Core IM | Internal Medicine Podcast

How do you choose btw PO vs. IV iron? What is the best counseling for oral iron formulations? How do you choose between different IV iron formulations? Should you use the Ganzoni formula? What is a Fishbane reaction? And how is it different from anaphylaxis?

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Time stamps:

02:09: Spaced repetition from the last Gray Matters Episode

05:29: Choosing between oral and IV iron

11:17: Considerations with oral iron repletion

24:02: Considerations with IV iron repletion

32:36: Complications and side effects of IV iron

Tags: hematology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant

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What do the different iron labs mean?! How to interpret iron labs in the setting of inflammation? How to take a good menstrual history?

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Expert Interviews on Youtube

Time stamps:

• 03:43 Iron deficiency labs and interpretation in inflammation
• 16:08 Heavy menstrual bleeding evaluation
• 27:04 When should a premenopausal woman with iron deficiency have endoscopy?
• 35:15 Recap

Tags: hematology, women's health, gastroenterology, heavy menstrual bleeding, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, iron deficiency diagnosis

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Uncover many blind spots on tube feeds!

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Youtube Interviews:

Short-term enteral access

Durable enteral access

What is venting aka decompression?

Show Notes & Transcript

Timestamp

• 02:21 Indications for tube feeds
• 09:36 Routes of enteral access
• 19:20 Components of tube feeds
• 7:03 Tube feeds complications
• 34:50 Counseling patients before discharge and medication interactions

Tags: IMCore, CoreIM, nursing home, primary care, dietician, nutrition support, hospital medicine, interprofessional education, enteral feeds

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How do you manage GDMT in a frail older adult? When is a guardian needed and what is the process for obtaining guardianship?

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Youtube Interviews:

When to consider a guardian?

Guardianship Process

Limitation and value of individualism

Show Notes & Transcript

Timestamp

• 04:03 Deep Dive 1: How do you approach guideline-directed medical therapy of heart failure with reduced ejection fraction in a frail older adult?
• 11:55 Deep Dive 2: When is a guardian needed and what is the process for obtaining guardianship?
• 28:30 Deep Dive 3: How do you re-evaluate GDMT in a frail older adult once an adverse event has occurred?
• 33:27 Reflections
• 37:06 Recap

Tags: IMCore, CoreIM, nursing home, primary care, cardiology, palliative care hospital medicine, interprofessional education, social work, case management

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How do you counsel patients eligible for the RSV vaccines? What do the results of the RENOIR and AReSVi trials tell us and how do they compare? How should we interpret vaccine trials in the first place? Tune in to the fourth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group.

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Show Notes & Transcript

Time Stamps

• 02:30 Epidemiology of RSV
• 03:46 Development of RSV vaccine
• 05:55 Vaccine trial design
• 12:22 ARESVI and RENOIR Trials
• 18:18 Who should we recommend the RSV vaccine to?
• 19:50 What don’t we know?

Tags: IMCore, CoreIM, primary care, infectious disease, nurse practitioner, pharmacist, physician assistant

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When you see a low mag or a low phos, what are you thinking about? And do PPIs effect magnesium absorption? How much sodium and potassium are found in a typical oral phosphorus supplement?

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Youtube interview on key points on magnesium

Youtube interview on key points on phosphate

CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamp

• 01:37 Pearl 1: Magnesium
• 09:39 Pearl 2: Framework for hypomagnesemia
• 16:53 Pearl 3: Magnesium repletion
• 22:39 Pearl 4: Phosphorous
• 28:36 Pearl 5: Phosphorous repletion

Tags: IMCore, CoreIM, nephrology, hospital medicine, interprofessional education, renal

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Sharpen your de-escalation skills!

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Timestamps:

• 02:26 Difficult Patients
• 10:25 Mediation Toolkit
• 17:20 Maxims of Mediation
• 26:46 When the Conversation Still Breaks Down
• 35:11 Conclusion

Tags: IMCore, CoreIM, ethics, humanities, nurse practitioner, pharmacist, physician assistant, burnout

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In community-acquired pneumonia, can steroids improve mortality? Past studies of steroids in CAP have been conflicting, with some showing a mortality benefit and others showing no difference. How does the CAPE COD trial change how we think about patients hospitalized with severe CAP? To find out, tune into the third episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group.

Show Notes & Transcript

• 01:50 Pathophysiology of Steroids and Infection
• 03:50 Steroids in PNA Studies
• 08:56 CAPE COD Trial
• 14:13 Discussion of CAPE COD Trial
• 18:36 Takeaways/Discussion

Tags: IMCore, CoreIM, primary care, cardiology, nurse practitioner, pharmacist, physician assistant

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Syncope history, PPM/ICD prior to MRI or surgery, anticoagulation for pacemaker or ICD procedures and new cardiac devices and how they may look different on EKG or chest x-ray!

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Show Notes & Transcript

Timestamps:

• 01:13 Pearl 1: Should we approach syncope history differently in our patients with pacemakers and ICDs?
• 06:31 Pearl 2: Considerations for patients with implantable devices before surgery.
• 12:26 Pearl 3: Considerations for patients with implantable devices before MRI.
• 14:45 Pearl 4: Anticoagulation in patients undergoing pacemaker or ICD procedures.
• 18:17 Timestamp 5: Emerging cardiac device technology and how they might look different on EKG or chest x-ray

Tags: IM Core, CoreIM, cardiology, prodromal symptoms, CRT, biventricular pacing

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Is Cr or Cystatin C better to assess eGFR? What are pros & cons of each? Does eGFR tell the full picture of kidney function? What may cause false positive albuminuria?

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CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamp:

00:13 Reviewing CKD Classification: G1-5 stage, A1-3 stage

04:20" What's wrong with how we estimate GFR?

06:50 Why is creatinine flawed as an estimator of GFR?

10:52 Enter new contender...Cystatin C!

16:16 Importance of the A Stage!

20:21 Which patients should you measure proteinuria in?

22:10 Treatments for albuminuria!

24:27 Summary and Closing

Tag: Creatinine, nephrology, renal, CoreIM, IMcore, internal medicine, primary care, nurse practitioner, physician assistant

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Check out the original interview on Youtube:

Essentials on Genetic Counselor | Lynch Syndrome

Who should be referred for genetic counseling? How can we set our our patients and genetic counselors up for success? And let's do some genetics myth busting!

Show Notes & Transcript

Timestamp

• 03:13 Part 1: Who should be referred to genetic counseling?
• 11:23 Part 2: How do we set up genetic counselors for success?
• 22:38 Part 3: Genetic counseling myth busting!

Tags: IMCore, CoreIM, primary care. oncology, surgonc, medonc, cancer, nurse practitioner, physician assistant

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See some of the original interviews on Youtube!

What is the evidence behind K+ repletion? What is a framework to think through for hypokalemia? What are the different repletion formulations and what else can you do to mitigate hypokalemia? Stepping back, do we really need to get labs every single day?!

CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamp

• 01:45 Pearl 1: Evidence for potassium repletion
• 09:10 Pearl 2: Framework for hypokalemia
• 17:09 Pearl 3: Repletion goals
• 23:00 Pearl 4: Options for hypokalemia treatment
• 29:13 Pearl 5: Frequency of lab checks and repletion

Tags: IMCore, CoreIM, nephrology, hospital medicine, potassium diet, interprofessional education

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What is the difference between semaglutide (ozempic) and tirzepatide (mounjaro) in outcomes and mechanism? How did we find out diabetes medications can help with weight loss?

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Show Notes & Transcript

• 02:08 Framework for thinking about obesity
• 03:42 History of obesity treatment
• 06:29 Gila monsters and GLP and GIP mechanisms
• 08:29 Story of how medications for diabetes were found to have a weight loss benefit
• 12:50 SURMOUNT-1 trial

Tags: IMCore, CoreIM, primary care, cardiology, nurse practitioner, pharmacist, physician assistant

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With progressing CKD & HFrEF, what GDMT medications can you start, continue or stop? What does the data on hydralazine/isosorbide tell us and what does it NOT tell us? What are the pros and cons of starting GDMT inpatient versus outpatient? Do you still keep patients on GDMT once their EF recovers?

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CME : http://bit.ly/CIMCME || Show Notes & Transcript

Timestamps

• 01:54 Pearl 1 – Recap of GDMT and CKD
• 09:15 Pearl 2 – Hydralazine and Isosorbide Dinitrate
• 20:59 Pearl 3 – Ivabradine
• 25:47 Pearl 4 – Inpatient vs Outpatient Initiation of GDMT
• 30:55 Pearl 5 – Ejection Fraction Recovery

Tags: IMCore, CoreIM, hydralazine, heart failure reduced ejection fraction, HFmrEF, HFimpEF, chronic kidney disease, cardiology

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What does medical education research say about improving diagnostic errors? What habits help in getting to diagnostic excellence?

Timestamps

• 01:00 System 1 vs. System 2
• 07:46 Cognitive Biases
• 13:46 Case for Knowledge
• 18:29 Other Practices to Decrease Error
• 28:26 Conclusion

CME: http://bit.ly/CIMCME || Show Notes & Transcript

This episode is made in part of ACP’s Diagnostic Excellence curriculum

Tags: IMCore, CoreIM, clinical reasoning, system 1 vs. system 2, cognitive bias, feedback and reflection

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What are side effects of tacrolimus and mycophenolate? And what are common medication interactions? What causes of acute kidney injury are unique to renal transplant recipients When a patient has a fever, what are the viral syndromes we should work up? What are signs and symptoms of rejection?

Timestamps

• 02:41 Types of Immunosuppression
• 14:31 Medication Reconciliation
• 22:36 AKI in the Transplant Patient
• 31:53 Infections in the Transplant Patient
• 40:00 Transplant rejection, cancer after transplant

CME: http://bit.ly/CIMCME || Show Notes & Transcript

Tags: IMCore, CoreIM, renal, internal medicine podcast, hospitalist, nephrology, immunosuppressive

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In patients with heart failure with low ejection fraction and chronic coronary disease without unstable symptoms, does stenting open blocked coronary arteries extend life or reduce hospitalizations? There is some literature to suggest those with low EF may benefit from revascularization with surgery.

How does the REVIVED trial change how we think about these patients? Tune in to the first episode in this new series brought to you by Core IM in collaboration with NEJM Group.

Show notes & Transcript

Access to Rotation Prep Cardiology guide on NEJM Resident 360 is free for August 2023. View the relevant sections on ACS and CHF.

Timestamps

• 00:50 Question REVIVED addressed
• 01:44 Revascularication in HFrEF
• 06:32 Revascularization in stable CAD
• 10:02 REVIVED trial
• 12:20 Summary and takeaways

Tags: IMCore, CoreIM, cardiology, internal medicine podcast, hospitalist, stent, CABG, evidence-based medicine

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Laugh and be humbled along some of Dr. Maria Rosasco's most memorable July stories !

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Tags: medical humanities, internal medicine, residency, medical school, interprofessional education, rotation, imposter syndrome, feedback

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BONUS on Cosyntropin stimulation tests! What exactly is it? How do you interpret them? What is the difference between adrenal insufficiency and steroid withdrawal syndrome?

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Show notes & Transcript

Subscribe to our new Youtube Channel !

Tags: IMCore, CoreIM, endocrine, internal medicine podcast, hospitalist, glucocorticoid withdrawal, fatigue

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How do you choose between the different steroids? At what dose and duration do you get concerned about worrisome complications? What types of prophylaxis should be started in patients on steroids and when?In which patients should we wean steroids vs. stop abruptly, and how should we do so? What factors limit steroid weaning?

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Show notes & Transcript

Time Stamps

• 02:59 Types of Corticosteroids
• 14:31 Side Effects of Steroids
• 21:15: Prophylaxis
• 27:32 Steroid Weaning
• 33:38 Steroid Weaning Limitations

Tags: IMCore, CoreIM, endocrine, adrenal insufficiency, internal medicine podcast, hospitalist, hydrocortisone, fludrocortisone, methylprednisolone, prednisone, dexamethasone, steroid withdrawal syndrome

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In cirrhosis, what actually contributes to the bleeding vs. clotting risk? Does the INR capture it? What is in FFP? Do you have to give FFP prior to a paracentesis and a thoracentesis? How much of FFP stays in the intravascular space? Does indwelling pleural catheters increase risk of malnutrition or infection?

Show notes & Transcript

Time Stamps

• 02:36 Deep Dive 1: Bleeding risk of paracentesis and thoracocentesis
• 05:35 Deep Dive 2: FFP effect on bleeding risk
• 15:43 Deep Dive 3: Risks of FFP
• 19:45 Deep Dive 4: Indwelling pleural catheters
• 30:31 Recap

Tags: IMCore, CoreIM, hepatology, internal medicine podcast, hospitalist, heme/onc, pulmonary

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How long can fatigue last for after radiation? Are all patient post radiation immunocompromised? What are the potential acute and long-term side effects after lung, breast, prostate and brain radiation?

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Show notes & Transcript

Whiteboard Animation Video of Radiation Physiology

Time Stamps

• 02:37 Systemic Radiation Side Effects
• 14:29 Lung Radiation Side Effects
• 18:22 Breast Radiation Side Effects
• 21:45 Prostate Radiation Side Effects
• 24:54 Brain Radiation Side Effects

Tags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, rad onc, EBRT, brachytherapy

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What are the different types of radiation? What should we and shouldn’t we put in our one-liners? What makes palliative radiation different from curative radiation? And when to refer to for palliative radiation?

Show notes & Transcript

Whiteboard Animation Video of Radiation Physiology

Time Stamps

• 02:04 What is radiation?
• 03:17 How does radiation therapy work?
• 04:50 How is today’s radiation different from the past?
• 05:40 What role does radiation play in cancer treatment?
• 07:48 What are the different types of radiation?
• 15:34 How do you write a rad onc one-liner as an internist?
• 19:59 What is palliative radiation and how/when should we use it?

Tags: IMCore, CoreIM, cancer, tumor, internal medicine podcast, hospitalist, heme/onc, EBRT, brachytherapy

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What did you have to "unlearn" in your learning journey? How do you organize your time? Organize how you keep up with medical evidence? What is your calendar management system? How can you use your leadership skills to improve the well-being of your team members?

Show notes & Transcript

Time Stamps

• 01:12 Learning Journey
• 05:58 Lifelong Learning
• 11:14 Time Management
• 16:38 Role Modeling
• 19:59 Re-Calibrating Failure

Tags: IMCore, CoreIM, failure, fixed mindset, growth mindset, imposter syndrome, leadership, learning styles, role modeling, success, time management

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What does the HbA1c really measure? What are its limitations? How does fructosamine and glycated albumin work? What will falsely elevate or decrease it? What are the benefits of continuous glucose monitoring? What are the limitations of a glucose-centric view and should we be more insulinocentric?

Show notes, Transcript and References

Time stamps

• 00:35 Random Glucose, Fasting Glucose, Glucose Tolerance Test
• 03:03 Hemoglobin A1c
• 08:26 Fructosamine and Glycated Albumin
• 10:50 Continuous Glucose Monitoring
• 15:44 The Overlooked Issue of Insulin Resistance
• 19:11 Summary

Tags: IM Core, CoreIM, insulin resistance, diabetes, microvascular and macrovascular complication

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When do you have a device interrogated? Do you know what kind of device your patient has? Do you know how to manage patients with a device who develop bacteremia? How do you discuss end of life care in patients with devices such as a pacemaker or ICD?

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• Show notes, Transcript and References

Time stamps

• 02:51 What are the different types of pacemakers and defibrillators? Who is it indicated for? How can where the leads clue you what the implantable device may do?
• 21:28 How to determine which type of device your patient has?
• 25:10 What can a device interrogation tell you and doesn't tell you?
• 32:13 Do all patients with bacteremia need their implantable cardiac devices taken out?
• 38:44 End-of-life considerations with pacemakers vs. ICDs

Tags: IM Core, CoreIM, sinus node dysfunction, AV dissociation, palliative care, CRT, biventricular pacing

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How does transplant compare to dialysis? Who is a good candidate for a kidney transplant? How long do patients have to wait for a deceased donor kidney transplant? What can increase or decrease the waiting time for your patient? Who is a good living donor candidate? What are the risks of living donors?

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• Show notes, Transcript and References

Time stamps

• 03:49 Episode start
• 07:13 Dialysis vs. kidney transplant morbidity and mortality
• 11:44 Eligibility for kidney transplant and when to refer
• 21:34 Pre-transplant evaluation process
• 25:38 How long are wait times on the transplant list?
• 36:21 What benefits of living donation? What are risks to the kidney donor?

Tags: IM Core, CoreIM, renal, dialysis, nephrology, nephrologist, renal, CKD, chronic kidney disease, living donor kidney

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What is your approach to trach complications? What do all the words in the one liner of a trach patient mean? What are best practices for airway clearance? When is a patient ready for a speaking valve? What is the process for decannulation?

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E10

Show notes, Transcript and References:

https://www.coreimpodcast.com/2023/03/08/trac/

Time stamps

2:56 Trach Components

12:47 Trach Complication Management

27:48 Airway Clearance

34:53 Speaking Valve

38:54 Decannulation

Tags: IM Core, CoreIM, pulmonary, critical care, ICU, nursing care, respiratory therapy, pharmacy

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Why are safety net hospitals barely surviving? What makes a hospital a safety net hospital? How essential are safety net hospitals in caring for low income Americans? How do we pay for that care?

Show notes, Transcript and References:

https://www.coreimpodcast.com/2023/03/02/safety-net-hospitals/

Timestamps:

0:00 Hahnemann University Hospital

4:36 What is a Safety Net Hospital?

11:11 The Origins and Paradox of the Safety Net Hospital

Links to other episodes:

A Complex Patchwork of Supplemental Payments:

https://www.healthaffairs.org/do/10.1377/hp20221223.651856/full/

The Future of Safety Net Hospitals & Payment Policies:

https://www.healthaffairs.org/do/10.1377/hp20221223.105519/full/

Tags: IM Core, CoreIM, health policy, health disparities, insurance, medicare and medicaid

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How does your problem representation change as we get more history in this episode? How can we use Oxaam's razor & Hickman's dictum as powerful diagnostic tools IF used properly?

Show notes, Transcript and References: https://www.coreimpodcast.com/2023/02/15/25438/

Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim

Time stamps

• 01:51 Intro
• 07:57 Case
• 13:09 Differential
• 16:15 Diagnosis
• 22:20 Problem Representation

Tags: IM Core, CoreIM, diagnostic tools, Occam's razor, Hickam's dictum, data collection, mental model, clinical reasoning, rheumatology

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How do you approach requests for 'futile' care? What do we mean by futility? What kind of recovery do we think is meaningful? How do we evaluate potentially inappropriate care? Where can we go for guidance on this?

Show notes, Transcript and References: https://www.coreimpodcast.com/2023/02/01/futility-at-the-bedside-segment/

Time stamps

• 04:45 What do we mean by “futility”?
• 11:20 Definitions
• 20:23 Ethical Analysis
• 39:13 Recommendations

Tags: IM Core, CoreIM, ATS, autonomy, justice, values, emotions, communication, medical humanities, ethics

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Check out original interviews on our Youtube channel!

What does the duration of afib tell you about the thromboembolic risk? When do you start anticoagulation for post-op afib? What do the most recent guidelines recommend for perioperative anticoagulation management? How many devices do you know that can be useful in post-discharge cardiac monitoring in new atrial fibrillation? How can we improve our communication regarding afib management?

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Show notes, Transcript and References: https://www.coreimpodcast.com/2023/01/18/diagnosis-of-atr…-matters-segment/

Time stamps

• 01:12 Intro
• 03:51 Deep Dive 1
• 08:16 Deep Dive 2
• 15:25 Deep Dive 3
• 21:05 Deep Dive 4
• 27:07 Deep Dive 5

Tags: IM Core, CoreIM, Devices, cardiac, risk, perioperative, stroke, surgery, anticoagulation

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Is it enough to look at LDL-C? What is Apo-B? How do you use TG/HDL ratio to understand your patients cardiovascular risk? Do you need to get a fasting lipid panel? How does it affect the triglycerides and LDL?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/12/15/reimagining-the-…-the-gap-segment/

Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E8

Time stamps

• 01:24 Intro
• 03:37 Fasting vs. Nonfasting Lipid Panel
• 05:11 Current guidelines
• 07:43 Pathophysiology Overview
• 09:04 Pathophysiology of Apo-B vs. LDL-C with traffic analogy
• 11:23 Apo-B
• 15:40 TG-to-HDL ratio
• 17:06 Takeaways

Tags: IM Core, CoreIM, risk, USPSTF, ACC/AHH, family medicine, cardiology, primary care

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What are some ways you address unrealistic hopes with your patients? How can you build a portfolio of hope with your patients? Can you learn to guide your patients hope?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/11/23/hope/

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Time stamps

• 01:20 Intro
• 04:37 What are some definitions of hope?
• 09:57 How can we address unrealistic hope?
• 21:39 Addressing hope in clinical practice
• 32:10 Conclusion

Tags: IM Core, CoreIM, care, communication, goal setting, support, strategies , medical humanities

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What tests and history points help with the diagnosis of alcohol-associated hepatitis? What other etiologies should be ruled out? To steroid or not to steroid? What are the medications for alcohol use disorder? Do you make sure your patients have a late night snack? How do you prognosticate?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/11/09/alcoholic-hepati…5-pearls-segment/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps

• 01:42 Intro
• 04:37 Pearl 1: Diagnosis
• 13:20 Pearl 2: Differential & Treatment
• 20:48 Pearl 3: Nutrition & Alcohol Cessation
• 27:45 Pearl 4: To steroids or to not steroids?!
• 35:34 Pearl 5: Throwback

Tags: IM Core, CoreIM, ALT, AST, liver abnormalities, gastroenterology, alcohol use disorder, nutrition, MELD, Lille, Steroids, Alcoholic Hepatitis

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How do you educate your patients on aspirin use? For what reasons do you start, continue or stop aspirin? What does trial data tell us? How does aspirin exerts its effect?

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ACP CME: http://bit.ly/CIMCME

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/10/19/mind-the-gap-asp…imary-prevention/

Time stamps

• 03:03 Guideline recommendations
• 07:00 How does Aspirin work?
• 09:11 Trial Data
• 13:00 ASCVD Risk Calculator
• 18:07 Starting vs. Stopping Aspirin
• 22:11 Summary

Tags: IM Core, CoreIM, guidelines, atherosclerosis, ASCVD, plaque, bleeding, shared decision-making

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Is a positive ANA always significant? What does the titer mean? Is the pattern of the ANA helpful? What patient histories should you not get an ANA for and which aspects of the history would raise suspicion for autoimmunity? How can you use the physical exam to assess likelihood of autoimmune disease? What is the ddx for a positive ANA?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/10/05/ana-antinuclear-…5-pearls-segment/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Sponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions. Discount code: “COREIM”

Timestamps:

• 01:37 Pearl 1
• 03:54 Pearl 2
• 13:53 Pearl 3
• 18:07 Pearl 4
• 29:30 Pearl 5

Tags: IM Core, CoreIM, autoimmune, joint disease, titers, Raynaud's, lupus, Rheumatology

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How do you decide which lung nodules should be worked up inpatient or outpatient? How common are incidental lung nodules? What considerations are there for patients that could potentially get lost to follow up? What risk adopted approach can be implement in our practice? Do you know what fast forward rounds are?

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Show notes, Transcript and References: https://www.coreimpodcast.com/2022/09/21/discharge-with-i…atters-segment-2/

Time stamps

• 01:30 Deep Dive #1
• 17:27 Deep Dive #2

Tags: IM Core, CoreIM, outpatient, inpatient, PCP, management, communication, discharge summary, incidentaloma

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Can you identify where along the clinical reasoning pathway the learner is struggling? What coaching exercises can be helpful? What feedback do you fall back on when working with learners? What are common challenges?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/12/09/hoofbeats-strugg…inical-reasoning/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

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Hear personal stories about racial trauma or stereotype threat. How can we respond and how do we differentiate an up stander from a bystander? What barriers exist when we try to respond?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/08/24/upstander/

Time stamps

• 04:51Overview of Microaggressions
• 08:11 Prevalence
• 11:43 How to respond
• 21:03 Barriers to appropriate response
• 26:00 Conclusion

Tags: IM Core, CoreIM, bystander, race, microaggressions, hidden curriculum, DEI

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What are the 3 types of solutes you can use in hyponatremia? What are each of their drawbacks? How do loop diuretics work help in hyponatremia? What can you use to tell you on day 1 that fluid restriction alone will not work?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/08/03/hyponatremia-man…5-pearls-segment/

Sponsor: https://go.amboss.com/CoreIM-E4

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps:

• 01:20 Intro
• 04:46 Pearl 1
• 13:13 Pearl 2
• 24:03 Pearl 3
• 32:49 Pearl 4
• 37:05 Pearl 5

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What does each diagnostic test tell you? How do you interpret urine osmolality, urine sodium, or urine urea? What studies can be used to better assess response to treatment? How can uric acid be utilized as a diagnostic tool? What is the interplay between ADH and UOsm?

Show notes and Transcript: https://www.coreimpodcast.com/2021/02/10/5-pearls-on-hyponatremia-episode-1/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Amboss Article on Hyponatremia

Tags: urine studies, SIADH, Core IM, IMCore, antidiuretic hormone, hospital medicine, family medicine, nephrology

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Other than infection, what do you think about as other causes of fever? How can you distinguish sepsis from drug fever from antibiotics? What medications are most likely to cause neurotoxicity? What are some risk factors? How do you think about goals of care with patients?

Show notes & Transcript: https://bit.ly/3P8wqG6

Sponsor: Visit www.medmastery.com/coreim for 15% off on all subscriptions

Discount code: "coreim"

Time stamps

• 02:50 Deep Dive #1
• 13:12 Deep Dive #2
• 26:39 Deep Dive Recap

Tags: IM Core, CoreIM, antibiotics, CMO, DNR/DNI, sepsis, reflection, grey matters

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What are the 3 different types of inhaler devices and what should you educate patients about each? When do you stop the inhaled steroid in COPD? And when do you think of increasing the dose? What is important to communicate at the time of diagnosis, and during goals of care discussions?

Show notes, Transcript and References:

https://www.coreimpodcast.com/2022/06/22/5-pearls-on-copd-management/

Sponsor: Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E3

Timestamps:

• Pearl 1: 3:20
• Pearl 2: 8:20
• Pearl 3: 15:47
• Pearl 4: 26:55
• Pearl 5: 34:10

Tags: IMCore, CoreIM, Pulmonary, medication management, spirometry

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How do you ask about spiritual health? How is spirituality different from religion?

Show notes, Transcript and References:

https://www.coreimpodcast.com/2022/06/15/spirituality/

Time stamps

• 00:01 What is spirituality?
• 7:12 Why does spirituality matter?
• 12:09 How do we screen for it?
• 18:50 Chaplains
• 27:49 Conclusion

Tags: IM Core, CoreIM, ethics, medical humanities

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What are the indications for a simple transfusion? And what the indications for an exchange transfusion? What is your approach to pain management in patients with sickle cell? What are the treatment options for sickle cell and which ones actually decrease sickle crisis and improve mortality? What are some of the major sickle cell complications to watch out for and how can we prevent some of them?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/06/01/5-pearls-on-sickle-cell-anemia/

Sponsor: https://go.amboss.com/CoreIM-E2

Timestamps:

• 1:33 Pearl 1
• 4:48 Pearl 2
• 18:43 Pearl 3
• 29:45 Pearl 4
• 35:22 Pearl 5

Tags: IM Core, CoreIM, hematology oncology, health inequity, vaso-occlusive crisis

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How do you counsel patients on beta blockers? Is one beta-blocker better than the other? What is preferred: ACEi, ARBs or ARNIs? What are the pros and cons of each? How does spironolactone compare to eplerenone? When do you stop mineralocorticoid receptor antagonist? What are risks with SGLT2 inhibitors? How do you initiate GDMT? Which meds do you start first and in what order?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/05/11/5-pearls-on-guideline-directed-medical-therapy/

Sponsor: https://go.amboss.com/GDMT

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps:

• 03:13 Pearl 1
• 12:14 Pearl 2
• 20:36 Pearl 3
• 26:42 Pearl 4
• 32:16 Pearl 5

Tags: IM Core, CoreIM, heart failure with reduced ejection fraction, GDMT, treatment, cardiology

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How much of D5W vs. isotonic saline contributes to intravascular volume? How do you distinguish between oncotic pressure and tonicity? What balanced solutions do you reach for? What is the data behind using colloids like albumin as an intravascular expander? How much do pRBCs stay in the plasma?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/04/27/fluids-colloids-5-pearls-segment/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps:

• 02:14 Intro
• 04:26 Pearl 1
• 11:08 Pearl 2
• 20:43 Pearl 3
• 31:06 Pearl 4
• 35:06 Pearl 5

Tags: IM Core, CoreIM, fluids, hypertonic, volume, crystalloid, tonicity, blood, nephrology, hospital medicine

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What do you include in your initial basic work-up for suspected pulmonary hypertension? Do you know how to calculate the PASP on the ECHO? What physiological insults that can cause high pulmonary pressures? How can we interpret the E/e’ ratio?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/04/06/pulmonary-hypertension/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps:

• 02:18 Intro
• 05:27 Pearl 1
• 12:17 Pearl 2
• 16:13 Pearl 3
• 24:04 Pearl 4
• 30:08 Pearl 5

Tags: IM Core, CoreIM, PASP, Echo, hypoxia, PA pressure, vascular resistance

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How can we use food as medicine? How can we best counsel our patients on their diets? Which pre-set diets can we recommend for or against? How can we make the changes sustainable?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/03/23/obesity-and-nutr…-2021-sgim-recap/

Time stamps:

• 03:10 Trends in weight and dieting
• 06:01 Counseling patients on diet
• 09:35 Food group recommendations
• 14:53 Pre-set diets
• 20:47 Making sustainable changes

Tags: Core IM, IM Core, diet, salt intake, fiber, weight

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What are some tricks to help you perform a virtual physical exam? What role do these visits play in our overall care for the patient? What tools do we have at our disposal for a more thorough evaluation?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/03/09/telemedicine-and…-2021-sgim-recap/

Tags: IM Core, CoreIM, tele visit, gizmos, history taking, virtual, physical exam, assessment, functional status, tips

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How long should you anticoagulant for a PE? When can you safely stop anticoagulation for thrombogenic patients who need an urgent biopsy? Should an IVC filter be placed to prefer further embolization of a DVT? What percentage of patients with cancer associated blood clots will have progression while on anticoagulation?

Show Notes, Transcript, and References: https://www.coreimpodcast.com/2022/02/23/24433/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im



Time Stamps:

• 02:40 Deep Dive #1 Anticoagulation
• 08:50 Deep Dive #2 DOACs
• 14:08 Deep Dive #3 IVC Filter
• 17:49 Deep Dive #4 Biopsy
• 25:00 Recap

Tags: Core IM, IM Core, Anticoagulation, Bleeding, DOACs, IVC, reflections, clots

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How can you implement effective note taking for virtual learning? Do you use interleaving during rounds? What is the 5/10/30 rule and how does it apply to mentorship? Does implicit bias affect gender performance scores in clinical rotations? How common are biased patient behaviours? How can you foster a safer learning environment for trainees? How can you promote antiracism?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/02/09/medical-educatio…ng-core-im-recap/

Time stamps

• 02:10 Make it Stick Virtually
• 08:35 Mentoring in the Modern Era: More than the Traditional Dyad
• 13:29 Clinical Update in Medical Education
• 20:58 Anti-Racism in Medical Education: Concrete Actions to Further Social Justice and Racial Equity

Tags: IM Core, CoreIM, virtual learning, note taking, feedback, mentorship, microaggressions, gender bias, sterotype threat

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What’s your comfort level with managing hyponatremia and how does it change in unfamiliar environment? How can you vary your practice to build up adaptive exerptise?

Show notes, Transcript & References: https://www.coreimpodcast.com/2022/01/26/hoofbeats-consult-case/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps

• 01:36 Case
• 10:42 Case analysis
• 22:45 An unfamiliar domain
• 25:50 Lab review
• 40:04 Conclusions



Tags: IM Core, CoreIM, hyponatremia, preeclampsia, reasoning, adaptive expertise, situational awareness

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Have you ever thought about where the 1g/dL hemoglobin appropriate bump after 1 unit of pRBC transfusion? How does the patient's intravascular volume affect this? What rise in hemoglobin should you expect? What factors can impact this?

Show notes, Transcript and References: https://www.coreimpodcast.com/2022/01/05/1-to-1-prbc-bump…-the-gap-segment/

Time stamps

• 01:22 Unpacking the question
• 01:55 The math
• 04:32 Functional hemoglobin
• 08:50 Donor and Patient
• 11:18 Scenarios
• 12:58 Summary
• 14:34 Clarification

Tags: IM Core, CoreIM, hemoglobin, intravascular volume, irradiation, donation

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Let’s apply to cases! We use the 7 questions framework to 3 practical cases

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/12/22/treatment-over-objection-part-2/

Time stamps

• 2:19 Case 1: Review of Framework
• 7:59 Case 2
• 9:04 Consent vs. Assent
• 11:11 Role of Consult Services
• 13:16 Role of Surrogates
• 15:29 Conclusion

Tags: IM Core, CoreIM, autonomy, capacity, human dignity, non-maleficence, ethics, medical humanities

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Get a very useful framework to help you weigh the risks and benefits of treatment over objection!

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/12/08/treatment-over-objection/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps

• 03:02 Ethical and emotional challenges
• 10:08 Case 1
• 18:55 Study of the 7 Questions
• 22:46 Conclusion

Tags: IM Core, CoreIM, autonomy, capacity, human dignity, non-maleficence, ethics, medical humanties

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What degree of hyperkalemia makes you worried enough to send your patient to the ED? Are ECG changes sensitive in detecting hyperkalemia? Do you know how to advise your patient on dietary changes? What medications can you effectively use in the outpatient setting?

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/11/17/hyperkalemia-mind-the-gap-segment/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps

• 01:01 Introductions
• 07:58 Nutrition
• 17:13 Medications
• 20:48 Outpatient medications
• 26:16 Recap

Tags: IM Core, CoreIM, outpatient, blood work, diet, electrolytes, ECG, nephrology, chronic kidney disease, nutrition

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What are pearls and pitfalls when assessing an older patient for the first time?

Time Stamps:

• 02:25 Initial Office Visit
• 08:08 Mobility Assessment
• 13:25 Cognitive Evaluation
• 19:27 Medications
• 26:29 Throwback Pearl

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/10/31/5-pearls-on-geriatric-care/

Tags: Core IM, IM Core, delirium, goals of care, dementia, mini cog, MOCA, deprescribing

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Should we use oral diabetes agents in our hospitalized patients? Do you hold metformin for fear of lactic acidosis? Do you typically order an insulin sliding scale? When can you comfortably restart PTA meds?

Time Stamps:

• 02:25 Can we give metformin in the hospital?
• 10:50 Incretin-based therapies
• 14:49 Sodium Glucose Cotransporter-2 Inhibitors
• 16:27 Sulfonylurea & Thiazolidinediones
• 18:00 Basal Insulin inpatient

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/10/13/oral-diabetes-medications-in-hospitalization-mind-the-gap-segment/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Tags: Core IM, IM Core, glucose, insulin, hospitalized patients, oral medications, sliding scale, DPP-4, GLP-1

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What are practical phrases can you incorporate to help patients who use drugs? What changes can you make to ensure person-first language? What safe drug practices can you advise? What is MOUD?

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/09/29/5-pearls-on-stig…oid-use-disorder/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time Stamps:

04:24 Starting the Conversation

10:43 The Shared Agenda

14:46 Exploring patient goals

18:54 Reducing drug use

24:09 Reducing harm in opioid use

29:06 Recap

Tags: Core IM, IM Core, MOUD, buprenorphine, patient centeredness, motivational interviewing, safe practices

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A very practical episode around nuanced code status conversations with many examples!

Time Stamps:

• 00:08 Introduction
• 04:01 Information Gathering
• 20:41 Informed Consent
• 29:47 Giving Recommendations
• 36:47 Mistakes
• 48:22 Wrap Up

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/09/12/code-status

Tags: Core IM, IM Core, DNR/DNI, CPR, intubation, goals of care, shared decision making, documentation, conversations, recommendations

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What are the differences in resources, nursing and clinician oversight and who pays for what?!

Show notes, transcript and references: https://www.coreimpodcast.com/2020/06/10/snf-sar-nh-alf-and-more-discharge-options-interprofessional-education-series/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps:

• 04:07 SAR vs SNF
• 13:35 Long term Nursing Home Care
• 18:30 Assisted Living Facility
• 24:40 Acute rehab
• 26:11 LTACH
• 27:49 Home

Tags: Subacute rehab, skilled nursing facility, long-term acute care hospital, CoreIM, Core_IM, hospital medicine, family medicine, emergency medicine, physician assistant, nurse practitioner, interprofessional education

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What are the indications for a stress test? How to choose stress protocol in a stress test? How to choose diagnostic imaging in a stress test? How do we interpret results from stress tests, and how should this be communicated to patients?

For full transcript, infographic and show notes: https://www.coreimpodcast.com/2019/04/24/stress-testing/

Tags: Internal Medicine, Internist, Primary Care Physician, Hospitalists, Emergency Medicine, Nurse Practitioner, Physician Assistant, Family Physician, Cardiology, angina, ischemia

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What goes into a capacity assessments? Is it just reciting risks, benefits and alternatives? Explore this and more on this At the Bedside Episode!

Show notes, Transcript and References: https://www.coreimpodcast.com/?p=22310

Tags: CoreIM, AMA Discharges, Psych, Competency, medical ethics, medical humanties

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20 Qs game with Core IM Team vs. Expert Discussant !

Full Transcript and Show notes

Get CME-MOC Credit for listening to this episode

Time Stamps

• 00:20 The game of medical Twenty Questions
• 04:37 Case introduction
• 05:50 The CoreIM team attempts to solve the case
• 15:36 The discussant’s diagnostic schema for abnormal bleeding
• 23:37 Primary versus secondary hemostasis
• 30:33 The pathology report !
• 37:38 Criteria for the final diagnosis
• 38:46 Dissecting a diagnostic coup
• 49:42 Conclusion

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Transitions can be hard. Laugh, commiserate, and be inspired by these July stories in medicine!

Very big thank you to everyone who told their stories !

Let's help each other feel a little less alone in the struggle, be more understanding and compassionate or laugh at ourselves. Please share this episode with colleagues. Do you have a July story? Email us at hello@coreimpodcast.com.

Tags: Narrative Medicine, CoreIM, IMcore, imposter syndrome

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How can we help colleagues that we think are struggling with substance use disorder? What options are available for physicians? Are these different state to state? What deterrents do physicians face when seeking help?

Time Stamps:

• 00:21 Introduction
• 02:59 Scope/Definitions
• 08:05 Systems for Physician Impairment
• 13:50 Barriers to Care
• 24:48 Helping an Impaired Physician
• 28:44 Systems Level Change

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/06/09/physician-clinician-impairment/

Tags: Core IM, IM Core, impairment, substance use disorder, mental health, stigma, treatment, cost

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Debunk common myths of penicillin allergies! What's the best way to ask about allergies? How can you challenge patients to determine if they have a true allergy? Organic chemistry buffs, what mediates cross-reactivity? What medications can you safely give your patients?

Show note, Transcript and References: https://www.coreimpodcast.com/2021/06/02/5-pearls-on-penicillin-allergy/

Time Stamps:

• 02:49 Penicillin Myths
• 07:20 Penicillin Allergy
• 11:21 Allergic Reactions
• 19:01 Managing allergic reactions
• 26:53 Alternative medications
• 33:28 Recap

Tags: CORE IM, IM Core, history taking, rash, skin testing, hypersensitivity, medications, over labeling, antibiotics, management

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What are good habits in QI? What are the areas of expertise needed to have a successful career in QI? How can you get involved in quality improvement? What projects can you get involved with, and how do you work outside of your own interests? How can you partner with your healthcare system to make changes?

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/05/08/quality-improvement-careers-series/

Time Stamps:

• 01:36 Getting started
• 05:01 Formal training
• 08:27 What are areas of expertise to get good at?
• 16:27 Typical Day
• 19:27 Challenges
• 23:56 Metrics

Tags: CORE IM, IM Core, fellowships, jobs, leadership, metrics, training, patient safety

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How does cost, potency, and bleeding risk affect which antiplatelet you choose P2Y12 inhibitors? How long after starting, do you feel comfortable stopping DAPT on a patient? How do you manage DAPT in patients who need anticoagulation?

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/04/07/5-pearls-on-dual…platelet-therapy/

Join Our Team

Time stamps

• 02:35 Indications
• 08:52 Medications
• 17:37 Duration
• 28:23 De-escalation
• 30:55 Anticoagulation

Tags: IM Core, CoreIM, anticoagulation, DAPT, acute coronary syndrome, stents, thrombosis, bleeding risk, cardiology, hospitalist, primary care

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Hear perspectives that don't get as much spotlight! What is it like to be a surrogate? How can we be better listeners for our patients and for their surrogates?

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/03/17/supporting-surrogates/

Time Stamps:

• 01:09 Background Information
• 03:54 Surrogate Challenges
• 16:04 Clinician Challenges
• 36:10 Conclusion

Tags: CORE IM, IM Core, decisions, prognosis, goals of care, clinicians, patients, family medicine, palliative care, end-of-life

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How can we better serve the public's health? What does the landscape of public health look like? What opportunities are available to better hone your skills? What are common challenges professionals face?

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/02/24/public-health-ca…rs-in-gim-series/

Time Stamps:

• 01:00 Introduction
• 05:07 Defining Public Health
• 11:17 Pursuing a Public Health Career
• 20:12 Politicization of Health

Tags: CORE IM, IM Core, fellowships, advocacy, healthcare, jobs, leadership, population health

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What does each diagnostic test tell you? How do you interpret urine osmolality, urine sodium, or urine urea? What studies can be used to better assess response to treatment? How can uric acid be utilized as a diagnostic tool? What is the interplay between ADH and UOsm?

Time Stamps:

• 04:50 General Diagnostic Approach
• 12:26 Serum Osmolality
• 19:34 Urine Osmolality
• 32:09 Urine Sodium
• 45:23 Uric Acid

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/02/10/5-pearls-on-hyponatremia-episode-1/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Tags: urine studies, SIADH, Core IM, IMCore, antidiuretic hormone, hospital medicine, family medicine, nephrology

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How can I best answer my families medical questions? How can I give my loved ones the best care without providing it directly for them? What boundaries should I have in place?

Show notes, Transcript and References: https://www.coreimpodcast.com/2021/01/13/treating-friends-family/

Time Stamps:

• 02:45 The tension, the push and pull
• 05:45 Prevalence
• 06:32 Stances of societies/professional organizations
• 08:18 Concerns
• 10:35 How to respond
• 17:52 Favors for physician/trainee colleagues, self-doctoring
• 22:26 Formal vs informal, documentation
• 23:55 Long-term care

Tags: patient care, advocate, advice, healthcare, Core IM, IM Core, medical ethics, medical humanities

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How do you form an educational mission statement? What role do coaches and mentors play? Do you need formal training for a MedEd career? What are the challenges with careers in medical education?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/12/27/medical-educatio…s-careers-series/

Time Stamps:

• 00:00 Introductions
• 05:44 General Tips
• 18:00 Challenges in Med Ed
• 24:54 Conclusion
• 
  

Tags: CoreIM, IM Core, mission statement, clinician educator, mentors, coaching, training, feedback

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Can you identify where along the clinical reasoning pathway the learner is struggling? What coaching exercises can be helpful? What feedback do you fall back on when working with learners? What are common challenges?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/12/09/hoofbeats-strugg…inical-reasoning/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time Stamps:

• 00:00 Introduction
• 03:33 Mental Health & Wellbeing
• 06:43 Case 1
• 11:48 Exercise 1
• 12:53 Exercise 2
• 14:35 Case 2
• 19:15 Exercise 3
• 21:22 Exercise 4
• 23:24 Case 3
• 27:29 Exercise 5
• 28:07 Exercise 6
• 29:24 Conclusion

Tags: CoreIM, IM Core, problem representation, coaching exercises, data gathering, hypothesis generation, clinical reasoning, faculty development

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What is the difference between mnemonics and schemata? What does the mnemonic NAACP bring to mind? How do repeat interviews bring you closer to or further away from the diagnosis? Show notes, transcript and references: https://www.coreimpodcast.com/2020/11/25/a-29m-with-cough…oofbeats-segment/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time Stamps:

• 00:43 Case presentation Part 1
• 04:55 Case presentation Part 2
• 06:50 Expert discussant
• 28:52 Framing bias
• 33:38 Concluding thoughts

Tags: IM Core, CoreIM, schemata, mnemonics, eosinophilia, framing bias

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What leads patients to search for alternative treatments than those offered in Western Medicine? How can we provide patients with safer complimentary interventions? How do we prioritize what is important in our patients health?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/10/15/approach-to-patients-with-cam-beliefs/

Time stamps:

• 01:49 Intro
• 04:54 What is CAM
• 06:29 Prevalence of CAM
• 08:01 Holistic approach to patient care
• 11:09 Patient empowerment
• 14:38 Integrating CAM
• 18:34 Risks and Benefits
• 19:50 Caution patients
• 22:29 Indirect Risk
• 23:45 Big Picture
• 26:04 Therapeutic Alliance
• 27:27 Conclusion

Tags: IM Core, CoreIM, supplements, homeopathic, naturopathic, Ayurvedic medicine, mind-body interventions, massage, acupuncture, and chiropractic manipulation, qi gong and Reiki

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How can we feel more comfortable in treating these patients? What treatment options do we now have in our toolbox to fight COVID-19? How has the landscape changed in what we can offer patients?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/09/30/covid-management/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps

• 04:16 Supportive Care
• 07:48 Step-up approach to oxygenation
• 13:44 Data Points
• 15:30 Clots
• 19:13 Steroid use

Tags: IM Core, CoreIM, oxygenation, proning, anticoagulation

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How do we respond to challenging times? Are you a driver of change? How can we forge ahead during times of adversity? What lessons can we learn from the stories of our peers and colleagues?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/09/16/transitions-episode/

Time Stamps:

• 02:48 Minneapolis 2020 with Dr. Uloko
• 06:44 Early HIV/AIDS with Dr. Kalet
• 12:07 Hurricane Sandy with Dr. Hwang
• 17:20 Aftermath of the Syrian Civil War
• 20:23 Transitions with Dr. Arora

Tags: Core IM, IM Core, change, inspiration, narrative medicine

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What are common mistakes with protein on the UA? What questions should you ask while obtaining a history that could clue you into nephrotic syndrome? Are kidney biopsies risky business? Is there an associated clot risk in patients with nephrotic syndrome?

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Show note, Transcript and References: https://www.coreimpodcast.com/2020/09/02/5-pearls-on-nephrotic-syndrome/

Amboss Article on Nephrotic Syndrome: https://www.amboss.com/us/knowledge/Nephrotic_syndrome?utm_source=affiliate&utm_medium=link&utm_campaign=coreim-01

Time Stamps:

• 03:22 Evaluating Proteinuria
• 09:37 Nephrotic Syndrome specifics
• 22:31 Who to biopsy
• 31:39 Diuretics
• 37:16 Thrombosis Risk

Tags - CoreIM, IM Core, edema, proteinuria, kidneys, thrombosis, urinalysis, diuresis

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How tough is it to forge your career in clinical research? What struggles do physicians face in finding protected time? Are there setbacks and frequent rejections? How can you follow your passion and find success?

Show note, Transcript and References: https://www.coreimpodcast.com/2020/08/19/research-careers…rs-in-gim-series/

Time Stamps:

1:28 Origins

6:57 Mentorship

14:30 Reality, Roadbumps, and Failures

18:17 The path of many fellowships

Tags - CoreIM, IM Core, clinical investigator, general internal medicine

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Are fall prevention programs helping our patients? Should patients receive outpatient PT based on clinical diagnosis? How has the landscape changed because of insurance reimbursement?

Show note, Transcript and References: https://www.coreimpodcast.com/2020/08/05/physical-therapi…education-series/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time Stamps:

• 01:47 Functional Assessment
• 07:47 Documentation
• 14:35 Outpatient PT
• 18:14 Durable Medical Equipment
• 22:55 Reimbursement

Tags: Core IM, IM Core, physical therapy, durable medical equipment, IPE, multidisciplinary team, interdisciplinary

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What goes into decision making? What are the invisible tugs that may keep patients from acting in line with their values? Why isn't it part of the formal capacity assessment?

Show notes, Transcript and References: https://www.coreimpodcast.com/2020/07/22/capacity-2-0-and-voluntarism/

Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time Stamps:

• 2:57 Defining voluntarism
• 5:36 Four elements that influence voluntarism
• 10:26 How do you incorporate voluntarism into the capacity assessment?
• 16:11 Discussions with uncooperative patients
• 19:14 Protecting unrepresented patients
• 21:30 Clinician perspective
• 25:06 Moral distress

Tags: medical humanities, ethics, psychiatry, IM Core, CoreIM

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Unpack a famous historical legend's medical dilemma on a special "Historical CPC" episode!

Show notes, transcript and references: https://www.coreimpodcast.com/2020/07/08/22729/

Time Stamps:

• 02:55 HPI
• 07:33 Past Medical History
• 04:25 Physician Exam findings
• 24:22 Historical Figure Revealed
• 26:30 Reflections on top 3 diagnosis

Tags: cognitive and neuropsychiatric disturbances, rabies, mercury poisoning, cholera, delirium, COREIM, IMCORE, clinical reasoning case

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Packed with so many clinically relevant points taking care of a patient with decompensated heart failure on general medicine floors!

Time Stamps:

• 03:17 What are the key initial clinical variables in evaluating heart failure admissions?
• 10:09 What are key lab findings for patients with heart failure exacerbation?
• 17:14 Which guideline-directed medical therapy, and in what circumstances?
• 22:12 What are diuretics dosing strategies and monitoring tips to help guide initial volume removal?
• 28:43 What role do thiazides and ultrafiltration play in diuresis, why does diuretic-induced metabolic alkalosis happen and what should you do about it?
• 38:09 Expert Recap

Show notes, transcript and references: https://www.coreimpodcast.com/2020/06/24/5-pearls-on-inpatient-heart-failure/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Tag: Cardiology, BNP, cardiorenal syndrome, beta-blockers, CoreIM, IMCore

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SNF vs. NH? SAR vs. SNF? What are the differences in resources, nursing and clinician oversight and who pays for what?!

Show notes, transcript and references: https://www.coreimpodcast.com/2020/06/10/snf-sar-nh-alf-and-more-discharge-options-interprofessional-education-series/

ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time stamps:

• 04:07 SAR vs SNF
• 13:35 Long term Nursing Home Care
• 18:30 Assisted Living Facility
• 24:40 Acute rehab
• 26:11 LTACH
• 27:49 Home

Tags: Subacute rehab, skilled nursing facility, long-term acute care hospital, CoreIM, Core_IM, hospital medicine, family medicine, emergency medicine, physician assistant, nurse practitioner, interprofessional education

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Let's dive deeper into the dogma of salt restriction in heart failure! Show notes, transcript and references: https://www.coreimpodcast.com/2020/05/20/salt-restriction-in-heart-failure-mind-the-gap-segment/ Get CME-MOC credit with ACP! Time Stamp

• 01:37 Sodium restriction guidelines
• 07:13 Current data in outpatient data
• 11:32 Do inpatient studies show signal?
• 13:44 Physiology behind sodium balance
• 16:27 Take away and clinical applicability

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How do you navigate new challenges with goals of care with your patients in clinics?

Show Notes, Transcript, References: https://www.coreimpodcast.com/2020/05/06/outpatient-advanced-care-planning-during-covid-19/

Time Stamps

• 01:32 COVID Crisis as an Outpatient and Advance Care Planning (ACP)
• 08:06 The virtual visit
• 12:44 Vital Talk Mnemonic: “CALMER”
• 22:03 Challenges to Outpatient COVID Care
• 26:03 Parting Thoughts

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Episode Outline

Disconnection/connection: Patients

Disconnection/connection: Family/friends

Disconnection: Security, Certainty

Connection: Other clinicians

• Sharing fears, supporting each other)
• Shared ethos in healthcare (one workforce, no division of specialty or hierarchy)

Conclusion: Post-traumatic growth / Peri-Traumatic Growth

Thank you to everyone we interviewed, particularly to the voices you heard:

Dr. Kimberly Manning (@gradydoctor)

Dr. John Hwang (Hoofbeats segment)

Dr. Steve Liu (Mind the Gap segment)

Dr Katherine Arthur

Dr. Maria Garcia-Jimenez

Dr. Kelsey Luoma

Hosts:

Dr. Margot Hedlin (@MargotHedlin) - Introduction and Ending

Dr. Tamar Schiff

Dr. Michael Shen (also audio editing)

Dr. Jafar Al-Mondhiry (@mondhiry)

tags: COVID19, COVID-19, CoreIM, coronavirus, narrative medicine

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What is your approach to goals of care conversations, particularly during COVID-19? How do you navigate some of the new challenges with COVID19?

Show notes, transcript and references: https://www.coreimpodcast.com/2020/04/22/goc-on-inpatient-service-during-covid-19/

Time stamps:

• 05:54 Laying the groundwork
• 08:56 Asking permission, eliciting values and making a recommendation
• 15:55 When a patient is dying
• 16:42 Sharing the prognosis first
• 20:28 Functional status post-CPR
• 21:52 Headline statement
• 23:40 Virtual and PPE Communication Challenges
• 25:28 Separate process from outcome

Tag: coronavirus, COVID, CoreIM, Sars-cov-2, medicine floors, wards, advanced care planning

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How do you organize your day? How do you minimize exposure of yourself and your colleagues? What are the new things to keep in mind with discharging patients?

Show notes, transcripts and references:

CME Credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time Stamps

• 02:37 Entrance and Exit strategy
• 04:25 Prioritizing patient acuity
• 08:14 PPE uses
• 11:11 Respiratory concerns in COVID-19 patients
• 16:35 Patient examination
• 18:49 Family updates
• 20:56 Oxygen requirements
• 23:12 Medications
• 24:08 Discharging patients
• 31:00 What we mean by isolation

tag: coronavirus, COVID, CoreIM, sars-cov-2, medicine wards

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Practical tips on starting estrogen or testosterone on patients who are transgender and approach to primary care with cancer screening.

CME Credit with ACP; https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Show notes, transcripts, and references: https://www.coreimpodcast.com/2020/04/01/5-pearls-on-transgender-health-hormone-therapy-and-preventive-screening/

Time Stamps:

• 02:54 Hormone therapy contraindications
• 07:09 Time course for hormone changes
• 10:21 Hormone risks
• 19:09 Hormone treatment options
• 25:22 Preventative Care Screening

Tags: CoreIM, gender affirming care

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Practical tips on Gender Affirming Care!

Show notes, transcript and references

Time Stamps:

• 02:43 The Gender Unicorn and how it helps us better understand gender identity, expression, and sex assigned at birth
• 11:15 Gender dysphoria
• 14:16 The organ or anatomical inventory
• 16:46 The inevitability of mistakes
• 18:39 Ways to ensure gender-affirming care in clinic

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What goes into a capacity assessments? Is it just reciting risks, benefits and alternatives? Explore this and more on this At the Bedside Episode!

Show notes, Transcript and References: https://www.coreimpodcast.com/?p=22310

Time Stamps:

• 2:04 Introduction to decision making
• 4:12 Choice
• 8:24 Understanding
• 11:22 Appreciation
• 13:58 Reasoning
• 21:55 Common myths and misconceptions
• 25:11 When and how to call a psychiatry consult for capacity assessment
• 27:47 Conclusion

Tags: CoreIM, AMA Discharges, Psych, Competency, medical ethics, medical humanties

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What are the new guidelines for influenza treatment? What are the diagnostic ratios of flu symptoms and tests? Time Stamps

• 03:10 The art of diagnosing the flu
• 05:17 Bayesian statistics and the diagnostic odds ratio
• 07:09 The ins and outs of diagnostic testing for the flu
• 08:44 Changes in influenza guidelines - testing and treatment
• 11:17 The not-so-rosy origin story of neuraminidase inhibitors (NAIs)
• 13:47 Neuraminidase inhibitors (NAIs), mortality benefit and limitations of studies
• 15:49Take aways

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What is the difference between a case manager and social worker? What are the limitations that social workers and case managers face? How do you create a safe space for the interdisciplinary team?

Show Notes and References

Get CME-MOC credit with ACP!

Time Stamps:

• 03:54 What are the various roles within a multidisciplinary teams?
• 10:42 Understanding limitations of social workers and case managers
• 15:55 The “behind the scenes” paperwork
• 18:42 Insurance and medications
• 22:17 Insurance and disposition options
• 25:08 The importance of creating a safe space for better communication

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What are the symptoms? What distinguishes coronavirus from other influenza-like illness? When coronavirus is suspected, what should you do?

Show notes and references

CME credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

ACP Interactive Learning Module

Time Stamps

• 01:30 Novel parts of coronavirus

• 03:00 What symptoms do patients present with for the novel coronavirus?

• 04:22 What distinguishes coronavirus from other influenza-like illness?

• 05:31 When coronavirus is suspected, what should you do?

• 07:13 What does testing for coronavirus entail?

• 09:06 What kind of isolation is required?

• 10:13 Do patients need to be isolated in biocontainment units?

• 10:42 What is treatment for the novel coronavirus?

• 12:30 Potential for vaccines

• 15:23 What is R0?

• 17:12 Animal reservoirs with 2019-nCoV, SARS, and MERS

• 19:18 What should we tell patients for prevention?

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How do you learn from diagnostic errors? Walk through a case that the host had initially gotten wrong and uncover possible reasons as why from data gathering to hypothesis generation to the interplay between hypothesis generation and evaluation. Learn interesting tidbits on prior work in medical education around how we think, particularly around diagnostic failures.

CME Credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time Stamps

• 02:39 Case Introduction
• 04:46 Yes/No questions with our first two discussants
• 18:43 The diagnosis is revealed
• 21:14 Why did I miss the diagnosis?
• 27:44 Using diagnostic problem solving to break down the case and understand our errors
• 30:20 The importance of data gathering
• 30:49 Introducing our third clinician
• 34:17 Hypothesis generation
• 37:11 The interplay between hypothesis generation and evaluation
• 38:34 The win-stay, lose-shift heuristic
• 41:33 Cognitive forcing strategies
• 49:32 Knowledge vs. experience

Tags: Dermatology, rash, DRESS, AGEP, varicella

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Why is prognostication hard? How do we improve at communicating prognosis? How should we approach uncertainty? Explore this and more on this At the Bedside episode!

Prognosis Calculators, Transcript and References

Time Stamps

• 02:48 What is prognosis?
• 04:00 Why offer prognostication?
• 08:32 Why is prognostication hard?
• 16:41 How do we improve at communicating prognosis?
• 21:56 How should we approach uncertainty?
• 31:06 Take Aways

Tag: life expectancy, CoreIM

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Dive deeper into hx of the influenza virus, how vaccines are made and vaccine effectiveness ! Time Stamps

• 02:59 The history of the influenza virus
• 08:18 What does the influenza vaccine target?
• 13:20 Chickens, and bugs, and mammalian cells, oh my! How the vaccine is made.
• 14:00 What to do about egg allergies.
• 15:53 Vaccine effectiveness and herd immunity.
• 17:43 Waning immunity and other debates

Show Notes, Transcript and References

Get CME-MOC credit with ACP!

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Explore gaps in your knowledge about the home health world, particularly on home health aides!

• Get CME-MOC credit with ACP !
• Full transcript, show notes, references

Time Stamps:

02:33 What support do our patients have at home and how does those people play a role in their care?

06:00 Are there various types of home care workers?

07:25 What role do home attendants play in caring for a patient?

08:31 What tasks do home health aides do?

10:11 What are the types of "skilled carez'?

13:17 What can Medicare cover for older adults in terms of home health aides?

15:17 How does Medicare define homebound?

16:03 How does having Medicaid impact access to home care?

19:10 What if a patient isn’t eligible for Medicare or Medicaid?

19:43 What is the cost to use a private agency for home health services?

24:02 What are some challenges that home health aides face?

25:42 What are “plans of care”?

30:01 Who makes up the home care workforce?

31:52 When patients get discharged from the hospital, do they go home to the same home care assistance?

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Get CME Credit with ACP! Full Transcript with references and show notes Time Stamps

• 4:30 What is the daily risk of thrombosis if HIT Is left untreated?
• 5:40 What happens during platelet activation?
• 07:11 How long does it take for patients to develop for IgG antibodies to Heparin to form?
• 09:52 Is HIT common?
• 10:28 Who is at higher risk for HIT?
• 11:48 Why does low molecular weight heparin have a lower risk for HIT than unfractionated heparin?
• 15:30 Approach to thrombocytopenia
• 17:44 How do medications cause thrombocytopenia?
• 18:38 With medications, what is the time course between medication initiation and thrombocytopenia?
• 22:20 What is the sensitivity and specificity of anti-PF4 antibody?
• 23:58 How does the serotonin-release assay (SRA) work?
• 29:10 What type of anticoagulant do you choose for treating HIT?
• 31:58 Why is it important to not use warfarin in patients with platelet counts <150,000?
• 33:32 What is the treatment duration for a patient has confirmed HIT?
• 36:29 Dr. Cuker’s story and the "Scarlet H"
• 39:07 Dr. Linkin’s Recap
• 42:25 Dr. Linkin’s story
• 44:37 Pearl 5: Throwback to coronary calcium scores

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House of God author, Samuel Shem and Prof Katharine Watson share thought-provoking takes on Gallows Humor. Laugh and listen to this captivating take on the different shades of humor in the day-to-day of medicine. Time Stamps

• 02:33 Episode preview and Guest Introductions
• 04:20 Definition of Gallows Humor
• 07:25 Gallows Humor by Comedians vs Patients vs Physicians

The Good

• 08:15 Benefits/Functions of Humor in General
• 11:10 Connection
• 13:07 Coping/Catharsis
• 16:22 Resistance Against Oppression
• 19:03 Humor as our Authenticity/Humanity

The Bad, The Ugly

• 21:01 Unintended Audiences (e.g., patients, families)
• 25:30 “Corporeal” Joking
• 28:00 Toxic Role Modeling
• 31:10 Desensitization/Losing Empathy
• Tips, Takeaways & Conclusion33:48 Challenging Inappropriate Jokes
• 35:45 Excessive Gallows Humor: Signal of Distress?
• 37:17 Using Gallows Humor: Questions to Ask Yourself
• 38:40 Keeping the Faith!

• 41:11 Excerpt from Man’s 4th Best Hospital by Samuel Shem

Transcript and References

Tag: medical humanities, medical ethics, CoreIM, IMCore

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1st outpatient clinical reasoning case on Core IM Hoofbeats!

Get CME-MOC Credit (live at 9AM EST on 10/16)

Time Stamps

• 01:18 Case introduction
• 11:40 The Casablanca strategy
• 23:17 The diagnosis revealed
• 25:30 Logical fallacy: Denying the antecedent
• 33:22 Components of illness scripts
• 41:37 Conclusion

Show notes, transcripts and references!

Do you have a good case or an expert you would like to suggest for an episode? Send it our way at hello@coreimpodcast.com

Tag: normocytic anemia, splenomegaly, CoreIM, endocarditis, clinic case

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Go deeper into the world of blood cultures!

Time stamps

• 04:10 Review of Choosing Wisely Guidelines
• 05:55 What are estimated incidences of positive blood cultures?
• 06:17 Which clinical signs or patient history is more likely to have positive blood cultures?
• 09:48 What is the estimated incidence of false positive blood cultures?
• 11:01 What infections more likely to have bacteremia?
• 13:50 How do positive blood cultures impact patient outcomes and the use of resources?

Show notes, transcript, and references

Tags: Infectious disease, CoreIM, pyelonephritis, cellulitis, community acquired pneumonia

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Practical tips on smoking cessation! Get CME Credit with ACP!

Full Transcript with References and Show Notes

Time Stamps

• 04:50 What questions are important to ask after a patient who contemplative about quitting tobacco?
• 07:00 Is quitting abruptly on a quit date or gradual cessation to a quit date better?
• 08:10 How can technology help support patients who are trying to quit?
• 08:49 How should we prepare patients who quit smoking and are worried about weight gain?
• 11:06 How can we try to convince patients to use medication as assistance to quit smoking?
• 11:50 What is the most effective nicotine replacement approach?
• 13:54 What are the potential side effects of the nicotine patch?
• 15:00 What should we prescribe for patients who smoke <5 cigarettes a day?
• 16:28 How can we determine how severe a patient’s nicotine dependence is?
• 18:26 When is the ideal frequency of nicotine gum or lozenge?
• 21:45 How does varenicline work?
• 25:05 Can you start varenicline in patients who have had psychiatric history?
• 27:15 What major side effect is seen in patients taking bupropion?
• 29:15 How do e-cigarettes work?
• 31:18 How should we approach adding e-cigarettes into a patient’s plan for quitting?
• 31:42 How should we discuss e-cigarette use with our patients?
• 33:47 Recap
• 39:54 Screening for Barrett’s Esophagus

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Do we have to sign the AMA form? Do insurances deny payment for patients who leave AMA? What is your approach to AMA discharges? Core IM At the Bedside speaks to ethics researcher, Dr. David Alfandre, author of Things We Do For No Reason: Against Medical Advice Discharges

Show Notes, Full Transcript and References

Time Stamps

• 3:03 Demographics of AMA discharges
• 5:59 Clinician/System related factors of AMA discharges
• 10:30 Strategies for mitigating AMA Discharges
• 15:59 Do we have to make patients sign the AMA form?
• 18:27 Do insurances deny payment for patients who leave AMA?
• 23:09 Take Away Points

Tags: shared-decision making, harm reduction

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We hope these stories can make us more introspective and open minded on how these concepts can affect each one of us differently.

Let's continue the discussion on the Women in Medicine Twitter chat on 8/25 at 9pm EST !

Full Transcript and Show Notes

Time Stamps

• 2:07 Introduction to one woman’s journey
• 3:00 Stereotype Threat
• 6:15 Not all Anger is Created Equal
• 10:17 Asking and Writing Your Own Job Description
• 13:08 Imposter Syndrome
• 15:50 Breaking Points to Self Care
• 18:50 Work Life Integration
• 21:40 Support Networks

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20 Qs with Core IM Team vs. Expert Discussant !

Full Transcript and Show notes

Get CME-MOC Credit for listening to this episode (live at 09:00 am EST on 8/7)

Time Stamps

• 00:20 The game of medical Twenty Questions
• 04:37 Case introduction
• 05:50 The CoreIM team attempts to solve the case
• 15:36 The discussant’s diagnostic schema for abnormal bleeding
• 23:37 Primary versus secondary hemostasis
• 30:33 The pathology report !
• 37:38 Criteria for the final diagnosis
• 38:46 Dissecting a diagnostic coup
• 49:42 Conclusion

Do you have a good case or an expert you would like to suggest for an episode? Send it our way at hello@coreimpodcast.com

Tags: Coagulopathy, Bleeding Disorder, Diagnostic Schema, Von Willebrand's Disease, Clinical Reasoning

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Night and Day… join us for part II of our exploration into why we prescribe medications in the morning vs. at night, featuring statins!

03:28 How do statins and cholesterol synthesis work again, anyway?

04:00 Power in numbers - what do the meta-analyses say about timing of statins?

04:40 The long and short of it - how half-life may dictate when to take your statin.

07:35 Effect magnitude - does medication timing actually really impact patient outcomes?

10:30 Practical matters - so what should we tell patients?

11:05 Review of teaching points

Show notes, transcripts and references

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Solidify your knowledge on Coronary calcium scores and Coronary CTAs!

ACP members can claim CME-MOC Credit !

Quiz yourself on the 5 pearls we will be covering below:

• 3:10 What are the big picture differences of functional stress tests and anatomical cardiac tests?

• 7:48 What is the role of coronary artery calcium scores in managing coronary artery disease (CAD)?

• 16:20 How do coronary CTAs compare to stress tests?

• 24:28 When should we avoid CTA?

• 29:33 How do we communicate coronary CTA results with patients?

• 36:02 Recap

Full transcript, infographics and show notes !

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In ‘At The Bedside’, our newest podcast segment, we tackle important topics that *aren’t* easily indexable in guidelines and UpToDate article – topics that are better discussed…well…at the bedside. Our first episode examines the all-too-common trope of the ‘difficult’ patient.

• 01:13 Introduction
• 05:27 Question 1: What makes a patient difficult for you?
• 13:22 Question 2: What is a “good outcome” when working with difficult patients?
• 23:05 Question 3: What have you learned from your difficult patients?
• 31:56 Conclusion

Show notes, Transcript, Further Reading

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Transitions can be hard. Laugh, commiserate and be inspired by these July stories in medicine!

Very big thank you to everyone who told their stories !

Let's help each other feel a little less alone in the struggle, be more understanding and compassionate or laugh at ourselves. Please share this episode with colleagues. Do you have a July story? Email us at hello@coreimpodcast.com.

Lets continue conversation over social media. Which stories moved you? Which July stories can you relate to? Tweet us, find us on instagram at coreimpodcast or Facebook. Good luck this coming July !

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Dissect clinical reasoning and dive deeper into an interesting case!

• 02:04 Initial Presentation
• 03:03 The Core IM team tackles the case
• 09:30 Social History
• 16:05 Physical Exam
• 22:47 An exercise in Bayesian inference
• 36:35 Pre-mortem
• 43:37 Revealing the diagnosis
• 48:57 How do we define diagnostic success?

Full transcript with references and show notes

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Dive deeper into why we prescribe medications in the morning vs. at night !

• Why do we dose warfarin at night? (2:45)
• Back to the basics - what are the pharmacodynamics of warfarin and how does vitamin K intake matter? (4:28)
• Practical matters - so what should we tell patients (6:14)
• Dippers and non-dippers - what happens to blood pressure (BP) at night? (9:32)
• The surprising link between dipping and cardiovascular outcomes (11:15)
• Timing is everything… or is it? The evidence behind taking BP meds at night (11:58)
• Review of teaching points (15:58)

What is your prescribing practice with blood pressure medications? Leave a comment, tweet us or share with us on instagram or facebook on how you dose BP meds?

Transcript with references and show notes

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Solidify your knowledge on stress tests! Quiz yourself on the 5 pearls we will be covering:

• What are the indications for a stress test? (2:18)
• How to choose stress protocol in a stress test? (8:29)
• How to choose diagnostic modality in a stress test? (14:46)
• How do we interpret results from stress tests, and how should this be communicated to patients? (24:08)
• Pearl Recap (31:13)
• Risk of contrast induced nephropathy between arterial and venous contrast load (36:02)

For full transcript, infographic and show notes: https://www.coreimpodcast.com/2019/04/24/stress-testing/

Tags: Internal Medicine, Internist, Primary Care Physician, Hospitalists, Emergency Medicine, Nurse Practitioner, Physician Assistant, Family Physician, Cardiology

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Dissect 3 interesting cases and improve your clinical reasoning skills! Time Stamps:

• New features in this episode [0:30]
• Case one: 66M w RUQ pain [1:09]
• Case two: 41M w Afib in RVR [9:26]
• Case three: 50M w Syncope [14:33]
• Reveal [19:57]
• Retrieving illness scripts [22:29]
• Typical versus Atypical presentation of diseases [26:12]

For full transcript and show notes: https://www.coreimpodcast.com/?p=21028

Tag: medical education, clinical cases, expert clinicians, internal medicine podcast

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Check out part 1: Acute Coronary Syndrome and TIMI Risk Score

Lets go deeper into

1) How the chest pain history correlates with pathophysiology? [2:40]

2) How has high-sensitivity troponin changed the way we think about unstable angina? [7:34]

For transcript, infographic and show notes: https://www.coreimpodcast.com/2019/03/27/unstable-angina/

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Solidify your knowledge on inpatient pain management! Quiz yourself on the 5 pearls we will be covering:

• How effective are non-opioids? ( 3:17)
• Are NSAIDs contraindicated in patients with kidney, liver or heart disease? If not, how can we use them safely? (10:51)
• What are the best practices for patients who require opioid analgesia? (19:00)
• When prescribing opioids at discharge what can we do to minimize harm? (25:02)
• Throwback to mechanism of acetaminophen and NSAIDs (27:14)
• How do we believe tylenol works and how does that compare to NSAIDS? (28:27)

For full transcript of the audio and show notes: https://www.coreimpodcast.com/2019/03/13/5-pearls-on-pain-management/

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Let's go deeper into the world of ACS and the origin of the TIMI score and major adverse cardiac events "MACE" outcomes!

• The basics – what is acute coronary syndrome? (4:08)
• Clinical context matters – angina pectoris, atypical chest pain, and troponins (5:22)
• You can’t just “cath” everyone – risk stratification to identify patients with high mortality risk (9:42)
• TIMI isn’t perfect – the issues with the score and MACE outcomes (14:00)
• Review of teaching points (17:58)

For full transcript and show notes: https://www.coreimpodcast.com/2019/02/27/acute-coronary-syndrome-acs-and-the-timi-score/

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Dissect an interesting case and improve your clinical reasoning skills!

Time Stamps:

• New features in this episode [00:25]
• Data point 1: Early hypothesis generation? [03:20]
• Data point 2: Pertinent negatives? [11:18]
• Data point 3: Representativeness heuristic over-represented in medical education? [13:28]
• Data point 4: Economical hypothesis generation by expert clinicians [19:20]
• Data point 5: Diagnosing diagnostic error [22:10]
• Data point 6: Moving toward a final diagnosis [27:11]
• Case resolution [29:50]

For full transcript and show notes: https://www.coreimpodcast.com/2019/02/13/hoofbeats-47m-with-chest-pain/

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Solidify your knowledge on Barrett's Esophagus and more! Quiz yourself on the 5 pearls we will be covering:

What is Barrett’s esophagus and why should we care? (4:12)

Who do we screen for Barrett’s, and why? (8:41)

How do we screen for Barrett’s and counsel? (13:50)

How do we treat and monitor Barrett’s esophagus? (18:21)

Take Aways (21:45)

Throwback to trending troponins (23:05)

For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2019/01/30/5-pearls-on-barretts-esophagus/

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Dissect an interesting case and improve your clinical reasoning skills!

Time stamps:

• Player three has entered the game! [0:15]
• Case presentation, part 1 [1:20]
• First impressions [3:24]
• Rethinking another provider’s diagnosis [4:36]
• Interpreting the test of treatment [8:48]
• Keeping your instincts on a leash? [10:58]
• Case presentation, part 2 [12:33]
• Diagnostic schemas [14:30]
• Our discussant’s differential and the final diagnosis [17:46]
• Shira’s cognitive autopsy [23:02]

For full transcript and show notes: https://www.coreimpodcast.com/2019/01/16/hoofbeats-34m-with-fever-headache-and-myalgias/

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Solidify your knowledge on troponins and more! Quiz yourself on the 5 pearls we will be covering:

What aspects of the history are concerning in a patient with a positive troponin? (4:00)

What is the difference between the TIMI, GRACE, and HEART scores, and how should we use them in the evaluation of a patient with an elevated serum troponin? (8:42)

How does the change in troponin over time help with diagnosis, and what should we consider in a patient with uptrending troponins but an unremarkable ECG? (14:48)

What can a “negative but detectable” troponin tell you about any patient, not just those with suspected ACS? (21:31)

Pearls Recap (25:26)

Throwback – what are the first-line medications for alcohol use disorder? (28:36)

For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2019/01/04/5-pearls-on-troponins/

Tags: chest pain, cardiology, myocardial infarction, acute coronary syndrome

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Let's dive deeper into the world of acetaminophen and fever and how it may work and patient outcomes

Time Stamps:

What data is there to support the use of acetaminophen as a fever reducer? (2:08)

Does acetaminophen improve patient outcomes? (4:30)

How does acetaminophen compare to other medications like NSAIDs? (9:56)

What is the mechanism of acetaminophen action? (10:50)

Review of teaching points (16:02)

For full show notes and transcript of audio: https://www.coreimpodcast.com/2018/12/19/mind-the-gap-on-acetaminophen-fevers-pathophysiology-and-patient-outcomes/

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Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here:

Time stamps:

Case [1:19]

Diagnostic weight [8:42]

Hypothesis driven reasoning [12:26]

Anomalous clinical data [19:30]

Final diagnosis [22:20]

Take away points [31:21]

Human Dx Case link: https://www.humandx.org/o/co7yrer3dim2y59t5c0sbd370?s=FEED

For show notes: https://www.coreimpodcast.com/2018/12/05/hoofbeats-43m-with-diarrhea/

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Women in medicine inspire us with what they would tell their younger selves. Some of the speakers with Shreya Trivedi MD @ShreyaTrivediMD at the Women in Medicine GirlMedLive Conference:

Qaali Hussein MD @QaaliHussein1 Clinical Pearl @ClinicalPearl Marguerite Duane MD @mduanemd Kate Prior MBBS @doctorwibble C. Nicole Swiner MD @docswiner Carmen Landrau MD @DrLandrau Jessica Willett MD @jkwillettmd Ilene Brenner MD @irb123 Joannie Yeh MD @BetaMomma Karen Davidson, Esq karend@kdavidsonlaw.com Suzanne Feigofsky MD @DrSuzyFeigofsky GirlMedLive: https://www.girlmedmedia.com/

Episode page: https://www.coreimpodcast.com/2018/11/21/what-would-you-tell-your-younger-self/

Tags: career development, professional development, lifelong learning, burnout, imposter syndrome, mentorship, worklife balance

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Solidify your knowledge on Alcohol Use Disorder (AUD) treatment and more! Quiz yourself on the 5 pearls we will be covering:

Throwback: At what levels of drinking does unhealthy alcohol use start, and how do you screen for unhealthy alcohol use? (1:47)

What does the brief intervention and counseling part of SBIRT entail? (4:43)

What are the first line medications for AUD and contraindications to them? (11:11)

What are the second-line medications for AUD and their limitations? (18:14)

What new therapies are being studied for for alcohol use disorder? (22:09)

Pearls Recap (25:06)

For full transcript of the podcast, show notes and references: https://www.coreimpodcast.com/2018/11/07/5-pearls-on-treatment-of-alcohol-use-disorder/

tag: naltrexone, acamprosate, gabapentin, topiramate, SBIRT, neuromodulation, nalmafene, psychaedelics, audit-c

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Dissect a working diagnosis through a process of validation!

Time Stamps:

Your collective differential [0:40]

The test results (that you asked for) are in... [2:13]

The hospital course, and the diagnosis (or is it?) [7:10]

Validating a diagnosis: Base rate, adequacy, and coherence [8:30]

Revisiting the differential [14:44]

What to do when there is no final diagnosis? [17:39]

For full show notes: https://www.coreimpodcast.com/2018/10/24/hoofbeats-85f-with-acute-ams-part-2/

Tags: Clinical reasoning, Diagnostic Uncertainty

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Submit your diagnosis or differential for this episode's case at HumanDx.org (free registration required): http://hdx.org/2VP ! Part 2 (releasing 10/24) will have the final diagnosis!

Time stamps:

A new challenge and the rules of the game (1:13)

Introduction to Human Dx (3:06)

The case: An 85 year-old woman with paranoid delusions (5:28)

What exactly is problem representation? (15:15)

Building the differential (19:53)

For full show notes: https://www.coreimpodcast.com/2018/10/10/hoofbeats-85f-with-acute-ams/

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Join us in this episode with Doctors Who Create where we explore how Core IM was started and some things that happen behind the scenes!

Episode page: https://www.coreimpodcast.com/2018/09/27/meet-the-producers/

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Let's go deeper into the world of UTIs and delirium!

The basics – what are the official (IDSA) definitions for bacteriuria, pyuria, and UTI? (02:07)

The lay of the land – how common are bacteriuria and delirium? (07:09)

The big money question – do UTIs really cause delirium and what does the evidence tell us? (10:50)

Review of teaching points (15:59)

Full show notes: https://www.coreimpodcast.com/2018/09/12/mind-the-gap-uti-delirium/

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Solidify your knowledge on Proton-Pump Inhibitors (PPIs) and more! Quiz yourself on the 5 pearls we will be covering:

What are associated adverse effects for patients are on long-term PPIs? (2:02)

What are strategies to get your patient off PPIs? (10:57)

How do histamine-2 (H2) receptor antagonists blockers work and how can it explain why H2 blockers might not be as effective as PPIs? (13:30)

How should you educate patients to take PPIs to get the maximize benefit? (16:48)

How do you manage ongoing symptoms in patients on PPIs? (21:41)

For full transcript of the podcast and references: https://www.coreimpodcast.com/2018/08/29/5-pearls-on-ppis/

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Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here:

Case history and exam 00:40

Causal models 11:24

Facets versus diagnoses 13:25

Problem representation 16:37

Part two of the case 17:10

Occam’s razor, Hickam’s dictum, and Crabtree’s bludgeon 23:00

Diagnostic uncertainty 27:10

Learning points 34:24

For show notes: https://www.coreimpodcast.com/2018/08/15/hoofbeats-57f-with-confusion/

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Lets go deeper into the misunderstood side of Vancomycin!

Where did vancomycin come from, and why is it so controversial? (0:28)

What is vancomycin-induced nephrotoxicity and how common is it? (4:37)

Vancomycin trough monitoring – what is it good for? (7:28)

AUC to MIC ratio – the real math behind vancomycin dosing (7:53)

Review of teaching points (10:27)

Full show notes: https://www.coreimpodcast.com/2018/08/01/mind-the-gap-vancomycin/

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Solidy your understanding of unhealthy alcohol use! Quiz yourself of the 5 Pearls we will be covering:

What is alcohol use disorder (AUD), and how is it different from unhealthy alcohol use?

Who should we screen for unhealthy alcohol use, and which screening tools are preferred?

What are the consequences of unhealthy alcohol use?

Can moderate alcohol be good for patients, and if so, how much is “moderate”?

Who, how and how often should patients with chronic hepatitis B infection be screened for hepatocellular carcinoma?

For full show notes: https://www.coreimpodcast.com/2018/07/11/5-pearls-unhealthy-alcohol-use/

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Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here:

Part one of case (0:56)

Cognitive ease and strain (03:51)

Metacognition and routine diagnostic timeout (08:15)

Think outside the box of organ systems (11:19)

Illness behavior (12:30)

Part two of case (14:06)

Algorithms (17:57)

Fast thinking & pattern recognition (19:30)

Slow thinking & analytical reasoning (21:31)

Diagnosis (25:15)

Takeaways (26:52)

For full show notes: https://www.coreimpodcast.com/2018/06/27/hoofbeats-54m-with-diarrhea/

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Be inspired by why so many are proud to be in General Internal Medicine (GIM)!

Episode page: https://www.coreimpodcast.com/2018/06/23/celebrating-proudtobegim/

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Let’s take your breath away… with a review on steroids in treating COPD exacerbations!

Time Stamps

How does GOLD (Global Initiative for Chronic Obstructive Lung Disease) define a COPD exacerbation? (2:44)

What outcomes do steroids actually improve in treating a COPD exacerbation? (5:08)

What is the evidence behind a 5 day steroid “burst”? (7:20)

Are IV steroids more powerful than PO? (9:00)

For full show notes: https://www.coreimpodcast.com/2018/05/30/mind-the-gap-steriods-in-copd/

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Solidify your understanding of contrast-induced nephropathy (CIN)! Quiz yourself on the 5 pearls we will be covering:

Are there diagnostic criteria for CIN? (2:11)

Is there a difference between exposure to intra-arterial vs. intra-venous contrast in terms of risk of CIN? (6:28)

What are the biggest risk factors for CIN? (14:48)

What preventive measures have been shown to best reduce the risk of CIN? (19:41)

Can ESRD patients on hemodialysis still suffer from CIN? (23:32)

Recap (25:49)

For full show notes: https://www.coreimpodcast.com/2018/05/16/5-pearls-contrast-induced-nephropathy/

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Dissect an interesting case and think about the way clinicians think! So many clinical reasoning pearls here:

Part 1 Case (2:05)

Framing bias (7:07)

Data-driving reasoning (11:48)

Hypothesis-driven approach (12:38)

Periodic paralysis syndromes (16:08)

Representativeness heuristic (17:26)

Part 2 Case (20:51)

Pivot Points (31:36)

Diagnosis (35:55)

Take aways (37:20)

Check out the key teaching points: https://www.coreimpodcast.com/2018/05/02/hoofbeats-a-36f-with-weakness/

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Solidify your knowledge on adrenal insufficiency! Quiz yourself on the 5 pearls we will be covering:

What are signs and symptoms of chronic adrenal insufficiency (AI)? What is the most sensitive? (2:02)

How do we diagnose and differentiate types of adrenal insufficiency? (6:05)

How sensitive and specific are the diagnostic tests for AI & at what cutoffs? (12:06)

Can we both test and treat adrenal insufficiency at the same time? (16:40)

Throwback: How do hypokalemia and hepatic encephalopathy connected? (24:55)

Dr. Nidhi Agrawal Recap (19:20)

For full show notes: https://www.coreimpodcast.com/2018/04/18/5-pearls-chronic-adrenal-insufficiency/

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Solidify your knowledge on latent TB! Quiz yourself on the 5 pearls we will be covering:

Who should be screened for latent tuberculosis infection (LTBI)? (1:45)

What screening tests are available and how do they differ? (6:30)

What are the LTBI treatment options available? (10:24)

What are the major adverse drug effects to consider? (13:28)

How frequently should you check liver function tests in a patient being treated for LTBI? What do you do with the results? 17:43

Dr. Caplan-Shaw Recap (21:29)

For full show notes: https://www.coreimpodcast.com/2018/03/28/5-pearls-latent-tuberculosis-infection/

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Solidify your knowledge on albuminuria! Quiz yourself on the 5 Pearls we will be covering:

How good is a dipstick, urinalysis and UACR in detecting albuminuria? (1:42)

What conditions that lead to transient proteinuria? What is the appropriate interval to recheck and how should be it be repeated? (5:14)

Who should be screened for albuminuria and can it prognosticate risk for cardiovascular mortality? (7:47)

Does increasing RAAS inhibition improve renal outcomes? (10:57)

Throwback Question: How do you prescribe oral iron and what tips do you tell your patients? (13:11)

For full show notes: https://www.coreimpodcast.com/2018/02/28/5-pearls-albuminuria/

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Let’s go deeper into to why we think about diseases the way we do: COPD Classifications through the years!

Time Stamps:

How did prior understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25)

How is COPD diagnosed? (6:13)

How has COPD been classified and why? (6:42)

For full show notes: https://www.coreimpodcast.com/2018/02/14/mind-the-gap-copd-classifications/

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Quiz yourself on the following 5 Pearls on Chronic Hepatitis B (HBV) Management!

What is the focused history, physical and lab workup in a patient with chronic HBV? (1:40)

What is the best imaging to evaluate for intermediate stages of liver fibrosis? (4:06)

• What scoring tools can you use to estimate fibrosis and what are their limitations?

What factors do you use to assess which patients get treatment? (7:41)

What drugs are available for HBV treatment and how do you choose? (11:18)

Which chronic HBV patient should be screened for HCC, and how often? (14:45)

For full show notes: https://www.coreimpodcast.com/2018/01/31/5-pearls-on-chronic-hepatitis-b-2/

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Solidify your knowledge on Chronic Hepatitis B (HBV) screening and vaccinations! Quiz yourself on the 5 Pearls we will be covering:

Who do you screen for HBV? (3:37)

• How is HBV transmitted and who is at risk for HBV reactivation?

What tests do you order when screening for HBV? (10:48)

• In which populations is HBV vaccination recommended?

What are the four possible meanings of an isolated positive total anti-HBc? (13:55)

In an asymptomatic adult, is it necessary to send an anti-HBc IgM to distinguish acute from chronic HBV infection? (15:01)

What are the implications of seroconversion of HBeAg from positive to negative? (16:19)

For full show notes: https://www.coreimpodcast.com/2018/01/17/5-pearls-on-chronic-hepatitis-b/

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Let's go deeper as to why we do what we do: albumin in spontaneous bacterial peritonitis (SBP) ! Time Stamps:1. How much albumin is recommended in SBP? (1:45)2. What antibiotics are used for the treatment of SBP? (2:30)3. Why do we give albumin in SBP? (4:15) - How does albumin compare to crystalloid? (7:15) - Do we always have to give to albumin? (9:00) For full shownotes: https://www.coreimpodcast.com/2018/01/03/mind-the-gap-albumin-in-sbp/

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Cement your knowledge on Hepatic Encephalopathy (HE)! Quiz yourself on the following 5 Pearls we’ll be covering on HE: Time Stamps

What are other causes of altered mental status in cirrhotics? (1:45)

• What are common precipitants for an acute episode of HE?

What is asterixis? (6:10)

• What is the diagnostic utility of a cirrhotic with asterixis?

How do lactulose & rifaximin reduce symptoms of HE? (11:00)

• What are their indications?

What is the connection between hypokalemia and HE? (14:10)

What is the discriminatory power of an ammonia level in HE? (16:40)

• In what situation does the NH3 has stronger predictive value?

For full shownotes: https://www.coreimpodcast.com/2017/12/13/5-pearls-on-hepatic-encephalopathy/

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Part 2 on Abdominal Paracentesis ! Let's go deeper

Time Stamps

Should a cirrhotic’s INR and platelets deter you from doing a paracentesis? (3:15)

Do generalist have worse procedure complications than specialists? (5:40)

Do you need to send ascites fluid in blood culture bottles? (6:10)

For full shownotes: https://www.coreimpodcast.com/2017/11/29/mind-the-gap-abdominal-paracentesis-2/

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Solidify your knowledge on iron deficiency anemia! Quiz yourself on the 5 Pearls we will be covering:

Should patients be screened for iron deficiency? If so, who and how often? (1:40)

What are the indications for diagnostic endoscopy in iron deficient patients? (3:23)

How should you advice patients to take oral iron? (5:53)

• What is optimal dosing for oral iron?

In which patients would you consider IV iron? What are the risks? (11:41)

Throwback Question: What is a medication-overuse HA? (14:44)

For full shownotes: https://www.coreimpodcast.com/2017/11/15/5-pearls-on-iron-deficiency-anemia/

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You have always been told to do a diagnostic paracentesis on admission in cirrhotics with ascites, but why? Can you just get away with clinical judgement to rule out SBP? Is faculty judgement any better? And if you’re going to do a paracentesis on admission, do you need to do it right away? Go deeper with Dr. Steve Liu and Dr. Janine Knudsen!

Click the link for the full show notes: https://www.coreimpodcast.com/2017/11/01/mind-the-gap-admission-paracentesis/

Time Stamps

What do guidelines say about diagnostic paracentesis in cirrhotics with ascites? (1:51)

Can we just use clinical judgement to decide if paracentesis is warranted? (3:13)

• Do attendings have better clinical judgement than residents to rule out SBP?

Does timing of paracentesis on admission matter for mortality? (6:33)

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Cement your knowledge on headaches with 5 Pearls on when imaging is indicated, approach to abortive medications, medication overuse headaches, when to use migraine prophylaxis and effective non-pharmacological treatment for migraines!

For full shownotes: https://www.coreimpodcast.com/2017/10/18/5-pearls-on-headaches/

Time Stamps

What are the indications for imaging for HA? (1:36)

What is your approach to abortive therapy for migraines? (4:45)

How do you diagnose medication overuse HA? (6:41)

What is your approach to migraine prophylaxis? (8:29)

What are some evidence based nonpharmacological therapies for migraines? (10:42)

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CORE IM is an independent consortium of educators aligned to create internal medicine-specific portable learning tools in the form of podcasts, corresponding show notes and illustrations. Segments include 5 Pearls and Mind The Gap.

For more information: https://www.coreimpodcast.com/2017/10/13/introducing-the-core-im-podcasts-5-pearls-mind-the-gap/

Sincerely,

CORE IM team:

Executive Producer: Shreya P. Trivedi, MD (@ShreyaTrivediMD)

Five Pearls Producer: Marty Fried, MD (@Marty_Fried)

Mind the Gap Producer: Steve Liu, MD

Advisors: Neil Shapiro MD, John Hwang MD, Vincent Santillo MD

Podcast editing and technical set-up: Harit Shah and Steven Liu MD

Director of Sound Design, Theme song: Shaun Finnegan

Artistic director: Dr. Mike Natter (@mike_natter)

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