Core IM | Internal Medicine Podcast (Core IM Team)

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

YouTube Videos

1. Anion Gap Metabolic Acidosis: https://youtu.be/oE0lygmMANM
2. Inhaler Delivery Systems: https://youtu.be/yYPdjClm9Bg
3. Iron Deficiency in Pregnancy https://youtu.be/xTzYSXUbLsc

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

01:27 | Anion Gap Metabolic Acidosis (Dr. Nick Villano)

02:52 | Inhaler Delivery Systems (Dr. Allie Sheridan)

04:44 | IDA in Pregnancy (Dr. Michael Auerbach)

Tags:IMCore, Medical Education, IDA, hospitalist medicine, hospitalist, primary care, nurse practitioner, chalktalks, hematology, asthma, COPD, pregnancy care, Medical Podcast, Clinical Teaching

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

Sponsor: At Panacea Financial, you don't need co-signers for personal loans and have reduced payments during training!

Behind the Scenes YouTube Interview

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:56) | How do immune checkpoint inhibitors work?

(07:15) | How do you organize the different immune-related adverse events (irAEs)?

(13:42) | Generally, when do different adverse events can present?

(22:20) | What makes someone more likely to develop an adverse effect?

(26:38) | What role does complementary & alternative medicine play in this patient population?

Tags: Side effects, oncology, cancer, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, pharmacology

Should your patients be reaching for albuterol when their asthma flares up? Some of us may have been treating asthma exacerbations incorrectly for many years… What is the right approach? Tune in to the fifth episode of Beyond Journal Club, a new series brought to you by Core IM in collaboration with NEJM Group, to learn about the latest asthma management trials and guidelines, and how to translate them into better patient care.

Show Notes & Transcript

Timestamps:

(01:47) | Evolving story of asthma management

(03:26) | Pathophysiology of asthma management

(06:01) | Key players & terms

(08:56) | Story of asthma through the decades

(17:55) | MANDALA Trial

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

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

Behind the Scenes YouTube Interview

Whiteboard Animation video

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

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?

• Use promo code COREIM for 1 month of free access to Glass Pro at https://glass.health/coreim 
• Use this link for CME-MOC credit with ACP
• 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

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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Behind The Scenes YouTube Interviews

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:59) | What causes HFpEF?

(11:22) | Does diastolic dysfunction imply HFpEF?

(19:21) | Is the BNP level helpful in HFpEF?

(25:06) | What scoring systems can be helpful in ruling in HFpEF?

(32:03) | What's the treatment for HFpEF?

Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, heart failure with preserved ejection fraction

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?

Sponsors: Post Investment: Real Estate Syndications || Hellofresh  

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

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

Incidental fibrosis on CT —what now? What does prone imaging tell you? Is it fibrosis, aspiration, or atelectasis? And once you diagnose ILD, does the “alphabet soup” really matter for treatment? Antifibrotics vs. immunosuppression?

Plus, how do we bridge the gap when social barriers make care unsafe?

🔹 This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

Transcript and Show Notes

Timestamps:

(01:26) | Deep Dive 1

(06:38) | Deep Dive 2

(12:37) | Deep Dive 3

(21:13) | Deep Dive 4

(28:06) | Deep Dive 5

Tags: CoreIM, Internal Medicine, Pulmonology, Clinical Pearls, Medical Education, IMCore, Radiology, Hospitalist, Physician Assistant, Nurse Practitioner, Medical Student, interstitial lung disease

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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Pranay's Free Masterclass (Sept 20 and 27th at 5pm PST)

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

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?

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

Use this link for CME-MOC credit with ACP

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

How do you differentiate immune checkpoint inhibitor-related adverse events aka IrAEs from other conditions like infection? Join as we go through pneumonitis, colitis, dermatitis and endocrinopathies due to immune checkpoint inhibitor toxicity!

Transcript and Show Notes

ICIs & IrAEs 101 Episode

Behind The Scenes video

Sponsor:

• Interested in integrating Glass AI into your EMR? Reach out to enterprise@glass.health.
• Use code "COREIM" for one month free access of AI queries through Glass Pro.

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Get CME-MOC credit with ACP!

Timestamps:

(03:14) | Pearl 1

(13:34) | Pearl 2

(24:42) | Pearl 3

(30:34) | Pearl 4

(35:21) | Pearl 5

Tags: CoreIM, Internal Medicine, ClinicalPearls, Skin Toxicity, Medical Education, IMCore, oncology, hospitalist, physician assistant, nurse practitioner, medical student

What is the impact of microplastics on human health? How can we use observational data to support the argument that microplastics may lead to poor health outcomes?

Join us as we tackle these questions and discuss the APAChE study on microplastics and cardiovascular disease on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

🔹 Transcript and Show Notes

🔹 Behind The Scenes YouTube Video

This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

Timestamps:

(02:24) | Introduction to Plastic's Key Players

(07:59) | Bradhill/Observational Work

(10:33) | APAChE Study Deep Dive

(18:03) | Discussion

📢 Special Thanks:

🎙️ Audio Editing: Jerome Reyes

📊 Graphics: Dr. Jimin Hwang

Tags:

CoreIM, Environmental Health, Medical Education, IMCore, Public Health, Clinical Pearls, Physician, Medical Student, Nurse Practitioner, Epidemiology

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!

Behind the Scenes YouTube Interview

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

A new way to think of clots beyond provoked vs. unprovoked: Learn all about how important it is to think about reversibility! What patient states affect the inherited thrombophilia testing? Learn the nuances and practical approaches!

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Use the code CORE50 to get 50% off your first month with Freed

🔹 This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

Transcript and Show Notes

Timestamps:

(02:07) | Pearl 1: Reframing Provoked vs. Unprovoked to Reversibility

(09:12) | Pearl 2: How can Virchow's Triad help us categorize the etiology of a clot?

(17:01) | Pearl 3: What factors affect anti-thrombin III, Protein C and Protein S deficiency

(28:50) | Pearl 4: Is the Factor V Leiden or Prothrombin Gene Mutation as important as the family history?

(38:41) | Pearl 5: Spaced Repetition of Learning Points

Tags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematology

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!

Sponsor: Post Investment: Real Estate Syndications 

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

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?

Behind The Scenes YouTube Interview

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

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.

Sponsor: Pathway FREE evidence-based clinical decision support app. Guideline summaries, interactive algorithms, landmark trials & more

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

Why are we missing peripheral arterial disease (PAD)? How is it diagnosed using the Ankle-Brachial Index (ABI)? What treatments improve symptoms and reduce cardiovascular risks? When should revascularization be considered?

Transcript and Show notes

Behind The Scenes YouTube Interview

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:23) | PEARL 1: When to suspect PAD? Risk factors?

(07:34) | PEARL 2: How to work up PAD?

(16:26) | PEARL 3: Improving symptoms and quality of life 

(25:38) | PEARL 4: Approach to therapy: Preventing CV mortality 

(33:53) | PEARL 5: Deeper Dive into Antithrombotic Therapy and Anticoagulation 

(39:09) | PEARL 6: Who needs revascularization? 

Tags: CoreIM, PAD, Peripheral Arterial Disease, ABI, claudication, vascular medicine, revascularization, internal medicine, smoking cessation, lipid management, primary care, physician assistant, nurse practitioner, cilostazol. supervised exercise therapy

Does colonoscopy prevent colon cancer, and does it save lives? There has never been a randomized controlled trial on screening colonoscopies before NordICC trial, even though it is a guideline based recommendation for everyone over 45! How did this come to be? What do we tell our patients who are on the fence about undergoing screening colonoscopy? To find out, tune into the sixth 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

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamp:

(00:00) | Introduction

(02:28) |Pathophysiology of Colorectal Cancer & Why Screening Makes Sense

(06:15) | General Cancer Screening – Observational Studies

(09:17) | General Cancer Screening – Randomized Controlled Trials

(14:40) | NordICC Trial

(22:36) | Implications for Patient Care

Tags: IMCore, CoreIM, primary care, gastroenterology, nurse practitioner, pharmacist, physician assistant, sigmoidoscopy, per protocol analysis and intention to treat analysis

Can the MINT trial change how we treat anemia in acute MI? The largest trial of its kind compared liberal vs. restrictive transfusion strategies in patients with myocardial infarction.

Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! 

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Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:29) | History of Transfusion Guidelines/Studies

(06:49) | Pathophysiology of Anemia in heart disease

(10:04) | Transfusion in MI Studies

(13:45) | MINT Trial

(22:20) | Takeaways/Discussion

Tags: Tags: CoreIM, IMCore, cardiology, internal medicine, myocardial infarction, anemia, transfusion, physician assistant, nurse practitioner, pharmacist, clinical trials, MINT trial, transfusion strategies, restrictive vs. liberal transfusion, heart attack

Listen to 3 cardiorenal cases that highlight that “without flow it really doesn't matter what you're doing with the diuretic!”

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Transcript and Show notes

Cardiorenal Considerations: 5 Pearls Segment

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:53) | Case 1: Diuretic Resistance from Ascites and Intra-abdominal Hypertension

(09:57) | Case 2: Diuretic Resistance from Low Cardiac Output

(26:34) | Case 3: Diuretic Resistance from Inadequate Renal Perfusion Pressure

Tags: IMCore, CoreIM, Diuretics, Cardiorenal, Medical Education, nephrology, cardiology, CCU, ICU, critical care

Dive into 4 microskills from the book “Microskills: Small Actions, Big Impact” that offer tangible tools for navigating the professional world with grace and intention.

Book by Dr. Adaira Landry, Dr. Resa E. Lewiss:

MicroSkills: Small Actions, Big Impact

Show notes & Transcript

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

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

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

Strategies to address moral distress and moral injury — hear from the experts on their work on the topic!

Transcript and Show notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:07) | Strategies for Addressing Moral Distress

(09:25) | Strategies for Address Moral Injury

(20:52) | Conclusion

Tags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, Medical Humanities, medical ethics

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?

• Visit www.medmastery.com/coreim for 15% off Medmastery Pro subscription. Discount code: “COREIM15”
• Use this link for CME-MOC credit with ACP
• 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

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?

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

Behind The Scenes video on YouTube

Show notes & Transcript

Subscribe to our new Youtube Channel !

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

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

Sponsor: Freed is an AI scribe that listens, prepares your notes, and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! 

Use the code CORE50 to get 50% off your first month with Freed

Behind The Scenes YouTube Videos

Transcript and Show Notes

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

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

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?

Behind the Scenes YouTube Interview

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

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

What does Lipoprotein(a) tell us that a standard lipid panel doesn’t? Should we be testing everyone for it? Dive into the genetics, clinical implications, and evolving management strategies for Lp(a). Learn how to interpret results, counsel patients, and navigate topics with limited data like aspirin and PCSK9 inhibitors in treatment.

🔹 Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! 

Use the code CORE50 to get 50% off your first month with Freed

🔹 Transcript and Show Notes

Timestamps:

(02:17) | Pearl 1: What makes Lp(a) unique? How does it raise ASCVD risk?

(10:32) | Pearl 2: Who should be tested for Lp(a)? When and why?

(16:54) | Pearl 3: Understanding and interpreting Lp(a) levels

(24:04) | Pearl 4: How does an elevated Lp(a) affect management?

(37:05)| Pearl 5: The role of aspirin and PCSK9 inhibitors in Lp(a)

Tags: CoreIM, Internal Medicine, Primary Care, Preventive Cardiology, Atherosclerosis, Lipid Management, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student

How is TPN and PPN similar and how is it different? When should each be used? How does bacterial overgrowth lead to complications? Does TPN cause diarrhea?

Transcript and Show notes

Behind the Scenes Youtube Interview

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(01:35) | PEARL 1: Basics of PN: What makes up parenteral nutrition?

(06:54) | PEARL 2: Indications and Contraindications for TPN and PPN: When should I order parenteral nutrition?

(13:40) | PEARL 3: Complications of parenteral nutrition: What are the common adverse effects of parenteral nutrition?

(19:41) | PEARL 4: Parenteral nutrition myths: What should patients know before they start TPN?

(23:56) | PEARL 5: Recap on Tube Feeds: How do we determine the amount of free water to give out patients on tube feeds?

Tags: IMCore, CoreIM, parenteral nutrition, TPN, PPN, clinical nutrition, nutritional support, complications, patient safety, gastrointestinal disorders, critical care, internal medicine, fluid management, ICU, Crit Care, GI, gastroenterology

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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Behind The Scenes YouTube Interview

Show Notes & Transcript

Timestamps:

(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

SPEP vs. UPEP? What does it tell you and not tell you? What is the role for immunofixation and free light chains in diagnosis? Learn about paraneoplastic antibodies with MGCS and its renal, neurologic, and dermatologic manifestations!

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🔹 This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

Behind The Scenes Youtube Interview with Dr. Vincent Rajkumar

Transcript and Show Notes

Timestamps:

(01:26) | Pearl 1: What is a monoclonal gammopathy? What is our expected clinical presentation?

(10:12) | Pearl 2: What is our initial workup? Understanding SPEP, Immunofixation, and Free Light Chains

(24:13) | Pearl 3: Do we need urine testing? When urine testing is necessary and when it is not.

(26:26) | Pearl 4: How should we differentiate monoclonal gammopathies? The continuum of MGUS, SMM, and MM.

(41:35) | Pearl 5: Demystifying Monoclonal gammopathy of clinical significance (MGCS)

Tags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine

What is moral residue vs. moral injury vs moral distress? How do these concepts impact us as clinicians?

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Transcript and Show notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(04:59) | Definitions

(06:50) | Moral Distress

(09:01) | Moral Residue

(09:01) | Moral Residue

(11:34) | Moral Injury

(13:32) | Causes of Moral Distress and Moral Injury

(18:18) | Consequences

Tags: IMCore, CorelM, Burnout, Moral Distress, Moral Injury, Moral Residue, medical humanities, humanism

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

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

Timestamps:

(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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Behind the Scenes Youtube Interview

Show notes & Transcript

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(03:04) | What is the philosophy of hospice?

(06:13) | Who qualifies for hospice?

(08:17) | Who makes up the hospice team?

(17:24) | Who pays for hospice?

(21:31) | What are the different levels of care?

(31:57) | What are some limitations of the hospice medicare benefit?

Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant

What are the benefits of early rhythm control versus rate control alone? When is electrical cardioversion used and what information can it tell us? What side effects for amiodarone, dofetilide, and sotalol, propafenone and flecainide? When should catheter ablation be considered in patients with atrial fibrillation?

Behind the Scenes YouTube Interview

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Time stamps:

(02:05) | Pearl 1 - Rhythm control

(11:23) | Pearl 2 - Electrical cardioversion

(17:53) | Pearl 3 - Class III antiarrhythmics and side effects

(26:31) | Pearl 4 - Class Ic antiarrhythmics and side effects

(31:55) | Pearl 5 - Catheter ablation

Tags: cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, nursing education, atrial fibrillation

Signouts! How can we do them better? Hear these memorable stories & ask yourself these FIVE questions when getting your handoff ready for the covering team.

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Show notes & transcripts

Behind the Scenes YouTube Interview

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:44) | What makes this patient different from others with similar symptoms or diagnosis?

(07:28) | Does your covering team have the tools to follow up on tasks and information they need for success? 

(16:06) | Is the handoff updated? 

(18:26) | What information about goals of care and prognosis should be communicated to the night team, especially for critically ill patients? 

(22:41) | What are we still uncertain about? 

(25:30) | Closing thoughts 

Tags: IMCore, CoreIM, Contingency Planning, Handoffs, Medical Education, Nocturnists. Signouts, hospitalist

What’s the evidence been for the use of PPIs in mechanically ventilated patients? What do more recent studies reveal about PPIs and possible harmful side effects of aspiration pneumonia and C. difficile colitis? To find out, tune into the second season of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

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Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:13) | Define the problem / Clinically important bleeding Outcome/Risk benefit /Risk factors]

(05:58) | Hx and H2 antagonists

(10:42) | SUP-ICU

(15:12) | PEPTIC

(19:30) | REVISE trial

(27:28) | Deprescribing

(29:06) | Outstanding questions

Transcript and Show Notes

Tags: CoreIM, InternalMedicine, CriticalCare, Proton Pump Inhibitors, GIbleeding, ICU, ICU bleeding, Clinical Trials, Evidence Based Medicine, Patient Centered Outcomes, Deprescribing

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Get CME-MOC credit with ACP!

Transcript and Show Notes

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(02:05) | Urinalysis in a patient with AKI from purely cardiorenal syndrome?

(08:47) | What is bioavailability, duration of action, and outcomes with furosemide, torsemide, and bumetanide?

(18:08) | How can spot urine sodium measurements be used to assess diuretic response?

(27:35) | What are the differences between thiazides (PO Metolazone vs. IV Chlorothiazide) and acetazolamide augment diuresis?

(35:08) | Spaced Repetition: RAAS inhibitors or SGLT2 inhibitors as GMDT in CKD?

Tags: nephrology, cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, diuretic resistance

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

Limitations to urine drug screening (UDS) in primary care? What are common false positives and false negatives with the urine drug screen test?

Transcript and Show notes

Behind The Scenes YouTube Interviews

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

(03:01) | PEARL 1: Basics to Urine Drug Screen (UDS)

(08:03) | PEARL 2: Types of urine drug tests, and what are immunoassays (IA)?

(18:44) | PEARL 3: What are gas chromatography/mass spectrometry (GC/MS)-based tests?

(26:51) | PEARL 4: How do you address unexpected test results on a UDS?

(30:29) | PEARL 5: Throwback to “5 Pearls on Stigma in Opioid Use Disorder” episode

Tags: IMCore, CoreIM, primary care, urine drug screening, opioid use disorder, substance use, harm reduction, addiction medicine, clinical toxicology, patient safety, compassionate care

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

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

Uncover many blind spots on tube feeds!

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Behind the Scenes Youtube Interviews: 

• Short-term enteral access
• Durable enteral access
• What is venting aka decompression?

Show Notes & Transcript

Timestamps:

(02:21) | Indications for tube feeds

(09:36) | Routes of enteral access

(19:20) | Components of tube feeds

(27:03) | 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

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

Listen to the original July Stories: https://bit.ly/3Y4n8jG

Behind The Scenes videos on YouTube

Subscribe to our new Youtube Channel !

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

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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Behind the Scenes YouTube Interview

Transcript and Show Notes

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

What is the last sense to go? How can music create connection, ease anxiety, and help process emotions at the end of life? Join Dr. Jafar Al-Mondhiry, Dr. Harry Han, and music therapist Bryanna Tobin as they explore the power of music therapy in hospice care, sharing moving stories and clinical insights.

🔹 This episode is also sponsored by Factor! Get fresh, ready-made meals delivered to your door. Use the code factorpodcast for a special discount at factor75.com.

🔹 Transcript and Show Notes

Timestamps:

(00: 39) | 1st: What is Music Therapy in Hospice?

(07:59) | 2nd: A Powerful Story

(14:19) | 3rd: Challenges in the Field of Music Therapy

Tags:  IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant

What if a patient can't afford hospice? Which medications do you deprescribe when on hospice? What happens when patients who are on hospice return to the hospital or ED?

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Behind the Scenes Youtube Interview

Show notes & Transcript

Hospice 101 Episode 1

Subscribe to Core IM’s YouTube Channel for more behind the scenes, whiteboard animations and more!

Timestamps:

A hospitalized patient elects to enroll in hospice, now what?

What treatments are typically covered  by hospice?

What medications to continue and discontinue?

Code status in hospice

Approaching the hospice patient coming back to the hospital

Hospice enrollment and re-enrollment is voluntary.

Tags: IMCore, CoreIM, primary care, palliative care, end-of-life, oncology nurse practitioner, pharmacist, physician assistant

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?

Whiteboard animation video on YouTube

Show notes, Transcript and References

Get CME-MOC credit with ACP

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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

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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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

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

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

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/

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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

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

1. What do guidelines say about diagnostic paracentesis in cirrhotics with ascites? (1:51)
2. 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?

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

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)

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

1. What are the indications for imaging for HA? (1:36)
2. What is your approach to abortive therapy for migraines? (4:45)
3. How do you diagnose medication overuse HA? (6:41)
4. What is your approach to migraine prophylaxis? (8:29)
5. What are some evidence based nonpharmacological therapies for migraines? (10:42)

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

1. Should patients be screened for iron deficiency? If so, who and how often? (1:40)
2. What are the indications for diagnostic endoscopy in iron deficient patients? (3:23)
3. How should you advice patients to take oral iron? (5:53)

• What is optimal dosing for oral iron?

1. In which patients would you consider IV iron? What are the risks? (11:41)
2. 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/

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/

1. Cement your knowledge on Hepatic Encephalopathy (HE)! Quiz yourself on the following 5 Pearls we’ll be covering on HE: Time StampsWhat are other causes of altered mental status in cirrhotics? (1:45)

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

1. What is asterixis? (6:10)

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

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

• What are their indications?

1. What is the connection between hypokalemia and HE? (14:10)
2. 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/

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/

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

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

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

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

• In which populations is HBV vaccination recommended?

1. What are the four possible meanings of an isolated positive total anti-HBc? (13:55)
2. In an asymptomatic adult, is it necessary to send an anti-HBc IgM to distinguish acute from chronic HBV infection? (15:01)
3. 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/

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

1. What is the focused history, physical and lab workup in a patient with chronic HBV? (1:40)
2. 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?

1. What factors do you use to assess which patients get treatment? (7:41)
2. What drugs are available for HBV treatment and how do you choose? (11:18)
3. 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/

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

Time Stamps:

1. How did prior understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25)
2. How is COPD diagnosed? (6:13)
3. 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/

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

1. How good is a dipstick, urinalysis and UACR in detecting albuminuria? (1:42)
2. What conditions that lead to transient proteinuria? What is the appropriate interval to recheck and how should be it be repeated? (5:14)
3. Who should be screened for albuminuria and can it prognosticate risk for cardiovascular mortality? (7:47)
4. Does increasing RAAS inhibition improve renal outcomes? (10:57)
5. 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/

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

1. Who should be screened for latent tuberculosis infection (LTBI)? (1:45)
2. What screening tests are available and how do they differ? (6:30)
3. What are the LTBI treatment options available? (10:24)
4. What are the major adverse drug effects to consider? (13:28)
5. How frequently should you check liver function tests in a patient being treated for LTBI? What do you do with the results? 17:43
6. Dr. Caplan-Shaw Recap (21:29)

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

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

1. What are signs and symptoms of chronic adrenal insufficiency (AI)? What is the most sensitive? (2:02)
2. How do we diagnose and differentiate types of adrenal insufficiency? (6:05)
3. How sensitive and specific are the diagnostic tests for AI & at what cutoffs? (12:06)
4. Can we both test and treat adrenal insufficiency at the same time? (16:40)
5. Throwback: How do hypokalemia and hepatic encephalopathy connected? (24:55)
6. Dr. Nidhi Agrawal Recap (19:20)

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

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

1. Part 1 Case (2:05)
2. Framing bias (7:07)
3. Data-driving reasoning (11:48)
4. Hypothesis-driven approach (12:38)
5. Periodic paralysis syndromes (16:08)
6. Representativeness heuristic (17:26)
7. Part 2 Case (20:51)
8. Pivot Points (31:36)
9. Diagnosis (35:55)
10. Take aways (37:20)

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

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

1. Are there diagnostic criteria for CIN? (2:11)
2. Is there a difference between exposure to intra-arterial vs. intra-venous contrast in terms of risk of CIN? (6:28)
3. What are the biggest risk factors for CIN? (14:48)
4. What preventive measures have been shown to best reduce the risk of CIN? (19:41)
5. Can ESRD patients on hemodialysis still suffer from CIN? (23:32)
6. Recap (25:49)

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

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

Time Stamps

1. How does GOLD (Global Initiative for Chronic Obstructive Lung Disease) define a COPD exacerbation? (2:44)
2. What outcomes do steroids actually improve in treating a COPD exacerbation? (5:08)
3. What is the evidence behind a 5 day steroid “burst”? (7:20)
4. 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/

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/

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

1. Part one of case (0:56)
2. Cognitive ease and strain (03:51)
3. Metacognition and routine diagnostic timeout (08:15)
4. Think outside the box of organ systems (11:19)
5. Illness behavior (12:30)
6. Part two of case (14:06)
7. Algorithms (17:57)
8. Fast thinking & pattern recognition (19:30)
9. Slow thinking & analytical reasoning (21:31)
10. Diagnosis (25:15)
11. Takeaways (26:52)
12. For full show notes: https://www.coreimpodcast.com/2018/06/27/hoofbeats-54m-with-diarrhea/

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

1. What is alcohol use disorder (AUD), and how is it different from unhealthy alcohol use?
2. Who should we screen for unhealthy alcohol use, and which screening tools are preferred?
3. What are the consequences of unhealthy alcohol use?
4. Can moderate alcohol be good for patients, and if so, how much is “moderate”?
5. 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/

Lets go deeper into the misunderstood side of Vancomycin!

1. Where did vancomycin come from, and why is it so controversial? (0:28)
2. What is vancomycin-induced nephrotoxicity and how common is it? (4:37)
3. Vancomycin trough monitoring – what is it good for? (7:28)
4. AUC to MIC ratio – the real math behind vancomycin dosing (7:53)
5. Review of teaching points (10:27)

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

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

1. Case history and exam 00:40
2. Causal models 11:24
3. Facets versus diagnoses 13:25
4. Problem representation 16:37
5. Part two of the case 17:10
6. Occam’s razor, Hickam’s dictum, and Crabtree’s bludgeon 23:00
7. Diagnostic uncertainty 27:10
8. Learning points 34:24

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

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

1. What are associated adverse effects for patients are on long-term PPIs? (2:02)
2. What are strategies to get your patient off PPIs? (10:57)
3. 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)
4. How should you educate patients to take PPIs to get the maximize benefit? (16:48)
5. 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/

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

1. The basics – what are the official (IDSA) definitions for bacteriuria, pyuria, and UTI? (02:07)
2. The lay of the land – how common are bacteriuria and delirium? (07:09)
3. The big money question – do UTIs really cause delirium and what does the evidence tell us? (10:50)
4. Review of teaching points (15:59)

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

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/

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:

1. A new challenge and the rules of the game (1:13)
2. Introduction to Human Dx (3:06)
3. The case: An 85 year-old woman with paranoid delusions (5:28)
4. What exactly is problem representation? (15:15)
5. Building the differential (19:53)
6. For full show notes: https://www.coreimpodcast.com/2018/10/10/hoofbeats-85f-with-acute-ams/

Dissect a working diagnosis through a process of validation!

Time Stamps:

1. Your collective differential [0:40]
2. The test results (that you asked for) are in... [2:13]
3. The hospital course, and the diagnosis (or is it?) [7:10]
4. Validating a diagnosis: Base rate, adequacy, and coherence [8:30]
5. Revisiting the differential [14:44]
6. 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

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

1. Throwback: At what levels of drinking does unhealthy alcohol use start, and how do you screen for unhealthy alcohol use? (1:47)
2. What does the brief intervention and counseling part of SBIRT entail? (4:43)
3. What are the first line medications for AUD and contraindications to them? (11:11)
4. What are the second-line medications for AUD and their limitations? (18:14)
5. What new therapies are being studied for for alcohol use disorder? (22:09)
6. 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

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

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

Time stamps:

1. Case [1:19]
2. Diagnostic weight [8:42]
3. Hypothesis driven reasoning [12:26]
4. Anomalous clinical data [19:30]
5. Final diagnosis [22:20]
6. 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/

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

Time Stamps:

1. What data is there to support the use of acetaminophen as a fever reducer? (2:08)
2. Does acetaminophen improve patient outcomes? (4:30)
3. How does acetaminophen compare to other medications like NSAIDs? (9:56)
4. What is the mechanism of acetaminophen action? (10:50)
5. 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/

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

1. What aspects of the history are concerning in a patient with a positive troponin? (4:00)
2. 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)
3. 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)
4. What can a “negative but detectable” troponin tell you about any patient, not just those with suspected ACS? (21:31)
5. Pearls Recap (25:26)
6. 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

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/

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

1. What is Barrett’s esophagus and why should we care? (4:12)
2. Who do we screen for Barrett’s, and why? (8:41)
3. How do we screen for Barrett’s and counsel? (13:50)
4. How do we treat and monitor Barrett’s esophagus? (18:21)
5. Take Aways (21:45)
6. 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/

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/

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/

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/

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/

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

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

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