The Curbsiders Internal Medicine Podcast

Master common skin and soft tissues infections: cellulitis, abscesses, human and animal bites with returning guest, infectious diseases expert, Dr Boghuma Titanji MD, PhD @boghuma (Emory; TED). Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written (including CME) and Produced by: Matthew Watto MD, FACP Cover Art and Infographic by: Beth Garbitelli Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto (written materials); Clair Morgan of nodderly.com Guest: Boghuma Titanji MD, M.Sc., DTM&H, PhD Sponsor: 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. 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. Time Stamps* *Note: Time Stamps refer to ad free version. 00:00 Intro, disclaimer, guest bio 02:00 Picks of the Week 06:00 Definitions, Initial Approach to cellulitis 10:35 Nonpurulent cellulitis; antibiotic choice
18:10 Fish handler’s disease 24:30 Recurrent cellulitis 31:30 Purulent cellulitis and MRSA; Antibiotic choice; Step down therapy 47:33 Abscesses; Adjuvant antibiotics; Packing Wounds 53:30 Decolonization for recurrent MRSA infections 56:30 Human Bites (clenched fist injury); Dog bites and Cat bites 67:10 Take home points and Outro

Diagnosis, Management, and Social Implications of Attention Deficit Hyperactivity Disorder.  Ever gotten overwhelmed by all the categories of ADHD, or interpreting the scores on a Vanderbilt form? Join us with Dr. Sarah Vinson, a triple-boarded clinician in adult  psychiatry, child psychiatry, and pediatrics who helps us optimize a diagnosis and management process for ADHD. What other conditions can masquerade as ADHD? Which type of stimulant should you use? Listen to find out more! Show notes at: https://thecurbsiders.com/cribsiders/13 Subscribe at: Apple , Google, Spotify Credits Writer, Producer, Infographic: Angela Zhang Cover Art: Chris Chiu Hosts: Justin Berk, Chris Chiu Editor:Justin Berk; Clair Morgan of nodderly.com Guest(s): Dr. Sarah Y. Vinson Time Stamps 5:30 Diagnosis of ADHD 6:53 Considering a differential diagnosis of ADHD 8:43 Categories of ADHD 15:02 Ancillary Supports 18:27 Consequences of Misdiagnosis 19:53 Parent Counseling 22:08 Behavioral Interventions Treatment 25:56 Gender Differences in ADHD 28:00 Anaphylaxis Promo 28:39 Alternative Treatments 30:54 Pharmacotherapy for ADHD 37:29 Side Effects of Medical Treatments 44:33 Monitoring Progress 46:19 Treating concurrent mood disorders 49:21 ADHD in Young Adults 55:29 ADHD and Race 1:08:13 Future of ADHD

Learn about the latest in COVID-19: Do masks prevent infection?, SARS-CoV-2 home testing, vaccine advice, and how to prevent and treat VTE in COVID-19. Join us as our tzar-of-clinical-appraisal Curbsider/internist/epidemiologist Rahul Ganatra MD MPH (@rbganatra) talks us through the controversial DANMASK-19 trial, plus Watto reports back on his conversation with Dr Parth Rali @parthrali (Temple Lung Center) who helped write the CHEST anticoagulation guidelines for COVID-19. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Producer: Deb Gorth ScM Show Notes, Cover Art, and CME by: Deb Gorth ScM and Matthew Watto MD Written by: Matthew Watto MD, Paul Williams MD, and Rahul Ganatra MD MPH Hosts: Rahul Ganatra MD MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com 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 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. Time Stamps 00:00 Intro, disclaimer, Picks of the week* and Vaccines 08:00 DANMASK-19 25:00 Anticoagulation in COVID-19 35:06 COVID-19 home PCR testing Outro

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. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! 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 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.

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

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).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   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 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 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* De Gaulle by Julian Jackson  Command and Control by Eric Schlosser Auerbach's Wilderness Medicine, 2-Volume Set  Whatever book Paul said he was reading, sounds nerdy (The First Law Trilogy)  Wilderness Medicine Society Stop The Bleed: Home  Into Thin Air: A Personal Account of the Mt. Everest Disaster by Jon Krakauer National Outdoor Leadership School Advanced Wilderness Life Support  Inside the ER at Mt. Everest  Annapurna by Maurice Herzog  K2, The Savage Mountain: The Classic True Story Of Disaster And Survival On The World's Second-Highest Mountain– by Charles Houston and Robert Bates    *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

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.