The Curbsiders Internal Medicine Podcast

Dr. Michelle Kittleson shares insights on managing acute decompensated heart failure, discussing jugular venous pressure exams, diuresis, and hospital discharge. Other topics include book recommendations, evaluation and diagnosis of heart failure, diuretic dosing, and interventions in heart failure prevention.

Enjoy this rapid clinical overview of CBC abnormalities based on Episode #167 LIVE! Common CBC Abnormalities Featuring Dr. Mary Kwok! Production & graphics by our very own and very talented Dr. Matt Watto! Unfortunately, this episode is not available for CME : ( Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME! Credits Written, Produced, and Hosted by: Matthew Watto MD, FACP; Paul Williams MD, FACP; Beth Garbitelli Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Show Segments Intro, disclaimer, guest bio Approaching a mildly abnormal CBC, red flags Build the diff, Fy(a-b-) phenotype Physical exam and advanced testing Polycythemia vera Thrombocytopenia Outro

Enjoy this Curbsiders classic and stay tuned this Wednesday, August 25, 2021 for a brand new CBC Abnormalities Triple Distilled episode. Take a deep dive into common CBC abnormalities. We recorded LIVE at joint grand rounds between Walter Reed NMMC and Uniformed Services University with hematologist, Dr. Mary Kwok MD. Topics include: which parts of the complete blood count (CBC) are most important, interpreting the differential, when to order flow cytometry, who needs a hematology consult and simplified approaches to patients with leukocytosis, leukopenia, erythrocytosis and thrombocytopenia. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written, Produced and Edited by: Matthew Watto MD, FACP Cover Art and Infographic by: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Guest: Mary Kwok MD Sponsor: American College of Physicians acponline.org/100curb ACP CME 100 virtual video package includes 75 hours of practice-changing updates by expert faculty from Internal Medicine Meeting 2021 acponline.org/100CURB. Plus enjoy an exclusive: 25 bonus CME sessions and access until June 1, 2024! Sponsor: Birch by Helix birchliving.com/curb Birch is giving $200 dollars off ALL mattresses and 2 free eco-rest pillows at birchliving.com/curb   Time Stamps* Time Stamps refer to ad-free version 00:00 Intro; Paul shame’s the audience; Guest bio 03:17 Guest one-liner, book recommendation* –Emperor of All Maladies (book) by Siddhartha Mukherjee, When Breath Becomes Air (book) by Paul Kalanithi; Career advice -set goals for whatever you’re learning. 08:43 Picks of the week: John Wick 3 (film); The Movies That Made Me (podcast) by Joe Dante; The Tim Ferriss Podcast with Julie Rice of Soul Cycle; Infinity Chamber (film) by Travis Milloy 11:50 A case of asymptomatic leukocytosis; Red flags; Repeat the CBC until it’s normal 17:30 The peripheral smear; Leukemoid reaction 20:00 The physical exam; When to send flow cytometry? 22:18 A case of lymphopenia; benign ethnic neutropenia; What to look for in the history 27:10 A case of erythrocytosis; Checking EPO levels; JAK2 mutation; Differential Diagnosis; Therapeutic Phlebotomy; Physical findings of Polycythemia Vera 36:53 A case of thrombocytopenia; Lab workup; Differential diagnosis; Pathophysiology; Culprit meds 45:35 Advice for internists 46:36 Take Home Points 47:46 Dr. Kwok’s disclaimer 48:10 Outro and post credit scene

Enjoy this rapid clinical overview of afib (atrial fibrillation) based on Curbsiders episode #164 with Neurologist Dr. Chris Favilla!  This mini episode is not available for CME, but episode #164 on Stroke and TIA is available for CME credit through the ACP! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME! Credits Written, Produced, and Hosted by: Matthew Watto MD, FACP; Paul Williams MD, FACP; Beth Garbitelli Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor: Ten Thousand tenthousand.cc Head to tenthousand.cc and enter our code CURB at checkout to save 15%.  Show Segments Intro, disclaimer, guest bio Afib prevention Workup for afib Treatment of afib Updates on ablation, Left atrial appendage occlusion Outro

Enjoy this Curbsiders classic and stay tuned this Wednesday, August 18, 2021 for a brand new Stroke and TIA Triple Distilled episode. Update your management of stroke and TIA in primary care. Stroke neurologist, Chris Favilla MD (University of Pennsylvania), walks us through the plumbing of the brain, so we can identify ischemic risks in stroke and TIA patients to prevent recurrences.  Learn factors that make a TIA high risk, which imaging studies to order, new research around aspirin dosing, dual antiplatelets, DOACs, cardiac monitoring and more!  Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders  Credits Producers: Molly Heublein MD; Matthew Watto MD, FACP Writer (including CME questions): Molly Heublein MD Cover Art: Bryan Brown MD Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto, MD; Matthew Watto MD, FACP Guest: Chris Favilla, MD Sponsor: Indeed indeed.com/internalmedicine Get a $75 sponsored job credit to upgrade your job post at Indeed.com/internalmedicine. Sponsor: Qalo qalo.com/curb Head to qalo.com/curb to get 20% off your purchase today. Time Stamps* Time Stamps refer to ad-free version 00:00 Intro, disclaimer, guest bio, and a bad pun 04:20 Chris’ one-liner, advice as a teacher, book recommendation -The Goldfinch,  07:40 Molly’s pick of the week -Extreme Measures (book) by Jessica Zitter 08:40 A case of TIA; definition of TIA 12:14 Stroke territories 14:24 New definition of TIA 16:00 Differentiation from complex migraine 19:17 Risk stratifying TIA and ABCD2 score 22:00 A bit on tPA 24:01 Workup for TIA; workup for amaurosis fugax 25:36 CNS imaging studies after stroke or TIA; Choice of imaging study 33:15 HINTS exam for posterior circulation stroke 34:48 Is an echo necessary? Bubble study for PFO? 38:32 Duration of afib monitoring 40:24 Echo reports: what to look for in patient with stroke or TIA; “soft markers” 41:55 Blood testing after Stroke and TIA (lipid panel, HbA1C; +/- RPR, coags, CBC) 43:50 Folic acid; Sparkle trial: high dose atorvastatin versus placebo for secondary prevention 47:00 Incidental finding: multiple patchy infiltrates in a patient without stroke or TIA; Is it significant? 48:50 Aspirin therapy after TIA; Dosage adjustment based on weight? 51:10 A case of stroke; TOAST trial and classification of acute stroke; ESUS; aortic arch atheromas 55:58 Large artery strokes (hypoperfusion, acute thrombosis, artery to artery embolization) 57:15 Antiplatelets after stroke and TIA; DAPT and duration of therapy 62:57 Antidiabetic drugs and stroke 63:40 Lightning round: CHA2DS2VASc score and women; how much afib is significant?; 66:32 Are all DOACs created equal?; 68:20 Regaining function after a stroke; 69:47 Silent infarcts on imaging 71:54 Resources for stroke: Decision making in neurology textbook 73:28 Outro

Enjoy this rapid clinical overview of afib (atrial fibrillation) based on Curbsiders episode #159 with Cardiologist Dr. James Furgerson; Plus, updates on ablation and left atrial appendage occlusion!  This episode is not available for CME, but episode #159 on Atrial Fibrillation is available for CME credit through the ACP! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written, Produced, and Hosted by: Matthew Watto MD, FACP; Paul Williams MD, FACP; Beth Garbitelli Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor: FIGS wearfigs.com Head to wearfigs.com and enter our code CURB at checkout to save 15%.  ASN Loan Mitigation Pilot Program: asn-online.org/lmpp The American Society of Nephrology’s Loan Mitigation Pilot Program (LMPP) aims to decrease the loan burden of those entering the field of nephrology, while also increasing interest in the specialty. Year 1 of the program will center on individuals historically underrepresented in medicine. Visit ASN-online.org/lmpp or email grants@asn-online.org  Show Segments Intro, disclaimer, guest bio Afib prevention Workup for afib Treatment of afib Updates on ablation, Left atrial appendage occlusion Outro

Enjoy this Curbsiders classic and stay tuned this Wednesday, August 11, 2021 for a brand new Afib Triple Distilled version. Take control of atrial fibrillation with expert insights and pearls from cardiologist, Dr. James Furgerson, in this jam-packed episode! You’ll learn why atrial fibrillation is such a big deal, how to diagnose it, how to treat it and when to call in for reinforcements. Dr. James Furgerson, MD  is a cardiologist from San Antonio, Texas with over 20 years in academics. Buckle up – This episode is going to send your heart racing! You might even skip a beat!  Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com  Credits Writer and Producer: Cyrus Askin MD Infographic: Cyrus Askin MD Cover Art: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Cyrus Askin MD Editors: Matthew Watto MD Guest: James Furgerson MD Sponsor: American College of Physicians acponline.org/100curb ACP CME 100 virtual video package includes 100 hours of practice-changing updates by expert faculty from Internal Medicine Meeting 2021 acponline.org/100CURB. Plus enjoy an exclusive: 25 bonus CME sessions and access until June 1, 2024! Sponsor: Panacea Financial panaceafinancial.com Visit panaceafinancial.com today to open your account and join a bank built with you in mind.  Time Stamps* *Note: Time stamps refer to ad-free version  00:00 Intro, disclaimer and guest bio 03:45 Guest one liner, a bit on physician well-being and some other randomness 08:15 A case of palpitations; risk factors for atrial fibrillation 12:17 Subclinical atrial fibrillation, overdiagnosis of atrial fibrillation; How much afib burden matters?  15:08 Case summary and next steps in initial work up 18:48 Counseling patient about atrial fibrillation and its consequences 21:40 Ischemic heart disease and atrial fibrillation 24:17 Recap of diagnosis, initial work up and risk stratification in atrial fibrillation 25:25 Rate versus rhythm control; AFFIRM trial 30:50 Strict versus lenient rate control;  RACE trial 33:30 Deciding on rate versus rhythm control; Downside of antiarrhythmic therapies; When to switch from rate to rhythm control strategy 36:52 Ablation for atrial fibrillation; CASTLE-AF, CABANA trials 40:40 When to refer to cardiology and electrophysiology 42:42 Choice of agent for anticoagulation and latest guidelines for atrial fibrillation; New definition for valvular atrial fibrillation 45:22 DOACs in CKD and some other nuances in choice of agent 52:27 Bleeding and anticoagulation 58:38 Cardioversion for atrial fibrillation (initial versus delayed) 63:32 Anticoagulation before and after cardioversion 67:48 Lifestyles measures for atrial fibrillation 70:45 Atrial fibrillation during critical illness, after CABG and in hyperthyroidism 74:12 Aspirin monotherapy is not appropriate for atrial fibrillation 76:42 Take home points 78:50 Outro

We’ve got a neutropenic fever and the only cure is...more cowbell? LIVE! It’s neutropenic fever (aka febrile neutropenia) deconstructed with infectious diseases expert, Dr. Susan Seo (Memorial Sloan Kettering Cancer Center). Topics: identifying low vs high risk patients, initial labs & imaging, empiric antibiotic therapy, when to add antifungals, de-escalation, and the G-CSF controversy.  Free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Writer and Producer: Matthew Watto MD, FACP Infographic: Edison Jyang Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Matthew Watto MD, FACP Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Susan Seo MD Sponsor: American College of Physicians acponline.org/100curb ACP CME 100 virtual video package includes 75 hours of practice-changing updates by expert faculty from Internal Medicine Meeting 2021 acponline.org/100CURB. Plus enjoy an exclusive: 25 bonus CME sessions and access until June 1, 2024! Sponsor: BetterHelp betterhelp.com/curb ​​Special offer for Curbsiders listeners: get 10% off your first month at betterhelp.com/curb Sponsor: Provider Solutions & Development info.PSDConnect.org/curbsiders Start the conversation or reach out to one of their career navigators today at info.PSDConnect.org/curbsiders   CME Partner: 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. Show Segments Intro, disclaimer, guest bio Guest one-liner, Picks of the Week* Case from Kashlak; Definitions Initial workup for neutropenic fever  Low risk neutropenic fever High risk neutropenic fever When to add antifungal coverage, G-CSF Audience questions Outro

We recap the top pearls on angina, Stable CAD, Heavy Menstrual Bleeding, and Hypercalcemia. It’s Tales from the Curbside! (TFTC), our monthly series providing a rapid review of recent Curbsiders episodes for your spaced learning. Note: No CME for this mini-episode but visit curbsiders.vcuhealth.org to claim credit for shows #279, #280, and #281.  Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written, Produced, and Hosted by: Matthew Watto MD, FACP; Paul Williams MD, FACP   Infographics by: Beth Garbitelli, Avital O’Glasser, and Nora Taranto Cover Art: Edison Jyang Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Sponsor: Amercian College of Physicians acponline.org/100curb ACP’s all-new CME 100 video package is now available at acponline.org/100CURB Use code 100CURB. Sponsor: The Jordan Harbinger Show jordanharbinger.com/subscribe CME Partner: 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. Show Segments Intro, disclaimer Angina and Stable CAD Heavy Menstrual Bleeding and Anticoagulation in Menstruating patients Hypercalcemia and primary hyperparathyroidism Outro

Shaken by a shortage of shingles savvy? Vexed by varicella-zoster imposters? Perplexed by post-herpetic neuralgia? Get ready to sharpen your expertise in varicella vaccines, learn how to tell a zoster from a zebra, and administer infection interventions with an eye towards prevention. We are joined today by special guest and returning Curbsiders expert, Dr. Boghuma Kabisen Titanji MD, M.Sc., DTM&H, PhD. (@Boghuma on Twitter!). Unfortunately, CE credit is NOT YET available for this episode : ( Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written and Produced by: Sarah Phoebe Roberts, MPH Show Notes by: Sarah Phoebe Roberts MPH, Kate GrantMBChB MRCGP DipGUMed Cover Art: Kate Grant MBChB MRCGP DipGUMed  Infographic: Sarah Phoebe Roberts  Hosts: Matthew Watto MD, FACP; Sarah Phoebe Roberts MPH   Reviewer: Paul Williams MD, FACP   Editor: Kate Grant MD, Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Dr. Boghuma Titanji, MD, M.Sc., DTM&H, PhD Sponsor: BetterHelp betterhelp.com/curb Special offer for listeners: get 10% off your first month at betterhelp.com/curb Sponsor: Grammarly grammarly.com/curb Get 20% off Grammarly Premium by signing up at Grammarly.com/curb CME Partner: 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 . Show Segments Intro, disclaimer Guest bio and one-liner First Kashlak case: Diagnosis of varicella-zoster virus (VZV, aka shingles)  Mimics and atypical presentations Treatment for uncomplicated shingles cases  Second Kashlak case: Post-herpetic neuralgia (PHN) PHN treatment options  Management of complicated shingles cases  VZV prophylaxis and infection control Third Kashlak case: Immunization guidelines for older adults VZV vaccine efficacy, live attenuated vs. recombinant vaccine Varicella (chickenpox) vaccine guidelines Final pearls and Outro