The Clinical Problem Solvers

Episode description

Reza and Rabih tackle a case of abdominal pain. 

These additional episodes will be available on Patreon only. 

Why?

More about the RLR series here.

Episode description

Reza and Rabih have an important announcement about the RLR series.

More about the RLR series here.

Rabih and Reza tackle a clinical unknown at MUSC with host, Dr. Marc Heincelman.

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Dr. Marc Heincelman

Marc Heincelman is an assistant professor within the Department of Medicine at the Medical University of South Carolina, where he also serves as director of the Medicine Clerkship and Acting Internship.  He received his undergraduate degree from the University of Pittsburgh, medical degree from Loyola University of Chicago, and completed his combined internal medicine/pediatrics residency at the Medical University of South Carolina in 2014.  His passion for medical education stems from his mission to motivate and inspire learners to become the best physicians possible for their future patients.

Case Summary

A middle-aged woman with a history of treated breast cancer and unspecified uveitis presented with subacute fever, arthralgias, and headache. She was found to have elevated inflammatory markers, extensive lymphadenopathy, and a cholestatic pattern of liver injury with an unrevealing evaluation for infectious and autoimmune pathologies. She remained febrile despite broad-spectrum antibiotics. She was then started on empiric doxycycline, which resulted in prompt resolution of her fevers. A serologic test for Rickettsia rickettsii returned positive, confirming the diagnosis of “spotless” Rocky Mountain Spotted Fever.

Teaching Points:

• Rocky mountain spotted fever(RMSF) is an acute, life-threatening febrile illness caused by the intracellular pathogen,Rickettsia rickettsii. Endemic  to the southeastern and south central regions of the United States, it is transmitted by ticks (esp Dermacentor ). The classic triad of symptoms includes fever, headache, and rash (often beginning on the wrists and ankles, progressing from maculopapular to petechial). Roughly 10-12% of cases may present without rash (i.e., “spotless” RMSF), more commonly reported in elderly and/or African American patients. Given its high mortality rate, prompt initiation of empiric doxycycline is important for improving outcomes.

Episode description

Drs. Kimberly Manning and Gurpreet Dhaliwal discuss an unknown case as part of the 50th CPSolvers Virtual Morning Report.

Virtual Morning Report

Click here to learn more about joining VMR and learn together, live.

Dr. Kimberly Manning

Kimberly D. Manning, MD is a general internist/hospitalist who serves as Associate Vice Chair of Diversity, Equity, and Inclusion for the Department of Medicine at Emory University School of Medicine. Manning was recently promoted to Professor of Medicine and additionally serves as residency program director for the Transitional Year Residency Program at Emory. She has a strong commitment to supporting underrepresented minorities in medicine, serving underserved populations, and creating better understanding of our patients and each other through storytelling and narrative medicine. A huge fan of the CP Solvers, Dr Manning is as enthusiastic about being a teacher as she is being a lifelong learner. 

Dr. Gurpreet Dhaliwal

Dr. Dhaliwal is a clinician-educator and Professor of Medicine at the University of California, San Francisco. He is the site director of the internal medicine clerkship at the San Francisco VA Medical Center, where he teaches medical students and residents in the emergency department, urgent care clinic, inpatient wards, outpatient clinic, and morning report. His academic interests are the cognitive processes underlying diagnostic reasoning and clinical problem-solving and the study of diagnostic expertise. Dr. Dhaliwal enjoys playing pickup basketball with his two sons … even though both can handily defeat him

Case Summary

A 69-year-old man with a history of prior cerebrovascular accident (CVA) presented with acute onset right leg weakness and paresthesias. Laboratory analysis was notable for elevated inflammatory markers. A magnetic resonance image of the brain showed a ring-enhancing lesion in the left parietal lobe, with fine needle aspiration revealing gram positive cocci in chains. Cultures grew Streptococcus intermedius (a member of the S. anginosusgroup), and the patient was diagnosed with a bacterial brain abscess.

Teaching Points:

• Brain abscesses can be caused by bacteria, fungi, and parasites. Bacterial brain abscesses can arise via contiguous spread of bacteria from head and neck sources or by hematogenous routes. The causative organism often varies with the underlying immune status of the host. Among immunocompetent hosts, the most common organisms are Staphylococcusand Streptococcus spp (e.g., S anginosus). Neurosurgical sampling may be required to identify the pathogen and achieve source control.
• Lacunar infarctions are an important form of ischemic strokes (representing ~20%) caused by cerebral small vessel disease. Pathophysiologically, the most important risk factor is uncontrolled hypertension, which can lead to small vessel injury and subsequent occlusion. Most lacunar strokes involve the basal ganglia, pons, and subcortical white matter structures (e.g., internal capsule). While many clinical syndromes have been described, the 5 most common include pure motor, pure sensory, mixed sensorimotor, ataxic hemiparesis, and dysarthria-clumsy hand syndrome. 

Episode description

Reza and Rabih talk through a case

RLR #4 – Transient loss of consciousness 
A 43-year-old man with a history of epilepsy, coronary artery disease, and pulmonary sarcoidosis presented after experiencing an unheralded transient loss of consciousness. His initial evaluation revealed no abnormalities. Ambulatory cardiac event monitoring demonstrated an episode of complete heart block, and myocardial perfusion imaging showed a focal perfusion defect in the left ventricle (thought to represent a prior myocardial infarction versus sarcoidosis). He underwent pacemaker and implanted cardiac defibrillator (ICD) placement and was discharged home.

Teaching Point:

• Small-cell lung cancer(SCLC) is a primary pulmonary malignancy of epithelial origin that most commonly occurs in older patients with long-standing smoking histories. Clinically, it typically presents aggressively with pulmonary symptoms (e.g., cough, dyspnea, hemoptysis), manifestations related to intra- or extra-thoracic spread, or with a variety of paraneoplastic syndromes (e.g., endocrine, dermatologic, neurologic). Prognosis is poor, with median survival without treatment being 2-4 months.
• Sarcoidosis is a multisystem granulomatous disease that most often affects the lungs, skin, and eyes.Cardiac manifestationsof sarcoidosis include arrhythmias, cardiomyopathy, sudden cardiac death, and, rarely, coronary artery vasculitis. Diagnosis can be made by endomyocardial biopsy or with compatible imaging findings (e.g., delayed gadolinium enhancement on cardiac MRI) or cardiac manifestations (e.g., complete heart block, ventricular arrhythmias, or otherwise unexplained heart failure) in a patient with known extra-cardiac sarcoidosis. 

Episode description

Reza and Rabih talk through a case

RLR #3 – Scrotal pain 
A 75-year-old man with a history of Alzheimers dementia presented with 2 weeks of bilateral scrotal pain. Genital exam was unremarkable. Chest radiography revealed a right lower lobe opacity and computed tomography of the abdomen was notable for diffuse retroperitoneal lymphadenopathy. Biopsy was performed of a mediastinal lymph node which revealed findings consistent with metastatic small-cell lung cancer.

Teaching Points:

• Acute scrotal pain is a common complaint encountered in the emergency department and can be caused by pathology within the scrotum, abdomen (i.e., inguinal hernia), or referred from the retroperitoneum. The most common causes of acute scrotal pain include torsion of the testicular appendage, epididymitis, and testicular torsion. The initial evaluation is focused on excluding the presence of testicular torsion (a surgical emergency) by exam and, often times, doppler ultrasonography. 

Student Dr. Dereck Paul, Dr. Utibe Essien and Dr. Kimberly Manning join the CPSolvers to discuss racial disparities. This all-star crew discusses the role of race and inequality in the current COVID-19 pandemic and medicine more broadly. Don’t miss out on this truly powerful episode. 

Student Dr. Dereck Paul

Dereck Paul is a 4th-year medical student at the University of California, San Francisco School of Medicine and applying into residency this fall. He studies the relationships between homelessness and health under Dr. Margot Kushel at the UCSF Center for Vulnerable Populations. He was a 2018 Student National Medical Association David E. Satcher MD, PhD Health Disparities Research Fellow for his work mapping the role of structural racism in susceptibility to housing insecurity and homelessness. Outside of his studies and research, he writes about health policy, medical education, and the underrepresented medical trainee experience.

Dr. Utibe Essien

Utibe Essien is an Assistant Professor of Medicine at the University of Pittsburgh and a health disparities researcher in the VA Center for Health Equity Research and Promotion. He completed Primary Care residency and General Internal Medicine fellowship at the Massachusetts General Hospital and Harvard Medical School. Dr. Essien’s research focuses on developing interventions to advance equity in the management of cardiovascular diseases.

Dr. Kimberly Manning

Kimberly D. Manning, MD is a general internist/hospitalist who serves as Associate Vice Chair of Diversity, Equity, and Inclusion for the Department of Medicine at Emory University School of Medicine. Manning was recently promoted to Professor of Medicine and additionally serves as residency program director for the Transitional Year Residency Program at Emory. She has a strong commitment to supporting underrepresented minorities in medicine, serving underserved populations, and creating better understanding of our patients and each other through storytelling and narrative medicine. A huge fan of the CP Solvers, Dr Manning is as enthusiastic about being a teacher as she is being a lifelong learner. 

Dr. Avital O’Glasser presents a clinical unknown on Virtual Morning Report to CPSolvers, Jack and Reza.

Case overview and teaching points

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Dr. Avital O’Glasser

Avital O’Glasser is an Associate Professor of Medicine at Oregon Health & Science University (OHSU) in the Division of Hospital Medicine. She is the medical director of OHSU’s hospitalist-led Pre-Operative Medicine Clinic, as well as The Curbsiders Kashlek Memorial Hospital Chief of Perioperative Medicine. She is also the Assistant Program Director for Social Media and Scholarship for OHSU’s Internal Medicine Residency Program. She has been a member of the OHSU faculty since completing her internal medicine residency training there, and she is a graduate of Jefferson Medical College. She enjoys spending time with her husband, two young boys, and labradoodle Matilda.

Case Summary

A 31-year-old man with no prior medical problems presented with subacute abdominal pain, recurrent fevers, and weight loss. His work-up was notable for stigmata of endocarditis, although bacterial blood cultures were persistently negative. Ultimately, he underwent aortic valve replacement, and pathologic examination of the valve tissue demonstrated coliform bacteria with molecular testing confirming a diagnosis of Streptobacillus moniliformis. Further history confirmed that he owned a pet rat and had experienced repeated bites prior to his illness. 

Teaching Points

• Streptobacillus moniliformisis a pleomorphic, gram-negative rod that is the predominant cause ofrat bite fever (RBF). This pathogen is found across the United States and is most commonly transmitted by rat bites, with numerous cases being acquired from pets or laboratory animals. Clinical manifestations include fever (potentially relapsing), arthralgias, and rash. Serious complications include infective endocarditis, meningitis, systemic vasculitis, and other organ involvement.

Episode description

Reza and Rabih talk through a case

RLR #2 – Hoarseness
A 54-year-old man with a history of PTSD, depression, and a recent diarrheal illness presented with acute dysphagia to liquids and solids. Neurologic exam was initially unremarkable, but the patient returned the next day with diplopia and ataxia. Exam was notable for new bilateral cranial nerve III palsies and areflexia. Laryngoscopy revealed unilateral vocal cord paralysis. Cerebrospinal fluid analysis was notable for elevated protein and positive GQ1b antibody testing. He was diagnosed with Miller Fisher’s syndrome, a variant of Guillain-Barre Syndrome.

Teaching Points:

• Miller Fisher’s Syndrome(MFS) is a rare variant of Guillain-Barre syndrome (acute inflammatory demyelinating polyneuropathy) that primarily affects the bulbar nerves. MFS is suggested by the classic triad of acute-onset ophthalmoplegia, ataxia, and areflexia and often occurs following a prodromal illness (upper respiratory infection or gastroenteritis). Diagnosis is supported by elevated cerebrospinal fluid protein as well as demonstration of GQ1b ganglioside autoantibodies (which are positive in 85% of cases). Prognosis is typically favorable, and most cases are self-limited. 

Episode description

Reza and Rabih talk through a case

RLR #1 – Lymphadenopathy
A woman in her 20’s with a history of prior possible thrombotic thrombocytopenic purpura (TTP) and recently treated secondary syphilis was transferred to a tertiary referral center for evaluation of generalized lymphadenopathy, new anemia, and thrombocytopenia. Laboratory workup was concerning for a Coombs-positive autoimmune hemolytic anemia, possible immune thrombocytopenia, and polyclonal gammopathy. Core and excisional lymph node biopsies were unrevealing for either infection or malignancy. Ultimately, anti-nuclear, anti-dsDNA, and anti-Sm autoantibodies were grossly positive and the patient was diagnosed with systemic lupus erythematosus.

Teaching Points:

• Systemic Lupus Erythematosus(SLE) is a complex autoimmune disease that most frequently presents with inflammatory arthritis, malar rash, and nephropathy.Hematologic abnormalities are common in SLE and are components of both the American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) diagnostic criteria. Common features include leukopenia (both neutropenia and lymphopenia), autoimmune hemolytic anemias (generally Coombs-positive, warm-type), and thrombocytopenia. SLE is a recognized cause of secondary thrombotic thrombocytopenic purpura (TTP), which may present concurrently with or, in some instances, precede the diagnosis of SLE.

Dr. Kushal Vaishnani presents a clinical unknown on Virtual Morning Report to student Dr. Jean-Claude Guidi and Dr. Ramya Ramachandran.

Case Overview & Teaching Points

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Problem Representation
A 53-year-old woman with a history of rheumatoid arthritis and amiodarone-induced lung injury on immunosuppression presented with acutely progressive hypoxic respiratory failure and hypotension, found to have a serpiginous truncal rash, acute anemia, and elevated beta-d-glucan.

Schemas
In this episode, we revisit the schemas for fever and rash (which highlights first addressing the life-threatening causes) and diffuse alveolar hemorrhage (which focuses on differentiating vasculitis from other etiologies).

Diagnosis
The patient underwent bronchoscopy with bronchoalveolar lavage fluid demonstrating elevated leukocytes with a neutrophilic predominance as well as progressively bloody fluid, consistent with diffuse alveolar hemorrhage. Silver stain was diagnostic for Pneumocystis jiroveci, and pathology revealed helminthic larvae consistent with Strongyloides stercoralis. The patient was diagnosed with both Pneumocystis pneumonia and Strongyloides hyperinfection syndrome!

Teaching Points:

• Beta-D-glucan(BDG) is a cell wall polysaccharide found in many fungal organisms (with notable exceptions including Cryptococcus, the zygomycetes, and Blastomyces dermatitidis) and is frequently used as a laboratory marker for invasive fungal infections. Caution is advised when interpreting this test, as it is imperfectly sensitive and false positives have been reported in association with certain hemodialysis filters, immunoglobulins (e.g., IVIG), albumin, and beta-lactam antimicrobials (thought to be more of an issue with older formulations). 
• Strongyloides stercoralisis an important human pathogen in tropical and subtropical areas throughout the world. While many cases of chronic strongyloidiasis are mild and may go unrecognized, severe manifestations can include the strongyloides hyperinfection syndrome and disseminated strongyloidiasis. Hyperinfection occurs when there is accelerated autoinfection (i.e., the ability to complete the parasitic life cycle entirely within the host – a trait relatively unique to Strongyloides among human helminthiases) and most commonly occurs in the setting of immune dysregulation or exogenous immunosuppression. 
• Pneumocystis jiroveciis an important opportunistic infection in immunosuppressed patients. Originally identified by Carlos Chagasin 1909, who believed it to represent a pulmonary manifestation of the parasite Trypanosoma cruzi, it was later reclassified as a fungus in 1988. The most frequent symptoms include subacute dyspnea, nonproductive cough, and low-grade fever, with hypoxemic respiratory failure being the most common manifestation of severe decompensation. 

Dr. Ruchit Rana presents a Human Dx unknown to Dr. André Mansoor and OHSU residents  – Drs. Logan Jones and Patricia Liu.

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Human Dx case

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Dr. Logan Jones

“Logan” Jones is a PGY-3 at OHSU in Portland, and will be joining the faculty as an assistant professor in the Division of Hospital Medicine with an academic focus on student assessment, curricular innovation, learner scholarship, clinical reasoning, and EMR proficiency. He is active in organized medicine with the American Medical Association and the American College of Physicians. Outside of medicine, he enjoys cooking with his sig fig Samantha, spending time on his yoga mat, and hiking throughout the Pacific Northwest.

Dr. Patricia Liu

Pat is currently one of the IM chief residents at Oregon Health & Science University. She will be a hospitalist next year and is interested in medical education, empowering women in medicine and improving care for inpatients with substance use disorders. In her free time, you can find her running, snowboarding and teaching tricks to her cat, Pekoe.

Dr. Ruchit Rana

Ruchit Rana is currently a second-year internal medicine resident at Baylor College of Medicine. He completed medical school at Baylor College of Medicine. He has a passion for practicing and improving medical education at all levels. In his free time, he enjoys cooking and baking dishes across all ethnicities and maintaining his multiple freshwater aquariums at home.

Dr. André Mansoor

André Mansoor is an Assistant Professor of Medicine at Oregon Health and Science University in Portland, Oregon. His favorite book is the Count of Monte Cristo and his favorite band is Stone Temple Pilots. He is the author of an internal medicine textbook called Frameworks for Internal Medicine. https://www.amazon.com/Frameworks-Internal-Medicine-Andre-Mansoor/dp/1496359305. 

Case Summary

A 70-year-old man presented with six months of dyspnea on exertion, night sweats, and weight loss. He was found to be febrile and in distributive shock, with laboratory analysis demonstrating cytopenias, coagulopathy, and lactic acidosis. Computed tomography of the abdomen and pelvis was notable for hepatosplenomegaly, and a bone marrow biopsy revealed a monoclonal B-cell population with hemophagocytosis. The patient was diagnosed with diffuse large B-cell lymphoma complicated by hemophagocytic lymphohistiocytosis (HLH).

Teaching Points:

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening, immune-mediated disease caused by impaired NK and cytotoxic T-cell function. While genetic defects play a prominent role in triggering HLH in children, most cases of HLH in adults are secondary to another disorder, such as infections (e.g., EBV, histoplasmosis), hematologic malignancies (e.g., NK, T, or B-cell lymphomas), or autoimmune disease (e.g., systemic lupus erythematosis). 

Dr. Anand Patel presents a Human Dx unknown to Rabih and Indiana residents  – Drs. Devika Gandhi and Cody Hill.

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Human Dx case

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Dr. Devika Gandhi

Devika Gandhi is a second-year internal medicine resident at Indiana University. She is originally from Dayton, Ohio and received her undergraduate degree from the University of Akron. She earned her medics degree from Northeast Ohio Medical University in Rootstown, Ohio (Go Walking Whales!). After residency, she plans to pursue a career in gastroenterology/hepatology. During her free time, she enjoys reading, cooking, and going out to trivia with friends.

Dr. Cody Hill

Cody Hill is a second-year Med-Peds resident at Indiana University. He attended Clemson University for his undergraduate/graduate studies and the University of South Carolina School of Medicine Greenville for medical school. Although he loves taking care of patients, his true passion lies in medical education, especially when it relates to clinical reasoning and evidence-based medicine. He is also very invested in resident wellness and mentorship, which led him and a fellow classmate to start their own podcast called The Resident Lounge (@resident_lounge). After residency, he plans to pursue a career as a Med-Peds hospitalist and a medical educator with the ultimate goal of one day becoming a program director. Cody also just became a father, so in addition to taking care of his newborn daughter, he and his wife enjoy walking their dog, gardening, cooking and exploring Indianapolis for new craft beers.

Dr. Anand Patel

Dr. Anand Patel is a hematology-oncology fellow at the University of Chicago and the Medical Education Lead at the Human Diagnosis Project. He attended University of Missouri-Columbia for medical school and completed both his internal medicine residency and chief residency at Northwestern. Anand’s academic interests include medical education and clinical reasoning. Specifically within hematology-oncology, he is interested in clinical trial design using targeted therapies for patients with leukemias and myeloid neoplasms.

Case Summary

An 83-year-old woman with acute myeloid leukemia and psoriasis (on immunosuppression) presented with six weeks of fatigue, weight loss, and a dry cough. Her medical history was notable for two indeterminate interferon-gamma release assays. Computed tomography of the chest demonstrated a 3 x 3 cm right lower lobe mass, with subsequent biopsy revealing necrotizing granulomas and acid-fast bacilli. Cultures ultimately grew Mycobacterium avium complex (MAC).  

Teaching Points:

Mycobacterium avium complex (MAC) is a ubiquitous water and soil-based organism. Clinical manifestations include pulmonary infections, lymphadenitis, and disseminated disease in severely immunocompromised patients (e.g., those with HIV and CD4 counts < 50 cells/µL). Pulmonary manifestations of MAC include cavitary upper lobe disease similar to tuberculosis, fibronodular bronchiectasis that often develops in the right middle lobe or lingula, solitary pulmonary nodules, and hypersensitivity pneumonitis. 

Dr. Anand Jagannath presents a Human Dx unknown to Reza and U of C residents – Drs. Alec and Austin Rezigh.

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Human Dx case

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Dr. Alec Rezigh

Alec Rezigh is a third-year internal medicine resident at The University of Colorado. He is originally from Houston, TX and received his undergraduate degree at the University of Texas at Austin. He then went back to Houston for medical school at the University of Texas at Houston (McGovern) Medical School. In his free time, he loves all things basketball, traveling with his wife, and napping on the couch with his dog. Following completion of his training, he will return to Houston to be an academic hospitalist. He wishes to thank Dr. Juan Lessing for his amazing mentorship and inspiring his interest in clinical reasoning – and introducing him to Rabih and Reza!

Dr. Austin Rezigh

Austin Rezigh is a third-year internal medicine, primary care track resident at the University of Colorado. He completed medical school at UT Southwestern and is excited to pursue a career in academic general internal medicine. In his free time, he enjoys trying new cuisines, exercising, and spending time with his fur-niece, Kensie.

Dr. Anand Jagannath

Dr. Anand Jagannath is a clinician-educator at the University of California, San Diego (UCSD) and hospitalist at the VA San Diego. He completed medical school at the Tufts University School of Medicine and internal medicine residency and chief residency at Albert Einstein College of Medicine/Montefiore Medical Center. At UCSD, Anand’s interests include bedside team rounding, teaching clinical reasoning to medical students and residents, learning from his learners, and promoting a safe and inclusive learning environment. He is also a Section Editor for adult medicine cases at the Human Diagnosis Project. When he’s not getting excited about medicine, you’ll probably find Anand cooking food, watching shows about food on Netflix, running, or playing basketball or his violin.

Human Dx Case Summary

A 66-year-old man with alcohol use disorder and chronic NSAID use presented with one day of abdominal pain and nausea. Laboratory analysis was notable for hypercalcemia to 16 mg/dL (with low parathyroid hormone and vitamin-D levels), metabolic alkalosis, and an acute kidney injury. The patient disclosed that he had recently consumed large amounts of calcium carbonate for his abdominal pain, and he was diagnosed with the milk alkali syndrome. His serum calcium normalized after receiving intravenous fluids and withholding further calcium supplementation.

Teaching Points:

The milk alkali syndrome, the third most common cause of hospital admission for hypercalcemia, develops from excess consumption of calcium supplements (e.g., calcium carbonate). Patients classically present with hypercalcemia, metabolic alkalosis, and renal insufficiency. The metabolic alkalosis is thought to be due to hypercalcemia-induced nephrogenic diabetes insipidus, while renal insufficiency develops as a result of calcium-induced renal tubular damage and vasoconstriction of the renal afferent arteriole. Treatment includes intravenous fluid resuscitation and cessation of calcium supplementation.

The CPSolvers share a case of hyponatremia and AKI – let’s practice those schemas together!

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Hyponatremia schema

AKI schema

Dr. Ellie Garbade presents a clinical unknown to Dr. Aimee Zaas and CPSolvers.

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Learn-Live!

Dr. Ellie Garbade

Ellie Garbade is a current chief resident at the University of Rochester Medical Center, where she completed her internship and residency in Internal Medicine. Following chief year, she plans to continue her career at the University of Rochester as an academic hospitalist.

Dr. Aimee Zaas

Aimee Zaas is an Associate Professor of Medicine at Duke University School of Medicine in the Division of Infectious Diseases and International Health. She serves at the Program Director for the Duke Internal Medicine Residency Program and spends her clinical time on the general medicine service with residents and students as well as on the Transplant Infectious Diseases consultative service at Duke Hospital. After completing her medical school at the Feinberg School of Medicine at Northwestern University, she completed her residency and Assistant Chief of Service (Thayer!) at The Johns Hopkins Hospital and her Infectious Diseases fellowship at Duke. She enjoys spending time with her husband, two boys (but, let’s face it, they are teenagers so are never home) and two dogs, cheering on her kids’sports, the Duke Blue Devils and St. Louis Cardinals as well as trying out new restaurants and excellent coffee.

Dr. Sneha Thatipelli presents a Human Dx case to student doctor Boateng Kubi and CPSolvers Sal and Reza.

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Human Dx case

Student Doctor Boateng Kubi

Boateng Kubi is a third-year medical student at Johns Hopkins University School of Medicine and will be applying to residency programs this fall.
He is excited to pursue a career in academic surgery and has developed an early interest in cardiothoracic surgery. He is interested in outcomes research, medical education, and clinical reasoning. His clinical interests include cardiovascular infections, thoracic malignancies, and heart & lung transplantation. A Maryland native, he enjoys spending his free time with family, working out, or exploring restaurants in Baltimore with friends.

Dr. Sneha Thatipelli

Sneha Thatipelli is a third year internal medicine resident at Northwestern Memorial Hospital. She completed her medical school at UCSF, and is excited to pursue a career in Infectious Disease with a focus on HIV medicine. She is passionate about medical education and understanding barriers to provide equitable care for vulnerable populations. She will be a graduate of the Health Equity and Advocacy Clinical Scholars (HEACS) program at McGaw and hopes to use this training for clinical care and also medical education of trainees.

Dr. Hajduczok presents a a Human Dx case to Einstein residents, Dr. Gandhi and Dr. Bressman, and Rabih.

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Human Dx Case

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Dr. Himali Gandhi

I graduated from NYU medical school and am now finishing my PGY-3 year at Montefiore Medical Center in the Bronx, NY. My clinical interests include preventative cardiology and medical education and I am excited to be starting my cardiology fellowship at Northshore University Hospital- Northwell in Long Island. When I am not in the hospital I love hiking, running, cooking, and exploring different styles of dance.

Dr. Max Bressman

I went to Swarthmore College where I played tennis for the college team (ranked top 25), went to NYU Medical School (switched to golf, now attempt to qualify for the US Open every year and came 1 stroke from making the US national amateur championship last year). Finishing PGY-3 year at Montefiore in the Bronx, NY. Was originally planning on cardiology, but changed my mind and am going to stay as a Hospitalist at Montefiore and get involved in education. While at Montefiore, published abstracts, posters, and just got a manuscript into AJM. Anand Jagannath was my chief as an intern and we wrote and abstract/poster (along with Firm-1 leader Matt Shaines) that won the top prize at SHM in 2018.

Alex Hajduczok

Alex Hajduczok is a second-year internal medicine resident at Penn State Hershey Medical Center. He is originally from Buffalo, New York and completed is undergraduate degree in biochemistry at the University of Rochester and stayed at the University of Rochester School of Medicine & Dentistry for medical school. After residency, he plans to pursue a career as a clinician-investigator in cardiology. He is currently engaged in heart failure remote monitoring research at Penn State Hershey. In his free time, he enjoys working out, coaching CrossFit, and playing hockey.

Episode description

Student Dr. Emma Levine moderates a COVID-19 case discussion with expert input from Drs. Brian Block, Neeta Thakur and Peter Chin-Hong

Dr. Peter Chin-Hong

Peter Chin-Hong is Associate Dean for Regional Campuses at UCSF School of Medicine. He is a medical educator who specializes in treating infectious diseases, particularly infections that develop in patients who have suppressed immune systems, such as as solid organ and hematopoietic stem cell transplant recipients and HIV+ organ transplant recipients. He directs the immunocompromised host infectious diseases program at UCSF. He has been involved in the COVID19 clinical consultation and treatment team.

Dr. Neeta Thakur

Neeta Thakur is a Pulmonary Critical Care Physician and health disparities researcher at UCSF. Her main research interests are in understanding how the social environment contributes to disease and modifies disease course in low-income communities and communities of color. Dr. Thakur’s experience as a clinician and Medical Director of the Zuckerberg San Francisco General Hospital Chest Clinic, gives her first-hand insight on how social and environmental stress negatively affect asthma and other health outcomes, and practical knowledge of the existing barriers to adoption of evidence-based interventions into practice. With the evolving COVID-19 epidemic, her research focus has shifted to better understand the fears, needs, and socioeconomic impact in low-income, diverse communities.

Dr. Brian Block

Brian Block is an Instructor of Medicine and Research Fellow in the Division of Pulmonary and Critical Care Medicine at UCSF. He has interests in medical ethics and critical illness communication. He graduated from Harvard Medical School and completed Internal Medicine training at Columbia University where he was also a Chief Resident. He then came to UCSF to complete fellowship training in Pulmonary and Critical Care medicine. His UCSF bio also describes him as a “mediocre golfer” and now he can’t figure out how to have that removed.

Dr. Madeline McCrary and Dr. Bob Centor present a clinical unknown to Dr. Joel Topf.

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Dr. Joel Topf

Joel Topf went to medical school at Wayne state University School of Medicine and did Med-Peds at Indiana University. He completed an adult fellowship in nephrology at the University of Chicago. He is currently a clinical nephrologist in Detroit at Oakland University William Beaumont School of Medicine. Joel’s passion is using social media and new media to teach nephrology. He started his blog, PBFluids in 2008. He developed NephMadness and NephJC to leverage the power of community, digital scholarship and creativity to teach nephrology. He is the founder and program director of the Nephrology Social Media Collective internship which trains medical professionals to use social media for medical education. Joel is a pioneer in bringing visual abstracts to nephrology and is a visual abstract editor for CJASN and the American Journal of Nephrology. He is creator and host of the nephrology podcast, Freely Filtered. He was recognized by the American Society of Nephrology with the Robert Narins award for innovations in Teaching in 2017.

Dr. Madeline McCrary

Madeline McCrary is a third year Internal Medicine resident at Christiana Care in Delaware. She is originally from Annapolis, MD but moved down south to North Carolina for the next 10 years. She went to Duke for undergrad then switched sides and went to UNC for medical school. She will be starting Infectious Diseases fellowship at UNC in July. In her spare time, she enjoys exploring with her dog Sammie, spending time with family and friends, and playing board games.

Dr. Bob Centor

Dr. Centor is Professor Emeritus of Internal Medicine at the University of Alabama at Birmingham, Chair Emeritus for the Board of Regents for the American College of Physicians (ACP) and a retired Dean working part-time at Huntsville and the VA in Alabama.

Episode description

Mike Rose, Ryoko Hamaguchi, Reza Manesh and Rabih Geha interview Drs. Ripa and Monti from the IRCCS San Raffaele Hospital

CPSolver morning report 

Dr. Marco Ripa

Marco Ripa is a Researcher and Infectious Disease physician working at IRCCS San Raffaele Hospital in Milan. His main research topics are sepsis, bloodstream infections and infective endocarditis. During his specialty training, he worked for one year at the Hospital Clinic in Barcelona with professor Alex Soriano and professor José Maria Miró in the Nosocomial Infections and Cardiovascular Infection Units. He is a member of the ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES). Currently, he is working in the COVID-19 dedicated ward of San Raffaele Hospital.

Dr. Giacomo Monti

Giacomo Monti is a consultant in Anesthesia and Intensive Care working in the general ICU, medical emergency team and emergency operating room of one the most important University Hospital in Italy. He’s actively involved in scientific research on sepsis, invasive and non-invasive ventilation, outcome after surgery, sedation in ICU, and kidney failure. He has been the Principal Investigator for many international collaborative studies. Currently, he’s leading different research projects, thanks to different grants from public and private founders. He’s active in teaching as adjunct professor on different topics both for medical and post graduates students.

Episode description

Mike Rose, Ryoko Hamaguchi, Reza Manesh and Rabih Geha interview Drs. Ripa and Monti from the IRCCS San Raffaele Hospital

Dr. Marco Ripa

Marco Ripa is a Researcher and Infectious Disease physician working at IRCCS San Raffaele Hospital in Milan. His main research topics are sepsis, bloodstream infections and infective endocarditis. During his specialty training, he worked for one year at the Hospital Clinic in Barcelona with professor Alex Soriano and professor José Maria Miró in the Nosocomial Infections and Cardiovascular Infection Units. He is a member of the ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES). Currently, he is working in the COVID-19 dedicated ward of San Raffaele Hospital.

Dr. Giacomo Monti

Giacomo Monti is a consultant in Anesthesia and Intensive Care working in the general ICU, medical emergency team and emergency operating room of one the most important University Hospital in Italy. He’s actively involved in scientific research on sepsis, invasive and non-invasive ventilation, outcome after surgery, sedation in ICU, and kidney failure. He has been the Principal Investigator for many international collaborative studies. Currently, he’s leading different research projects, thanks to different grants from public and private founders. He’s active in teaching as adjunct professor on different topics both for medical and post graduates students.

Episode description

Student Dr. Emma Levine & the CPSolvers talk COVID-19 with Dr. Carlos Del Rio

Dr. Carlos Del Rio

Carlos del Rio, MD is Distinguished Professor of Medicine at Emory University School of Medicine and Professor of Global Health and Epidemiology at the Rollins School of Public Health of Emory University. He is co-Director of the Emory CFAR and co-PI of the Emory-CDC HIV Clinical Trails Unit and the Emory Vaccine Treatment and Evaluation Unit.   Dr. del Rio is a native of Mexico where he was Executive Director of the National AIDS Council of Mexico (CONASIDA, the Federal agency of the Mexican Government responsible for AIDS Policy throughout Mexico), from 1992 through 1996.  He was also a member of the National Academy of Medicine.  

Episode description 

Rabih, Reza, Arslan, Sharmin and Tony Breu share their approach to lactic acidosis.

Lactic Acidosis Schema

Hyperacute CHF Schema

Tweetorial

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Dr. Travis Smith presents a Human Dx unknown to Rabih and UNC residents  – Drs. Kumfer and Diddams.

Human Dx case

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Dr. Ann Marie Kumfer

Dr. Kumfer is a third year resident at the University of North Carolina Internal Medicine Residency. She completed medical school at Texas Tech University Health Science Center. She is pursuing a career in hospital medicine and is interested in medical education and diagnostic clinical reasoning. In her time away from work, she enjoys traveling, running, and spending time with her husband and dog.

Dr. Maxwell Diddams

Dr. Maxwell Diddams is a 3rd year resident in Internal Medicine at the University of North Carolina at Chapel Hill where he will be staying for his fellowship in pulmonary and critical care. Max can be easily identified by the portable ultrasound he always carries, and is interested in point-of-care ultrasound for the internist and intensivist. Outside of medicine he enjoys rock climbing, good jokes, Chinese language learning, and pants with pockets large enough for the whole bottle of ultrasound gel.

Dr. Travis Smith

Travis Smith is an attending EM doc and clinical preceptor at St. Vincent’s Southside in Jacksonville, Florida. He also currently serves as a Regional Dean for the Lake Erie College of Osteopathic Medicine where he helps mentor 50 wonderful and bright third and fourth year medical students. He is a graduate from the University of Florida Emergency Residency-Jacksonville campus in 2012 and Lake Erie College of Osteopathic Medicine-Bradenton in 2009. He received a degree in Biological Science from The Florida State University in 2005 (go Noles). In his spare time, he enjoys being a father of 3 young kids, golfing as much as possible, FSU football, and bedside ultrasound with his new Butterfly IQ.  

Dr. Janna Raphelson presents a  Human Dx unknown to Reza and Pitt residents  – Drs. Mallarino-Haeger and Augustin.

Human Dx case

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Dr. Christina Mallarino-Haeger

Christina Mallarino-Haeger is a third year Internal Medicine resident at UPMC/University of Pittsburgh. Originally from Bogota, Colombia; Christina completed her medical school at the Pontificia Universidad Javeriana, followed by a postdoctoral research fellowship at Brigham and Women’s hospital in Boston. Christina will be moving to Atlanta to continue her training in infectious diseases at Emory and is interested in pursuing a career as a physician-scientist and HIV researcher. When not in the hospital, Christina enjoys riding her bike, going to the symphony and watching movies.

Dr. Ryan Augustin

Ryan Augustin is a second-year internal medicine resident at the University of Pittsburgh Medical Center. He is originally from Minnesota (Twin Cities) and received his undergraduate degree in biochemistry from the University of St. Thomas. He graduated from Case Western Reserve University School of Medicine where his love for all things med-ed took root. After residency, he plans to pursue a career in medical oncology. During his free time, he enjoys playing piano and cooking with his wife.

Dr. Janna Raphelson 

Janna Raphelson is a PGY-1 in Internal Medicine at UC San Diego. She is a born Midwesterner who moved to Montreal to complete her medical degree at McGill University and learn some French. Her clinical interests include physical exam teaching, clinical anatomy for internists, and point of care ultrasound. Since moving to California, she spends her free time running outside all year round and reading books on the beach. 

CPS team Stephenie Le, Dan Minter, and Rabih Geha present a clinical unknown case to Dr. Lekshmi Santhosh.

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Dr. Lekshmi Santhosh

Dr. Santhosh is Assistant Professor at UCSF in the Divisions of Pulmonary/Critical Care Medicine and Hospital Medicine. She cares for patients at UCSF in the medical and neurological ICUs, the general pulmonary outpatient clinic, and on the general medicine teaching service. She serves as the Associate Program Director of the UCSF Pulmonary/Critical Care Fellowship Program and is the Co-Director of the UCSF Women in Leadership Development program. She is involved in medical education at the medical student, resident, and fellow levels and is passionate about clinical reasoning, medical education, and leadership development.

Episode description

The CPSolvers share a case of hemolysis and infection  – let’s practice those schemas together!

Show notes

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Schemas

Hemolysis

Infection in inpatient

Dr. Mady Heldman presents a Human Dx unknown to Rabih and CPSolvers, Drs. Penner and Rose.

Human Dx case

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Dr. Mady Heldman

Dr. Heldman is currently an infectious diseases fellow at the University of Washington. Originally from Cincinnati, OH, she completed her undergraduate education at Brown University in Providence, RI. She then began making her way west across the country, completing both medical school and internal medicine residency at Northwestern in Chicago, before heading out to the Pacific Northwest. Her academic interests include transplant ID, immunocompromised hosts, and medical education. In her spare time, she enjoys running, hiking, and exploring new restaurants.

Drs. Jack Penner & Mike Rose

Meet Us

Episode description

Dr. Nick Duca presents a Human Dx unknown to Reza and Pitt team  – Drs. Mallarino-Haeger and Augustin.

Human Dx case

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Dr. Ryan Augustin

Ryan Augustin is a second-year internal medicine resident at the University of Pittsburgh Medical Center. He is originally from Minnesota (Twin Cities) and received his undergraduate degree in biochemistry from the University of St. Thomas. He graduated from Case Western Reserve University School of Medicine where his love for all things med-ed took root. After residency, he plans to pursue a career in medical oncology. During his free time, he enjoys playing piano and cooking with his wife. 

Dr. Christina Mallarino-Haeger

Christina Mallarino-Haeger is a third year Internal Medicine resident at UPMC/University of Pittsburgh. Originally from Bogota, Colombia; Christina completed her medical school at the Pontificia Universidad Javeriana, followed by a postdoctoral research fellowship at Brigham and Women’s hospital in Boston. Christina will be moving to Atlanta to continue her training in infectious diseases at Emory and is interested in pursuing a career as a physician-scientist and HIV researcher. When not in the hospital, Christina enjoys riding her bike, going to the symphony and watching movies.

Dr. Nick Duca

Dr. Nick Duca is an assistant professor of medicine in the division of general internal medicine at Penn State College of Medicine. He completed his internal medicine residency and chief residency at the University of Pittsburgh Medical Center- Presbyterian. He joined as faculty at Penn State College of Medicine in July of 2017. His clinical roles include outpatient medicine as well as attending on the inpatient teaching services at Hershey Medical Center. He has a strong interest in mentoring and clinical reasoning. He currently serves as clerkship director for the internal medicine clerkship. In his free time he loves spending time with his wife, Lauren, 3-month-old daughter Natalie, and their Beagle, Simon. He also enjoys fishing the beautiful trout streams of central Pennsylvania, hiking, and practicing mindfulness meditation. 

Episode Description

Dr. Andrew Olson presents a clinical unknown case to Reza & Rabih at DEM, with an introduction by Dr. Gurpreet Dhaliwal.

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Show notes

Patreon website

Dr. Andrew Olson

Andrew Olson is an Associate Professor of Medicine and Pediatrics at the University of Minnesota Medical School. He grew up on a farm in Iowa and then attended medical school at the University of California, Davis, did an internship in medicine at UCSF, and then residency in Medicine and Pediatrics at the University of Minnesota.  A hospitalist, his work focuses on improving diagnostic performance through education as well as educational approaches to teach clinical reasoning.  He is the co-chair of the Education Section of the Society to Improve Diagnosis in Medicine.

Dr. Gurpreet Dhaliwal

Dr. Dhaliwal is a clinician-educator and Professor of Medicine at the University of California, San Francisco. He is the site director of the internal medicine clerkship at the San Francisco VA Medical Center, where he teaches medical students and residents in the emergency department, urgent care clinic, inpatient wards, outpatient clinic, and morning report. His academic interests are the cognitive processes underlying diagnostic reasoning and clinical problem-solving and the study of diagnostic expertise. Dr. Dhaliwal enjoys playing pickup basketball with his two sons … even though both can handily defeat him.

Episode description 

Rabih, Reza, Arsalan, Sharmin, and Jack share their approach to hypoglycemia.

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Hypoglycemia Schema

Tweetorial

Patreon website

Show notes

Episode description

Dr. Travis Smith presents a Human Dx unknown to Reza and Penn team  – student Drs. Hernando and Murdock.

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Mary Ann Hernando

Mary Ann Hernando is a 5th-year medical student at the University of Pennsylvania in the process of applying in Internal Medicine. She is originally from Miami, Florida and received her undergraduate degree in neuroscience from the University of Miami. During medical school, she took a year out to pursue a Master of Public Health at Johns Hopkins University with a concentration in health systems and policy. In her spare time, Mary Ann enjoys cooking with friends, live music, and working her way through every escape room in Philadelphia. 

H. Moses Murdock

H. Moses Murdock is a 5th year medical student at the University of Pennsylvania applying in Internal Medicine. He is originally from Orlando, Florida, and received his undergraduate degree at the University of Central Florida in molecular biology and microbiology. In his free time, Moses enjoys running, reading, and discovering new vegetarian restaurants.

Dr. Travis Smith

Travis Smith is an attending EM doc and clinical preceptor at St. Vincent’s Southside in Jacksonville, Florida. He also currently serves as a Regional Dean for the Lake Erie College of Osteopathic Medicine where he helps mentor 50 wonderful and bright third and fourth year medical students. He is a graduate from the University of Florida Emergency Residency-Jacksonville campus in 2012 and Lake Erie College of Osteopathic Medicine-Bradenton in 2009. He received a degree in Biological Science from The Florida State University in 2005 (go Noles). In his spare time, he enjoys being a father of 3 young kids, golfing as much as possible, FSU football, and bedside ultrasound with his new Butterfly IQ.  

Episode description

Dr. Patrick Murphy presents a Human Dx clinical unknown to UCSD team – student Dr. Deshpande and Drs. Hastie & Jagannath

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Rima Deshpande

Rima Deshpande is a fourth year medical student at the University of California San Diego (UCSD) School of Medicine. She is originally from Thousand Oaks, California and completed her undergraduate biology degree from UCSD. She is interested in pursuing residency in Internal Medicine. In her free time she enjoys cooking, hiking, and going to the dog beach with her dog Rajah. 

Dr. Elizabeth Hastie

Elizabeth (Lizzy) Hastie is a second year Internal Medicine resident at the University of California San Diego. She is originally from Cincinnati and graduated from Emory University School of Medicine. She is currently a part of the RACE (Resident as Clinical Educator) Track at UCSD and is interested in pursuing a career in medical education. During her free time, she enjoys hiking, running, and watching scary movies. 

Dr. Anand Jagannath

Dr. Anand Jagannath is a clinician-educator at the University of California, San Diego (UCSD) and hospitalist at the VA San Diego. He completed medical school at the Tufts University School of Medicine and internal medicine residency and chief residency at Albert Einstein College of Medicine/Montefiore Medical Center. At UCSD, Anand’s interests include bedside team rounding, teaching clinical reasoning to medical students and residents, learning from his learners, and promoting a safe and inclusive learning environment. He is also a Section Editor for adult medicine cases at the Human Diagnosis Project. When he’s not getting excited about medicine, you’ll probably find Anand cooking food, watching shows about food on Netflix, running, or playing basketball or his violin.

Dr. Patrick Murphy

Pat is currently a 2nd year fellow in an acute care surgery and trauma fellowship in Indianapolis, Indiana. Originally from Nova Scotia, Canada he completed his General Surgery training at Western University in London, Ontario. During his training he successfully completed with MPH from Johns Hopkins University and his MSc from Western University. His main areas of interests are outcomes and health services research in emergency general surgery and trauma, with a focus on quality of care. Outside of medicine he enjoys competing in triathlons and playing soccer.

Human Dx

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Episode Description

Dr. Martin Rofael presents a clinical unknown case to Dr. Meshell Johnson and CPS team, Dan Minter and Rabih Geha.

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Dr. Martin Rofael

Martin Rofael graduated from the University of Washington School of Medicine and subsequently completed his residency at Highland Hospital in Oakland, California. He is currently a first year pulmonary and critical care fellow at UCSF. His clinical interests include global health, ultrasound, and health disparities in pulmonary and critical care. When away from the hospital, he enjoys being outdoors, playing sports, and traveling.

Dr. Meshell Johnson

Meshell Johnson is a Professor of Medicine at UCSF in the Division of Pulmonary, Critical Care, and Sleep Medicine. Her clinical home is the San Francisco VA Medical Center, where she attends mostly in the ICU. Her research lab is also located at the VA, where she focuses on better understanding the role of alveolar type I cells in lung injury and repair. She is passionate about diversity, equity, and inclusion (DEI) and has roles both in the Department of Medicine and the School of Medicine to promote DEI efforts across multiple platforms. In her free time, she loves to travel and spend time with family and friends.

Episode description 

Rabih, Reza, Ryoko, Arsalan, and Sharmin share their approach to ascites

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Ascites Schema

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Episode description

Dr. David Kudlowitz presents a Human Dx case to Reza and Northwestern’s Drs. Katherine McGee and Graham Peigh.

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Show notes

Human Dx case

Dr. Katherine McGee

Dr. McGee graduated from Northwestern University Feinberg School of Medicine. She is a second year internal medicine resident at Northwestern. After residency she plans to pursue training in cardiology, and takes particular interest in transcatheter interventions and medical education. In her free time she enjoys swimming, cooking for friends, and listening to jazz.

Dr. Graham Peigh

Graham Peigh is a third year Internal Medicine resident at Northwestern. Originally from Chicago, Graham completed undergrad at Princeton and medical school at Jefferson before returning to the Windy City for residency. Next year, Graham will be staying at Northwestern as a Chief Medical Resident, and will be applying for fellowship in Cardiology with hopes to pursue a career in academic Cardiology. When outside the hospital, Graham enjoys golfing, hiking, and cheering for the Chicago Cubs. 

Dr. David Kudlowitz

David Kudlowitz is an internist and Site Director for the Internal Medicine Residency Program at NYU Langone Health. He works as a hospitalist and primary care physician. He is also Content Director of Clinical Reasoning for 1st year medical students.

Episode description

Dr. Stephanie Sherman presents a Human Dx case to Rabih and Brigham and Women’s Drs. Sophia Hayes and Pooja Mehta.

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Show notes

Human Dx case

Dr. Sophia Hayes

Dr. Hayes graduated from the School of Medicine at the Oregon Health and Science University in Portland, Oregon. She is a 2nd year resident of the Brigham and Women’s Internal Medicine Residency in Boston, Massachusetts. Her clinical interests include pulmonary and critical care, the care of geriatric patients in the ICU, ethics and communication, and medical education. When away from the hospital, she is either curled up with a cup of tea and good book, or exploring a new river, mountain bike trail, or ski slope.

Dr. Pooja Mehta

Dr. Mehta graduated from Harvard Medical School. She is an intern of the Brigham and Women’s Internal Medicine Residency/Division of General Internal Medicine Primary Care Program in Boston, Massachusetts. Her clinical interests include primary care,health equity and social justice, trauma-informed care, and medical education. When away from the hospital she loves to explore various styles of dance, hike in the mountains, go for long walks along the river,read and cook.

Dr. Stephanie Sherman

Dr. Stephanie Sherman is an academic hospitalist at Baylor College of Medicine (BCM) at Ben Taub General Hospital and the Houston VA Medical Center. She is also an associate program director for the internal medicine residency with a focus on resident-as-teacher training, clinical reasoning, and bedside rounding. If she’s being truthful about how she spends her spare time, she often finds herself re-watching The Office with her husband and fellow clinical problem solver, Zaven Sargsyan.

Episode description

Emma Levine presents a clinical unknown to Dr. Paul Sax

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Dr. Paul Sax

Dr. Paul E. Sax is Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women’s Hospital (BWH), and Professor of Medicine at Harvard Medical School. Dr. Sax received his MD from Harvard Medical School, then did his residency in Internal Medicine at BWH, then fellowship in Infectious Diseases at Massachusetts General Hospital. He is Editor-in-Chief of Open Forum Infectious Diseases, is Section Editor of HIV/AIDS in UpToDate, on the Editorial Board of NEJM Journal Watch Infectious Diseases (where he writes the HIV and ID Observations blog), and on the editorial advisory board of Medscape HIV/AIDS. Dr. Sax is also on the core faculty of the International AIDS Society – USA and the New England AIDS Education and Training Center. In addition to his clinical practice and teaching, Dr. Sax’s ongoing areas of research include clinical trials of antiretroviral therapies, cost-effectiveness of management strategies for HIV, and toxicity of antiretroviral therapy. He is presently the principal investigator at the BWH AIDS Clinical Trials Unit, and is a member of the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) Research Group.

Episode description

Dan Minter presents a clinical unknown to Dr. Paul Sax

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Dr. Paul Sax

Dr. Paul E. Sax is Clinical Director of the Division of Infectious Diseases and the HIV Program at Brigham and Women’s Hospital (BWH), and Professor of Medicine at Harvard Medical School. Dr. Sax received his MD from Harvard Medical School, then did his residency in Internal Medicine at BWH, then fellowship in Infectious Diseases at Massachusetts General Hospital. He is Editor-in-Chief of Open Forum Infectious Diseases, is Section Editor of HIV/AIDS in UpToDate, on the Editorial Board of NEJM Journal Watch Infectious Diseases (where he writes the HIV and ID Observations blog), and on the editorial advisory board of Medscape HIV/AIDS. Dr. Sax is also on the core faculty of the International AIDS Society – USA and the New England AIDS Education and Training Center. In addition to his clinical practice and teaching, Dr. Sax’s ongoing areas of research include clinical trials of antiretroviral therapies, cost-effectiveness of management strategies for HIV, and toxicity of antiretroviral therapy. He is presently the principal investigator at the BWH AIDS Clinical Trials Unit, and is a member of the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) Research Group.

Rash

Radiology

Episode description

The CPSolvers share a case of fever and rash  – let’s practice those schemas together!

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Schemas

Fever and rash

Fever in a returning traveler

Episode description

Dr. Rebecca Berger presents a Human Dx case to Rabih and Jefferson’s Drs. Rachel Redfield and Sean Dikdan.

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Human Dx case link

Dr. Rachel Redfield

Dr. Redfield is a third-year internal medicine resident at Thomas Jefferson University Hospital. She is a graduate of University of Maryland and received her MD from University of Texas Health Science Center in San Antonio. Her clinical interests include mental health disease, hepatology and functional gastroenterology. When not in the hospital she enjoys eating, traveling and most importantly spending quality time (her love language) with friends and family.

Dr. Sean Dikdan

Dr. Dikdan is a third-year internal medicine resident at Thomas Jefferson University Hospital. He is a graduate of Boston College and obtained his dual MD/MPH from Rutgers New Jersey Medical School. His clinical interests include atrial fibrillation and medical education. Outside of the hospital, he enjoys cooking, podcasting, and escape rooms. He is applying for cardiology fellowship and creating his own podcast (Med Lit Review), but his most challenging aspect of residency is surviving the streets of Philadelphia as an avid NY Giants fan. #DannyDimes

Dr. Rebecca Berger

Rebecca Berger is an Assistant Professor of Medicine at Weill Cornell Medicine and a Hospitalist at New York Presbyterian Hospital. She completed medical school at Columbia University College of Physicians and Surgeons in New York and residency in internal medicine at Massachusetts General Hospital in Boston. Rebecca worked as an editorial fellow at the New England Journal of Medicine and was on the faculty at MGH before moving back to New York in 2018. Her academic interests include patient safety, quality and process improvement, and medical education. 

Human Dx

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Episode description

Dr. Jad Al Danaf presents a Human Dx case to Baylor’s Drs. Jacqueline Birnbaum & Zaven Sargsyan, and Johns Hopkins Dr. Bibin Varghese

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Human Dx Case link

Dr. Jacqueline Birnbaum

Dr. Birnbaum graduated from Boston University School of Medicine. She is a third year Internal Medicine resident at the Baylor College of Medicine, and will be staying in Houston next year for her chief residency. Her clinical interests include primary care and medical education. When not in the hospital and clinics, she enjoys exploring the Houston foodie scene, watching movies, enjoying all things true crime, and spending time with her husband, Tyler, and Olde English Bulldogge, Bella.

Dr. Bibin Varghese

Bibin was born in the United Arab Emirates and moved to Texas as a teenager. He graduated from Baylor College of Medicine and is currently a 2nd year Internal Medicine resident at the Johns Hopkins Hospital. Bibin’s interests include cooking, watching the Great British baking show, eating, and going to the gym. His clinical interests include cardiology and medical education.

Dr. Jad Al Danaf

Dr. Al Danaf is a third year Cardiovascular Medicine Chief Fellow at the University of Utah and is board certified in Internal Medicine. He graduated from the Lebanese American University School of Medicine and finished his Masters in Public Health in Biostatistics & Epidemiology with a certificate in Quality, Patient Safety and Outcomes Research from the Johns Hopkins Bloomberg SPH. He completed his Internal Medicine training at Thomas Jefferson University Hospital in Philadelphia. He is an aspiring Interventional Cardiologist with interests in cardiac critical care, mechanical support, medical education, provider wellness, and quality improvement projects. Outside of work he enjoys cooking, being a foodie, exploring the outdoors and learning about new cultures with his wife and friends.

Dr. Zaven Sargsyan

Dr. Zaven Sargsyan is a hospitalist and associate residency director at Baylor College of Medicine (BCM). He completed medical school at BCM and medicine residency at Massachusetts General Hospital, and now rounds at Ben Taub Hospital and the VA in Houston. His academic interests include clinical decision-making, physical diagnosis, point-of-care ultrasound, and the language of medicine. In his free time, he likes to play soccer and chess with his nephews and hang out with his wife and fellow clinical problem solver Steph Sherman.

Human Dx

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Episode description

Dr. Saman Nematollahi presents a clinical unknown to Dr. Jennifer Babik

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Show Notes

Dr. Jennifer Babik

Jennifer Babik is an Associate Clinical Professor in the Division of Infectious Diseases at UCSF. She specializes in clinical infectious diseases, with a particular focus on infections in immunocompromised hosts. She attends on the Immunocompromised Host and General Infectious Diseases Consult Services as well as the Internal Medicine teaching wards. She is also very interested in medical education, in particular the intersection of subspecialty education and residency training. She is an Associate Program Director for the Internal Medicine Residency and also the Infectious Diseases Fellowship at UCSF. She teaches about infectious diseases in various courses for students, residents, fellows, and faculty.

Dr. Saman Nematollahi

Saman (TxID_Edu) is from Tucson, AZ. He graduated from the University of Arizona College of Medicine and finished internal medicine residency at Columbia. He is currently a second year ID fellow at Johns Hopkins. He is interested in transplant ID and is obtaining a Master’s of Education in the Health Professions at The Johns Hopkins School of Education. He enjoys cooking with Reza and washing the dishes. In his spare time, he loves to watch PJ Masks with his wife and son, who was featured in Episode 42 as AstroBoy.

Episode description 

Dr. Amit Goyal joins the CPSolvers to share his approach to heart failure with a reduced ejection fraction

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HFrEF schema

Patreon website

Dr. Amit Goyal

Amit Goyal (@AmitGoyalMD) is a cardiology fellow at the Cleveland Clinic.  He completed his medical school at the University of California, San Diego and went on to enjoy residency training in the Osler Program at Johns Hopkins, where he served as the Assistant Chief of Service of the Barker Firm (aka Firm of Choice!).  As ACS he co-founded (with Reza Manesh!) Osler Grand Rounds, an interactive mystery case discussion guided by expert discussants, and helped establish a novel morning report structure integrating bedside skills education.  Amit is looking forward to a career as an interventional cardiologist and clinician educator.  He began the Osler Program’s twitter account (@OslerResidency) and now co-manages the CCF Cardiology fellowship twitter account (@CCFcards).  He relishes time with friends and family including with his wife Riddhi and son Dhruv.

Episode description

The CPSolvers share a case of altered mental status and hypercalcemia – let’s practice those schemas together!

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Schemas

Altered mental status

Hypercalcemia

Show Notes

Episode description

Dr. Anand Jagannath presents a Human Dx unknown to Rabih and UAB residents Drs. Shipley & Urquiaga

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Human Dx case link

Case referred by Dr. Robert Thomas

Dr. Mariana Urquiaga

Mariana Urquiaga is a second-year internal medicine resident at the University of Alabama at Birmingham. She is from Lima, Peru, where she graduated from Universidad Peruana Cayetano Heredia. She has an interest in disorders of gut immunology. Outside of the hospital, she enjoys reading, swimming, and spending time with her boyfriend, Mauricio, and her dog, Otis. 

Dr. Lindsey Shipley

Lindsey Shipley is a second year internal medicine resident at the University of Alabama, Birmingham. She was raised in Jackson, TN and received her medical degree from East Tennessee State University, Quillen College of Medicine. After residency, she hopes to pursue a career in gastroenterology. In her free time she enjoys lifting weights and spending time with family, friends, and her Airedale Terriers, KC and Izzy. 

Dr. Anand Jagannath

Dr. Anand Jagannath is a clinician-educator at the University of California, San Diego (UCSD) and hospitalist at the VA San Diego. He completed medical school at the Tufts University School of Medicine and internal medicine residency and chief residency at Albert Einstein College of Medicine/Montefiore Medical Center. At UCSD, Anand’s interests include bedside team rounding, teaching clinical reasoning to medical students and residents, learning from his learners, and promoting a safe and inclusive learning environment. He is also a Section Editor for adult medicine cases at the Human Diagnosis Project. When he’s not getting excited about medicine, you’ll probably find Anand cooking food, watching shows about food on Netflix, running, or playing basketball or his violin.

Human Dx

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Episode description

Dr. Andrew Smaggus presents a Human Dx unknown to Reza and SLU residents Drs. Hendrickson and Bteich

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Human Dx case link

Dr. Jordan Hendrickson

I am from the great state of Oklahoma (Ohhhhhh-klahoma if you say it like the musical). I attended medical school and stayed for residency at Saint Louis University where I am currently a second year resident. After residency I hope to pursue a fellowship in pulmonology and critical care. I’m a serial hobbyist with interests ranging from sewing, to college football (Boomer Sooner), to researching future projects to do around my house. 

Dr. Fernand Bteich

I hail from Lebanon and went to Saint Joseph University School of Medicine in Beirut (learnt medicine in French). I am now a third year Internal Medicine Resident at the Saint Louis University Hospital. I am pursuing a fellowship in hematology and oncology after residency. In my free time, I enjoy attending concerts, trying new restaurants, working out, fiddling with computer hardware and binging on Youtube.

Dr. Andrew Smaggus

Dr. Andrew Smaggus is a general internist in Kingston, Ontario, Canada. He is currently pursuing a Ph.D. in Healthcare Quality & Safety at Queen’s University. His interests include complexity science and its applications to healthcare.  He has served as a contributing editor at HumanDx since 2017

Human Dx

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Episode description

Dr. Casey McQuade co-host of the popular case-based clinical reasoning handle @MedEdPGH presents a clinical unknown to Reza and Rabih.

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Show Notes

Dr. Casey McQuade

Dr. Casey McQuade is a current chief medical resident at the University of Pittsburgh Medical Center. He completed his undergraduate studies in bioengineering and subsequently medical school at the University of Pennsylvania in Philadelphia. After he finishes his chief year, he will pursue a career as an academic hospitalist and wants to continue developing his skills as a clinician-educator. His primary research interests include strategies for reducing heart failure readmission rates and the use of social media for education. With the help of his colleagues, he runs the popular Twitter feed @MedEdPGH, which hosts live case discussions focused on developing participants’ clinical reasoning skills. Outside of work, Casey enjoys running, hiking, and playing the piano.

Episode description

The CPSolvers share a schema for chest pain

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