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Bundle of Dr. Ted Parks Books

Bundle of Dr. Ted Parks Books

Musculoskeletal Injections in Primary Care

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Sandy Shoichet Clinical Vignette Resident Travel Fund

Support the Sandy Shoichet Clinical Vignette Resident Travel Fund We invite you to consider a donation to the Sandy Shoichet Clinical Vignette Resident Travel Fund. Dr. Shoichet was a long-standing member of the Michigan Chapter, a dedicated participant on the Governor’s Council, and a long-time Chair of both the Program Director Committee and the Nominations Committee. His passion for education, steadfast support of the Chapter’s work, and commitment to developing future internists shaped generations of trainees. This fund will provide annual support for the top resident clinical vignette winner to travel to the National ACP Internal Medicine Meeting to present their work Any amount makes a meaningful difference. Thank you for your support.

ACP POCUS 3: Focused Cardiac Ultrasound

ACP POCUS 3: Focused Cardiac Ultrasound

ACP POCUS: Lung Ultrasound

ACP POCUS: Lung Ultrasound

ACP POCUS: Obtaining Adequate Clinical Images for Interpretation

ACP POCUS: Obtaining Adequate Clinical Images for Interpretation

ACP Physician Peer Coaching - QI Champion Bundle

Receive up to 6 hours of personalized, one-on-one coaching support focused on quality improvement over 6-months with an ACP Physician Peer Coach. This program offers: Registration to the Quality Improvement Leadership Training Pre-course held on Wednesday, April 15, 2026 in San Francisco, CA in conjunction with the 2026 ACP Internal Medicine Meeting Live, virtual coaching sessions with your coach (6 hours)

ACP Quality Improvement Curriculum All 4 Together

ACP Quality Improvement Curriculum All 4 Together

ACP QI Curriculum Module 4: Implement and Sustain Change

ACP Quality Improvement Curriculum The ACP Quality Improvement curriculum focuses on simple, core concepts that can be applied to help achieve meaningful quality goals in a practical manner. A step-wise approach guides you through each stage of the QI journey from establishing the “what” and “why” for change to implementing and sustaining change. This online curriculum, developed by physicians for physicians and their teams, is offered as a series of four modules. Physicians who complete all four modules are eligible for up to3.75 AMA PRA Category 1 CreditsTM and ABIM MOC points. Physicians are also eligible to earn patient safety credit.

ACP QI Curriculum Module 3: Plan for Change and Identify Solutions

ACP Quality Improvement Curriculum The ACP Quality Improvement curriculum focuses on simple, core concepts that can be applied to help achieve meaningful quality goals in a practical manner. A step-wise approach guides you through each stage of the QI journey from establishing the “what” and “why” for change to implementing and sustaining change. This online curriculum, developed by physicians for physicians and their teams, is offered as a series of four modules. Physicians who complete all four modules are eligible for up to3.75 AMA PRA Category 1 CreditsTM and ABIM MOC points. Physicians are also eligible to earn patient safety credit.

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Displaying 11 - 20 of 499 in Annals of Internal Medicine: Clinical Cases

Breathless on Standing: Hepatopulmonary Syndrome in Chronic Liver Disease | Annals of Internal Medicine: Clinical Cases

In patients with chronic liver disease, positional dyspnea (platypnea) and desaturation (orthodeoxia) should prompt immediate evaluation. Although the differential diagnosis includes many cardiopulmonary disorders, platypnea-orthodeoxia raises concern for right-to-left shunting and gravity-dependent ventilation–perfusion ratio mismatch, particularly hepatopulmonary syndrome. This condition carries high mortality and requires prompt evaluation for liver transplantation. We present a patient with chronic untreated hepatitis C who developed significant platypnea and orthodeoxia. Work-up revealed a markedly elevated alveolar-arterial gradient, and contrast-enhanced (agitated saline) echocardiography demonstrated substantial intrapulmonary shunting, confirming the diagnosis.

Acute Thigh Pain in a Patient With Diabetes Mellitus: A Rare Case of Diabetic Myonecrosis | Annals of Internal Medicine: Clinical Cases

Diabetic myonecrosis (also known as diabetic muscle infarction, or DMI) is a rare complication of poorly controlled diabetes, with fewer than 200 discrete cases reported in the English language medical literature over the past 60 years. In most published cases, diabetic myonecrosis occurs concurrently with other micro/macrovascular diabetic sequelae (e.g., nephropathy). Here, we describe a case of a patient with DMI without nephropathy, whose presentation was otherwise pathognomonic for DMI. We share this case to increase clinician awareness of this uncommon condition and to highlight the diagnostic and treatment considerations to keep in mind when managing suspected DMI, as choice of treatment can dramatically affect clinical course.

Multisystem Neuroimmune, Autonomic, Thromboembolic, and Vestibular Dysfunction Following mRNA COVID-19 Vaccination: A Case Report | Annals of Internal Medicine: Clinical Cases

Multisystem neurologic, autonomic, immune, and vestibular complications following mRNA COVID-19 vaccination remain rare. We report a previously healthy woman who developed profound dysautonomia, constant neuropathic pain, persistent postural-perceptual dizziness, mast cell activation–like symptoms, acquired thrombophilia requiring anticoagulation, migraines, and new-onset generalized seizures shortly after vaccination. Symptoms persisted despite extensive evaluation and treatment. Although causality cannot be established from a single case, the temporal association, extensive diagnostic evaluation, and biological plausibility warrant clinical awareness and further study.

Intracardiac Migration of a TIPS Stent Causing Ventricular Tachycardia | Annals of Internal Medicine: Clinical Cases

Intracardiac migration of a transjugular intrahepatic portosystemic shunt (TIPS) stent is a rare but potentially life-threatening complication. A 52-year-old man developed asymptomatic nonsustained ventricular tachycardia within 24 hours of elective TIPS creation. Echocardiography demonstrated a migrated TIPS bare-metal stent segment protruding into the right ventricle and interacting with the tricuspid valve. The stent was retrieved endovascularly using balloon and snare techniques via dual venous access under echocardiographic and fluoroscopic guidance. Arrhythmias resolved after stent removal. This case highlights the importance of early post-TIPS monitoring and prompt endovascular intervention for intracardiac stent migration presenting with ventricular arrhythmias.

Case of Splenic Marginal Zone Lymphoma Presenting as Acquired Angioedema | Annals of Internal Medicine: Clinical Cases

Acquired angioedema (AAE-C1INH) is a rare, potentially life-threatening disorder resulting from acquired C1 esterase inhibitor deficiency, often secondary to lymphoproliferative diseases such as splenic marginal zone lymphoma (SMZL). We report on a 68-year-old woman presenting with facial and tongue swelling, gastrointestinal symptoms, and splenomegaly. Laboratory work-up revealed low C1 esterase inhibitor and C1q complement levels, consistent with AAE-C1INH. Imaging showed marked splenomegaly with increased fluorodeoxyglucose uptake; bone marrow biopsy confirmed SMZL. Treatment with rituximab and bendamustine chemotherapy led to clinical improvement, normalization of complement levels, and cessation of angioedema episodes.

Unexpected Discovery of a Gastrocutaneous Fistula | Annals of Internal Medicine: Clinical Cases

We report a case detailing the discovery of a gastrocutaneous fistula (GCF) during an exploratory laparoscopy. The patient required percutaneous endoscopic gastrostomy tube placement owing to mucositis after a glossectomy. Illustrative of the interdisciplinary treatment of disease, this case emphasizes the importance of collaboration between primary care practitioners and the medical subspecialties.

A Cause of Intestinal Obstruction From Clay | Annals of Internal Medicine: Clinical Cases

This case describes a 34-year-old woman presenting with progressive abdominal distension initially concerning for pregnancy, which was ultimately diagnosed as severe fecal impaction with stercoral colitis due to geophagia, or the compulsive eating of clay. Imaging revealed a massive stool mass with high-density nonfecal material that required operative removal, confirmed to be clay. She also had severe iron deficiency anemia, which is a common complication of this disorder.

Cardiac Tamponade, Mesenteric Ischemia, and Macrophage Activation Syndrome as the Initial Manifestation of Systemic Lupus Erythematosus: A Case Report | Annals of Internal Medicine: Clinical Cases

A 36-year-old man presented with dyspnea requiring emergent pericardiocentesis for cardiac tamponade (700 mL). On hospital day 19, he developed acute mesenteric ischemia; exploratory laparotomy revealed vasculitic vessel wall thickening without retrievable thrombus on embolectomy. Postoperatively, he developed macrophage activation syndrome with ferritin >16 000 ng/mL and transaminitis >3000 U/L. Systemic lupus erythematosus was diagnosed (ACR/EULAR score 21), representing the first reported case to our knowledge of simultaneous cardiac tamponade, mesenteric vasculitis, and macrophage activation syndrome at SLE onset. Treatment with cyclophosphamide and rituximab achieved remission. The surgical finding of vasculitis rather than thrombosis proved critical in guiding immunosuppressive therapy.

Hydroxychloroquine Cardiomyopathy—A Case Series and Review of the Literature | Annals of Internal Medicine: Clinical Cases

Cardiomyopathy is a rare but serious adverse effect of long-term hydroxychloroquine therapy, manifesting as conduction abnormalities and heart failure. Its incidence is not well established. We present the largest case series, to our knowledge, of 13 patients with endomyocardial biopsy–proven hydroxychloroquine cardiomyopathy conducted over an 8-year period at one institution. Outcomes after therapy discontinuation varied, ranging from complete resolution to progressive heart failure requiring advanced therapies, including the first reported cases of left ventricle assist device as destination therapy. Early recognition and timely drug cessation may allow for partial or full recovery of cardiac function.

Sequential Drug-Induced DRESS Syndrome With Severe Rhabdomyolysis and Probable Myocarditis: A Case Report | Annals of Internal Medicine: Clinical Cases

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe hypersensitivity syndrome with multiorgan involvement. An 81-year-old man with cardiomyopathy and stage IV chronic kidney disease developed DRESS syndrome after sequential exposure to allopurinol and vancomycin. He presented with diffuse rash, eosinophilia, transaminitis, severe rhabdomyolysis (CK 19,228 U/L), and probable myocarditis (troponin 9,712 ng/L). Corticosteroids started late, and a repeat vancomycin dose was temporally associated with rapid multiorgan deterioration and death. This case illustrates a rare presentation of DRESS syndrome with concurrent rhabdomyolysis and myocarditis, emphasizing the lethality of delayed diagnosis and sequential exposure to high-risk agents.

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