Produced by ACP and the Clerkship Directors in Internal Medicine (CDIM), IM Essentials Text and IM Essentials Questions are the next. IM Essentials Questions is the next generation of MKSAP for Students, and produced collaboratively between ACP and The Clerkship Directors in Internal Medicine (CDIM). IM Essentials Questions is a self-assessment question book that uses clinically based, MKSAP-style questions to. IM Essentials Questions - Download as Word Doc .doc /.docx), PDF File .pdf), Text File .txt) or read online. internal medicine MSKASAP.
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Clerkship Directors in Internal Medicine. Edition: Examination Questions IM essentials text: a medical knowledge self-assesment program (MKSAP) for. Also available is IM Essentials Questions, containing over self-assessment questions. IM Essentials Text includes FREE access to the. Read Online Premium E-Books IM Essentials Text American College of IM Essentials Text and IM Essentials Questions are the next generation of For Full BOOK ONLINE BEST PDF Premium E-Books IM Essentials Text.
Diagnose lymphocytic thyroiditis as a cause of hyperthyroidism Key Point: In patients with subacute. It is also the most sensitive and specific method to help diagnose the cause of a thyroid nodule o FNA biopsy is recommended for any nodule greater than 1 cm in diameter that is solid and hypoechoic on ultrasonography and for any nodule 2 cm or greater that is mixed cystic-solid without worrisome sonographic characteristics. Thyroiditis involves transient destruction of thyroid tissue.
Evaluate thyroid nodules with fine-needle aspiration biopsy Key point: A fine-needle aspiration biopsy is the most accurate way to determine if a thyroid nodule is benign or malignant. FNA biopsy is the most accurate method to determine whether a nodule is benign or malignant.
Treat Graves Disease Key point: Toxic multinodular goiter and toxic adenoma result from an activating somatic mutation in the TSH receptor gene.
Since 0. In patients with hyperglycemic hyperosmolar syndrome. Intravenous insulin should be given to normalize his blood glucose concentration. If results of two different diagnostic tests for diabetes mellitus are discordant. Insulin treatment in patients with type 1 diabetes helps preserve endogenous insulin secretion for a longer period of time.
Differentiate type 1 from type 2 diabetes mellitus. Screen for dyslipidemia in a patient with type 1 diabetes mellitus. In young patients with probable diabetes mellitus. Manage hypoglycemia in a patient taking a sulfonylurea. FNA biopsy is not routinely recommended for thyroid nodules less than 1 cm in diameter Prediabetes o may be diagnosed in the presence of: Diagnose type 2 diabetes mellitus.
The American Diabetes Association recommends that patients with type 1 diabetes mellitus have a fasting lipid panel performed after puberty or at diagnosis if the diagnosis is established after puberty.
Treat hyperglycemic hyperosmolar syndrome with fluid resuscitation. Manage hyperglycemia in a patient in the medical intensive care unit. Diabetic ketoacidosis DKA is associated with hyperkalemia. This critically ill patient with pneumonia and sepsis is at risk for lactic acidosis. Insulin therapy will stimulate transfer of potassium from the extracellular to the intracellular space. The optimal glucose management for critically ill hospitalized patients is unknown. When delivered by this route.
As with almost all small peptides. A o An elderly patient with a history of DM with A1c levels within normal range may reflect a level of control in an older patient that may be causing episodes of hypoglycemia.
Select the appropriate type and route of insulin therapy in a patient with a hyperglycemic emergency. Treat hypoglycemic unawareness. The use of oral antihyperglycemic agents is also limited in hospitalized patients who are not critically ill in order to avert the possibility of developing medication-related complications.
Hypoglycemia is the major rate-limiting factor in attempting tight glycemic control. This intervention allows the body to reset its adrenergic responses.
This is compounded by a lack of circulating insulin. Hydration and improvement in the glomerular filtration rate facilitate urine potassium excretion. In patients who require emergent treatment of hyperglycemia. In contrast. Because the leading cause of death in patients with pituitary tumor apoplexy is adrenal insufficiency due to acute adrenocorticotropic hormone deficiency.
Other symptoms include anxiety. Tumors originating in the adrenal glands are referred to as pheochromocytomas. Increases in other mineralocorticoids occur in patients with unusually excessive cortisol secretion Cushing syndrome. The most appropriate screening test for hyperaldosteronism is the determination of the ratio of plasma aldosterone toplasma renin activity o Hypertension and hypokalemia are two of the main manifestations of primary hyperaldosteronism.
Pheochromocytoma Key Point: The classic symptoms of pheochromocytoma are hypertension.
Lability of blood pressure is due to episodic catecholamine release. There are many different types of insulin. Chronic complications of excess catecholamine release include cardiac arrhythmias.
An acute-onset headache is consistent with acute bleeding into the pituitary gland o In the setting of local mass effect and severe headache. Severe flushes are accompanied by a fall in blood pressure and rise in heart rate. Diagnose hypercortisolism Cushing syndrome as a secondary cause of diabetes mellitus. Screening tests can be performed on random blood samples. Episodic flushing is most characteristic of the carcinoid syndrome.
The patient does not have flushing or hypotension. For example. Lab values are normal. Hypercortisolism Cushing syndrome is a likely cause of secondary diabetes mellitus in a patient with hypertension.
There should also be no evidence of hydrocortisone underreplacement. Patients with primary adrenal insufficiency. Because prolactinomas in female patients often present with galactorrhea and signs and symptoms of secondary amenorrhea. Manage central adrenal insufficiency. Osteoporosis is diagnosed by the presence of fragility fractures or by a bone mineral density score less than —2.
Osteomalacia is a generalized disorder of bone resulting in decreased mineralization of newly formed osteoid at sites of bone turnover.
Calcitonin has been shown to prevent primarily vertebral fractures and is generally safe and well tolerated. Treat a woman with low bone mass. Evaluate for secondary osteoporosis Key Point: A secondary cause for osteoporosis should be suspected in younger patients.
The serum alkaline phosphatase level is typically elevated. Prevent Osteoporosis Key Point: Among the modifiable risk factors for osteoporosis are adequate amounts of both calcium and vitamin D.
Intravenous bisphosphonates. Esophagitis is a risk of oral bisphosphonate agents.
Although it may be asymptomatic. This step is necessary to minimize the possibility of adrenal crisis Manage secondary adrenal insufficiency due to exogenous glucocorticoid administration.
Calcitonin injections and nasal spray are approved for the treatment of established osteoporosis but not for its prevention. Preventive Services Task Force recommends screening for osteoporosis with DEXA in all women age 65 years or older and also in younger women with an elevated fracture risk.
It most commonly occurs in patients with low levels of vitamin D. Although Paget disease is usually asymptomatic. Please upgrade your browser to improve your experience. To ensure optimal security, this website will soon be unavailable on this browser. Please upgrade your browser to allow continued use of ACP websites. Order Now. Table of Contents. Sample pages of IM Essentials Questions. IM Essentials Questions is a self-assessment question book that uses clinically based, MKSAP-style questions to assess mastery of important internal medicine concepts and identify areas in which additional study is needed.
Specific features include the following:. With the download of IM Essentials Questions, you will receive free access to the online version of IM Essentials , which integrates the content of IM Essentials Text and IM Essentials Questions into an electronic resource and offers several specific features that are particularly useful to clerkship directors and students:. IM Essentials was created by over 90 CDIM-member clerkship directors and 5 associate editors specifically for use in the clerkship to help students grasp important internal medicine concepts and apply them clinically.