The Curbsiders Internal Medicine Podcast

Practice solving diagnostic puzzles with The Curbsiders and Internist / Diagnostician, Reza Manesh MD, Assistant Program Director for Clinical Reasoning of the Osler Medical Training Program at Johns Hopkins! Solve along with us at these links: Case 1 http://hdx.org/I2B and Case 2 http://hdx.org/uM2. Topics include: clinical reasoning terminology, how to use cases to practice diagnostic reasoning, how to build a diagnostic schema, and how to conduct your own cognitive autopsy. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Hannah Abrams Hosts: Hannah Abrams, Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Reza Manesh MD Special thanks to: Doctors Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing cases Time Stamps 00:00 Disclaimer, intro and guest bio 04:02 Guest one liner, book recommendation, favorite failure, advice for learners 11:27 Human Dx Project and Global Morning Report 15:35 Diagnostic terminology 21:25 Case #1, Reza solves 33:40 Diagnostic autopsy and teaching points for case #1 38:00 Case #2, The Curbsiders solve 57:30 Diagnostic autopsy and teaching points for case #2 61:33 Take home points and a plug 64:30 Outro

Sanjay Desai, an Internal Medicine program director at Johns Hopkins and coauthor of ACP’s Position Paper on Hidden Curriculum, dives into the often-overlooked aspects of medical training. He illustrates how institutional norms shape both learners and patient interactions through various compelling cases. The discussion emphasizes the balance between education and patient care, uncovering the impact of language and behavior in clinical settings. Desai advocates for a supportive learning environment that prioritizes compassion, autonomy, and effective communication.

Shoulder pain made simple. Develop your confidence and skills with tips from sports medicine specialist Dr. Carlin Senter MD. We discuss her simplified approach to the basic shoulder exam, including when and how to do special tests, high yield exam maneuvers, when to refer shoulder pain patients to orthopedic surgery, and who can be managed conservatively. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Molly Heublein MD and Nora Taranto MS4 Editor: Matthew Watto MD Hosts: Molly Heublein, MD, Paul Williams MD, Matthew Watto MD Guest: Carlin Senter, MD Time Stamps 00:00 Disclaimer, intro, and guest bio 03:15 Guest one liner, book recommendation, career advice, and some picks of the week 13:20 Clinical case of shoulder pain; helpful historical features 18:54 Differentiating referred pain from c-spine pathology from shoulder pathology 21:00 A framework for shoulder pain, HIP-ROT, and using ROM to generate a differential 27:40 Frozen shoulder aka adhesive capsulitis 31:57 Glenohumeral joint arthritis 33:52 Rotator cuff disease 40:53 Specific testing for rotator cuff tears 51:45 Impingement syndrome versus bursitis 56:25 Counseling patient with shoulder pain or injury 59:03 Steroid injections, topical therapy, and AC joint arthritis 65:18 When to refer to surgery and some take home points

Dr. Barbara Phillips, a recently retired professor of pulmonary critical care and sleep medicine, shares her expertise on obstructive sleep apnea. She dives into the differences between home sleep studies and in-lab polysomnography. The conversation highlights the importance of oxygen saturation metrics like T90 and ODI in sleep study interpretation. Dr. Phillips offers strategies to enhance CPAP adherence and discusses alternatives for treatment, emphasizing the need for personalized patient care and the public health implications of untreated sleep apnea.

We delve into advanced management of headaches, including novel therapies, migraines with aura, migraines in complicated patients, and headaches of short duration with Dr. Rebecca Burch, a headache medicine specialist at the John R. Graham Headache Center at Brigham and Women’s Hospital. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Paul Williams MD Edited by: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Rebecca Burch MD Time Stamps 00:00 Disclaimer, intro and guest bio 03:28 Guest one-liner, movie and podcast recommendations, favorite failure and picks of the week from The Curbsiders 10:38 Clinical case of migraines; diagnosis and classification 14:12 Does medication overuse headache exist? 16:16 Chronic daily headache; Conversion from episodic to chronic and vice versa 21:43 Approaches to medication overuse headache 25:54 Case 2: migraine with aura and other types of migraine (retinal, hemiplegic, etc.) 32:09 Pathophysiology of migraine; how triptans work; How should aura effect management? 38:44 Migraine cocktails 41:15 Comorbid mood disorders; Use of psych meds and triptans 45:08 Migraines and oral contraceptives 48:42 Botulinum toxin and new CGRP therapies 53:36 What does success look like in migraine therapy? 55:32 Nonpharmacologic management 60:45 Case 3: headaches of short duration 66:36 Headache red flags; Imaging for headaches; pathophysiology of high and low pressure headaches 72:00 Idiopathic intracranial hypertension 75:25 Take home points 77:00 Outro  

HIV care for the internist with author and HIV expert, Michael Saag MD, Professor of Infectious Diseases at University of Alabama and founder of the 1917 Clinic. We discuss the specifics of screening & diagnostic testing in HIV, monitoring CD4 counts and viral loads, first line antiretroviral therapy, harm reduction, and how to provide excellent HIV care in your primary care clinic. 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 & Produced by: Elena Gibson MS4, Justin Berk MD MBA MPH Artwork by: Elena Gibson MS4 Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MBA MPH Editor: Matthew Watto MD Guest: Michael Saag MD Time Stamps 00:00 Disclaimer, intro, and guest bio 04:35 Getting to know our guest, a movie recommendation, and words of wisdom 08:48 Clinical case, HIV screening, in-depth discussion of HIV testing & diagnosis 15:56 New diagnosis of HIV, counseling after diagnosis, confirmation, follow-up testing, the second visit 24:20 Treatment - what to start and when; some basic comments on therapy 30:05 Primary care after diagnosis, vaccines, cancer screening, cardiovascular disease prevention 34:35 Monitoring CD4 counts and viral load; interpreting CD4 count; time course of response for CD4 and viral load 42:02 Harm reduction counseling; addressing medication non-adherence 47:40 PCP prophylaxis 49:43 The 1917 Clinic, Ryan White Clinics, and linking patients to care 53:10 Take home points 55:40 Plugs 57:45 Will a cure or vaccine for HIV emerge? 59:16 Outro

Join Deep Shah, a practicing internist and comparative social policy expert from Oxford, for an engaging discussion on healthcare's complexities. They tackle the burdensome administrative tasks plaguing primary care, emphasizing the importance of prioritizing patients over paperwork. Shah and cohost Fatima Syed dissect the new CMS payment model and its ripple effects on private insurance. They also explore innovations to ease these administrative pressures and debate the ongoing challenges of the Affordable Care Act and price transparency.

In this podcast, the hosts discuss the lack of nutrition education in medical schools and the importance of addressing this issue. They also break down the components of the Mediterranean diet and highlight the challenges of effectively communicating dietary information to patients. The speakers explore the impact of physical activity on cardiovascular health and discuss a medical education program and upcoming nutrition course. They wrap up the episode by expressing gratitude and joking about cats.

Houston, we have a female sexual dysfunction problem. Female sexual problems, which can affect women of all ages, are underdiagnosed and undertreated--in part because clinicians are not the best at asking about sex in primary care visits. In the course of this episode, learn about how to have that sex talk you’ve (maybe) been avoiding, what to ask when working up sexual problems in women, and find the words to talk to patients about sex. Today, we’re lucky to have the female sexual health expert of experts, Dr. Stacy Lindau, MD, MA, Professor of Obstetrics and Gynecology and Medicine-Geriatrics at the University of Chicago Medicine, on the show to teach us the best “sex talk” language, the differential for female sexual problems, and explore therapies. Sadly, there’s no sildenafil-like magic bullet, but a multidisciplinary team can make real impact on female sexual problems. Don’t forget to check out http://womanlab.org Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4 Hosts: Leah Witt MD and Matthew Watto MD Infographic: Leah Witt MD Editor: Matthew Watto MD Guest: Stacy Lindau MD Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 03:30 Guest one liner, book recommendations, favorite failure, career advice and picks of the week 12:57 Clinical Case of female sexual dysfunction and some definitions 15:08 Are sexual problems a normal part of aging?; How to take a sexual history; Etiology of sexual dysfunction; “Diagnostic sex”; Red flags 27:54 Medications that contribute to sexual dysfunction 31:00 Labs 34:45 Treatment: pelvic PT, medications, counseling, flibanserin, herbal supplements 49:05 Screening for female sexual problems 51:58 Take home points; WomanLab.org 55:19 Outro

Summary Conquer Clostridium difficile (Clostridioides difficile) with this “spore-tacular” episode featuring infectious diseases expert, Dr. Curtis Donskey, Professor at Case Western Reserve University and clinician at the Louis Stokes VA Hospital. We discuss the updates in the 2017 IDSA C. difficile guidelines plus a bunch of random pearls. If you have ever laid awake at night wondering how many pills are needed for a fecal transplant, then this is the episode for you!  We discuss why metronidazole was dropped as the first line therapy for Clostridium difficile infection (CDI) along with other hot topics such as two-step testing, loperamide use, which antibiotics are the least likely to cause CDI, and more. Do not miss this episode! 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 by: Carolyn Chan MD Produced by: Matthew Watto MD Hosts: Carolyn Chan MD, Matthew Watto MD, Paul Williams MD Editor: Matthew Watto MD Guest: Curtis Donskey, MD