Medical Student Perspectives: Is the Physical Exam Dying?
The future of the physical exam has come into question again in both the scientific journals and the popular press. For the last decade or longer, the debate has raged over the value of the annual physical exam. A study by the Agency for Healthcare Research and Quality (AHRQ)1, which began in 1989 and was published in 2006, is commonly cited by opponents of the annual physical.More
My Kind of Medicine: Real Lives of Practicing Internists: Nirav Shah, MD
When it comes to New York City, there are two kinds of people—those who can live there and those who cannot. To be a true New Yorker, you have to thrive on the hustle and bustle, the never-ending cycle of action. There is never a dull day in NYC, and the people who make it their home would not have it any other way. That is how Dr. Nirav Shah feels about being a New Yorker. It is also how he feels about being an internist.Read More Watch Video
Feature: Finding the Right Mentor for You
Once that you are medical school graduates all you have to remember to say is, “I do not know how to do this! Please help me.” Finding the right mentor can really help you along in your journey as a young physician.
Internal Medicine Interest Group of the Month: Meharry Medical College
Since being first featured as the Internal Medicine Interest Group of the Month in the September 2008 issue of IMpact, the Thomas-Hardy Internal Medicine Society (THIMS) of Meharry Medical College’s School of Medicine has continued to maintain an abounding presence on the Meharry campus and in the surrounding community of Nashville, Tennessee.More
Winning Abstracts from the 2010 Medical Student Abstract Competition: The Sound Of Bleeding
Heyde’s syndrome was first reported in 1958 as a correlation between aortic stenosis and gastrointestinal (GI) bleeding. Recently, it has been associated with the triad of aortic stenosis, gastrointestinal angiodysplasia, and acquired von Willebrand syndrome. Several case studies and small series have appeared in the literature, yet, 50 years later, there are no clinical guidelines for evaluation of anemia or GI bleeding in patients with aortic stenosis.More
Subspecialty Careers: Highlights about Careers in Internal Medicine: Hematology
The discipline of hematology relates to the care of patients with disorders of the blood, bone marrow, and lymphatic systems, including the anemias, hematological malignancies and other clonal processes, and congenital and acquired disorders of hemostasis, coagulation, and thrombosis.More
Did You Know: ACP’s Council of Student Members is looking for new representatives?
If you are active in your local chapter, get involved nationally by running for a seat on the ACP Council of Student Members (CSM). The CSM is responsible for planning programs for the annual meeting for medical students and providing a student perspective on current issues impacting the field of internal medicine.More
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
C. Oral ferrous sulfate
MKSAP for Students 4 Question 2
A 50-year-old woman is hospitalized for lower-extremity edema and accelerated hypertension. She has a 3-year history of diet-controlled type 2 diabetes mellitus and hypertension treated with enalapril.
On physical examination, she is afebrile, heart rate is 60/min, respiration rate is 25/min, and blood pressure is 198/106 mm Hg. There is no jugular venous distention. Cardiopulmonary examination is normal. There is pitting edema in the bilateral lower extremities.
|Blood urea nitrogen||21 mg/dL|
|Urinalysis||pH 5.0, specific gravity 1.015, 1+ blood, 4+ protein|
|Urine protein/creatinine ratio||3.5 mg/mg|
A photomicrograph of the urine sediment is shown. Renal ultrasonography reveals small bilateral 1-cm simple cysts, normal-sized kidneys, and no hydronephrosis.
Which of the following is the most likely diagnosis?
A. Acute glomerulonephritis
B. Acute interstitial nephritis
C. Acute tubular necrosis
D. Prerenal azotemia
Advocacy Update: American College of Physicians Response to the Institute of Medicine’s Report, The Future of Nursing: Leading Change, Advancing Health
The Institute of Medicine (IOM) recently released a study, The Future of Nursing: Leading Change, Advancing Health.1 The report calls for new and expanded roles for nurses in a redesigned health care system. It recommends improving education for all nurses and allowing nurses to practice to the full extent of their license and ability. It advocates overhauling state scope of practice acts and suggests that advanced practice registered nurses (APRNs) -- certified registered nurse anesthetists, certified nurse-midwives, clinical nurse specialists, and certified nurse practitioners – should be allowed to practice independently.More
Ask the Program Director
IMpact is developing a new feature that will focus on providing medical students practical advice to help them navigate the process of obtaining a residency position in internal medicine. Issues to be covered include CV development, writing a personal statement, the Match process, residency program interviews, and more. At this time, we are collecting questions and issues that medical students would like addressed by program directors, program coordinators, clerkship directors and chief residents. We will then recruit volunteers to answer those questions in a series of monthly columns that will be included in upcoming newsletter editions.