IMpact: News for Medical Students

Discover your future in Internal Medicine

The General Internist Career Path

Internal Medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.

More About Internal Medicine Careers

The Subspecialist Career Path

Subspecialists in internal medicine have chosen to receive additional, more in-depth training and board certification in the diagnosis and management of diseases of a specific type or diseases affecting a single organ system.

More About Subspecialty Careers

The Hospitalist Career Path

Hospitalists are providers who dedicate most of their career to the care of hospitalized patients. They focus on clinical management, with an added eye to quality, safety, and utilization.

More About Hospitalist Careers

My Kind of Medicine:
Real Stories of ACP Internists

David L. Katz, MD, MPH, FACPM, FACP

Dr. David L. Katz

Director, Yale University Prevention Research Center

Susan L. Turney, MD, MS, FACMPE, FACP

Dr. Susan L. Turney

CEO, Marshfield Clinic Health System

Farzanna S. Haffizulla, MD, FACP

Dr. Farzanna S. Haffizulla

Internist in Private Practice

Saad Z. Usmani

Dr. Saad Z. Usmani

Director of Clinical Research

Joshua M. Liao, MD

Dr. Joshua M. Liao

Internal Medicine Resident

Dr. Valerie J. Lang

Dr. Valerie J. Lang

Associate Professor of Medicine

Dr. David Fleming

Dr. David Fleming

ACP President with Dr. Robert Centor, ACP Chair, Board of Regents

Dr. Kent J. DeZee

Dr. Kent DeZee

Program Director, General Medicine Fellowship

Dr. Erik Wallace

Dr. Erik Wallace

Associate Dean

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MKSAP 5 - Question of the Week

A 57-year-old woman is evaluated in the emergency department for a 1-week history of swelling and pain in the left leg. She has had two normal pregnancies and no miscarriages. There is no family or personal history of thromboembolic disease. The patient is otherwise healthy.

A proximal deep venous thrombosis is confirmed on ultrasound. Unfractionated heparin is given as an initial bolus followed by a continuous infusion at a dose to prolong the activated partial thromboplastin time to two times the control value. Warfarin, 5 mg/d, is also initiated.

The appropriate treatment for a patient with deep venous thrombosis that is either idiopathic or associated with a transient risk factor is an initial short course of an immediate-acting anticoagulant such as unfractionated heparin, low-molecular-weight heparin, or fondaparinux for at least 5 days. Warfarin should be started at approximately the same time that heparin is administered, and the two drugs should be overlapped until the INR reaches a therapeutic range (>2) measured on two occasions approximately 24 hours apart. This timing allows for further reduction of prothrombin, the vitamin K–dependent factor with the longest half-life (approximately 60 h), which is responsible for much of the antithrombotic effect of warfarin. Usually 5 to 7 days of therapy are required to achieve this therapeutic level. The initial recommended daily warfarin dose is 5 mg, but occasionally 7.5 to 10 mg may be used. Lower doses (2.5 mg) are recommended in the elderly, especially in the setting of malnourishment, liver disease, or recent major surgery.

Key Point

  • Treatment of deep venous thrombosis consists of an immediate-acting anticoagulant such as unfractionated heparin, low-molecular-weight heparin, or fondaparinux for at least 5 days.
Q.Which of the following is the most appropriate duration of heparin therapy for this patient?
Abstract Competition

Abstract Competition

The College sponsors local and national abstract competitions especially for student members that offer monetary awards and the chance to win recognition.

Doctor's Dilemma

Doctor's Dilemma™

ACP's national medical jeopardy competition, held each year at ACP’s annual meeting, allows dozens of teams of residents and medical students from around the nation to compete for the coveted title of national champion.

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