Core IM | Internal Medicine Podcast

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

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

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

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

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

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

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

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

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

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

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

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

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

1. How good is a dipstick, urinalysis and UACR in detecting albuminuria? (1:42)
2. What conditions that lead to transient proteinuria? What is the appropriate interval to recheck and how should be it be repeated? (5:14)
3. Who should be screened for albuminuria and can it prognosticate risk for cardiovascular mortality? (7:47)
4. Does increasing RAAS inhibition improve renal outcomes? (10:57)
5. Throwback Question: How do you prescribe oral iron and what tips do you tell your patients? (13:11)

For full show notes: https://www.coreimpodcast.com/2018/02/28/5-pearls-albuminuria/

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

Time Stamps:

1. How did prior understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25)
2. How is COPD diagnosed? (6:13)
3. How has COPD been classified and why? (6:42)

For full show notes: https://www.coreimpodcast.com/2018/02/14/mind-the-gap-copd-classifications/

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

1. What is the focused history, physical and lab workup in a patient with chronic HBV? (1:40)
2. What is the best imaging to evaluate for intermediate stages of liver fibrosis? (4:06)

• What scoring tools can you use to estimate fibrosis and what are their limitations?

1. What factors do you use to assess which patients get treatment? (7:41)
2. What drugs are available for HBV treatment and how do you choose? (11:18)
3. Which chronic HBV patient should be screened for HCC, and how often? (14:45)

For full show notes: https://www.coreimpodcast.com/2018/01/31/5-pearls-on-chronic-hepatitis-b-2/

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

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

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

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

• In which populations is HBV vaccination recommended?

1. What are the four possible meanings of an isolated positive total anti-HBc? (13:55)
2. In an asymptomatic adult, is it necessary to send an anti-HBc IgM to distinguish acute from chronic HBV infection? (15:01)
3. What are the implications of seroconversion of HBeAg from positive to negative? (16:19)

For full show notes: https://www.coreimpodcast.com/2018/01/17/5-pearls-on-chronic-hepatitis-b/

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Let's go deeper as to why we do what we do: albumin in spontaneous bacterial peritonitis (SBP) ! Time Stamps:1. How much albumin is recommended in SBP? (1:45)2. What antibiotics are used for the treatment of SBP? (2:30)3. Why do we give albumin in SBP? (4:15) - How does albumin compare to crystalloid? (7:15) - Do we always have to give to albumin? (9:00) For full shownotes: https://www.coreimpodcast.com/2018/01/03/mind-the-gap-albumin-in-sbp/

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

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

1. What is asterixis? (6:10)

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

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

• What are their indications?

1. What is the connection between hypokalemia and HE? (14:10)
2. What is the discriminatory power of an ammonia level in HE? (16:40)

• In what situation does the NH3 has stronger predictive value?

For full shownotes: https://www.coreimpodcast.com/2017/12/13/5-pearls-on-hepatic-encephalopathy/

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Part 2 on Abdominal Paracentesis ! Let's go deeper

Time Stamps

Should a cirrhotic’s INR and platelets deter you from doing a paracentesis? (3:15)

Do generalist have worse procedure complications than specialists?  (5:40)

Do you need to send ascites fluid in blood culture bottles? (6:10)

For full shownotes: https://www.coreimpodcast.com/2017/11/29/mind-the-gap-abdominal-paracentesis-2/

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

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

• What is optimal dosing for oral iron?

1. In which patients would you consider IV iron? What are the risks? (11:41)
2. Throwback Question: What is a medication-overuse HA? (14:44)

For full shownotes: https://www.coreimpodcast.com/2017/11/15/5-pearls-on-iron-deficiency-anemia/

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You have always been told to do a diagnostic paracentesis on admission in cirrhotics with ascites, but why? Can you just get away with clinical judgement to rule out SBP? Is faculty judgement any better? And if you’re going to do a paracentesis on admission, do you need to do it right away? Go deeper with Dr. Steve Liu and Dr. Janine Knudsen!

Click the link for the full show notes: https://www.coreimpodcast.com/2017/11/01/mind-the-gap-admission-paracentesis/

Time Stamps

1. What do guidelines say about diagnostic paracentesis in cirrhotics with ascites? (1:51)
2. Can we just use clinical judgement to decide if paracentesis is warranted? (3:13)

• Do attendings have better clinical judgement than residents to rule out SBP?

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

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Cement your knowledge on headaches with 5 Pearls on when imaging is indicated, approach to abortive medications, medication overuse headaches, when to use migraine prophylaxis and effective non-pharmacological treatment for migraines!

For full shownotes: https://www.coreimpodcast.com/2017/10/18/5-pearls-on-headaches/

Time Stamps

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

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CORE IM is an independent consortium of educators aligned to create internal medicine-specific portable learning tools in the form of podcasts, corresponding show notes and illustrations. Segments include 5 Pearls and Mind The Gap.

For more information: https://www.coreimpodcast.com/2017/10/13/introducing-the-core-im-podcasts-5-pearls-mind-the-gap/

Sincerely,

CORE IM team:

Executive Producer: Shreya P. Trivedi, MD (@ShreyaTrivediMD)

Five Pearls Producer: Marty Fried, MD (@Marty_Fried)

Mind the Gap Producer: Steve Liu, MD

Advisors: Neil Shapiro MD, John Hwang MD, Vincent Santillo MD

Podcast editing and technical set-up: Harit Shah and Steven Liu MD

Director of Sound Design, Theme song: Shaun Finnegan

Artistic director: Dr. Mike Natter (@mike_natter)

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