Core IM | Internal Medicine Podcast

Discover who really faces fracture risks and why most fragility fractures occur in those without osteoporosis. Explore the surprising potential of just one or two IV infusions of zoledronate to prevent fractures for years. Examine the evolution of bisphosphonates in treatment and current debates over their risks. Delve into alternative options like teriparatide and learn about a significant trial showing promising results in a low-risk group. Finally, rethink how to discuss fracture prevention with patients and the public health implications of these findings.

Explore the complexities of managing orthostatic hypotension with insightful discussions on various medications, including midodrine and fludrocortisone. Discover the challenges posed by autonomic failure and how to navigate simultaneous hypertension. Learn about practical strategies for patient care, such as risk stratification and the importance of physical therapy for safe discharge. This conversation prepares healthcare providers to tackle nuanced scenarios in clinical practice effectively.

Discover the intricacies of diagnosing and managing orthostatic hypotension, especially in the elderly. Learn about the importance of multiple blood pressure readings and contextual patient factors. The podcast highlights innovative non-pharmacologic strategies like hydration techniques and the use of compression garments. It also discusses the significance of tailored treatment approaches and encourages listener engagement in sharing their experiences. Tune in for practical insights that prioritize patient functionality over mere blood pressure numbers.

Mihir Parikh, an interventional pulmonologist at BIDMC, dives into the complexities of diagnosing and managing pneumothorax. He breaks down the differences between X-ray, POCUS, and CT for diagnosis and discusses when chest tubes are truly necessary. Parikh also shares insights on effectively explaining pneumothorax to patients and the essential components of pleural drainage systems. Listeners will learn how to monitor air leaks and the best strategies for managing persistent issues, including innovative treatment options.

Join hematologists Jason Fried, Lauren Wirtz, and Eric Poe as they dive into the intricacies of neutropenia. They discuss when neutrophils recover and how to diagnose neutropenic fever quickly. Key insights include the importance of a thorough patient history over lab tests and strategies for managing febrile neutropenia effectively. Learn about the nuances of drug-induced neutropenia and dietary considerations for neutropenic patients. They also tackle timely antibiotic treatment and the complexities of recovery dynamics in cytotoxic therapy.

Dive into heartwarming stories that blend humor and deep reflection. Discover the power of personal narratives in patient care through a touching encounter with a vulnerable patient. Navigate the complexities of leading family meetings with empathy and humility. Explore the emotional toll on healthcare workers during the early COVID-19 pandemic, revealing the stark contrast between patient perceptions and reality. Finally, reflect on the importance of kindness and personal values in medical practice.

Dr. McQuaid, a hospice physician and director of the clinical reasoning curriculum at the University of Pittsburgh, dives into complex diagnostic challenges in clinical practice. He unpacks a clinical case involving severe symptoms and critical lab findings, emphasizing the urgency of recognizing sepsis. The discussion also highlights cognitive biases and the importance of structured problem analysis. With insights into diagnosing lymphoma and tumor lysis syndrome, Dr. McQuaid shares lessons that blend clinical reasoning with personal reflection to enhance diagnostic accuracy in high-pressure situations.

Chris Kapp, an interventional pulmonologist at Northwestern, shares his expertise on pleural effusions. He explains the nuances of thoracentesis and sheds light on Light’s Criteria for differentiating pleural fluid types. Listeners learn about the diagnostic importance of pleural fluid studies, including pH levels and cell differentials. Kapp also discusses the challenges in managing parapneumonic and malignant pleural effusions, emphasizing tailored treatment strategies and the role of patient preferences in effective care.

Interns face tough realities as they embark on their medical journeys, confronting critical patient situations that unearth feelings of imposter syndrome. Emotional support from mentors and peers becomes essential in navigating these challenges. Anxiety peaks during night shifts, but personal connections with patients offer surprising comfort. Humorous camaraderie shines through, highlighting how small gestures can uplift colleagues during difficult times. These raw stories encapsulate the highs and lows of starting a medical career.

Chris Kodanidis, an editorial fellow at the New England Journal of Medicine, dives into the evolving role of beta blockers following heart attacks. He discusses the historical significance of these medications and critiques their effectiveness in light of the REDUCE-AMI trial findings. The conversation emphasizes the importance of individualized treatment approaches, challenging outdated norms in cardiology. Additionally, they explore Goodhart's Law and its implications on clinical decision-making, ultimately advocating for a more nuanced understanding of patient care.