The Curbsiders Internal Medicine Podcast

Latest Episodes:

#244 Vulvovaginitis for All Ages with Dr. Monica Christmas Nov 30, 2020

Show notes

Everything you need to know about vulvovaginitis: candidiasis, bacterial vaginosis, and Genitourinary Syndrome of Menopause. Join us on the journey of a lifetime as we learn all about diagnosing, treating and managing vulvovaginal conditions in patients of all ages. Plus, a bit on how to recognize and treat lichen sclerosus. Our brilliant guest for this episode is Dr. Monica Christmas (@drmonicaxmas on Twitter), who is a self-described yoga enthusiast, avid reader, wannabe artist and gynecologist. Dr. Christmas is currently an Assistant Professor at the University of Chicago in the section of Minimally Invasive Gynecologic Surgery where she is the director of the Menopause Program. Monica specializes in gynecologic surgery, abnormal uterine bleeding and menopause management with an interest in sexual dysfunction. Her focus is on helping women live healthy, vibrant, happy lives.

Credits

Produced by: Kate Grant MD; Sarah Phoebe Roberts MPH
Written by: Kate Grant MD
Show Notes by: Sarah Phoebe Roberts MPH, Kate Grant MD
Cover Art and Infographic: Kate Grant MD
Hosts: Kate Grant MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
Guest: Dr. Monica Christmas, MD

Sponsor: ACP’s I Raise the Rates
Join with other clinicians in working to raise influenza and other adult vaccination rates. Visit acponline.org/ai to access free tools and learn new strategies to support your efforts.

Sponsor: VCU Health CE

#243 Diabetes Triple Distilled Nov 23, 2020

Show notes

Listen in as we recap four of our favorite diabetes episodes to bring you the pearls you need to stay up to date on type 2 diabetes management in the clinic. We cover pitfalls of A1c testing, guidelines for A1C targets, when and how to use the newer medications SGLT-2 inhibitors and GLP-1 agonists. We wrap up with a discussion of managing DM2 in patients with kidney disease and in which patients to consider de-intensifying treatment. Feel confident managing diabetes with the latest data in 2020!

Listeners can claim 4 HOURS of Free CE credit for this episode through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

Credits

Written and Produced by: Molly Heublein, MD
Infographic and Cover Art: Isabel Valdez, PA
Show Notes: Isabel Valdez, PA; Molly Heublein, MD
Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein, MD
Editors: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com

Sponsors:

ACP’s I Raise the Rates

Join with other clinicians in working to raise influenza and other adult vaccination rates. Visit acponline.org/ai to access free tools and learn new strategies to support your efforts.

VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

Time Stamps

0:00 Intro,

2:45 Pitfalls of A1c testing,

7:00 Diabetes goals/A1c guidelines; Macrovascular vs Microvascular benefits,

16:20 Choosing between SGLT2 inhibitors vs GLP1 agonists,

19:10 Stuart rants on insulin for symptomatic hyperglycemia,

22:32 Start your patient on an SGLT2i and counsel them about potential adverse events,

30:30 GLP-1 agonists,

36:50 Deintensification; Diabetes Treatment in CKD,

Tags

Diabetes, hypoglycemia, SGLT2 inhibitors, GLP-1 agonist, metformin, CKD, primary care, assistant, doctor, education, family, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, physician, resident, student

#242 Wilderness Medicine: Prepare for Disaster Nov 16, 2020

Show notes

Explore the essentials of Wilderness Medicine and prepare yourself for austere environments as we discuss Altitude Sickness, Frostbite, Animal Bites, Thermoregulation, Wound Care and the proper way to apply a tourniquet.

Thinking about outdoor escapes and vacations now more than ever? Listen as our esteemed guest Dr. Thomas DeLoughery @Bloodman (Oregon Health & Science University) takes us through the fascinating, and at times chilling, world of Wilderness Medicine. This episode will empower you to explore the great outdoors as safely as possible. We discuss the breadth of wilderness medicine, multiple unique clinical entities encountered in austere environments, and practical ways to protect yourself and others on your adventures. This episode is truly wild!

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

Credits

Written, Produced, and Infographic by: Avital O’Glasser MD, FACP, FHM
Show Notes: Deborah Gorth ScM and Avital O’Glasser MD, FACP, FHM
Cover Art: Kate Grant, MD
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Avital O’Glasser MD, FACP, FHM
Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
Guest: Thomas DeLoughery MD, MACP, FAWM

Sponsors: Provider Solutions and Development

Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders.

VCU Health CE

Time Stamps

Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/
Sponsor - VCU Health CE curbsiders.vcuhealth.org
00:00 Intro, disclaimer, guest bio
03:45 Guest one-liner, advice and Picks of the Week*
08:10 Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/
09:00 Case of mountaineering; What is Wilderness Medicine? 
12:05 What’s in your first aid kit? 
21:36 Altitude sickness: acute mountain sickness, high altitude cerebral edema and High altitude pulmonary edema 
31:25 Hypothermia
39:36 Frostbite  
47:25 Hyperthermia: Heat exhaustion and Heat stroke; How much water should you drink? 
51:55 Bat bites and rabies 
58:20 Snake bites 
66:03 Wound care and tourniquets 
75:40 Take Home Points; Outro; Bonus clip
Sponsor - VCU Health CE curbsiders.vcuhealth.org

Links*

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will learn the basics of wilderness medicine and how to approach a few common conditions.

Learning objectives

After listening to this episode listeners will…

Appreciate Wilderness Medicine as a medicine subspeciality and understand why or how someone might pursue this clinical focus area
Recognize signs and symptoms of high altitude sickness
Develop an approach to treating animal bites and injuries
Learn high yield tips for administering first aid in the wilderness including field hemostasis

Disclosures

Dr DeLoughery reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation

O’Glasser AY, Gorth D, Deloughery T, Williams PN, Watto MF. “#242 Wilderness Medicine: Prfor Disaster”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original air date November 16, 2020.

Tags

Wilderness Medicine, Travel medicine, first aid, first aid kit, altitude sickness, acute mountain sickness, high altitude cerebral edema, high altitude pulmonary edema, acetazolamide, dexamethasone, hypothermia, frostbite, frostnip, heat exposure, heat exhaustion, heat syncope, hyperthermia, hyponatremia, animal bites, bats, rabies, snakes, antivenom, wound care, tourniquet, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#241 Chronic Cough Nov 09, 2020

Show notes

Rejoice! as our phenomenal guest Dr. Brad Hayward @bradleyjhayward (Weill Cornell Medicine) demystifies chronic cough for the primary care provider. Dr. Hayward, an internist, pulmonologist, intensivist AND palliative care physician sits down with us to discuss common causes for chronic cough, work up pearls and options for treatment. Follow him on Twitter, @BradleyJHayward. Listeners can claim free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). We hope you enjoy learning from this episode as much as we enjoyed producing it!

Credits

Written (including CME questions) and Produced by: Cyrus Askin MD
Infographic by: Cyrus Askin MD
Cover Art: Kate Grant MBChb, MRCGP
Hosts: Matthew Watto MD, FACP; Stuart Brigham MD; Paul Williams MD, FACP
Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com
Guest: Brad Hayward MD

Sponsors: Panacea Financial

This episode is supported by Panacea Financial, digital banking built for doctors, by doctors. At Panacea Financial you can have your own free personal banker and a support team that works around the clock- just like you do. Open your free checking account today at panaceafinancial.com

Panacea Financial, a Division of Sonabank, Member FDIC

VCU Health CE

Time Stamps

Sponsor - Panacea Financial panaceafinancial.comSponsor - VCU Health CE curbsiders.vcuhealth.org
00:00 Intro, disclaimer, guest bio; Guest one-liner and Pick of the Week*
06:23 Sponsor - Panacea Financial panaceafinancial.com
07:30 Case of Post Infectious Cough; Basic definitions for cough
Important aspects of the history
Empiric therapies for post-viral cough
22:50 Case of idiopathic chronic cough; Physical exam
29:20 Basic testing and empiric therapy for the common causes of chronic cough
41:51 When to refer to pulmonology; Therapy for idiopathic chronic cough; OTC cough meds
54:28 Take home message; Outro
Sponsor - VCU Health CE curbsiders.vcuhealth.org

Links*

90 Day Fiancé (show)
Below Deck Mediterranean (show)
Mastering Communication with Seriously Ill Patients by Anthony Back, Robert Arnold & James Tulsky (book)

Goal

Listeners will develop a pragmatic approach to evaluating subacute and chronic cough in adult patients.

Learning objectives

After listening to this episode listeners will be able to…

... define sub-acute vs chronic cough
... build a repertoire of history questions geared towards identifying the etiology of cough in a patient
... build a toolbox of diagnostic studies / tests that can be used in the evaluation of cough
... marry history, physical and diagnostic studies into a coherent approach to diagnosing subacute and chronic cough through a tiered/logical approach
... understand empiric therapies for cough that may have an advantageous risk-reward profile, even in the absence of diagnosis
... educate patients on common causes for subacute cough and chronic cough, as well as how to appropriately set expectations regarding symptoms severity and duration

Disclosures

Dr. Hayward reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation

Askin CA, Hayward B, Williams PN, Brigham SK, Okamoto E, Watto MF. “241: Chronic Cough”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original Air Date: November 9, 2020.

Tags

Cough, dyspnea, asthma, COPD, eosinophil, IL-5, allergy, ENT, allergist, pulmonary, pulmonologist, PFT, spirometry, post-nasal drip, GERD, reflux, eczema, rash, atopy, mucus, bronchiectasis, lung, antihistamine, CT, X-Ray, smoking, vaping, birds, dust, cockroaches, steroids, ICS, inhaled, gabapentin, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#240 Elbow Pain: Straighten it out Nov 02, 2020

Show notes

Returning guest expert Dr Ted Parks helps us get the elbow straight with a simple approach to common causes of elbow pain for primary care. Listen as he guides Stuart through physical exam techniques (or watch them on YouTube) for epicondylitis and learn what the bursa is there for anyways. Find out what fracture you can treat in your office, why you shouldn’t stab straight into the olecranon bursa and when elbow pain should be referred. Feel confident when your patient comes in with elbow pain!

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

Credits

Written and Produced by: Molly Heublein, MD
Cover Art and Infographic: Edison Jyang
Hosts: Stuart Brigham MD, Matthew Watto MD, FACP; Molly Heublein, MD
Editor: Emi Okamoto, MD (written materials); Clair Morgan of Nodderly.com (audio/video)
Guest: Ted Parks, MD

Sponsors Provider Solutions and Development

VCU Health CE

Time Stamps

Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/
Sponsor - VCU Health CE curbsiders.vcuhealth.org
00:00 Intro, disclaimer, guest bio
04:00 Picks of the Week*
Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/
09:50 Medial and lateral epicondylitis case, Elbow anatomy
13:00 Pathophysiology of epicondylitis, Epicondylitis exam, Epicondylitis treatment
34:11 Olecranon bursitis, Bursitis diagnosis and aspiration
46:12 Radial head fracture diagnosis, Radial head fracture treatment
55:30 Cubital tunnel nerve entrapment
57:45 Platelet rich plasma
60:39 Take home points, Plug and Outro
64:00 Bonus Pick of the Week
Sponsor - VCU Health CE curbsiders.vcuhealth.org

Goals

Listeners will have a working differential of elbow complaints that commonly present in primary care, and understand how to diagnose these and initiate treatment.

Learning objectives

After listening to this episode listeners will...

Perform an exam for medial and lateral epicondylitis.
Describe treatment options for medial and lateral epicondylitis
Identify when further evaluation for clinical olecranon bursitis beyond clinical exam is needed
Explain how radial head fractures differ from most other fractures, and why casting or surgery is generally not needed.

Links*

Molly’s Pick: The Warmth of Other Suns (book) by Isabel Wilkerson
Stuart’s Pick: The Fringe (TV show), JJ Abrams
Practical Office Orthopedics (textbook) by Ted Parks, MD

References

Johnson GW, Cadwallader K, Scheffel SB, Epperly TD. Treatment of lateral epicondylitis. Am Fam Physician. 2007 Sep 15;76(6):843-8. PMID: 17910298.
Simental-Mendía M, et al. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials. Clin Rheumatol. 2020 Aug;39(8):2255-2265. doi: 10.1007/s10067-020-05000-y. Epub 2020 Feb 26. PMID: 32103373.
Parks, Ted. Practical Office Orthopedics. McGraw-Hill Education / Medical; 1st Edition (December 29, 2017).
Khodaee M. Common Superficial Bursitis. Am Fam Physician. 2017 Feb 15;95(4):224-231. PMID: 28290630.
Liow RY, Cregan A, Nanda R, Montgomery RJ. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. Injury. 2002 Nov;33(9):801-6. doi: 10.1016/s0020-1383(02)00164-x. PMID: 12379391.
Boone S, Gelberman RH, Calfee RP. The Management of Cubital Tunnel Syndrome. J Hand Surg Am. 2015 Sep;40(9):1897-904; quiz 1904. doi: 10.1016/j.jhsa.2015.03.011. Epub 2015 Aug 1. PMID: 26243318.

Tags

Elbow, orthopedics, olecranon bursitis, bursa, aspiration, septic joint, medial epicondylitis, lateral epicondylitis, radial head fracture, PRP, platelet rich plasma, humerus, olecranon, radius, tendonitis, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Disclosures

Dr Parks reports is the author of Practical Office Orthopedics (McGraw-Hill 2017) . The Curbsiders report no relevant financial disclosures.

Citation

Heublein M, Parks T, Jyang E, Brigham SK, Okamoto E, Watto MF. “#240 Elbow Pain: Straighten it out. A dabble into elbow care with Dr Ted Parks”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 02, 2020.

#239 Sinusitis: It’s Not That Tricky Oct 23, 2020

Show notes

A runny nose won’t have you running in circles this cold season with our fantastic overview of rhinosinusitis in all its forms! We discuss etiology and presentation of viral versus bacterial rhinosinusitis, practical counseling tips for guiding patients on nasal irrigation, and working up chronic rhinosinusitis! Our guest is the fabulous Dr. Dink Jardine, a general otolaryngologist, Commander in the US Navy, and Director for Professional Education (DPE) and Designated Institutional Official (DIO) at Naval Medical Center Camp Lejeune (NMCCL).

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

Credits

Written and Produced by: Paul Williams MD, FACP, Beth Garbitelli
Cover Art: Kate Grant MBChb, MRCGP
Infographic by: Beth Garbitelli
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com (audio)
Guest: Dink Jardine, MD

Sponsors: National Internal Medicine Day

Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential.

VCU Health CE

Time Stamps

Sponsor – National Internal Medicine Day, The American College of Physicians
Sponsor - VCU Health Continuing Education
00:30 Intro, disclaimer, guest bio
03:00 Guest one-liner, Favorite failure, Pick of the Week*: Still Life by Louise Penny
Sponsor – National Internal Medicine Day, The American College of Physicians
09:30 Case 1 - Acute Viral Rhinosinusitis
10:40 Rhinosinusitis vs. Sinusitis
14:20 Physical exam in rhinosinusitis
20:40 Counseling patients about viral vs. bacterial infection
22:56 Sinus regimen/nasal irrigation - “Is there a sinus toilet”
27:10 Intranasal fluticasone and other intranasal medications
29:40 Rhinitis medicamentosa
30:40 Nasal spray positioning
33:50 Case 1 - Double Sickening
37:40 Worst case scenarios from rhinosinusitis
40:40 Antibiotic treatment for bacterial rhinosinusitis
43:20 Failed improvement on antibiotics? Second-line options
49:30 Case 2 - Chronic rhinosinusitis
52:28 Etiology of chronic rhinosinusitis
53:33 Making a diagnosis of chronic rhinosinusitis
55:25 Treating chronic rhinosinusitis
58:40 Vasomotor rhinitis
60:40 Sinus irrigation counseling and tips (YouTube)
65:30 Case 3 - Allergic Rhinitis
70:13 Oral medications for allergic rhinitis; Chronic allergic/non-allergic rhinitis
73:51 Take-home points

Links*

Still Life: A Chief Inspector Gamache Novel by Louise Penny, Chief Inspector Gamache series
“Dr. Adappa and Dr. Palmer teach you How to do Nasal Irrigation” https://www.youtube.com/watch?v=Br928VfiC1M

Goals

Listeners will develop an approach to the diagnosis and management of rhinosinusitis.

Learning objectives

After listening to this episode listeners will...

Classify rhinosinusitis, including acute, chronic, bacterial, and viral.
Discuss the microbiology and pathophysiology underpinning rhinitis and sinusitis.
Differentiate the presentation and management of acute bacterial and acute viral rhinosinusitis.
Develop an approach to the diagnosis and management of allergic rhinosinusitis.
Recognize and manage patients with non-allergic rhinitis.
Discuss the role of antibiotic therapy and surgery in the management of rhinosinusitis.

Disclosures

Dr. Jardine reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation

Williams PN, Garbitelli B, Jardine D, Heublein M, Watto MF.. “#239 Sinusitis: It’s not that tricky.” The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 26, 2020.

Tags

sinus, sinusitis, rhinitis, acute bacterial, rhinosinusitis, bacterial, viral, virus, nose, chronic sinusitis, ENT, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#238 DVT / PE Triple Distilled Oct 22, 2020

Show notes

DVT / PE Triple Distilled! Our favorite VTE pearls summarized in this fast paced recap gleaned from our discussions with Dr Oren Friedman #92 Pulmonary Embolism for the Internist and hematologist, heavy metal enthusiast, Dr Michael Streiff #154 DVT and PE Master Class. Introducing our new Triple Distilled sub-series offering shorter episodes that reinforce and refresh key concepts from past shows along with any pertinent updates.

Listeners can claim 2 hours of Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

Credits

Written and Produced by: Matthew Watto MD, FACP
Cover Art by: Matthew Watto MD, FACP
Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsor: VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.

Time Stamps

00:00 Intro, disclaimer
01:40 Making the diagnosis of VTE
09:07 Triage and risk stratify Pulmonary Embolism
14:00 Anticoagulant choice; Duration of therapy after unprovoked DVT / PE
21:00 Workup for unprovoked DVT / PE; DOACs in special populations: at extremes of weight, advanced CKD and in antiphospholipid syndrome
28:22 IVC filters
30:20 Outro

Links

Check out the full show notes from previous Curbsiders’ shows covering VTE.

Dr Oren Friedman #92 Pulmonary Embolism for the Internist
Dr Michael Streiff #154 DVT and PE Master Class

Goals

Listeners will feel confident in the diagnosis and management of VTE

Learning objectives

After listening to this episode listeners will...

Diagnose (VTE) DVT and PE using imaging, risk scores and clinical gestalt

Risk stratify patients with pulmonary embolism

Choose the appropriate initial anticoagulant for VTE

Decide duration of anticoagulation for VTE

Recall real risks and questionable benefits of IVC filters in DVT / PE

Determine need for cancer or thrombophilia workup in unprovoked DVT / PE

Disclosures

The Curbsiders report no relevant financial disclosures.

Citation

Watto MF, Williams PN, Brigham SK, Watto MF. “#238 DVT / PE Triple Distilled”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 22, 2020.

Tags

Pulmonary embolism, vte, dvt, pe, heparin, anticoagulation, right ventricle, RV, left ventricle, LV, circulation, hypotension, shock, IVC filter, TPA, echocardiogram, CT scan, bleed, clot, deep, vein, thrombosis, DOAC, NOAC, anticoagulation, d-dimer, Wells, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#237 Ophthalmology for Primary Care Oct 19, 2020

Show notes

Fun, fluorescein, and fundoscopy unite as our esteemed guest, Dr. Nisha Chadha @iEducatorMD (Mount Sinai School of Medicine) brings us ophthalmology for primary care! Dr. Chadha is a medical educator and the content creator of the med-ed simulation website 20/20 Sim. She teaches us the 3-vital signs of ophthalmology, how to recognize common diabetic eye diseases, how to explain diabetic retinopathy to our patients, how to optimize a patient for cataract surgery and so much more. This episode is truly vision-ary!

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).

Credits

Written, Produced, and Infographic by: Carolyn Chan, MD
Cover Art: Kate Grant
Hosts: Matthew Watto MD, FACP; Carolyn Chan, MD
Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com
Guest: Dr. Nisha Chadha

Sponsors: National Internal Medicine Day

VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.

Time Stamps

Sponsor – National Internal Medicine Day, The American College of Physicians
Sponsor – VCU Health Continuing Education
00:30 Intro, disclaimer, guest bio
03:21 Guest one-liner, Carolyn’s Pick of the Week
09:05 Picks of the Week*
10:13 Case from Kashlak, 3 - Vital Signs of Ophthalmology
17:09 Ocular complications of diabetes
20:22 Screening for diabetic retinopathy; Reports and Abbreviations
26:07 Counseling Patients: The eye is a camera; Clinical symptoms of ocular complications
32:07 Fluorescein Stain; Treatment Options for Diabetic Eye Disease: NPDR, PDR, VH, and RD
41:16 Eye Vitamins for Macular Edema
43:35 Cataracts
47:22 Missing Glaucoma Drops
50:50 Periop Optimization for Cataract Surgery, Anticoagulation and Other Medical Management
58:14 Take Home Points, Plug: 20/20 Sim; Outro
Sponsor – VCU Health Continuing Education

Links*

Mindset: The New Psychology of Success by Carol S. Dwek
Crackdown Podcast
20/20 Sim Site

Goal Listeners will discuss screening, counseling, and management of common ocular diseases seen within primary care. Learning objectives

After listening to this episode listeners will…

Define and assess the three vital signs of ophthalmology.
List ocular complications of diabetes.
Counsel a patient on a new diagnosis of diabetic retinopathy.
Describe treatments for diabetic retinopathy.
Define proliferative retinopathy, non-proliferative retinopathy, and macular edema.
Compose a perioperative medication management plan for cataract surgery

Disclosures

Dr. Chadha reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation

Chan C., Chadha N., Okamoto E., Watto MF. “#237 Ophthalmology for Primary Care”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original air date October 19, 2020.

Tags

Eye, ophthalmology, ophtho, optometry, glaucoma, diabetes, diabetic retinopathy, macular edema, cataracts, cataract surgery, perioperative management, physical exam, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#236 Approach to Shortness of Breath: Physical Exam Series Oct 12, 2020

Show notes

Learn which exam maneuvers are worthwhile and which ones are worthless in your approach to shortness of breath. In our evidence based series on the physical exam, we discuss the approach to the dyspneic patient with Dr. Brian Garibaldi (Hopkins, SBM), associate professor of pulmonary and critical care medicine at Johns Hopkins, and co-president of the Society of Bedside Medicine. We discuss the physical exam’s effect on our differential diagnosis, maneuvers that are commonly taught, and some simple tests with great data that may go overlooked. Be prepared, this episode may take your breath away!

Credits

Written and Produced by: Justin Berk, MD, MPH, MBA and Sam Masur, MD
Infographic: Sam Masur, MD, Beth Garbitelli
Cover Art: Beth Garbitelli
Hosts: Stuart Brigham, MD; Matthew Watto, MD, FACP; and Paul Williams, MD, FACP
Editor:Justin Berk MD; Clair Morgan of nodderly.com
Guest(s): Brian Garibaldi, MD

Sponsors: National Internal Medicine Day

VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.

Time Stamps

Sponsor – National Internal Medicine Day, The American College of Physicians
Sponsor – VCU Health Continuing Education
00:00 Intro, disclaimer, guest bio
Sponsor – National Internal Medicine Day, The American College of Physicians
03:47 Introduction to evidence-based exam, pre-test probability, and likelihood ratios
05:29 Case from Kashlak Memorial
06:51 Dr. Garibaldi’s initial maneuvers for the dyspneic patient
11:33 Recapping the exam maneuvers
14:05 Likelihood ratios for common maneuvers
18:25 Over 6/Under 6 maneuvers
25:30 Recap of Dr. Garibaldi’s go-to maneuvers
28:19 Role of labs and diagnostic imaging
31:03 Role of point-of-care ultrasound (POCUS)
34:10 Friday at 5pm
36:31 Take home points
39:25 Outro
Sponsor – VCU Health Continuing Education

Links*

Goal

Listeners will feel confident how to optimally use the physical exam to guide clinical decision-making in patients presenting with dyspnea.

Learning objectives

After listening to this episode listeners will…

Describe the effectiveness of the exam when it comes to aiding diagnosis in a patient with dyspnea
Identify specific exam maneuvers that can aid clinical decision-making
Identify exam maneuvers that may not offer more information compared to imaging such as POCUS

Disclosures

This episode was made with assistance from the Society of Bedside Medicine and funding from the New York Academy Medicine. Dr Garibaldi reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation

Masur S, Garibaldi BT, Watto M, Williams P, Brigham S, Berk J. #236 Physical Exam Series: Approach to Shortness of Breath. The Curbsiders Internal Medicine Podcast. https:/www.thecurbsiders.com/episode-list. Original Air Date October 12, 2020.

References

Mochizuki K et al. Importance of respiratory rate for the prediction of clinical deterioration after emergency department discharge: a single-center, case-control study. Acute Med Surg. Nov 2016. doi:10.1002/ams2.252
Sarkar M et al. Physical signs in patients with chronic obstructive pulmonary disease. Lung India. 2019. doi:10.4103/lungindia.lungindia_145_18
Fagan TJ. Letter: Nomogram for Bayes theorem. N Engl J Med. 1975;293(5):257. doi:10.1056/NEJM197507312930513
Simel, David, et al. Rational Clinical Examination, McGraw-Hill Professional Publishing, 2009. ProQuest Ebook Central
McGee, Steven. Evidence-based physical diagnosis [4th edition] Elsevier, 2018. Clinical Key
Benbassat, J., Baumal, R. Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?. J GEN INTERN MED 25, 865–872 (2010). https://doi.org/10.1007/s11606-010-1327-8
Al Deeb M et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med. 2014;21(8):843-852. doi:10.1111/acem.12435
Yousefifard et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis. Emerg (Tehran). 2016;4(1):1-10.
Martindale et al. Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2016;23(3):223-242. doi:10.1111/acem.12878
Caldentey et al. Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure). JACC Heart Fail 2014.. doi:10.1016/j.jchf.2013.10.004

Tags

Physical exam, dyspnea, shortness of breath, auscultation, PMI, percussion, heart failure, wheeze, POCUS, COPD, JVD, hepatojugular reflux, observation, asymmetry, Brian Garibaldi, practice, pallor, lung, heart, hands.

#235 Spooky Cakes: Dapa-CKD, Turmeric for Knee Pain, Honey for URTI Oct 05, 2020

Show notes

Time for spooky cakes with a side of candy corn. We discuss Dapagliflozin (SGLT2i) for CKD, Turmeric for knee pain and Honey for URTI (cough) on this halloween themed hotcakes with Rahul Ganatra MD, MPH @rbganatra

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (Note: CME for this episode won’t be available until 10/12/20. We apologize for the inconvenience).

Credits

Producer: Sarah Phoebe Roberts
Written by: Rahul Ganatra MD, MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Sarah Phoebe Roberts MPH
Cover Art: Matthew Watto MD, FACP
Hosts: Rahul Ganatra MD, MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Sarah Phoebe Roberts MPH
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsors National Internal Medicine Day

VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.

Time Stamps

00:00 Sponsor – National Internal Medicine Day, The American College of Physicians
00:25 Sponsor – VCU Health Continuing Education
00:40 Intro, disclaimer, Picks of the Week
07:38 Sponsor – National Internal Medicine Day, The American College of Physicians
08:40 Dapa-CKD
20:00 Turmeric for Knee Osteoarthritis
32:10 Honey for URTI and Cough
46:32 Shout out to @votehealth2020 and PatientVoting.com
48:25 Outro
Sponsor – VCU Health Continuing Education

Links*

Candy Corn (autumn mix) and (classic)
Paul’s Halloween movie marathon: Cabin in the Woods, The Descent, The Witch, Ghostbusters

Goal

Listeners will review and perform critical appraisal of recent articles with the potential to change internal medicine practice

Learning objectives

After listening to this episode listeners will…

Review the potential benefits of dapagliflozin for prevent of CKD progression and death
Evaluate the utility of turmeric for osteoarthritis with inflammatory synovitis
Discuss the efficacy of honey for the treatment of acute upper respiratory tract infection and persistent post-infectious cough

Disclosures

The Curbsiders report no relevant financial disclosures.

Citation

Watto M, Ganatra R, Williams PN, Brigham SK, Roberts SP. “235 Spooky Cakes”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 5, 2020.

Tags

Dapagliflozin, slgt2i, sglt2 inhibitors, ckd, turmeric, curcumin, knee osteoarthritis, knee pain, synovitis, honey, urti, respiratory tract infection, cough, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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