What really works when treating HRS? Vasoconstrictors like terlipressin vs. norepinephrine vs. midodrine: how do we decide which to use? Do you give albumin? When do you give Lasix or another diuretic? When is the better choice transplant, dialysis, or even palliative care?

🔹 Sponsor: Oakstone CME

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🔹 Transcript & Show Notes

Timestamps:

 (00:12) | Introduction and Overview of Hepatorenal Treatment

 (03:38) | Vasoconstrictors Focus: Terlipressin, Norepinephrine, and Midodrine

 (12:32) | Finding the Right Dose of Albumin and Knowing When to Stop

 (15:06) | Volume Management: Balancing MAP, Diuretics, and Creatinine

 (21:42) | Understanding the High Mortality of HRS-AKI

 (32:30) | Transplant, Dialysis, or Palliation Care

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Hepatorenal Syndrome, HRS-AKI, Cirrhosis, Nephrology, Liver Disease

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HRS-AKI vs. other causes of AKI in cirrhosis: What do serum or urine sodium clues, albumin challenges, and shifting diagnostic criteria actually reveal about getting the diagnosis right?

🔹 Sponsor: Oakstone CME

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🔹 Transcript & Show Notes

Timestamps:

 (00:57) | Understanding the Pathophysiology of HRS

 (03:42) | How Portal Hypertension Traps the Kidneys

 (10:32) | Sorting the Differential of AKI in Cirrhosis Beyond HRS

 (18:28) | Hyponatremia and Urine Sodium in Advanced Cirrhosis

 (24:04) | Official Diagnosis and Evolving Criteria of HRS

 (29:30) | Albumin: When It Helps and When to Hold Back

 (34:00) | Recap and Future Directions

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Nephrology, renal, hepatology, Portal Hypertension, Liver Disease

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Who’s really at risk for fractures, and how should we be treating them? 

Most fragility fractures occur in patients without osteoporosis. Should we rethink who gets treated? And could just one or two IV infusions (spread years apart) of zoledronate prevent fractures for years? Have the concerns about bisphosphonates been overblown?

Find out all the nuances on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.

🔹 Sponsor: Oakstone CME

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🔹 Transcript & Show Notes

Timestamps:

(00:59) | Diagnosing Osteoporosis and Hidden Fracture Risk

(05:38) | Evolution of Bisphosphonate Use in Osteoporosis Treatment

(07:51) | Current Use of Bisphosphonates: Benefits, Risks, and Side Effects

(10:31) | Exploring Non-Bisphosphonate Options for Fracture Prevention

(11:44) | Teriparatide and Alternative Osteoporosis Medications

(14:53) | Inside the Latest Bisphosphonate Clinical Trial

(18:07) | Key Findings from the Zoledronate Fracture Prevention Study

(22:38) | Public Health Impact of Fracture Prevention Strategies

(24:24) | Final Takeaways and Expert Perspectives on Osteoporosis Care

Tags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Osteoporosis, Fragility Fractures, Zoledronate, Bone Health

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Medications for orthostatic hypotension! When to initiate treatment, how to use them safely, and what to do when new issues arise during treatment. How do those change if someone has autonomic failure? What do you do when your patient has hypertension AND also has orthostatic hypotension?

🔹 Sponsor: Oakstone CME’

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🔹 Transcript & Show Notes

Timestamps (+/- 1-2 mins):

(00:28) | Case Recap: Beyond Non-Pharm Strategies

(03:07) | Midodrine: Timing, Testing, & Supine Hypertension

(06:23) | Fludrocortisone: Benefits vs. Risks

(09:01) | Droxidopa: Evidence, Side Effects, Access Issues

(10:11) | Pyridostigmine & NSAIDs: Secondary Options

(12:31) | Balancing Hypertension and Orthostatic Hypotension

(14:29) | Functional Hypotension & Risk Stratification

(18:45) | Symptomatic Patients: What to Stop, What to Continue

(20:19) | Autonomic Disease: Supine & Nocturnal Hypertension

(21:47) | Bed Elevation, Compression, & Non-Pharm Pearls

Tags: Internal Medicine, Geriatrics, Autonomic Dysfunction, Hypertension, Syncope, Falls, Patient Safety, Medical Education, physician assistant, nurse practitioner, hospitalist, primary care, neurology

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Learn specific, practical ways to counsel patients on non-pharmacologic interventions. What is our goal with OH treatment? Is it the blood pressure number that matters? How do we avoid missing neurogenic causes of orthostatic hypotension (OH)? 

🔹 Sponsor: Oakstone CME’

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🔹 Transcript & Show Notes

Timestamps:

(00:05) | Case Presentation: Urinary Retention → Lightheadedness

(02:37) | Defining Orthostatic Hypotension & Prevalence

(04:10) | Why Diagnosis Is Harder Than It Seems

(06:20) | How (and When) to Measure Orthostatic Vitals

(10:06) | Role of Heart Rate in Narrowing the Differential

(14:41) | Rethinking Treatment Goals: Function > Numbers

(17:52) | Recognizing Orthostatic Intolerance Symptoms

(22:14) | Non-Pharmacologic Strategies in the Hospital

Tags: Primary care, Internal Medicine, Physician Assistant, Nurse Practitioner, Geriatrics, Autonomic Dysfunction, Syncope, Falls, Patient Safety, Medical Education

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Next time you’re squinting at a chest tube, feel confident you know exactly what to look for and why. Hear it explained in a way that really sticks!

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(02:50) | Xray vs. POCUS vs. CT for Pneumothorax Diagnosis

(07:29) | Do All PTXs Need Chest Tubes?

(11:55) | Explaining Pneumothorax to Patients

(14:58) | Understanding the Pleural Drainage System

(26:11) | Monitoring Air Leaks with the Water Seal Chamber

(32:27) | Managing Persistent Air Leaks

Tags: CoreIM, Internal Medicine, Pulmonology, Critical Care, Medical Education, 3-Chamber Drainage System, Endobronchial Valves and Pleurodesis

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How do you work up neutropenia? When is neutropenia benign? When do neutrophils recover? How can you diagnose neutropenic fever in the first 15 minutes and start antibiotics in the first 60 minutes? Do you always add MRSA coverages? Only Pseudomonas coverage? When do you add fungal coverage?

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript & Show Notes

Timestamps:

(02:24) | Approach to Neutropenia & Duffy Null

(11:38) | Dose and duration-dependent neutropenia vs. immune-mediated neutropenia

(19:46) | When do neutrophils recover?

(29:56) | Classifying Neutropenic Fever Syndromes

(29:53) | Strategies for Managing Low-Risk Neutropenic Fever

(33:02) | Antimicrobial Therapy and Duration in Febrile Neutropenia

Tags: CoreIM, Internal Medicine, Oncology, Hematology, Medical Education, Physician Assistant, Nurse Practitioner, Neutropenic Fever Management, Antibiotics

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Have a good laugh and reflect deeply with these three stories that hit the feels in different ways.

If you'd love to hear more stories from Dr. Maria Rosasco, check out some of her other appearances on the podcast: July Stories and Handoffs & Contingency Planning.

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript and Show Notes

Timestamps:

(01:04) | Story 1: Sharing a Personal Story for Patient Care

(03:42) | Story 2: Leading a Family Meeting

(06:52) | Story 3: Early Days of the COVID-19 Pandemic

(10:22) | What Rituals and Values Guide Your Path in Medicine

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Narrative Medicine, Humanities

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What went wrong? What were the reasoning or contextual missteps that led us astray?

🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply! Due Aug 1, 2025

🔹 Transcript and Show Notes

Timestamps:

(00:02) | Case Presentation and Initial Diagnosis

(02:47) | Tachycardia and Early Impressions

(04:10) | Clinical Deterioration and New Clues

(07:19) | Problem Representation and Reflection

(21:45) | Lessons on Reasoning and Bias

(26:55) | Final Takeaways and Action Steps

Tags: Clinical Reasoning, Internal Medicine, Diagnostic Accuracy, Hoofbeats, Cognitive Bias, Medical Education, Illness Scripts

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• Imaging Pearls | (01:12)
• Deciding on Thoracentesis | (04:00)
• Light’s Criteria and Pseudoexudates | (07:00)
• Pleural Fluid Studies: pH and Cell Differential | (16:56)
• Diagnosing and Treating Parapneumonic Effusions | (23:32)
• Malignant Pleural Effusions: Diagnosis and Management | (30:39)

🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio Companion

Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP

🔹 Transcript and Show Notes

Tags: Internal Medicine, Medical Education, Pulmonology, CoreIM, Clinical Reasoning, critical care, pulm

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