Core IM | Internal Medicine Podcast

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 ACPShow notes, Transcript and ReferencesTime stamps03:49 Episode start07:13 Dialysis vs. kidney transplant morbidity and mortality11:44 Eligibility for kidney transplant and when to refer21:34 Pre-transplant evaluation process25:38 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 kidneyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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-E10Show notes, Transcript and References: https://www.coreimpodcast.com/2023/03/08/trac/Time stamps2:56 Trach Components12:47 Trach Complication Management27:48 Airway Clearance34:53 Speaking Valve38:54 DecannulationTags: IM Core, CoreIM, pulmonary, critical care, ICU, nursing care, respiratory therapy, pharmacyAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 Hospital4:36 What is a Safety Net Hospital?11:11 The Origins and Paradox of the Safety Net HospitalLinks 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 Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 (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 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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/ (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 RecommendationsTags: IM Core, CoreIM, ATS, autonomy, justice, values, emotions, communication, medical humanities, ethics Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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  (https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im%C2%A0)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 5Tags: IM Core, CoreIM, Devices, cardiac, risk, perioperative, stroke, surgery, anticoagulation Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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/ (https://www.coreimpodcast.com/2022/12/15/reimagining-the-lipid-panel-mind-the-gap-segment/)Use the code “COREIM-AMBOSS” to get a free month of access on https://go.amboss.com/CoreIM-E8 (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 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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/Sponsor: Use the code “COREIM-AMBOSS (https://go.amboss.com/CoreIM-E5)” to get a free month of access on https://go.amboss.com/CoreIM-E7 (https://go.amboss.com/CoreIM-E7)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 ConclusionTags: IM Core, CoreIM, care, communication, goal setting, support, strategies , medical humanities Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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/ (https://www.coreimpodcast.com/2022/11/09/alcoholic-hepatitis-5-pearls-segment/)Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im  (https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im%C2%A0)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 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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?Sponsor: Use the code “COREIM-AMBOSS (https://go.amboss.com/CoreIM-E5)” to get a free month of access on https://go.amboss.com/CoreIM-E6 (https://go.amboss.com/CoreIM-E6)ACP CME: http://bit.ly/CIMCMEShow notes, Transcript and References:  https://www.coreimpodcast.com/2022/10/19/mind-the-gap-asp…imary-prevention/ (https://www.coreimpodcast.com/2022/10/19/mind-the-gap-aspirin-for-primary-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 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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/ (https://www.coreimpodcast.com/2022/10/05/ana-antinuclear-antibody-test-5-pearls-segment/)Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im (https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im)Sponsor: Visit www.medmastery.com/coreim (http://www.medmastery.com/coreim) for 15% off on all subscriptions. Discount code: “COREIM”Timestamps:* 01:37 (https://www.coreimpodcast.com/?p=25112#) Pearl 1* 03:54 (https://www.coreimpodcast.com/?p=25112#) Pearl 2* 13:53 (https://www.coreimpodcast.com/?p=25112#) Pearl 3* 18:07 (https://www.coreimpodcast.com/?p=25112#) Pearl 4* 29:30 (https://www.coreimpodcast.com/?p=25112#) Pearl 5Tags: IM Core, CoreIM, autoimmune, joint disease, titers, Raynaud's, lupus, Rheumatology Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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?Sponsor: Use the code “COREIM-AMBOSS (https://go.amboss.com/CoreIM-E5)” to get a free month of access on https://go.amboss.com/CoreIM-E5 (https://go.amboss.com/CoreIM-E5)Show notes, Transcript and References: https://www.coreimpodcast.com/2022/09/21/discharge-with-i…atters-segment-2/ (https://www.coreimpodcast.com/2022/09/21/discharge-with-incidental-findings-gray-matters-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 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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?Digital Education Conference 2022 in Oct 7 2022: https://cmecatalog.hms.harvard.edu/digital-education (https://cmecatalog.hms.harvard.edu/digital-education)Show notes, Transcript and References: https://www.coreimpodcast.com/2020/12/09/hoofbeats-strugg…inical-reasoning/ (https://www.coreimpodcast.com/2020/12/09/hoofbeats-struggles-with-clinical-reasoning/)ACP CME: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im (https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im) Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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/ (https://www.coreimpodcast.com/2022/08/24/upstander/) Time stamps* 00:59 Intro* 05:51Overview of Microaggressions* 09:11 Prevalence* 12:43 How to respond* 22:03 Barriers to appropriate response* 27:00 ConclusionTags: IM Core, CoreIM, bystander, race, microaggressions, hidden curriculum, DEI Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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/ (https://www.coreimpodcast.com/2022/08/03/hyponatremia-management-part-1-5-pearls-segment/)Sponsor: https://go.amboss.com/CoreIM-E4 (https://go.amboss.com/CoreIM-E4)Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im (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 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

Digital Education Conference 2022 in Oct 7 2022: https://cmecatalog.hms.harvard.edu/digital-education (https://cmecatalog.hms.harvard.edu/digital-education)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/ (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 (https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im)Amboss Article on Hyponatremia (http://go.amboss.com/hyponatremia)Tags: urine studies, SIADH, Core IM, IMCore, antidiuretic hormone, hospital medicine, family medicine, nephrology Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 (https://bit.ly/3P8wqG6)Sponsor: Visit www.medmastery.com/coreim (http://www.medmastery.com/coreim) for 15% off on all subscriptionsDiscount 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 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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/ (https://www.coreimpodcast.com/2022/06/22/5-pearls-on-copd-management/)Sponsor: Use the code “COREIM-AMBOSS (https://go.amboss.com/CoreIM-E3)” to get a free month of access on https://go.amboss.com/CoreIM-E3 (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: 34:10Tags: IMCore, CoreIM, Pulmonary, medication management, spirometry Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

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 (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 5Tags: IM Core, CoreIM, hematology oncology, health inequity, vaso-occlusive crisis Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy