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!   Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   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 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   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)    *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 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

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).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com 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 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 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 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   *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.   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.

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).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   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 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 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   *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.   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

Dr Oren Friedman and Dr Michael Streiff discuss VTE diagnosis, risk stratification, anticoagulation choice, treatment duration, workup for unprovoked BTE, anticoagulation in special populations, and the indications for using IVC filters.

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).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   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 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 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   *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 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  

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 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 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* Stanford 25: Teaching and promoting bedside exam skills to students, residents and healthcare professionals both in person and online The 5 Minute Moment at the Society of Bedside Medicine The POCUS Atlas: Evidence Based Point of Care Ultrasound   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.

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).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   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 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 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   *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 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

Master your breast cancer screening spiel, cultivate your approach to the breast mass, and empower your patients with empathetic shared decision-making (which we know you’re all already fabulous at)!  On this fantastic episode, we are joined by Dr. Nancy Keating @NancyKeatingMD, policy wonk and primary care doc extraordinaire at Brigham and Women’s Hospital. This episode is rife with drama, as the ACS butts heads with the USPTF and the ACR, and you have to figure out  what’s right for the patient by talking with them--almost as exciting as that moment on Grey’s when Izzie cuts the...anyway, I won’t ruin a key plot point in the most excellent medical show of all time, all in a day’s work, here at The Curbsiders. Enjoy!    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).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Producer and Writer: Nora Taranto MD Show Notes: Nora Taranto MD, Isabel Valdez PA  Infographic: Nora Taranto MD Cover Art: Kate Grant, MD  Hosts: Stuart Brigham MD, FACP; Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Reviewer: Arielle Medford MD  Guest: Nancy Keating MD, MPH   Sponsors   Provider Solutions & 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 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 - Provider Solutions & Development www.psdrecruit.org/curbsiders. Sponsor - VCU Health Continuing Education 00:30   Intro & Guest Bio 03:27   Guest one-liner 05:27   Best Advice for Women in Medicine 07:34   Picks of the Week Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. 10:00   Case 1: Brenda Cantwell and Breast Lump DDx 13:39   Clinical Breast Exam vs Self Breast Exam 17:26   Practical Tips for the Clinical Breast Exam 21:50   Imaging to Evaluate the Breast Lump 26:36   Demystifying BIRADS 28:36   Epidemiology Potpourri 33:02   Breast Pain without a Mass 34:30   Case 2: Mammie Gram and Breast Screening 46:03   Average Risk vs High Risk Screening 47:18   Breast Risk Prediction Tools 48:51   Breast Density 53:16   Imaging Modalities 61:28     Shared Decision Making in Screening   68:04    Case 3: Ms Britta Lumpworth and When to Stop Screening Mammograms 74:42    Take Home Points and Outro Sponsor - VCU Health Continuing Education     Links* Evicted: Poverty and Profit in the American City by Matthew Desmond Run The List podcast  ACOG Practice Bulletin 179, 2017 Elmore et al, Ten Year Risk of False Positive Screening Mammograms and Clinical Breast Examinations, N Engl J Med, 1998.  Thomas, et al, Randomized trial of breast self-exam in Shanghai: final results. JNCI, 2002. Semagliazov et al, Results of a prospective randomized investigation [Russia] to evaluate the significance of self-examination for the early detection of breast cancer, Vopr Onkol, 2003.  Fuller, M. S., Lee, C. I., & Elmore, J. G. Breast cancer screening: an evidence-based update. The Medical clinics of North America, 2015. Chan et al, False-negative rate of combined mammography and ultrasound for women with palpable breast masses. Breast Cancer Res Treat, 2015.  ACS Recommendations for the Early Detection of Breast Cancer, 2020. USPTF Breast Cancer Screening Recommendations, 2016.  Henderson et al, Breast Examination Techniques, 2020.  Kolb et al. Comparison of the performance of screening mammography, physical exam, and breast ultrasound and evaluation of factors that influence them: an analysis of 27.825 patient evaluations, Radiology, 2002.  Mammogram Interpretation, Chapter 2. Radiology Key.Com.  Flobbe et al, The Additional Diagnostic Value of Ultrasonography in the Diagnosis of Breast Cancer. Arch Intern Med, 2003.  ACS Understanding Mammogram Readings, 2019.  Bittner, Guide to mammography reports: BIRADS terminology, Am Fam Physician, 2010.  Seer cancer statistics review, 1975-2017. 2020.  Anders CK et al, Breast carcinomas arising at a young age: unique biology or a surrogate for aggressive intrinsic subtypes?. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011  ACS How Common is Breast Cancer?  SEER Lifetime Risk (%) of Dying from Cancer by Site and Race/Ethnicity: Females, Total US, 2014-2016 Garcia et al, Cardiovascular disease in women: clinical perspectives, Circ res, 2017.  Cancer Statistics Center: Breast Statistics.  Independent UK Panel on Breast Cancer Screening, The Benefits and harms of breast cancer screening: an independent review, Lancet, 2012.  CDC Breast Cancer Screening Guidelines 2020  ACS Breast Cancer Screening Guidelines, 2015 USPTF Breast Cancer Screening Recommendations, 2016.  ACR Breast Cancer Screening Update, 2018.  Canadian Task Force Breast Cancer Screening Recommendations  UK-NHS Breast Cancer Screening Recommendations  Biller-Andorno et al. Perspective: Abolishing Mammography Screening Programs? A View from the Swiss Medical Board, N Eng J Med, 2014.  Nelson et al, Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 US PTF Recommendation, Ann Intern Med, 2016.  Miller et al, Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial, BMJ, 2014.  Breast Cancer Risk Assessment Tool (NCI)   BCSC Breast Cancer Risk Assessment Tool  Health Decision/University of Wisconsin Decision Tool Harding Center for Risk Literacy Fact Box   Keating et al, Breast Cancer Screening in 2018: Time for Shared Decision Making, Jama Insights, 2018.  ePrognosis life expectancy calculator      *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 how to evaluate a breast lump in the primary care clinic, what the guidelines recommend for asymptomatic breast cancer screening, and how to engage a patient in shared-decision making given the data available on mammograms.    Learning objectives After listening to this episode listeners will…   Triage and evaluate the Breast Lump  Perform breast cancer risk assessment  Recall the Guideline Recommendations for Breast Cancer Screening and how they vary  Engage patients in conversation about b...

Listen to our medical education heroes, Dr. Abby Spencer, @abbyCCim (Cleveland Clinic), and Dr. Alia Chisty, @aliachisty (Penn State Health), school us on how to give effective and meaningful feedback! Topics include: the ADAPT framework, how to give difficult feedback, keywords and phrases when giving feedback, how to avoid gender and racial bias when giving feedback, giving feedback to your peers and how to solicit effective feedback as a team leader.     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).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Written and Produced by Paul Williams MD, FACP Cover Art: Paul Williams, MD, FACP Infographic: Edison Jyang Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guests: Abby Spencer MD and Alia Chisty MD   Sponsors   Provider Solutions & 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 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 - Provider Solutions & Development www.psdrecruit.org/curbsiders. Sponsor - VCU Health Continuing Education 00:30 Intro, disclaimer, guest bio, pun 04:00 Guest one-liners, Picks of the Week* (see links below) 10:25 Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders. 11:00 Case from Kashlak, Feedback definitions 15:00 Addressing perceived barriers to feedback 31:45 ADAPT model of feedback 38:10 Addressing potentially gendered feedback;  42:45 Giving feedback to those who lack insight 48:29 Feedback and racial bias 52:25 Giving peer feedback 58:10 Tips for soliciting feedback as a supervisor 69:05 Does giving difficult feedback mean people won’t like you? 75:10 Take home points and Outro Sponsor - VCU Health Continuing Education   Links* Radical Candor (book) Host (film) Percy Jackson & The Olympians: The Lightning Thief movie  Hamilton on Disney Plus Her (film)    *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 demonstrate effective techniques to deliver and solicit meaningful feedback.   Learning objectives After listening to this episode listeners will…   Discuss the definitions and terms used to discuss feedback. Deliver effective feedback that is concordant with the learning goals of their trainees. Address potential perceived barriers to feedback. Utilize the ADAPT framework to partner with their learners and develop shared goals. Develop strategies to mitigate against using gender- or racially-biased narrative language. Deliver feedback to learners with limited insight by leveraging the impact of perception on achieving goals. Solicit effective and meaningful feedback despite being in a position of authority   Disclosures Drs. Spencer and Chisty report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Williams PN, Spencer A, Chisty A, Brigham SK, Jyang E, Watto MF. “#233 Giving effective feedback with Abby Spencer and Alia Chisty”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date September 21, 2020.   References  Ende J. Feedback in Clinical Medical Education.  JAMA.  1983. . [https://pubmed.ncbi.nlm.nih.gov/6876333/]  Brown B.  2018.  Dare to Lead.  Random House. Stone D and Heen S.  2014.  Thanks for the Feedback.  Penguin Books. Scott K.  2019.  Radical Candor.  St. Martin’s Press. Fainstad T et al.  Feedback can be less stressful: Medical trainee perceptions of using the Prepare to ADAPT (Ask-Discuss-Ask-Plan Together) framework.  Cureus.  2018. [https://pubmed.ncbi.nlm.nih.gov/30906679/]  Rojek AE et al.  Differences in narrative language in evaluations of medical students by gender and under-represented minority status.  J Gen Int Med.  2019.  [https://pubmed.ncbi.nlm.nih.gov/30993609/]  Mueller AS et al.  Gender differences in attending physicians’ feedback to residents.  JGME.  2017.  [https://pubmed.ncbi.nlm.nih.gov/29075375/]  Ross, DA et al.  Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations.  PLoS ONE.  2017.  [https://pubmed.ncbi.nlm.nih.gov/28792940/] 

Dive deep into common dermatological conditions of the scalp and face including alopecia, seborrheic dermatitis, rosacea, acne, and even the scourge of health professionals, ‘maskne’! We are joined by our Kashlak Chief of Dermatology and resident Skinternist Dr. Helena Pasieka (of @MedStarWHC). After listening to this episode, your dermatology knowledge will be head and shoulders above the rest! 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).  Note: The full slide deck with images for this episode is not available at this time. We will post it to this show notes page as soon as we clear the image rights.  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Written and Produced by: Beth Garbitelli, Matthew Watto MD, FACP,  Cover Art and Infographic by:  Beth Garbitelli Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Beth Garbitelli   Editor:  Cyrus Askin MD (written materials); Clair Morgan of nodderly.com Guest: Helena Pasieka MD, MS   Sponsors   Provider Solutions & 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 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 - Provider Solutions & Development www.psdrecruit.org/curbsiders. Sponsor - VCU Health Continuing Education 00:30 Intro, disclaimer, guest bio 04:35 Guest one-liner, Picks of the Week*: Hamilton and Alexander Hamilton by Ron Chernow, Ultra-Gooey Stovetop Mac and Cheese Recipe, The Food Lab: Better Home Cooking Through Science by J. Kenji Lopez-Alt Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders 08:30 Case 1: Alopecia  12:05 Assessing scalp for inflammatory changes and follicular drop-out 13:10 Central Centrifugal Cicatricial Alopecia (CCCA) 14:00 Alopecia/hair loss non-scarring subtypes 25:00 Alopecia Treatments 28:55 Case 2:  Psoriasis vs. Seborrheic Dermatitis  31:45 Looking for psoriatic plaques 32:11 Seborrheic dermatitis hallmarks  35:19 Treatment for Seborrheic Dermatitis 42:10 Case 3: Rosacea vs. Acne  50:40 Differentiating rosacea rash from SLE 52:40 Rosacea management & treatment 55:00 Identifying rosacea in Black skin 56:50 Acne management &  treatment 59:10 Retinoid dermatitis 1:00:30 Maskne 1:02:29 Antibiotics for acne 1:03:38 Retinoids and pregnancy 1:04:09 Doxycycline for rosacea 1:06:15 Take home points Sponsor - VCU Health Continuing Education   Links* Hamilton and Alexander Hamilton by Ron Chernow,  Serious Eats/The Food Lab's Ultra-Gooey Stovetop Mac and Cheese Recipe (Beth’s Cheese Blend: 8oz American cheese, 8 oz Fontina, 8 oz cheddar- not Seriously Sharp!! Also, you may be able to get away with not using 1.5lb of cheese, mix in and see how it goes, feel free to DM @VermontKitchen on Instagram for cooking guidance)  The Food Lab: Better Home Cooking Through Science by J. Kenji Lopez-Alt  Mineral sunscreens: suggestions include Neutrogena Sensitive Skin Sunscreen or Elta MD UV Physical Broad-Spectrum Tinted Facial Sunscreen (Formulations with Zinc Oxide only tend to be very heavy and will not blend well in all skin tones)  Brown Skin Matters on Twitter and Instagram Skin of Color Society American Academy of Dermatology Society for Dermatology Hospitalists Black Skin Directory Learning Journal Mind the Gap (2020) by Malone Mukwende  Ethnic Dermatology: Principles and Practice (2013) Skin of Color: A Practical Guide to Dermatologic Diagnosis and Treatment (2012) An Atlas of African Dermatology (2001)   *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.   Goals Listeners will appropriately recognize, diagnose and treat common dermatological complaints of the scalp and face seen in the primary care clinic.   Learning objectives After listening to this episode listeners will... Recognize and treat common skin complaints of the scalp and face in primary care. Become familiar with the basic therapeutic arsenal to treat scalp and face complaints in primary care. Be able to differentiate non-scarring versus scarring hair loss on physical exam. Comprehend nuances in total body presentations of psoriasis as a means to differentiate from seborrheic dermatitis.  Review when referral to dermatology for hair loss or skin changes of the face/scalp  is necessary. Recognize the extreme lack of diversity in dermatology and disparities in outcomes for various diagnoses.   Disclosures Dr. Pasieka reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Pasieka HB, Williams PN, Watto MF, Garbitelli EC. “#232 Skinternship: Scalp & Face”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date September 14, 2020.