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.

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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.

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My Kind of Medicine:
Real Stories of ACP Internists

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

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

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MKSAP 5 - Question of the Week

A 35-year-old woman is evaluated in the office for a 5-month history of right-hand numbness and tingling. She says that these symptoms involve the entire hand, seem to be worse when she drives or holds a book or newspaper, and have been awakening her at night. She reports no history of neck pain or hand weakness. Personal and family medical histories are noncontributory, and she takes no medication.

General physical examination reveals no abnormalities. Neurologic examination shows normal strength but sensory loss in the first three digits and the radial half of the fourth digit in the right hand.

This patient most likely has carpal tunnel syndrome. Carpal tunnel syndrome refers to median nerve compression at the wrist in the carpal tunnel. Symptoms include aching wrist pain with sparing of the palm, numbness and tingling in the median nerve sensory distribution of the fingers, and weakness of the thenar muscles. The paresthesias are often worse at night or when holding a book or steering a car.

de Quervain tenosynovitis is an exercise-related injury associated with knitting and sports involving extensive wrist action. Tenderness may be elicited in the anatomic snuffbox (the extensor pollicis brevis and abductor pollicis longus tendons). Pain elicited by flexing the thumb into the palm, closing the fingers over the thumb, and then bending the wrist in the ulnar direction (Finkelstein test) is confirmatory.

Ganglion cysts are synovia-filled cysts arising from joints or tendon sheaths that typically appear on the dorsal hand or ventral wrist. They can cause pain and compress other structures. The absence of cystic structures on the dorsal and ventral wrist and the distribution of the patient's pain eliminate this diagnosis.

Ulnar nerve compression at the wrist is also called Guyon tunnel syndrome, because the entrapment occurs where the ulnar nerve transverses the Guyon tunnel between the pisiform and hamate bones on the anterolateral side of the wrist, and cyclist's palsy, because the compression of the ulnar nerve often occurs as the hand rests on the handlebars. However, the ulnar nerve can be compressed by muscles, tumors (lipomas), scar tissue, synovial cysts, or any other internal structure that passes close to the tunnel. The presentation is similar to that of carpal tunnel syndrome, but with symptoms and signs on the ulnar distribution of the hand.

Key Point

  • Symptoms of carpal tunnel syndrome include aching wrist pain with sparing of the palm, numbness and tingling in the median nerve sensory distribution of the fingers, and weakness of the thenar muscles.
Q. Which of the following is the most likely diagnosis?
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