Core IM | Internal Medicine Podcast

“The triglycerides are high. Now what?” This episode breaks down a practical approach to elevated TGs, from knowing when to check ApoB or non-HDL-C to choosing lifestyle changes, lipid-lowering medications, and when to suspect an underlying genetic disorder. 

🔹Transcript and Show Notes

02:17 | Check a non-HDL-C or ApoB if TGs are ≥150 mg/dL 

07:18 | Address waist circumference and lifestyle before meds for high TGs

10:52 | Dr. Watson’s 3-day carbohydrate responsiveness trial 

17:07 | Order a fasting or nonfasting lipid panel?

19:00 | When do you reach for TG-lowering medications? 

25:26 | Familial chylomicronemia syndrome (FCS)

Tags: CoreIM, Medical Education, Hypertriglyceridemia, ACC AHA lipid guidelines, lipid guidelines 2026, cardiovascular risk 

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“Too young for colon cancer.” This episode unpacks the red flags of early-onset CRC, from blood in the stool and iron deficiency anemia to persistent abdominal pain and changes in bowel habits, and offers practical pearls for closing the clinical loop. Also learn why a “negative” family history may need a yearly refresh.

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🔹Transcript and Show Notes

01:45 | Colorectal cancer rising in younger adults 

06:42 | Why screening starts at age 45

08:15 | What may be driving early-onset colorectal cancer 

13:37| Key takeaways: symptoms, follow-up, and family history 

Tags: Colorectal Cancer Screening, Internal Medicine, Gastroenterology, Cancer Screening, Oncology

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“It didn’t work.” This episode breaks down practical treatment options (dosing options for naltrexone, acamprosate, topiramate, gabapentin) and counseling pearls to help you meet patients where they are and support their recovery. Also discover blind spots in detox and rehab centers.

🔹Transcript and Show Notes

🔹 Explore ACP’s Substance Use Disorder Education Hub for videos and an AI-powered patient simulation to practice alcohol-use conversations: https://www.coreimpodcast.com/SUDhub

Alcohol Use and Chronic Health Conditions Mini Video Series

01:55 | #1: Naltrexone

12:06 | #2 Acamprosate

16:15 | #3: Topiramate

21:12 | #4: Other meds

29:31 | #5: Detox and rehab blind spots 

Tags: CoreIM, Medical Education, Addiction Medicine, Alcohol Withdrawal, Addiction Treatment, GLP-1, pharmacology

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Have you ever lost a patient and found yourself thinking about them long after the shift ended? This episode explores the grief clinicians can carry after a patient dies, including the losses that aren’t always obvious. We also discuss ways to work through that grief, recognize when it becomes complicated, and lean on your team for support.  

🔹Transcript and Shownotes

04:12 | What is Clinician Grief?

10:02 | Types of Losses

10:22 | Loss of a close relationship with a particular patient

12:56 | Loss due to a professional's identification with the pain of family members

13:56 | Loss of one's unmet goals and expectations and one's professional self-image and role

18:47 | Loss related to one's personal system of beliefs and assumptions about life

21:30 | Past unresolved losses or anticipated future losses

23:29 | The death of the self

25:44 | Coping

Tags: CoreIM, Medical Education, Clinician Wellbeing, Burnout, Secondary Traumatic Stress, Complicated Grief, Coping With Grief, Medical humanities, medical ethics

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How to choose between RUQ ultrasound, CT, HIDA, MRCP, EUS, and ERCP based on the clinical picture? When should you move from diagnostic imaging to therapeutic ERCP, and what should you know about sphincterotomy, stents, and stone removal? Plus, how to interpret bile duct dilation without jumping straight to obstruction?

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🔹Transcript and Shownotes

02:11 | Pearl 1: Gallbladder Problems Spectrum

07:33 | Pearl 2: Choose Imaging Strategically: Start with RUQUS, Escalate as Needed

14:34 | Pearl 3: Biliary Tree Diagnostics

19:19 | Pearl 4: Invasives that are Diagnostic and Therapeutic

27:06 | Pearl 5: Stenting in ERCP

Tags: CoreIM, Internal Medicine, Medical Education, Gallstones, Cholecystitis, Biliary Disease, ERCP, Biliary Imaging

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Throwback: Should you really fluid-restrict every patient with SIADH? When can IV fluids make hyponatremia better or worse? Are salt tabs actually doing enough? And what can urine studies tell you before you start treatment? Join us for a practical, physiology-driven approach to hyponatremia management, from fluids and solutes to loop diuretics and identifying the underlying cause. 

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🔹Transcript and Shownotes

6:46 | Pearl 1: Key Principles

15:13 | Pearl 2: Fluids in hyponatremia

26: 03 | Pearl 3: Solutes in hyponatremia management

35:49 | Pearl 4: Lasix in hyponatremia management

40:05 | Pearl 5: Etiologies

Tags: CoreIM, Internal Medicine, Medical Education, SIADH, Fluid Restriction, Nephrology, Hospital Medicine, Urine Osmolality

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Why can lower-dose combinations be more effective and better tolerated than maximizing one medication? How to troubleshoot common challenges such as amlodipine edema, gout, electrolyte abnormalities, and the patient who says they cannot tolerate anything? Why ACT (ARBs, Calcium Channel Blockers, Thiazides) is the preferred first-line framework, and how to personalize medication choices based on comorbidities and side effects.

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🔹Transcript and Shownotes

03:00 | Diagnosing Hypertension 

04:10 | When to Start Combination Therapy Instead of Monotherapy 

07:00 | Choosing First-Line Therapy Using the ACT Framework 

13:23 | Why ARBs Are Often Preferred Over ACE Inhibitors 

16:02 | Choosing the Right ARB: Candesartan vs Losartan 

18:39 | Comparing Potency & Duration Across First-Line Antihypertensives 

20:54 | Amlodipine Edema: Why It Happens and How to Fix It 

23:54 | Thiazides: Practical Tips, Electrolyte Problems & Class-Killer Side Effects 

29:33 | Managing Patients Who 'Can't Tolerate' Blood Pressure Medications 

Tags: Hypertension Management, High Blood Pressure, Primary Care, Internal Medicine, Core IM

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Learn from primary care docs what has been practiced and changed from the 2026 ACC/AHA Lipid Guidelines! Learn how the new CPR framework (Calculate, Personalize, Reclassify) and PREVENT risk calculator change statin decisions, why LDL targets are back, and when to use Lp(a), ApoB, and coronary artery calcium (CAC) testing. Discover updated risk-enhancing factors, expanded indications for non-statin therapies, and practical strategies to personalize lipid management for both primary and secondary

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🔹Transcript and Shownotes:  

01:17 | Highlight #1 & #2: CPR and PREVENT Score

03:14 | Highlight #3: Updated ASCVD Risk Categories Using the PREVENT Score

05:30 | Highlight #4: LDL Targets Are Back

07:20 | Highlight #5: High-Risk Conditions That Bypass the PREVENT Score

08:41 | Highlight #6: Lp(a) Screening for Everyone

11:51 | Highlight #7: When to Use ApoB Testing

13:16 | Highlight #8: Reproductive Risk Factors

15:29 | Highlight #9: Using CAC to Guide Statin Therapy

19:09 | Highlight #10: Non-Statin Therapies

Tags: CoreIM, Internal Medicine, Medical Education, Cholesterol, Statins, LDL, ASCVD, Preventive Cardiology, LpA, ApoB, CAC, ACC2026, Cardiology, PrimaryCare 

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MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?

In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.

Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.

This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.

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🔹Transcript and Shownotes:  

01:57 | Understanding MASLD as a Systemic Disease 

05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease 

08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan) 

16:15 | Lifestyle Treatment & Weight Loss Targets 

19:00 | ESSENCE Trial: Semaglutide for MASH 

21:58 | MAESTRO-NASH Trial: Resmetirom 

27:27 | Future Treatments for MASH 

30:51 | Key Takeaways for Clinicians 

Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver Fibrosis

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What blood pressure should we target in patients on hemodialysis? Why volume control remains the foundation of treatment? How blood pressure targets differ from the general population. Learn practical pearls on medication timing around dialysis, drug dialyzability, antihypertensive selection, and strategies to prevent intradialytic complications while optimizing long-term outcomes. 

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🔹Transcript and Shownotes:  

02: 19 | Pearl 1: Blood Pressure Targets 

09: 40 | Pearl 2: Timing Medications and Dialyzability 

15: 31 | Pearl 3 - Pharmacologic Management Nuances in Dialysis Patients 

22: 57 | Putting It All Together: The Medication Hierarchy 

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, ESRD, End-Stage Kidney Disease, Hypertension, Kidney Health, Dry Weight, Volume Overload

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