The Curbsiders Internal Medicine Podcast

Practice solving diagnostic puzzles with The Curbsiders and Internist / Diagnostician, Reza Manesh MD, Assistant Program Director for Clinical Reasoning of the Osler Medical Training Program at Johns Hopkins! Solve along with us at these links: Case 1 http://hdx.org/I2B and Case 2 http://hdx.org/uM2. Topics include: clinical reasoning terminology, how to use cases to practice diagnostic reasoning, how to build a diagnostic schema, and how to conduct your own cognitive autopsy. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Hannah Abrams Hosts: Hannah Abrams, Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Reza Manesh MD Special thanks to: Doctors Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing cases Time Stamps 00:00 Disclaimer, intro and guest bio 04:02 Guest one liner, book recommendation, favorite failure, advice for learners 11:27 Human Dx Project and Global Morning Report 15:35 Diagnostic terminology 21:25 Case #1, Reza solves 33:40 Diagnostic autopsy and teaching points for case #1 38:00 Case #2, The Curbsiders solve 57:30 Diagnostic autopsy and teaching points for case #2 61:33 Take home points and a plug 64:30 Outro

19 Nov 20181h 6min

Check out this audio treasure map to find the hidden curriculum and learn how it can change your practice. Learn how positive teaching spans not just the classroom or bedside but, how we simply talk about patients. Sanjay Desai MD, coauthor of ACP’s Position Paper on Hidden Curriculum and Internal Medicine program director at Johns Hopkins guides us through several cases that illustrate how our institutional norms can shape the practice of medicine...for better or worse. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Sanjay Desai MD; Justin Berk MD, MPH, MBA; Matthew Watto MD CME questions by: Justin Berk MD Editors: Chris Chiu MD & Matthew Watto MD Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD Guest: Sanjay Desai MD Time Stamps 00:00 Disclaimer, Intro and guest bio 04:00 Guest one liner, book recommendations, career advice 10:50 Intro to the hidden curriculum and ACP’s three recommendations 22:00 Case #1: A patient with schizophrenia 32:10 Case #2: The iPatient 38:07 Case #3: Attending forgets to wash their hands 41:10 Case #4: A dying patient’s primary care doctor saves the day 46:26 Case #5: A case of violating duty hours 60:10 Take home points 62:00 Outro

15 Nov 20181h 2min

Shoulder pain made simple. Develop your confidence and skills with tips from sports medicine specialist Dr. Carlin Senter MD. We discuss her simplified approach to the basic shoulder exam, including when and how to do special tests, high yield exam maneuvers, when to refer shoulder pain patients to orthopedic surgery, and who can be managed conservatively. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Molly Heublein MD and Nora Taranto MS4 Editor: Matthew Watto MD Hosts: Molly Heublein, MD, Paul Williams MD, Matthew Watto MD Guest: Carlin Senter, MD Time Stamps 00:00 Disclaimer, intro, and guest bio 03:15 Guest one liner, book recommendation, career advice, and some picks of the week 13:20 Clinical case of shoulder pain; helpful historical features 18:54 Differentiating referred pain from c-spine pathology from shoulder pathology 21:00 A framework for shoulder pain, HIP-ROT, and using ROM to generate a differential 27:40 Frozen shoulder aka adhesive capsulitis 31:57 Glenohumeral joint arthritis 33:52 Rotator cuff disease 40:53 Specific testing for rotator cuff tears 51:45 Impingement syndrome versus bursitis 56:25 Counseling patient with shoulder pain or injury 59:03 Steroid injections, topical therapy, and AC joint arthritis 65:18 When to refer to surgery and some take home points

12 Nov 20181h 11min

The sleep apnea episode that won’t put you to sleep. Become a sleep apnea guru with incredible insights from Barbara Phillips MD, MSPH, FCCP an expert in pulmonary medicine, critical care and sleep medicine who is also a past president of CHEST! We discuss high-yield topics in the world of obstructive sleep apnea including: home sleep studies vs in-lab polysomnography, the importance of oxygen saturation (the T90 and ODI) when interpreting sleep study results, tricks to improve CPAP adherence, and alternatives therapies for obstructive sleep apnea. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Cyrus Askin MD CME questions by: Cyrus Askin MD Editor: Chris Chiu MD & Matthew Watto MD Hosts: Cyrus Askin MD & Matthew Watto MD Guest: Barbara Phillips, MD Cover-Art & Infographic - Beth Garbitelli, MS1 Time Stamps 00:00 Disclaimer, intro, guest bio 03:00 Guest one liner, book recommendation, advice for trainees 08:10 Clinical case of sleep apnea, some basic stats, and key predictors of sleep apnea 12:38 Barriers to diagnosis and treatment of OSA 15:23 Discussion of T90, hypoxemia and sleep fragmentation 17:05 How to read a sleep study report 21:55 Home sleep apnea testing 24:15 What are the consequences of sleep apnea 28:30 What is the efficacy of cpap for lowering blood pressure and mortality 31:45 Counseling a patient who is new to cpap 33:45 Choice of mask 40:10 Do alternatives to cpap work? e.g. surgery, mandibular advancement devices 44:17 Modafinil and z-drugs 47:15 Driver’s license issues in sleep apnea 48:35 Future of sleep medicine and take home points

5 Nov 201852min

We delve into advanced management of headaches, including novel therapies, migraines with aura, migraines in complicated patients, and headaches of short duration with Dr. Rebecca Burch, a headache medicine specialist at the John R. Graham Headache Center at Brigham and Women’s Hospital. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Paul Williams MD Edited by: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Rebecca Burch MD Time Stamps 00:00 Disclaimer, intro and guest bio 03:28 Guest one-liner, movie and podcast recommendations, favorite failure and picks of the week from The Curbsiders 10:38 Clinical case of migraines; diagnosis and classification 14:12 Does medication overuse headache exist? 16:16 Chronic daily headache; Conversion from episodic to chronic and vice versa 21:43 Approaches to medication overuse headache 25:54 Case 2: migraine with aura and other types of migraine (retinal, hemiplegic, etc.) 32:09 Pathophysiology of migraine; how triptans work; How should aura effect management? 38:44 Migraine cocktails 41:15 Comorbid mood disorders; Use of psych meds and triptans 45:08 Migraines and oral contraceptives 48:42 Botulinum toxin and new CGRP therapies 53:36 What does success look like in migraine therapy? 55:32 Nonpharmacologic management 60:45 Case 3: headaches of short duration 66:36 Headache red flags; Imaging for headaches; pathophysiology of high and low pressure headaches 72:00 Idiopathic intracranial hypertension 75:25 Take home points 77:00 Outro

29 Okt 20181h 18min

HIV care for the internist with author and HIV expert, Michael Saag MD, Professor of Infectious Diseases at University of Alabama and founder of the 1917 Clinic. We discuss the specifics of screening & diagnostic testing in HIV, monitoring CD4 counts and viral loads, first line antiretroviral therapy, harm reduction, and how to provide excellent HIV care in your primary care clinic. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written & Produced by: Elena Gibson MS4, Justin Berk MD MBA MPH Artwork by: Elena Gibson MS4 Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MBA MPH Editor: Matthew Watto MD Guest: Michael Saag MD Time Stamps 00:00 Disclaimer, intro, and guest bio 04:35 Getting to know our guest, a movie recommendation, and words of wisdom 08:48 Clinical case, HIV screening, in-depth discussion of HIV testing & diagnosis 15:56 New diagnosis of HIV, counseling after diagnosis, confirmation, follow-up testing, the second visit 24:20 Treatment - what to start and when; some basic comments on therapy 30:05 Primary care after diagnosis, vaccines, cancer screening, cardiovascular disease prevention 34:35 Monitoring CD4 counts and viral load; interpreting CD4 count; time course of response for CD4 and viral load 42:02 Harm reduction counseling; addressing medication non-adherence 47:40 PCP prophylaxis 49:43 The 1917 Clinic, Ryan White Clinics, and linking patients to care 53:10 Take home points 55:40 Plugs 57:45 Will a cure or vaccine for HIV emerge? 59:16 Outro

22 Okt 20181h

Join us in this roundtable discussion of patients before paperwork, administrative burden, the new CMS payment model proposal, and a bit on health insurance with cohost, Fatima Syed MD MSc and guest, Deep Shah MD MSc. Doctors Syed and Shah are both early career physicians with masters degrees in comparative social policy from Oxford University and are active members of the American College of Physicians. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Fatima Syed MD MSc and Matthew Watto MD CME questions by: Matthew Watto MD Hosts: Fatima Syed MD MSc, Matthew Watto MD Guest: Deep Shah MD MSc Time Stamps 00:00 Disclaimer, intro, and guest bios 02:18 Guest one liners, book recommendations, picks of the week 11:00 Administrative burden 16:00 Will the documentation problem get better? Suggestions for improvement 25:11 Why do CMS rules spread to the private insurance sector? 29:30 What innovations might reduce administrative burden? 32:40 The Affordable Care Act, health insurance, price transparency 40:20 Take home points 43:20 Outro

19 Okt 201844min

Nutrition pearls from integrative cardiologist, Steven Devries MD, Associate Professor of Medicine, Northwestern Feinberg School of Medicine, Executive Director of The Gaples Institute. Clinicians receive little formal nutritional training in medical school and residency. It’s time to fill that gap! We discuss the strength of the literature supporting dietary interventions for cardiovascular health and review practical tips to help patients achieve healthy eating patterns. Patients need to hear from us that nutrition matters! Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written & Produced by: Molly Heublein MD Hosts: Matthew Watto MD, Paul Williams MD, Molly Heublein MD Guest: Stephen Devries MD Editor: Matthew Watto MD Special thanks to Elena Gibson MS4 for writing our show notes

15 Okt 201857min