The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2020/10/WDx-Episode-4_FINAL-2.mp3Dr. Steph Le shares a story of gender discrimination and Emma and Annette discuss gender biases and stereotypes with UCSF’s Department of Surgery Chair, Dr. Julie Ann Sosa Dr. Julie Ann SosaJulie Ann Sosa, MD MA FACS is the Leon Goldman MD Distinguished Professor of Surgery and Chair of the Department of Surgery at the University of California San Francisco (UCSF), where she is also a Professor in the Department of Medicine and affiliated faculty for the Philip R. Lee Institute for Health Policy Studies. Dr Sosa came to UCSF in 2018 from Duke. Her clinical interest is in endocrine surgery, with a focus in thyroid cancer. She is an NIH-funded investigator and author of more than 325 peer-reviewed publications and 78 book chapters and reviews, all largely focused on outcomes research, health care delivery, hyperparathyroidism, and thyroid cancer, with a focus on clinical trials. She has authored or edited 7 books. Dr Sosa is Treasurer of the American Thyroid Association (ATA) and serves on the Board of Directors/Executive Council of the ATA and International Thyroid Oncology Group, as well as practice guidelines committees for the ATA, NCCN, and the American Association of Endocrine Surgeons; for the ATA, she is chairing the committee responsible for writing the next iteration of differentiated thyroid cancer guidelines. She is the Editor-in-Chief of the World Journal of Surgery and is an editor of Greenfield’s Surgery: Scientific Principles and Practice. She has mentored more than 90 students, residents, and fellows, for which she was recognized with induction as a full member to the American College of Surgeons Academy of Master Educators in 2020, and with the Lewis E. Braverman Distinguished Lectureship Award from the ATA in 2017. Dr Sosa was born in Montreal and raised in upstate New York. She received her AB at Princeton, MA at Oxford, and MD at Johns Hopkins, where she completed the Halsted residency and a fellowship.Want to learn more about Women in Diagnosis (WDx) series?Blog post– by SmithaDownload CPSolvers App here Patreon website

https://clinicalproblemsolving.com/wp-content/uploads/2020/10/HDx_AD_CWRU-FINAL.mp3Description: Gizem Reyhanoglu presents a Human Dx unknown to Arsalan, Dr. Tranchito, & Dr. KramerDownload CPSolvers App herePatreon websiteSchemaWant to test your learning? Take our Episode QuizGizem ReyhanogluGizem Reyhanoglu is a 4th-year medical student at LECOM-Bradenton, applying to Internal Medicine this application cycle. She completed her undergraduate degree in biology at the University of Florida and completed a Master’s degree in Medical Sciences at the University of South Florida. In her spare time, Gizem enjoys watching The Office, training for half-marathon races, baking for her family/friends, and playing with her puppy, Leo. Lily TranchitoLily Tranchito is a PGY-3 at Case Western Reserve University/University Hospitals Internal Medicine program. She was born and raised in Cleveland, Ohio, earned her undergraduate degree from The Ohio State University, and graduated from Ohio University Heritage College of Osteopathic Medicine. She has a passion for medical education, cooking, gardening, daily walks around her neighborhood, and spending time with her family and friends. Patrick KramerPatrick Kramer is a PGY-3 in Internal Medicine at the Case Western Reserve University / University Hospitals Internal Medicine Residency Program in Cleveland, Ohio. Although he is originally just a kid from Akron, he took his talents to the University of Notre Dame and Loyola University Chicago – Stritch School of Medicine for his education. Career interests include pulmonary and critical care medicine as well as diagnostic reasoning and medical education. Outside of the hospital, Patrick has recently taken up disc golf in addition to his passions for coffee brewing, photography, and watching classic movies.

https://clinicalproblemsolving.com/wp-content/uploads/2020/10/HDx_SS_Oct_FINAL-qt.mp3Dr. David Jessee presents a Human Dx unknown to Sharmin, David & AntoinetteDownload CPSolvers App herePatreon websiteWant to test your learning? Take our Episode QuizDavid JesseeDavid Jessee is an assistant professor of medicine and academic hospitalist at Virginia Commonwealth University School of Medicine.  He was born and raised in Southwest Virginia and completed his premedical and undergraduate education at the University of Virginia.  After graduating from VCU School of Medicine, he remained in Richmond to complete his internal medicine residency training and subsequently joined the faculty in the division of hospital medicine.  His interests include medical student and resident education with a focus on diagnostic reasoning and simulation-based experiences and assessment.  Additionally, he is involved in efforts which recognize early signs of clinical decline and enhance inpatient emergency and code response.  Outside the hospital, he enjoys running with his dog, biking, playing racquetball, watching UVA sports, and traveling to state and national parks.Antionette PusaterriAntoinette Pusateri is a PGY-3 in Internal Medicine at The Ohio State University Medical Center. Born and raised in Columbus, Ohio she attended the University of Notre Dame for undergraduate majoring in Biology & Theology then returned to Columbus for medical school and Internal Medicine Residency at The Ohio State University College of Medicine and Wexner Medical Center.  She is currently interviewing for Gastroenterology & Transplant Hepatology Fellowship and has a passion for research and quality improvement, medical education and community engagement. She is also a strong advocate for trainee wellness, and herself finds wellness in CrossFit and horseback riding.David DengDavid Deng is a PGY-3 in Internal Medicine at The Ohio State University Medical Center. He spent most of his life around Atlanta, GA, went to medical school at Medical College of Georgia, but is feels right at home in the Midwest. He’s currently pursuing a career in academic hospital medicine and is passionate about clinical reasoning and medical education. In his spare time, he loves cheering on Liverpool FC, trying hole-in-the-wall restaurants, and staying active lifting weights and running. 

https://clinicalproblemsolving.com/wp-content/uploads/2020/10/SLS_AGMA_LacticAcidosis_FINAL.mp3The CPSolvers share a case of lactic acidosis – let’s practice those schemas together!Download CPSolvers App herePatreon websiteSchema Want to test your learning? Take our Episode Quiz below. Loading…

https://clinicalproblemsolving.com/wp-content/uploads/2020/10/Episode127-VMR-111-9-29-20-4.10-PM.mp3Episode DescriptionDr. Rencic and Colin presents a clinical unknown on Virtual Morning Report to CPSolvers, Rabih and Reza.Download CPSolvers App herePatreon websiteSchema 1  Schema 2 WhiteboardWant to test your learning?Take our Episode Quiz here.

https://clinicalproblemsolving.com/wp-content/uploads/2020/10/WDx-Episode-3_FINAL.mp3Zari Zahra, Mel Fellay, Lindsey, Emma, and Sharmin discuss gender biases through stories.Want to learn more about Women in Diagnosis (WDx) series?Blog post– by SmithaDownload CPSolvers App herePatreon websiteMelanie FellayMelanie Fellay is the CEO and Co-Founder of Spekit, the leading in-app learning and digital enablement companion that helps employees learn their tools and navigate process changes by accessing training resources in real-time, everywhere they work. Founded in 2018, Melanie and co-founder and former colleague, Zari Zahra, created Spekit to address the pain points they felt around driving adoption and continuous training that many Enablement and Operations leaders feel as well by bringing the sophistication of a modern digital adoption platform with the simplicity of a contextual knowledge base.She’s a Salesforce and BizOps enthusiast with expertise in leading operations and success teams, thinking at scale and architecting Salesforce solutions. In her role, Melanie oversees the sales, marketing, customer success, and corporate development teams at Spekit. Melanie graduated from the University of Colorado, Boulder with a degree in Accounting & Finance. In her free time, Mel enjoys seeing Odesza at Red Rocks, exploring less-traveled corners of the earth and escaping it all through meditation.Zari ZahraZari is a Pakistani-American Harvard MBA, an experienced Product Manager and builder of web and mobile apps for Pandora, SquareTrade, RealtyShares and Rakuten. Today, she is the Chief Product and Technology Officer and Co-founder of Spekit, the leading Salesforce adoption and contextual learning platform for growing orgs. Zari oversees all product and engineering departments, including a team office located in Karachi, Pakistan. In her free time, Zari spends time listening to audio books and spending time with her husband and mini-goldendoodle Rumi.

https://clinicalproblemsolving.com/wp-content/uploads/2020/09/HDx-Sept-AD-Final.mp3Dr. Varun Phadke presents a human dx case to Arsalan, Francesca Siegel, and Alec Yu.Download CPSolvers App herePatreon websiteSchemaWant to test your learning?Take our Episode Quiz here.Francesca SiegelFrancesca Siegel is a third year medical student at The Ohio State University College of Medicine. She received her masters in Nutritional Sciences from the University of Cincinnati. She’s passionate about preventive medicine, effective science communion, public health, and serving her community. Outside of her school work, she enjoys volunteering with Clinica Latina, OSU’s Hispanic free clinic, running with her husband, travel, and cooking.Alec YuAlec is medical student at the University of British Columbia in Vancouver, Canada. Prior to med school, he’s worked as an innovation officer at one of Vancouver’s tertiary care hospitals, and has served as a director and co-founder of a non-profit organization supporting youth engagement with humanitarian issues. A passionate problem-solver, Alec loves combining his interests with his lived experiences to start grassroots initiatives in his community. His current projects include investigating improvements to medical respite care for patients facing homelessness, and designing solid waste reduction strategies for improved hospital sustainability. On his down time, he loves cooking, running, and trying not to kill his plants.Varun PhadkeVarun Phadke is an Assistant Professor in the Division of Infectious Diseases at the Emory University School of Medicine. He is involved in microbiology and infectious diseases education for medical students, residents, and fellows, and his scholarly interests include subspecialty clinical reasoning and diagnostic error. He loves cooking, reading mystery novels, and spending time with his wife and son.

https://clinicalproblemsolving.com/wp-content/uploads/2020/09/HDx-Sept-SS-final.mp3Episode DescriptionDr. Joshua Inglis presents a Human Dx case to Sharmin, Vivek Nair and Joshua Morris.Human Dx Case LinkDownload CPSolvers App herePatreon websiteSchemaWant to test your learning?Take our Episode Quiz here.Joshua MorrisJosh is a proud cat dad to four kitties and a fourth year student at Dell Medical School applying Medicine-Pediatrics. He spent his third year doing an MA in design that cemented his passion for using creativity and innovation to better deliver care and information to patients and providers. In his spare time, he is active on MedTwitter (#MP4L), loves to run and be outside, and is obsessed with podcasts and audiobooks.Vivek NairVivek Nair is a second-year medical student at the University of Chicago Pritzker School of Medicine. He spent his undergraduate years at the University of Michigan. He is an avid runner and has been recently practicing his culinary skills (just in case medicine doesn’t work out).Joshua InglisDr Josh Inglis is an aspiring General Physician training at the Royal Adelaide Hospital. He obtained his medical degree from the University of Adelaide and is studying towards a Masters of Clinical Education. His academic interests include clinical reasoning, drug allergy and the electronic health record. Outside of work he enjoys playing tennis, brewing specialty coffee and walking his golden retriever.

https://clinicalproblemsolving.com/wp-content/uploads/2020/09/RLR-19_Vulvar-Pain-.mp3Episode descriptionReza and Rabih tackle a case of Vulvar Pain.More about the RLR series here.Want to test your learning?Take our Episode Quiz here.

https://clinicalproblemsolving.com/wp-content/uploads/2020/09/WDx_Episode2_StephSherman_FINAL-2-1.mp3Dr. Steph Sherman, Lindsey, Emma, and Sharmin tackle a case presented by AnnaWant to learn more about Women in Diagnosis (WDx) series?Blog post– by SmithaWant to test your learning?Take our Episode Quiz here.Dr. Steph ShermanDr. Stephanie Sherman is a hospitalist and residency associate program director at Baylor College of Medicine (BCM) who rounds at Ben Taub General Hospital and Houston’s VA hospital. She went to medical school at the University of Michigan and did internal medicine residency at Massachusetts General Hospital. She spends her free time with her husband, fellow clinical problem solver Zaven Sargsyan, and their ever-more-mobile 8-month-old son.Associated SchemaProblem RepresentationA 35-year-old man with advanced HIV/AIDS complicated by a recent diagnosis of Pneumocystis pneumonia and cytomegalovirus esophagitis presented with progressive fevers, dyspnea, and worsening pulmonary infiltrates in the weeks after starting antiretroviral therapy. SchemasThe CPSolvers’ schema for dyspnea highlights the relative importance of the pulmonary and cardiovascular systems before considering other etiologies.DiagnosisThe patient was found to have extensive bilateral consolidations on computed tomography of the chest. Laboratory evaluation demonstrated an elevated alkaline phosphatase, an increase in his CD4 count from 22 to 43 per cubic millimeter, and a reduction in his HIV viral load from > 1 million to 3000 copies. Ultimately, a respiratory culture from his prior admission grew Mycobacterium avium complex, raising the question of whether direct infection with this pathogen or an inflammatory reaction to it in the setting of immune reconstitution could account for his clinical deterioration.Teaching pointsMycobacterium avium complex (MAC) is the most common of the nontuberculous mycobacteria (NTM) that acts as a human pathogen. Clinical manifestations are varied, most typically presenting as a chronic pulmonary infection in immunocompetent individuals and either localized (e.g., affecting the lymph nodes or other focal sites) or disseminated infection in immunocompromised patients (especially those with HIV infection). In the early HIV epidemic, disseminated MAC was the most common bacterial opportunistic infection and conferred significant morbidity and mortality even with treatment.The immune reconstitution inflammatory syndrome (IRIS) is a potential complication of antiretroviral therapy (ART), wherein patients with advanced immunosuppression related to HIV develop an inflammatory response (generally to microbial antigens) as their immune system recovers. The two main types of IRIS are (1) paradoxical IRIS, in which a patient with a known opportunistic infection on appropriate therapy appears to deteriorate clinically after starting ART, and (2) unmasking IRIS, in which a previously silent opportunistic infection becomes clinically apparent due to the newly present immune response. IRIS to MAC most commonly presents with peripheral lymphadenitis, pulmonary-thoracic manifestations, or intra-abdominal findings.Female physicians face many challenges in the clinical environment. Among the most frequently experienced microaggressions is “role misidentification,” or incorrect identification of an individual’s contribution to the health care team (e.g., assuming a female physician is a nurse). It has been suggested that frequent role misidentification (both on the part of patients as well as other healthcare team members) can lead to anxiety and a loss of sense of professional credibility among female trainees.A pilot study recently demonstrated that distribution of new staff badges with the occupational title prominently displayed (i.e., reading “Doctor”) led to a significant improvement in role identification.Additionally, others have suggested that a more deliberate use of professional titles (i.e., introducing female physicians as “Dr. X”) may also serve to combat stereotype threat and role misidentification.