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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.

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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.

More About Hospitalist Careers

My Kind of Medicine:
Real Stories of ACP Internists

Dr. Larry Kaplan & Dr. Rosalind Kaplan

Dr. Larry Kaplan & Dr. Rosalind Kaplan

Dr. Kaiser-Smith

Dr. Joanne Kaiser-Smith

Assistant Dean

Dr. Mays

Dr. Christopher Mays

General Internist

Dr. Adams

Dr. Michael Adams

Internist & Program Director

Dr. Inouye

Dr. Lisa Inouye

Internist & Program Director

Dr. Shah

Dr. Ryan Mire

General Internist

Dr. Shah

Dr. Nirav Shah

Internist, Assistant Professor, Researcher

Dr. DeSalvo

Dr. Karen DeSalvo

Internist & Associate Professor

Voices of Internal Medicine:
Medical Student Perspectives

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MKSAP 5 - Question of the Week

An 81-year-old woman with aortic stenosis is evaluated for increased shortness of breath and exercise intolerance. She was asymptomatic until 2 weeks ago when she noted increased shortness of breath with exertion. She reports no chest pain, orthopnea, paroxysmal nocturnal dyspnea, or palpitations. She has had no fever, chills, or recent procedures that might increase the risk for infective endocarditis. She has no other medical problems and takes no medications.

On physical examination, she is afebrile, blood pressure is 116/72 mm Hg, pulse rate is irregularly irregular at 112/min, and respiration rate is 12/min. No jugular venous distention is present. Cardiac auscultation reveals an irregular rhythm with a grade 3/6 crescendo-decrescendo systolic murmur loudest at the second left intercostal space with radiation to the carotid arteries. Bibasilar pulmonary crackles are present, as is 1+ bilateral lower extremity edema.

New-onset atrial fibrillation is the most likely cause of the patient's new symptoms. Aortic valve sclerosis, or valve thickening without outflow obstruction, is present in more than 25% of persons older than 65 years. Patients are often diagnosed when an asymptomatic murmur is auscultated or following an incidental echocardiographic finding. The progression from aortic sclerosis to stenosis is slow, and fewer than 20% of patients develop valve obstruction over the next 10 years. When mild stenosis is present, however, progressive valve stenosis proceeds more rapidly. Classic manifestations of aortic stenosis are angina, syncope, and heart failure. In early stages, aortic stenosis may present subtly with dyspnea or a decrease in exercise tolerance. Atrial fibrillation can be associated with rapid and severe clinical deterioration due to the more rapid rate and loss of atrial contribution to left ventricular filling. Angina occurs in more than 50% of patients with severe stenosis, due in part to maldistribution of coronary flow in the hypertrophied myocardium. Patients with aortic stenosis have increased sensitivity to ischemic injury, and subsequently have higher mortality. Frank syncope associated with aortic stenosis is rare, with prospective studies documenting sudden cardiac death rates less than 1% annually.

Endocarditis should be suspected if an abnormal murmur is heard on examination, particularly in patients with a compelling history or concurrent fever. Incidence is higher in patients with underlying valve abnormalities and prosthetic valves. Because of the absence of fever and the presence of atrial fibrillation as a more likely cause of clinical deterioration, infective endocarditis is unlikely.

Patients with a history of rheumatic fever may have involvement of multiple heart valves, but this is not the case in patients with degenerative aortic sclerosis. Furthermore, the physical examination findings of chronic mitral regurgitation include a holosystolic murmur, heard best at the apex, with radiation laterally or posteriorly. The auscultatory findings for mitral stenosis include an opening snap with a low-pitched middiastolic murmur that accentuates presystole. These findings are not present, making mitral stenosis or regurgitation unlikely.

Key Point

  • In patients with aortic stenosis, atrial fibrillation can be associated with rapid and severe clinical deterioration due to the more rapid rate and loss of atrial contribution to left ventricular filling.
Q.Which of the following is most likely responsible for the new symptoms?
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

MKSAP for Students 5 Book

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On Being a Doctor 3

On Being a Doctor 3

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Landmark Papers in Internal Medicine

Landmark Papers in Internal Medicine

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