The Curbsiders Internal Medicine Podcast

Listen to our first ever discussion with @kidney_boy, Joel Topf MD. It’s a classic episode with a fresh intro as we prepare for @NephMadness 2019 with our friends from Twitter and @AJKDonline Dominate leg cramps, diuretic therapy, and resistant hypertension with tips from @kidney_boy, Joel Topf MD @kidney_boy, Chief of Nephrology Kashlak Memorial Hospital, co-creator @NephMadness. We start with basic renal physiology and build up to the treatment of resistant hypertension. Corrections: Dr Topf posted the following corrections on his blog PBfluids.com 3/22/2017 “I enjoyed the experience immensely, but in an hour of talking off the cuff I made some embarrassing mistakes: In describing water reabsorption I said it occured in the cortical collecting duct rather than the medullary collecting duct. In describing my cure for cramps I tell the story of Gitelman’s and say it is like congenital loop diuretics rather than congenital thiazide diuretics I mucked up the story about the MRFIT story and how it allowed a head to head comparison of HCTZ and chlorthalidone. I really oversold what happened.”   Full show notes at https://thecurbsiders.com/podcast. Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written by: Matthew Watto MD Produced by: Stuart Brigham MD and Matthew Watto MD Cohosts: Stuart Brigham MD and Matthew Watto MD Guest: Joel Topf MD Sponsor Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 201

Dr. Elizabeth (Foy) White-Chu, an assistant professor and medical director at OHSU, shares her expertise on chronic wound care. She offers simple yet effective strategies for managing complex wounds, including dressing selection and pain management. Explore the crucial aspects of wound cleansing, from the type of water to use to achieving optimal healing. Dive into her evidence-based practices that can revolutionize patient outcomes and learn how personal interests like gardening can even intersect with professional growth in healthcare.

Dr. Patrick Finley, a professor of clinical pharmacy at UCSF and expert in psychopharmacology, dives into the nuances of treating depression. He shares practical tips on switching antidepressants and managing withdrawal symptoms. They explore strategies for handling persistent depression and the complexities involved in antidepressant transitions, particularly during pregnancy. The discussion also touches on the role of genetic factors in medication response, emphasizing a tailored approach for patient care.

Join us at the forefront as we talk genetic testing in primary care with Dr Dallas Read, esteemed gynecologist and **the only** medical geneticist at Tufts Medical Center. Topics include: what internists should be comfortable testing for in the office, how and when to refer for screening, what tests to order, how to interpret test results, how to handle direct-to-consumer results or requests, and so much more! For years, the medical community has been talking about the immense potential for genetic testing to guide diagnosis and treatment. But has it realized its full potential? The answer to that seems to be a resounding no at the moment--but the days of ubiquitous genetic testing to identify disease and disease risk may not be so far off after all. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Coming to you from the Curbsiders, we hope you’ll enjoy this latest episode about the genes you wear, whether you want to put them on or not. Genes, Genes, they’re (maybe) good for your heart. But do patients want to know if they are, or if they aren’t? Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4 CME questions by: Nora Taranto MS4 Hosts: Stuart Brigham MD, Matthew Watto MD, Nora Taranto MS4 Images and infographics: Beth Garbitelli MS1 Edited by: Matthew Watto MD, Chris Chiu MD Guest: Dr. Dallas Reed MD Sponsor  Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Learn expert tips for the diagnosis and management of inflammatory bowel disease (IBD) from Dr. Adam Ehrlich. Topics include initial work-up, general principles of management, primary care considerations, ulcerative colitis, Crohn's disease, fecal transplants, documentary RBG, career advice, the underrated sci-fi film Edge of Tomorrow, extra intestinal manifestations of UC, diagnosis and differential of crampy abdominal pain, and the risk of colorectal cancer in IBD patients.

Dr. Joel Topf, Chief of Nephrology at KashlakHospital, shares insightful tips on managing hyperkalemia. Topics discussed include common causes of hyperkalemia, the U-shaped curve of potassium levels and mortality, safe use of insulin, potassium binding resins and colonic necrosis, loop diuretics and fluids, fludrocortisone use, and high potassium diet and oral supplements.

Stuck on sickle cell disease? We hammer out the basics of diagnosis, common sickle cell variants and their manifestations, preventive medicine, acute and chronic pain management, opioid use, and how to recognize and treat common complications like anemia, fever and acute chest syndrome. Sickle cell expert, Sophie Lanzkron MD, Associate Professor of Medicine and Oncology and Director of the Sickle Cell Center for Adults at Johns Hopkins joins! Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Sponsor ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA. We'll see you there! Credits Written (including CME questions) and produced by: Justin Berk MD, Martha Brucato MD PhD, Beth Garbitelli MS1 Hosts: Paul Williams MD, Justin Berk MD, Matthew Watto MD Edited by: Matthew Watto MD Guest: Sophie Lanzkron MD MHS Time Stamps 00:00 Announcements, intro 02:30 A quick refresher on hemoglobinopathy 03:45 Guest bio 05:03 Guest one-liner, movie recommendation, career advice, picks of the week 10:53 ACP Internal Medicine Meeting 2019 (ad read) 12:33 Clinical case; defining sickle cell; pathophysiology 16:23 Different types of hemoglobinopathy genotypes and phenotypes 20:20 Preventive care for sickle cell disease 22:56 Taking a history at the initial visit in patient with sickle disease 26:40 Life expectancy in SCD 28:30 Hydroxyurea 30:40 Chronic red blood cell transfusion therapy; complications; monitoring 37:07 Silent cerebral infarcts and mild cognitive impairment in SCD  40:10 Chronic pain management; opioid use disorder in sickle cell disease 46:00 Acute pain crisis management; PCAs vs bolus therapy 54:08 Reticulocyte count in sickle cell disease 55:40 Itching, opioids and naloxone? 58:10 Red blood cell transfusion threshold in sickle cell disease (anemia) 60:03 Acute fever in SCD 61:48 Acute chest syndrome 66:45 Transition from pediatrics to adult medicine in sickle cell 68:00 Incentive spirometry to prevent acute chest syndrome 68:45 Take home points 70:00 Outro

Optimize perioperative risk and dominate perioperative medicine. Topics include surgical risk calculators, preoperative labs, stress testing, use of BNP and troponins, postoperative MI, cardiac and pulmonary risk stratification, and more! We’re joined by perioperative medicine expert, Avital O’Glasser MD, Associate Professor of Medicine at Oregon Health & Science University and Assistant Program Director for Scholarship and Social Media. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Matthew Watto MD CME questions by: Matthew Watto MD Hosts: Matthew Watto MD, Stuart Brigham MD Edited by: Matthew Watto MD Guest: Avital O’Glasser MD Time Stamps 00:00 Disclaimer, intro and guest bio 04:20 Guest one-liner, book and movie recommendations, career advice 11:20 ACP Internal Medicine Meeting 2019 details 14:02 Patient with coronary artery calcifications going for elective hip surgery and wants "clearance" 20:50 Functional capacity 25:00 Preoperative stress testing and coronary revascularization 31:55 Canadian guidelines, BNP and troponin testing 36:30 The METS trial and predicting perioperative cardiac events and mortality 40:44 Preoperative testing (labs, imaging, urine studies) 50:24 Choosing your perioperative cardiac and surgical risk calculator (RCRI, MICA, ACS-NSQIP) 59:50 Communicating risk to patient and their surgeon 61:30 Pulmonary risk assessment and complications 70:35 Perioperative use of opioids 75:30 Who needs an echocardiogram prior to surgery? 79:00 Canceling a patient's surgery 82:55 Take home points 83:45 Outro

“Urinary tract infections” (UTIs) are overdiagnosed. Antibiotics are overprescribed. UTIs are inappropriately blamed for geriatric syndromes (eg delirium) despite little supporting evidence. Our guest, Tom Finucane MD, Emeritus Professor of Medicine at Johns Hopkins makes us question everything. Topics: How can we diagnose “UTI”? Who needs treatment? Do urinary tract symptoms matter? Does malodorous urine correlate with infection? Who’s at risk for pyelonephritis and sepsis? Don’t miss this paradigm changing episode. And stop using the term “urinary tract infection” unless it’s prefaced by air quotes! Sponsor: Join ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there! Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Matthew Watto MD Hosts: Matthew Watto MD, Paul Williams MD Edited by: Matthew Watto MD Guest: Tom Finucane MD, MACP Time Stamps 00:00 Disclaimer, intro and guest bio 04:00 Guest one liner, book recommendation, career advice 08:22 The “medical ignorome” 13:40 ACP Internal Medicine Meeting 2019 details 16:20 Case of malodorous urine; Urine is NOT sterile; Defining terms 25:14 Stop saying UTI unless using air quotes 28:34 What symptoms or history matters in evaluation for “UTI”? And can we predict who will become systemically ill? 34:47 Voltaire and when treatment is warranted for “urinary tract infections” 37:15 Delirium in an older adult with possible UTI, how to work it up, and who warrants antibiotics 51:55 Take home points 53:38 Outro

Take a trip down memory lane with top clinical pearls and favorite moments from The Curbsiders in 2018. Welcome to our 2018 Recap Extravaganza! Since last year, the Curbsiders team has grown substantially and the podcast has undergone several exciting developments. These include our collaboration with ACP that allows us to provide CME and MOC credit for select episodes, our new partnership with Human Dx as featured in our Kashlak Morning Reports, and the launch of our Women in Medicine series. For our 2017 year-end show, we had listeners vote for their favorite episodes from the past year. This year, we're changing it up a bit and have invited our Curbsider colleagues to share their picks for pearliest pearls and most illuminating episodes of 2018. We hope you’ll enjoy hearing the team’s highlights, and we’ll be back in 2019 with fresh content. Note: No CME-MOC credit for this episode, but stay tuned in 2019 for eligible episodes. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Chris Chiu MD and Sarah Phoebe Roberts, MPH Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Chris Chiu MD Edited by: Chris Chiu MD Time Stamps 00:00 Disclaimer, Intro 06:39 Clinical Reasoning Pearls 12:35 Pulmonary Hypertension Pearls 15:52 Women In Medicine Pearls 20:40 Iron Deficiency Pearls 24:52 Tick-Borne Illness Pearls 28:00 STI Pearls 31:00 Physical Exam Pearls 32:51 “Things we do for no reason” Pearls 36:16 Host Picks 42:38 Paul Wraps-up the Year 43:38 Outro and Curbsider Team sign-offs