Core IM | Internal Medicine Podcast

Solidify your knowledge on latent TB! Quiz yourself on the 5 pearls we will be covering: * Who should be screened for latent tuberculosis infection (LTBI)? (1:45) * What screening tests are available and how do they differ? (6:30) * What are the LTBI treatment options available? (10:24) * What are the major adverse drug effects to consider? (13:28) * How frequently should you check liver function tests in a patient being treated for LTBI? What do you do with the results? 17:43 * Dr. Caplan-Shaw Recap (21:29) For full show notes: https://www.clinicalcorrelations.org/?p=16783 (https://www.clinicalcorrelations.org/?p=16783)

Let’s go deeper into to potassium and repletion! For full show notes: https://www.clinicalcorrelations.org/?p=16553 (https://www.clinicalcorrelations.org/?p=16553)

Solidify your knowledge on albuminuria! Quiz yourself on the 5 Pearls we will be covering: * How good is a dipstick, urinalysis and UACR in detecting albuminuria? (1:42) * What conditions that lead to transient proteinuria? What is the appropriate interval to recheck and how should be it be repeated? (5:14) * Who should be screened for albuminuria and can it prognosticate risk for cardiovascular mortality? (7:47) * Does increasing RAAS inhibition improve renal outcomes? (10:57) * Throwback Question: How do you prescribe oral iron and what tips do you tell your patients? (13:11) For full show notes: https://www.clinicalcorrelations.org/?p=16133 (https://www.clinicalcorrelations.org/?p=16133)

Let’s go deeper into to why we think about diseases the way we do: COPD Classifications through the years! Time Stamps: * How did prior understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25) * How is COPD diagnosed? (6:13) * How has COPD been classified and why? (6:42) For full show notes: https://www.clinicalcorrelations.org/?p=15683 (https://www.clinicalcorrelations.org/?p=15683)

Quiz yourself on the following 5 Pearls on Chronic Hepatitis B (HBV) Management! * What is the focused history, physical and lab workup in a patient with chronic HBV? (1:40) * What is the best imaging to evaluate for intermediate stages of liver fibrosis? (4:06) * What scoring tools can you use to estimate fibrosis and what are their limitations? * What factors do you use to assess which patients get treatment? (7:41) * What drugs are available for HBV treatment and how do you choose? (11:18) * Which chronic HBV patient should be screened for HCC, and how often? (14:45) For full show notes: https://www.clinicalcorrelations.org/?p=15273 (https://www.clinicalcorrelations.org/?p=15273)

Solidify your knowledge on Chronic Hepatitis B (HBV) screening and vaccinations! Quiz yourself on the 5 Pearls we will be covering: * Who do you screen for HBV? (3:37) * How is HBV transmitted and who is at risk for HBV reactivation? * What tests do you order when screening for HBV?   (10:48) * In which populations is HBV vaccination recommended? * What are the four possible meanings of an isolated positive total anti-HBc? (13:55) * In an asymptomatic adult, is it necessary to send an anti-HBc IgM to distinguish acute from chronic HBV infection? (15:01) * What are the implications of seroconversion of HBeAg from positive to negative? (16:19) For full show notes: https://www.clinicalcorrelations.org/?p=14603 (https://www.clinicalcorrelations.org/?p=14603)

Let's go deeper as to why we do what we do: albumin in spontaneous bacterial peritonitis (SBP) ! Time Stamps:1. How much albumin is recommended in SBP? (1:45)2. What antibiotics are used for the treatment of SBP? (2:30)3. Why do we give albumin in SBP? (4:15) - How does albumin compare to crystalloid? (7:15) - Do we always have to give to albumin? (9:00) For full shownotes: https://www.clinicalcorrelations.org/?p=14273 (https://www.clinicalcorrelations.org/?p=14273)

Cement your knowledge on Hepatic Encephalopathy (HE)! Quiz yourself on the following 5 Pearls we’ll be covering on HE:  Time Stamps * What are other causes of altered mental status in cirrhotics? (1:45) * What are common precipitants for an acute episode of HE? * What is asterixis? (6:10) * What is the diagnostic utility of a cirrhotic with asterixis? * How do lactulose & rifaximin reduce symptoms of HE? (11:00) * What are their indications? * What is the connection between hypokalemia and HE? (14:10) * What is the discriminatory power of an ammonia level in HE? (16:40) * In what situation does the NH3 has stronger predictive value? For full shownotes: https://www.clinicalcorrelations.org/?p=13953 (https://www.clinicalcorrelations.org/?p=13953)

Part 2 on Abdominal Paracentesis ! Let's go deeper Time Stamps Should a cirrhotic’s INR and platelets deter you from doing a paracentesis? (3:15) Do generalist have worse procedure complications than specialists?  (5:40) Do you need to send ascites fluid in blood culture bottles? (6:10) For full shownotes: https://www.clinicalcorrelations.org/?p=13503 (https://www.clinicalcorrelations.org/?p=13503)

Solidify your knowledge on iron deficiency anemia! Quiz yourself on the 5 Pearls we will be covering: * Should patients be screened for iron deficiency? If so, who and how often? (1:40) * What are the indications for diagnostic endoscopy in iron deficient patients? (3:23) * How should you advice patients to take oral iron? (5:53) * What is optimal dosing for oral iron? * In which patients would you consider IV iron? What are the risks? (11:41) * Throwback Question: What is a medication-overuse HA? (14:44) For full shownotes: https://www.clinicalcorrelations.org/?p=13083 (https://www.clinicalcorrelations.org/?p=13083)

You have always been told to do a diagnostic paracentesis on admission in cirrhotics with ascites, but why? Can you just get away with clinical judgement to rule out SBP? Is faculty judgement any better? And if you’re going to do a paracentesis on admission, do you need to do it right away? Go deeper with Dr. Steve Liu and Dr. Janine Knudsen! Click the link for the full show notes: https://www.clinicalcorrelations.org/?p=12323 (https://www.clinicalcorrelations.org/?p=12323) Time Stamps * What do guidelines say about diagnostic paracentesis in cirrhotics with ascites? (1:51) * Can we just use clinical judgement to decide if paracentesis is warranted? (3:13) * Do attendings have better clinical judgement than residents to rule out SBP? * Does timing of paracentesis on admission matter for mortality? (6:33)

Listen to CORE IM’s first 5 Pearls segment on Headaches! Time Stamps *   What are the indications for imaging for HA? (1:36) *   What is your approach to abortive therapy for migraines? (4:45) *   How do you diagnose medication overuse HA? (6:41) *  What is your approach to migraine prophylaxis? (8:29) * What are some evidence based nonpharmacological therapies for migraines?  (10:42) Show notes Pearl 1: * Think about both patient characteristics and alarming headache qualities to determine if your patient’s headache requires imaging to look for secondary cause. * Important patient characteristics are age and high-risk comorbities. * Worrisome headache qualities include headache that awaken patient from sleep and constitutional symptoms. * Remember that unless you’re looking for an acute bleed, MRI is the preferred imaging modality. Pearl 2: * NSAIDs are the first-line abortive therapy for both tension and migraine headaches. * For moderate to severe migraines or when NSAIDs don’t work, triptans are useful abortive therapies. * Don’t be scared to try multiple types of triptans if the first fails to help your patient. Pearl 3: * If you notice your patient’s headache changes from intermittent to a chronic, daily headache while using lots of abortive therapy medications, consider medication overuse headache. * To avoid medical overuse headache, encourage your patient to limit triptans and NSAIDs to less than 2 times per week on average. Pearl 4: * If patients are getting migraines requiring abortive therapy more than 2x/week or have a medical overuse headache, think about adding migraine prophylaxis. * Beta blockers like propranolol and anti-seizure meds like topiramate are the mainstay of migraine prophylaxis. Pearl 5: * There is strong evidence to support nonpharmacologic headache treatment, such as CBT, progressive muscle relaxation regular sleep and exercise! References: Loder, Elizabeth, et al. “Choosing wisely in headache medicine: the American Headache Society’s list of five things physicians and patients should question.” Headache: The Journal of Head and Face Pain 53.10 (2013): 1651-1659. Health Quality Ontario. Neuroimaging for the evaluation of chronic headaches: An evidence-based analysis. Ont Health Technol Assess Ser. 2010;10:1- 57. Detsky, Michael E., et al. “Does this patient with headache have a migraine or need neuroimaging?.” Jama 296.10 (2006): 1274-1283. Gilmore, Benjamin, and Magdalena Michael. “Treatment of acute migraine headache.” Am Fam Physician 83.3 (2011): 271-280. Munksgaard SB, Jensen RH. “Medication overuse headache.” Headache. 2014: 807-22. Pringsheim, Tamara, et al. “Canadian Headache Society guideline for migraine prophylaxis.” Can J Neurol Sci 39.2 Suppl 2 (2012): S1-59. Mauskop, Alexander. “Nonmedication, alternative, and complementary treatments for migraine.” CONTINUUM: Lifelong Learning in Neurology 18.4, Headache (2012): 796-806. Silberstein, S. D., et al. “Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adult...

Cement your knowledge on headaches with 5 Pearls on when imaging is indicated, approach to abortive medications, medication overuse headaches, when to use migraine prophylaxis and effective non-pharmacological treatment for migraines! For full shownotes: https://www.clinicalcorrelations.org/?p=11493 (https://www.clinicalcorrelations.org/?p=11493) Time Stamps * What are the indications for imaging for HA? (1:36) * What is your approach to abortive therapy for migraines? (4:45) * How do you diagnose medication overuse HA? (6:41) * What is your approach to migraine prophylaxis? (8:29) * What are some evidence based nonpharmacological therapies for migraines?  (10:42)

By Shreya P. Trivedi, MD, Martin Fried, MD and Neil Shapiro, MD Stay tuned as Clinical Correlations will be partnering with CORE IM to bring our audience podcasts!  CORE IM is a consortium of educators aligned to create internal medicine-specific portable learning tools in the form of podcasts, corresponding show notes and illustrations.  Our goal is to help today’s busy clinician synthesize and consolidate important teaching points. The podcast will deliver high-yield digestible content on various clinically relevant internal medicine topics that can be easily incorporated into demanding schedules. To start, Core IM will have two formats with episodes released bi-weekly on Wednesdays: 5 Pearls Podcast:  This 15-20 minute segment will bring you five applicable, evidence-based pearls on a core IM topic. This brainchild of Dr. Shreya P Trivedi and Dr. Marty Fried will incorporate active learning by quizzing listeners at the beginning of the podcast.  We will review the evidence behind each pearl and discuss how to incorporate them into your practice.  Each podcast will also review clinical pearls from prior podcasts to boost retention over time.  Upcoming topics include approach to headaches, guideline-based review of iron deficiency anemia and pathophysiology and management of hepatic encephalopathy. Mind the Gap Podcast: This 10 to 15-minute segment will explore common practices in Internal Medicine and ask the question “Why do we do what we do?”.   Dr. Steven Liu and Dr. Janine Knudsen’s cozy banter and thoughtful insights will take you deeper into the evidence – or lack thereof – for common IM practices to tackle knowledge gaps and challenge dogma. Look forward to hearing about why do we do paracentesis for cirrhotics on admission and why we dose albumin the way we do for hepatorenal syndrome. There are several other formats currently under development that we hope to roll out in the coming months.  To ensure the accuracy of our information, all podcasts have been peer-reviewed by subspecialty experts in their respective fields.  Our inaugural podcast will debut next week.  We are excited to showcase our hard efforts over the last year! Sincerely, CORE IM team: Executive Producer: Shreya P. Trivedi, MD (@ShreyaTrivediMD) Five Pearls Producer: Marty Fried, MD (@Marty_Fried) Mind the Gap Producer: Steve Liu, MD Advisors: Neil Shapiro MD, John Hwang MD, Vincent Santillo MD Podcast editing and technical set-up: Harit Shah and Steven Liu MD Director of Sound Design, Theme song: Shaun Finnegan Artistic director: Dr. Mike Natter (@mike_natter)

CORE IM is an independent consortium of educators aligned to create internal medicine-specific portable learning tools in the form of podcasts, corresponding show notes and illustrations. Segments include 5 Pearls and Mind The Gap. For more information: https://www.clinicalcorrelations.org/?p=11623 (https://www.clinicalcorrelations.org/?p=11623) Sincerely, CORE IM team: Executive Producer: Shreya P. Trivedi, MD (@ShreyaTrivediMD) Five Pearls Producer: Marty Fried, MD (@Marty_Fried) Mind the Gap Producer: Steve Liu, MD Advisors: Neil Shapiro MD, John Hwang MD, Vincent Santillo MD Podcast editing and technical set-up: Harit Shah and Steven Liu MD Director of Sound Design, Theme song: Shaun Finnegan Artistic director: Dr. Mike Natter (@mike_natter)