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

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

Christine Laine

Dr. Christine Laine

Annals of Internal Medicine Editor

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Challenge your mind…

HEADLINES from ACP:

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MKSAP 5 - Question of the Week

A 35-year-old man comes for a new patient evaluation. He takes no medications. His parents both have diabetes mellitus.

On physical examination, blood pressure is 165/104 mm Hg and BMI is 31. The remainder of the examination is unremarkable.

Laboratory studies, including serum electrolyte, blood urea nitrogen, and creatinine levels and urinalysis results, are normal.

Lifestyle modifications are recommended, but blood pressure findings are unchanged on a subsequent visit 2 weeks later.

The most appropriate next step in management for this patient is initiation of lisinopril and hydrochlorothiazide. This patient has stage 2 hypertension (systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg), and both lifestyle modifications and antihypertensive therapy are indicated. The guidelines proposed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommend initiating treatment with two medications in patients with stage 2 hypertension or those whose blood pressure is greater than 20 mm Hg systolic or 10 mm Hg diastolic above target. Low-dose hydrochlorothiazide and an angiotensin-converting enzyme (ACE) inhibitor, such as lisinopril, would be reasonable in this patient to ensure adequate blood pressure control. Careful follow-up and monitoring for signs of impaired fasting glucose or glucose intolerance also are recommended.

Monotherapy with hydrochlorothiazide, metoprolol, or terazosin would not be appropriate in a patient with stage 2 hypertension. Furthermore, evidence suggests that β-blockers do not perform as well as comparator drugs, particularly in preventing stroke, and thus they are no longer universally recommended as first-line single agents in the absence of a compelling indication, which may include a history of myocardial infarction and heart failure. Finally, thiazide diuretics appear to be superior to α-blockers (such as terazosin), ACE inhibitors, and calcium channel blockers as initial therapy for reducing cardiovascular and kidney risk in patients with hypertension.

Key Point

  • Current guidelines recommend initiating treatment with two medications in patients with stage 2 hypertension or those whose blood pressure is greater than 20 mm Hg systolic or 10 mm Hg diastolic above target.
Q. Administration of which of the following is the most appropriate treatment?
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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MKSAP for Students 5 Digital

MKSAP for Students 5 Digital

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Internal Medicine Essentials

Internal Medicine Essentials for Students

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MKSAP for Students 5 Book

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On Being a Doctor 3

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Ethics Manual, Sixth Edition

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