBA, FACP Clerkship Director, Ambulatory Medicine Medicine Clerkship Director Section Chief, Division of General Internal Medicine Associate Program Director, IM Residency Medical Director, Internal Medicine Clinics University of California, Irvine Truman Medical Center-Hospital Hill Irvine, California University of Missouri-Kansas City School of Medicine Mary Jane Barchman, MD, FACP, FASN Kansas City, Missouri Associate Professor of Medicine Section of Nephrology and Hypertension Erik K. Alexander, MD, FACP Director, Introduction to Medicine Course Director, Medical Student Education Clerkship Director, Internal Medicine Brigham & Women’s Hospital Brody School of Medicine at East Carolina University Assistant Professor of Medicine Greenville, North Carolina Harvard Medical School Boston, Massachusetts Seth Mark Berney, MD, FACP Professor of Medicine Irene Alexandraki, MD, FACP Chief, Section of Rheumatology Assistant Professor of Medicine Director, Center of Excellence for Arthritis and University of Florida College of Medicine Rheumatology Jacksonville, Florida Health Sciences Center Louisiana State University School of Medicine Mark R. Allee, MD, FACP Shreveport, Louisiana Assistant Professor of Medicine Department of Internal Medicine University of Oklahoma College of Medicine Oklahoma City, Oklahoma v vi • Contributors Cynthia A. Burns, MD Janine M. Frank, MD Assistant Professor Assistant Professor of Medicine Clerkship Director, Inpatient Internal Medicine University of Pittsburgh Medical Center Section of Endocrinology and Metabolism University of Pittsburgh School of Medicine Department of Internal Medicine Pittsburgh, Pennsylvania Wake Forest University School of Medicine Winston-Salem, North Carolina Jane P. Gagliardi, MD Assistant Clinical Professor Amanda Cooper, MD Department of Internal Medicine Assistant Professor of Medicine Department of Psychiatry and Behavioral Sciences University of Pittsburgh School of Medicine Duke University School of Medicine University of Pittsburgh Medical Center Durham, North Carolina Pittsburgh, Pennsylvania Peter Gliatto, MD Nicole M. Cotter, MD Assistant Professor of Medicine Fellow, Section of Rheumatology Director, Medical Clerkships Center of Excellence for Arthritis and Rheumatology Mount Sinai School of Medicine Health Sciences Center New York, New York Louisiana State University School of Medicine Shreveport, Louisiana Eric H. Green, MD, MSc Course Director, Patients, Doctors, and Communities Reed E. Drews, MD, FACP Assistant Professor of Medicine Program Director Montefiore Medical Center Hematology-Oncology Fellowship Albert Einstein College of Medicine Co-Director, Core Medicine 1 Clerkship Bronx, New York Beth Israel Deaconess Medical Center Harvard Medical School Mark C. Haigney, MD Boston, Massachusetts Professor of Medicine Director of Cardiology Steven J. Durning, MD, FACP Uniformed Services University of the Health Sciences Major, Medical Corps, US Air Force Bethesda, Maryland Associate Professor of Medicine Co-Director, Intro to Clinical Reasoning Course Charin L. Hanlon, MD, FACP Uniformed Services University of the Health Sciences Assistant Professor of Internal Medicine Bethesda, Maryland Clerkship Director, Internal Medicine West Virginia University-Charleston Division Richard S. Eisenstaedt, MD, FACP Charleston, West Virginia Chair, Department of Medicine Abington Memorial Hospital Warren Y. Hershman, MD Professor of Medicine Director of Student Education Temple University School of Medicine Department of Medicine Philadelphia, Pennsylvania Boston University School of Medicine Boston, Massachusetts J. Michael Finley, DO, FACP, FACOI Associate Professor and Chair of Medicine Mark D. Holden, MD, FACP Department of Medicine Eagle’s Trace Medical Director Western University College of Osteopathic Medicine Erickson Retirement Communities Pomona, California Houston, Texas Contributors • vii Ivonne Z. Jiménez-Velázquez, MD, FACP Fred A. Lopez, MD, FACP Professor and Vice-Chair for Education Associate Professor and Vice Chair Geriatrics Program Director Department of Medicine Clerkship Director, Internal Medicine Department Louisiana State University Health Sciences Center University of Puerto Rico School of Medicine Assistant Dean for Student Affairs San Juan, Puerto Rico LSU School of Medicine New Orleans, Louisiana Lawrence I. Kaplan, MD, FACP Professor of Medicine Anna C. Maio, MD, FACP Section Chief, General Internal Medicine Division Chief and Associate Professor Internal Medicine Clerkship Director Division of General Internal Medicine Temple University School of Medicine Department of Internal Medicine Philadelphia, Pennsylvania Creighton University School of Medicine Omaha, Nebraska Asra R. Khan, MD Assistant Professor of Clinical Medicine Brown J. McCallum, MD, FACP Associate Program Director, Internal Medicine Assistant Professor Residency Co-Clerkship Director Medicine Clerkship Director Department of Internal Medicine University of Illinois College of Medicine University of South Carolina School of Medicine Chicago, Illinois Columbia, South Carolina Sarang Kim, MD Kevin M. McKown, MD, FACP Assistant Professor of Medicine Associate Professor of Medicine Division of General Internal Medicine Co-Chief, Section of Rheumatology University of Medicine and Dentistry of New Jersey Program Director, Rheumatology Fellowship Robert Wood Johnson Medical School Co-Clerkship Director New Brunswick, New Jersey Department of Medicine University of Wisconsin School of Medicine and Christopher A. Klipstein, MD Public Health Clerkship Director of Internal Medicine Madison, Wisconsin Associate Professor Department of Medicine Melissa A. McNeil, MD, MPH University of North Carolina School of Medicine Professor of Medicine and Obstetrics, Gynecology & Chapel Hill, North Carolina Reproductive Sciences Chief, Section of Women’s Health Cynthia H. Ledford, MD Division of General Medicine Clerkship Director of Internal Medicine University of Pittsburgh Ohio State University College of Medicine Pittsburgh, Pennsylvania Columbus, Ohio Janet N. Myers, MD, FACP, FCCP Bruce Leff, MD, FACP Associate Professor of Medicine Associate Professor of Medicine Deputy Clerkship Director, Department of Medicine Medicine Clerkship Director Uniformed Services University of the Health Sciences Johns Hopkins University School of Medicine Bethesda, Maryland Baltimore, Maryland viii • Contributors Kathryn A. Naus, MD Priya Radhakrishnan, MD Chief Fellow, Section of Rheumatology Clinical Assistant Professor Center of Excellence for Arthritis and Rheumatology University of Arizona College of Medicine Health Sciences Center Clerkship Director and Associate Program Director Louisiana State University School of Medicine Department of Internal Medicine Shreveport, Louisiana St. Joseph Hospital & Medical Center Phoenix, Arizona Robert W. Neilson Jr., MD Assistant Professor Joseph Rencic, MD, FACP Clerkship Director Assistant Professor of Medicine Department of Internal Medicine Clerkship Site Director, Associate Program Director Division of General Internal Medicine Department of Internal Medicine Texas Tech University Health Sciences Center Tufts-New England Medical Center Lubbock, Texas Boston, Massachusetts Katherine Nickerson, MD Kathleen F. Ryan, MD Vice Chair Associate Professor of Medicine Department of Medicine Clerkship Director Associate Professor of Clinical Medicine Division of General Internal Medicine Clerkship Director Department of Internal Medicine Columbia University, P & S Drexel University College of Medicine New York, New York Philadelphia, Pennsylvania L. James Nixon, MD Brijen J. Shah, MD Clerkship Director Chief Medical Resident, Department of Medicine Division of General Internal Medicine Beth Israel Deaconess Medical Center University of Minnesota Medical School Harvard Medical School University of Minnesota Medical Center, Fairview Boston, Massachusetts Minneapolis, Minnesota Patricia Short, MD Carlos Palacio, MD, MPH, FACP Major, Medical Corps, US Army Clerkship Director Associate Professor and Associate Clerkship Director Assistant Professor of Medicine Department of Medicine University of Florida College of Medicine Uniformed Services University of the Health Sciences Jacksonville, Florida Bethesda, Maryland Madigan Army Medical Center Hanah Polotsky, MD Tacoma, Washington Assistant Professor of Medicine Clerkship Director Diane C. Sliwka, MD Montefiore Medical Center Instructor of Medicine Albert Einstein College of Medicine Beth Israel Deaconess Medical Center Bronx, New York Harvard Medical School Boston, Massachusetts Nora L. Porter, MD Co-Director, Internal Medicine Clerkship St. Louis University School of Medicine St. Louis, Missouri Contributors • ix Harold M. Szerlip, MD, FACP, FCCP H. Douglas Walden, MD, MPH, FACP Professor and Vice-Chairman Co-Director, Internal Medicine Clerkship Department of Medicine St. Louis University School of Medicine Medical College of Georgia St. Louis, Missouri Augusta, Georgia Joseph T. Wayne, MD, MPH, FACP Gary Tabas, MD, FACP Associate Professor of Medicine Associate Professor of Medicine Associate Professor of Pediatrics University of Pittsburgh School of Medicine Clerkship Director, Internal Medicine Pittsburgh, Pennsylvania Albany Medical College Albany, New York Tomoko Tanabe, MD, FACP Assistant Professor of Medicine John Jason White, MD Associate Clerkship Director Assistant Professor of Medicine University of California, San Diego Nephrology Section San Diego, California Department of Medicine Medical College of Georgia David C. Tompkins, MD Augusta, Georgia Associate Chair Department of Medicine Kevin D. Whittle, MD SUNY Stony Brook Health Sciences Center Assistant Professor Stony Brook, New York Third Year Clerkship Director, Internal Medicine Sanford Medical School of the University of South Dario M. Torre, MD, MPH, FACP Dakota Clerkship Director Sioux Falls, South Dakota 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 Contents FOREWORD ..............................................................xv III Gastroenterology and Hepatology ACKNOWLEDGMENTS ..............................................xvii 13 Approach to Abdominal Pain ............................57 Priya Radhakrishnan I Cardiovascular Medicine 14 Approach to Diarrhea ......................................61 Sarang Kim 1 Approach to Chest Pain ......................................3 15 Diseases of the Gallbladder and Bile Ducts........64 Dario M. Torre Nora L. Porter 2 Chronic Stable Angina ........................................7 16 Acute Pancreatitis ............................................67 Anna C. Maio Nora L. Porter 3 Acute Coronary Syndrome................................11 17 Gastroesophageal Reflux Disease ......................70 Patrick C. Alguire Brown J. McCallum 4 Supraventricular Arrhythmias ............................15 18 Peptic Ulcer Disease ........................................72 Charin L. Hanlon Brown J. McCallum 5 Ventricular Arrhythmias ....................................20 19 Dyspepsia..........................................................74 Steven J. Durning and Mark C. Haigney Brown J. McCallum 6 Heart Failure ....................................................24 20 Approach to Gastrointestinal Bleeding ..............76 James L. Sebastian Warren Y. Hershman 7 Valvular Heart Disease ......................................28 21 Viral Hepatitis ..................................................80 H. Douglas Walden Carlos Palacio 22 Cirrhosis ..........................................................83 Mark J. Fagan II Endocrinology and Metabolism 23 Inflammatory Bowel Disease ............................87 Brown J. McCallum 8 Diabetes Mellitus and Diabetic Ketoacidosis ....37 Erik K. Alexander 9 Dyslipidemia ....................................................41 IV General Internal Medicine D. Michael Elnicki and Gary Tabas 10 Thryoid Disease................................................44 24 Test Interpretation............................................93 Erik K. Alexander D. Michael Elnicki 11 Adrenal Disease ................................................48 25 Health Promotion, Screening, and Prevention....96 Cynthia A. Burns L. James Nixon 12 Osteoporosis ....................................................52 26 Approach to Syncope......................................100 Melissa A. McNeil and Janine M. Frank Lawrence I. Kaplan xi
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