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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.

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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

Dr. Erik Wallace

Dr. Erik Wallace

Associate Dean

Dr. Suchitra Behl

Dr. Suchitra Behl

Consultant for FORTIS C-DOC

Dr. Aysha Khoury

Dr. Aysha Khoury

Clinical Decision Unit Internist

Victor Simms

Dr. Victor A. Simms

Associate Chief, Dept. of IM

Christine Laine

Dr. Christine Laine

Annals of Internal Medicine Editor

Christopher Moriates

Dr. Christopher Moriates

Assistant Clinical Professor

Janice M. Barnhart

Dr. Janice M. Barnhart

Locum Tenens Hospitalist

Bernard M. Karnath

Dr. Bernard M. Karnath

Professor of Medicine

Dr. Cooke

Dr. Molly Cooke & Dr. Charles Cutler

ACP President and ACP Chair, Board of Regents

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Challenge your mind…


MKSAP 5 - Question of the Week

A 66-year-old woman is evaluated because of right knee pain of 4 weeks' duration. Although the knee is stiff for 20 to 30 minutes in the morning, she does not have much pain at work. Walking up the stairs in her house, however, causes a good deal of pain, which is not relieved by ibuprofen or acetaminophen. Kneeling also causes pain. Knee radiographs done 6 weeks ago show mild medial compartment osteoarthritis bilaterally.

On physical examination, she is overweight. There is coarse crepitus with flexion and extension of the right knee. Both knees are in slight varus angulation (“bow-legged”). On palpation, there is tenderness along the joint margins of both knees and exquisite tenderness to digital pressure at the medial upper tibia on the right that reproduces her pain. In addition, with the patient's right knee semiflexed, palpation along the medial semimembranous tendinous (hamstring) edge of the thigh elicits pain when the examining fingers meet the tibia.

FVC 84% of predicted
FEV1/FVC 80%
DLCO 44% of predicted

The patient has anserine bursitis; the maneuver with the knee semiflexed helps to confirm the diagnosis. In anserine bursitis, the diagnosis rests on the finding of focal tenderness on the upper, inner tibia, about 5 cm distal to the medial articular line of the knee. Patients are usually middle-aged or older and often have knee osteoarthritis, but the problem can occur in active young people also. Usually, there is no redness, swelling, or increased warmth at the painful site. It may be that the underlying problem is strain of the pes anserinus tendon rather than true bursitis. Corticosteroid injection at the bursal site almost always provides relief of pain. Often, knee pain attributed to even severe osteoarthritis of the knee disappears after treatment of the anserine bursitis. Because the corticosteroid is injected into soft tissue, the risk of tendon rupture is minimal. In addition, patients should adhere to a regimen of isometric quadriceps exercises and, if applicable, weight reduction.

Osteoarthritis and gout would produce findings limited to the knee joint, and are not associated with focal tenderness of the upper, inner tibia. Rheumatoid arthritis of the knee is uncommon, particularly if it is asymmetrical, and would not produce focal tenderness along the upper tibia.

Key Point

  • In anserine bursitis, the diagnosis rests on the finding of focal tenderness on the upper, inner tibia, about 5 cm distal to the medial articular line of the knee.
Q. Which of the following is most likely responsible for the exacerbation of the right knee pain?
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Doctor's Dilemma™

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