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September 2010

Medical Student Perspectives: How to be an Active Leader of your School’s Internal Medicine Interest Group

I meet many medical students at various ACP-sponsored meetings who are full of lofty goals which they intend to accomplish—once they graduate from medical school, that is. Most of them are surprised to find out there is much to be done on the local level even as medical students. It is a valuable exercise to learn how to energize your school’s internal medicine interest group (IMIG) and thereby learn the skills necessary to be a productive physician.

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My Kind of Medicine: Real Lives of Practicing Internists: Mark Richman, MD, FACP

On the first day of school in a lecture hall at the Johns Hopkins School of Public Health, Mark Richman spied a beautiful girl walking across the stage. Like her, he was there picking up forms for the MPH program. “I remember thinking ‘Who’s that girl?’” he says. “I thought there’s no way I could date someone like her.” Ten years later the two are married. He’s also pleasantly surprised by his career trajectory, one he could never have predicted. He quickly adds however, that the end result, however circuitous, was a product of staying true to his personality and goals. “At a certain point, things stop being a coincidence,” he says.

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Internal Medicine Interest Group of the Month: Edward Via College of Osteopathic Medicine

Although the Internal Medicine Interest Group (IMIG) at Edward Via College of Osteopathic Medicine (VCOM) is one of the youngest clubs on campus, it is quickly becoming one of the fastest growing groups. In our short three-year history we have discovered that many of our first year students do not fully understand what internal medicine is and what this exciting field has to offer. Therefore, we have made it our primary goal to both educate and excite our student body about internal medicine.

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Winning Abstracts from the 2010 Medical Student Abstract Competition: Consult To Quit: Smoking Intervention At Large Public Hospital

Smoking is the leading cause of preventable death in the United States causing 40,000 deaths/year. Despite the benefits of quitting, screening and counseling for smokers remains inadequate, even in hospitalized patients. Hospital admission increases physician/patient interaction time allowing opportunies to counsel and enroll patients in smoking-cessation programs.

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Subspecialty Careers: Highlights about Careers in Internal Medicine: Adolescent Medicine

Adolescent medicine focuses on the physical, psychological, social, and sexual development of adolescents and young adults. Multidisciplinary and comprehensive in approach, this specialty encompasses the full spectrum of acute, chronic, and preventive health care. Adolescent medicine evaluates medical and behavioral problems within the context of puberty and tailors management to the individual's developmental needs.

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Did You Know You Can Enter the ACP’s National Medical Student Abstract Competition?

The College sponsors local and national abstract competitions for medical students that offer monetary awards and the chance to win recognition. The winning entries in both the National Clinical Vignette and Research competitions are featured each year at the College's premier annual Internal Medicine meeting. National winners are awarded a monetary prize to offset the cost of attending the meeting, and finalists are invited to compete on-site in the poster competitions for monetary prizes.

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MKSAP for Students 4 Question 1

A 27-year-old woman with a 2-year history of systemic lupus erythematosus is evaluated in the office for new-onset fatigue and shortness of breath of 10 days' duration. Her medications are hydroxychloroquine and ibuprofen. The medical history is otherwise noncontributory.

On physical examination, the heart rate is 109/min, respiration rate is 14/min, and blood pressure is 130/80 mm Hg. Other than pale conjunctivae and pallor, the physical examination is normal.

Laboratory studies indicate a hemoglobin of 5.2 g/dL, compared with a normal value 3 months ago, and an absolute reticulocyte count of 300,000/µL (normal, 25,000 –75,000/µL). The peripheral blood smear shows polychromatic red blood cells and microspherocytes.

Which of the following is the most appropriate initial treatment for this patient?

A. Corticosteroid therapy
B. Erythropoietin
C. Oral ferrous sulfate
D. Plasmapheresis

Answer

MKSAP for Students 4 Question 2

A 35-year-old man is evaluated in the office because of a 2-day history of painful sores on his penis without fever, headache, dysuria, or photophobia. He has never had similar lesions. The patient reports a new sexual partner for the past 6 months but does not know if his partner has a history of any sexually transmitted diseases.

On physical examination, vital signs are normal. There is no rash or evidence of meningismus. Nontender right inguinal lymphadenopathy is noted. Examination of the genitals is shown Figure 14.

Which of the following is the most likely diagnosis?

A. Group B streptococcal infection
B. Herpes simplex virus infection
C. Herpes zoster
D. Syphilis

Answer

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MKSAP for Students 4 Answer 1

Answer A: Corticosteroid therapy

This patient has warm-antibody autoimmune hemolytic anemia (AIHA); the first step in treatment is corticosteroid therapy. Polychromasia in patients with AIHA usually results from reticulocytosis. Reticulocytes contain nucleic acids that stain blue. Warm-antibody AIHA occurs when IgG antibodies bind to red blood cell antigens (usually of the Rh-type) at body temperature. These cells are eventually cleared by splenic macrophages. Spherocytes are detected in patients with warm-antibody AIHA because of membrane removal by macrophages in the spleen. Although warm-antibody AIHA is initially treated with corticosteroid therapy, intravenous immune globulin and splenectomy are also treatment options. However, intravenous immune globulin has not been shown to be as effective as corticosteroid therapy in these patients.

Red blood cells are microcytic in patients with iron deficiency, and reticulocytosis is decreased in the absence of iron. Therefore, iron and erythropoietin are not useful in the treatment of this patient. Plasmapheresis is used in the treatment of thrombotic thrombocytopenic purpura, which is a microangiopathic hemolytic anemia characterized by the presence of schistocytes.

Bibliography
1. Gehrs BC, Friedberg RC. Autoimmune hemolytic anemia. Am J Hematol. 2002;69:258-71. [PMID: 11921020] [PubMed]

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MKSAP for Students 4 Answer 2

Answer: Herpes simplex virus infection

The diagnosis is genital herpes simplex virus infection. Primary genital herpes appears as vesicles progressing to pustules and then to ulcers or erosions. At the time of presentation, only ulcers or erosions may be present. Tender inguinal lymphadenopathy usually develops after the genital lesions develop and lasts after the genital lesions resolve. Extra-genital herpes may be seen on the buttocks, thighs, anus, rectum, fingers (whitlow), or conjunctiva. The first episodes may be severe or so mild as to be unrecognized.

Herpes zoster lesions would be more extensive and would involve other areas in a dermatomal distribution. Lesions in patients with syphilis are not painful and tend to be larger. Group B streptococcal infection is manifested as a diffuse cellulitis or abscess formation rather than as vesicular, pustular, or erosive lesions.

Bibliography
1. Sen P, Barton SE. Genital herpes and its management. BMJ. 2007;334:1048-52. [PMID: 17510153] [PubMed]

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MKSAP for Students 5 Digital

MKSAP for Students 5 BookEnsure your success on the IM Clerkship rotation and exams. Study the material recommended by the Clerkship Directors in Internal Medicine and ACP with this integrated digital product. The full content of MKSAP for Students 5 and Internal Medicine Essentials for Students is presented on the product website, with links between questions and textbook. Questions can also be accessed through the new Osmosis medical app and website using a unique push-notification system. Learn more.

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