Core IM | Internal Medicine Podcast

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.clinicalcorrelations.org/?p=21253 (https://www.clinicalcorrelations.org/?p=21253) tag: naltrexone, acamprosate, gabapentin, topiramate, SBIRT, neuromodulation, nalmafene, psychaedelics, audit-c

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: http://bit.ly/2Pll1qs (http://bit.ly/2Pll1qs) Tags: Clinical reasoning, Diagnostic Uncertainty

Submit your diagnosis or differential for this episode's case at HumanDx.org (free registration required): http://hdx.org/2VP (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)  

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!

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.clinicalcorrelations.org/?p=19463 (https://www.clinicalcorrelations.org/?p=19463)

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.clinicalcorrelations.org/?p=18833 (https://www.clinicalcorrelations.org/?p=18833)  

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.clinicalcorrelations.org/?p=18693 (https://www.clinicalcorrelations.org/?p=18693)

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.clinicalcorrelations.org/?p=18393 (https://www.clinicalcorrelations.org/?p=18393)

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.clinicalcorrelations.org/?p=18183 (https://www.clinicalcorrelations.org/?p=18183)

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)

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

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.clinicalcorrelations.org/?p=17823 (https://www.clinicalcorrelations.org/?p=17823)

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.clinicalcorrelations.org/?p=17613 (https://www.clinicalcorrelations.org/?p=17613)  

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.clinicalcorrelations.org/?p=17333 (https://www.clinicalcorrelations.org/?p=17333)

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.clinicalcorrelations.org/?p=16993 (https://www.clinicalcorrelations.org/?p=16993)