Core IM | Internal Medicine Podcast

Latest Episodes:

Novel Coronavirus: What the Clinician Needs to Know Interview Feb 04, 2020

Show notes

What are the symptoms? What distinguishes coronavirus from other influenza-like illness? When coronavirus is suspected, what should you do?

Show notes and references

CME credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

ACP Interactive Learning ModuleTime Stamps

01:30 Novel parts of coronavirus
03:00 What symptoms do patients present with for the novel coronavirus?
04:22 What distinguishes coronavirus from other influenza-like illness?
05:31 When coronavirus is suspected, what should you do?
07:13 What does testing for coronavirus entail?
09:06 What kind of isolation is required?
10:13 Do patients need to be isolated in biocontainment units?
10:42 What is treatment for the novel coronavirus?
12:30 Potential for vaccines
15:23 What is R0?
17:12 Animal reservoirs with 2019-nCoV, SARS, and MERS
19:18 What should we tell patients for prevention?

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#57 A 39M on Inpatient Psychiatry with a Fever: Hoofbeats Segment Jan 22, 2020

Show notes

How do you learn from diagnostic errors? Walk through a case that the host had initially gotten wrong and uncover possible reasons as why from data gathering to hypothesis generation to the interplay between hypothesis generation and evaluation. Learn interesting tidbits on prior work in medical education around how we think, particularly around diagnostic failures.

CME Credit: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im

Time Stamps

02:39 Case Introduction
04:46 Yes/No questions with our first two discussants
18:43 The diagnosis is revealed
21:14 Why did I miss the diagnosis?
27:44 Using diagnostic problem solving to break down the case and understand our errors
30:20 The importance of data gathering
30:49 Introducing our third clinician
34:17 Hypothesis generation
37:11 The interplay between hypothesis generation and evaluation
38:34 The win-stay, lose-shift heuristic
41:33 Cognitive forcing strategies
49:32 Knowledge vs. experience

Tags: Dermatology, rash, DRESS, AGEP, varicella

#56 Prognosis: At the Bedside Segment Jan 01, 2020

Show notes

Why is prognostication hard? How do we improve at communicating prognosis? How should we approach uncertainty? Explore this and more on this At the Bedside episode!

Prognosis Calculators, Transcript and References

Time Stamps

02:48 What is prognosis?
04:00 Why offer prognostication?
08:32 Why is prognostication hard?
16:41 How do we improve at communicating prognosis?
21:56 How should we approach uncertainty?
31:06 Take Aways

Tag: life expectancy, CoreIM

#55 Influenza History and Vaccine: Mind the Gap Segment Dec 18, 2019

Show notes

Dive deeper into hx of the influenza virus, how vaccines are made and vaccine effectiveness ! Time Stamps

02:59 The history of the influenza virus
08:18 What does the influenza vaccine target?
13:20 Chickens, and bugs, and mammalian cells, oh my! How the vaccine is made.
14:00 What to do about egg allergies.
15:53 Vaccine effectiveness and herd immunity.
17:43 Waning immunity and other debates

Show Notes, Transcript and References

Get CME-MOC credit with ACP!

#54 Home Health Aides: Interprofessional Education Series Nov 27, 2019

Show notes

Explore gaps in your knowledge about the home health world, particularly on home health aides!

Get CME-MOC credit with ACP !
Full transcript, show notes, references

Time Stamps:

02:33 What support do our patients have at home and how does those people play a role in their care?

06:00 Are there various types of home care workers?

07:25 What role do home attendants play in caring for a patient?

08:31 What tasks do home health aides do?

10:11 What are the types of "skilled carez'?

13:17 What can Medicare cover for older adults in terms of home health aides?

15:17 How does Medicare define homebound?

16:03 How does having Medicaid impact access to home care?

19:10 What if a patient isn’t eligible for Medicare or Medicaid?

19:43 What is the cost to use a private agency for home health services?

24:02 What are some challenges that home health aides face?

25:42 What are “plans of care”?

30:01 Who makes up the home care workforce?

31:52 When patients get discharged from the hospital, do they go home to the same home care assistance?

#53 Heparin-Induced Thrombocytopenia: 5 Pearls Segment Nov 13, 2019

Show notes

Get CME Credit with ACP! Full Transcript with references and show notes Time Stamps

4:30 What is the daily risk of thrombosis if HIT Is left untreated?
5:40 What happens during platelet activation?
07:11 How long does it take for patients to develop for IgG antibodies to Heparin to form?
09:52 Is HIT common?
10:28 Who is at higher risk for HIT?
11:48 Why does low molecular weight heparin have a lower risk for HIT than unfractionated heparin?
15:30 Approach to thrombocytopenia
17:44 How do medications cause thrombocytopenia?
18:38 With medications, what is the time course between medication initiation and thrombocytopenia?
22:20 What is the sensitivity and specificity of anti-PF4 antibody?
23:58 How does the serotonin-release assay (SRA) work?
29:10 What type of anticoagulant do you choose for treating HIT?
31:58 Why is it important to not use warfarin in patients with platelet counts <150,000?
33:32 What is the treatment duration for a patient has confirmed HIT?
36:29 Dr. Cuker’s story and the "Scarlet H"
39:07 Dr. Linkin’s Recap
42:25 Dr. Linkin’s story
44:37 Pearl 5: Throwback to coronary calcium scores

#52 Gallows Humor: At the Bedside Segment Oct 30, 2019

Show notes

House of God author, Samuel Shem and Prof Katharine Watson share thought-provoking takes on Gallows Humor. Laugh and listen to this captivating take on the different shades of humor in the day-to-day of medicine.Time Stamps

02:33 Episode preview and Guest Introductions
04:20 Definition of Gallows Humor
07:25 Gallows Humor by Comedians vs Patients vs Physicians

The Good

08:15 Benefits/Functions of Humor in General
11:10 Connection
13:07 Coping/Catharsis
16:22 Resistance Against Oppression
19:03 Humor as our Authenticity/Humanity

The Bad, The Ugly

21:01 Unintended Audiences (e.g., patients, families)
25:30 “Corporeal” Joking
28:00 Toxic Role Modeling
31:10 Desensitization/Losing Empathy
Tips, Takeaways & Conclusion33:48 Challenging Inappropriate Jokes
35:45 Excessive Gallows Humor: Signal of Distress?
37:17 Using Gallows Humor: Questions to Ask Yourself
38:40 Keeping the Faith!

41:11 Excerpt from Man’s 4th Best Hospital by Samuel Shem

Transcript and References

Tag: medical humanities, medical ethics, CoreIM, IMCore

#51 A 65M with Fatigue: Hoofbeats Segment Oct 16, 2019

Show notes

1st outpatient clinical reasoning case on Core IM Hoofbeats!

Get CME-MOC Credit (live at 9AM EST on 10/16)

Time Stamps

01:18 Case introduction
11:40 The Casablanca strategy
23:17 The diagnosis revealed
25:30 Logical fallacy: Denying the antecedent
33:22 Components of illness scripts
41:37 Conclusion

Show notes, transcripts and references!

Do you have a good case or an expert you would like to suggest for an episode? Send it our way at hello@coreimpodcast.com

Tag: normocytic anemia, splenomegaly, CoreIM, endocarditis, clinic case

#50 Blood Cultures: Mind the Gap Segment Oct 02, 2019

Show notes

Go deeper into the world of blood cultures!

Time stamps

04:10 Review of Choosing Wisely Guidelines
05:55 What are estimated incidences of positive blood cultures?
06:17 Which clinical signs or patient history is more likely to have positive blood cultures?
09:48 What is the estimated incidence of false positive blood cultures?
11:01 What infections more likely to have bacteremia?
13:50 How do positive blood cultures impact patient outcomes and the use of resources?

Show notes, transcript, and references

Tags: Infectious disease, CoreIM, pyelonephritis, cellulitis, community acquired pneumonia

#49 Smoking Cessation: 5 Pearls Segment Sep 18, 2019

Show notes

Practical tips on smoking cessation! Get CME Credit with ACP!

Full Transcript with References and Show Notes

Time Stamps

04:50 What questions are important to ask after a patient who contemplative about quitting tobacco?
07:00 Is quitting abruptly on a quit date or gradual cessation to a quit date better?
08:10 How can technology help support patients who are trying to quit?
08:49 How should we prepare patients who quit smoking and are worried about weight gain?
11:06 How can we try to convince patients to use medication as assistance to quit smoking?
11:50 What is the most effective nicotine replacement approach?
13:54 What are the potential side effects of the nicotine patch?
15:00 What should we prescribe for patients who smoke <5 cigarettes a day?
16:28 How can we determine how severe a patient’s nicotine dependence is?
18:26 When is the ideal frequency of nicotine gum or lozenge?
21:45 How does varenicline work?
25:05 Can you start varenicline in patients who have had psychiatric history?
27:15 What major side effect is seen in patients taking bupropion?
29:15 How do e-cigarettes work?
31:18 How should we approach adding e-cigarettes into a patient’s plan for quitting?
31:42 How should we discuss e-cigarette use with our patients?
33:47 Recap
39:54 Screening for Barrett’s Esophagus

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