#121 HIV Care for the Internist

#145 NephMadness: Hepatorenal Syndrome vs AKI

Does your sympathetic nervous system get activated when you notice acute kidney injury in patients with cirrhosis? Ever wonder how to really diagnose hepatorenal syndrome (HRS)? Think you have the bile-acid-stones to start diuretics on a patient requiring pressor support for kidney failure? You have come to the right place! Listen to @kidney_boy Joel Topf, HRS expert Juan Carlos Velez (@veleznephhepato), and self-proclaimed most-handsome-nephrologist Bill Whittier (@TWhittier_RUSH) tackle the complex pathophysiology and treatment of hepatorenal syndrome in this NephMadness 2019 special episode! Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! Earn CME and read about each region at AJKD blog. Full show notes available at https://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: Justin Berk MD, Nora Taranto MS4 Infographic by: Alex M @nephroguy Hosts: Matthew Watto MD Edited by: Matthew Watto MD, Emi Okamoto MD Guests: Joel Topf MD, Juan Carlos Velez MD, Bill Whittier MD Sponsor Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 NephMadness Kidney Pun Contest 01:04 Disclaimer 01:38 Sponsor - Become an ACP member today! 02:12 Intro, guest bio 04:38 Guest one-liners, some career advice and Joel’s pick of the week 13:14 Sponsor - Become an ACP member today! 14:48 Case of acute kidney injury in a patient with cirrhosis 16:37 Initial differential diagnosis and approach to newly elevated creatinine in cirrhosis (urinalysis, FeNa, urine sodium) 21:34 History and physical in cirrhosis and AKI 24:56 Hepatorenal physiology 26:45 Fluid choice 30:27 Diuretic therapy in cirrhosis and volume overload 34:38 Is a Renal Ultrasound useful in AKI? 40:05 Recap: the initial approach to AKI in cirrhosis 40:52 Therapeutic trials when volume status is uncertain 46:02 Hepatorenal physiology revisited 50:03 Vasoconstrictor therapy with octreotide, terlipressin, or norepinephrine 62:24 Type 1 versus type 2 hepatorenal syndrome 63:55 Large volume paracentesis (LVP) in cirrhosis with AKI; how much fluid to remove; use of diuretics or LVP in patient on norepinephrine?! 71:18 Diagnostic criteria or HRS 73:00 NephMadness matchups including bile cast nephropathy 78:40 Outro

#144 NephMadness: Inpatient Hypertension

Inpatient hypertension is tricky. What’s the best way to answer those overnight nursing phone calls for elevated blood pressures? What’s the role of treating hypertensive urgency in the hospital? Plus, Our nephrology experts put a new issue on the generalist’s radar: are ACE-inhibitors dangerous to give (or hold) during an operation? This NephMadness 2019 episode, features special guests Dr. Pascale Khairallah (@Khairallah_P), Dr. Charlie Wray (@WrayCharles) and Dr. Joel Topf (@kidneyboy) to better understand the role of anti-hypertensives in the inpatient setting and keep your blood pressure down on those overnight calls. Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! Full show notes available at https://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: Justin Berk MD, MPH, MBA; Pascale Khairallah MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto, MD Guest:  Pascale Khairallah MD, Charlie Wray DO, Joel Topf MD Sponsor Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 Kidney Pun Contest with Hannah Abrams 01:16 Disclaimer 01:45 Sponsor - Become an ACP Member today! 02:14 Intro and guest bios 03:50 Picks of the weeks 06:00 Sponsor - Become an ACP Member today! 07:20 Case of acute severe hypertension; Does hypertensive urgency exist? Should we treat it? 26:40 Case of perioperative medicine. Should we hold the ace inhibitor? Is there evidence to guide us? 35:02 Take home points 36:54 Everyone picks their NephMadness winners for the hospital medicine region 43:13 Outro

#142 Cirrhosis TIPS: Acute Complications

Cirrhosis TIPS for the decompensated cirrhotic & acute on chronic liver failure from expert hepatologist and keto-practitioner Scott Matherly MD, @liverprof and chief hepatologist at @KashlakHospital. We walk through acute management of variceal bleeds, when to suspect SBP in decompensated cirrhosis (all the time, it turns out), how much fluid to remove in paracentesis, and some definitions about what decompensated cirrhosis and acute on chronic liver failure really mean. Take our pretest on cirrhosis! 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, Matthew Watto MD Pretest by: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Images and infographics: Hannah Abrams MS3 Edited by: Matthew Watto MD Guest: Scott Matherly MD Sponsor  Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 NephMadness teaser 00:50 Sponsor - Become an ACP Member today! 01:25 Intro, guest bio 03:45 Guest one-liner, keto diet 07:40 Picks of the week from Paul, Matt and Scott 11:50 Sponsor - Become an ACP Member today! 13:26 Clinical case of bleeding and altered mental status in cirrhosis 16:10 Interpretation of our patient’s labs and physical exam 18:53 Defining terminology in cirrhosis (decompensated vs compensated vs acute on chronic liver failure) 24:48 Initial workup, resuscitation and stabilization in variceal bleeding 26:10 Why occult blood and ammonia levels are unhelpful in cirrhosis 29:00 Fluid choice for the cirrhotic patient with hypotension; octreotide (or terlipressin); antibiotics prophylaxis 33:10 Proton pump inhibitors and ulcers from variceal banding 34:00 Mechanism of action for octreotide and terlipressin 35:54 Prevention of recurrent bleeding with TIPS, or nonselective beta blockers 40:40 Scores for prognostication in the acute setting 44:00 Coagulopathy of cirrhosis and should DVT prophylaxis be used 48:38 Elevated INR and procedures 56:55 Paracentesis in the acute setting and interpretation of fluid studies:cell count, total protein, SAAG, blood culture vial; pathophysiology of ascites 67:30 Treatment of SBP: antibiotics, IV albumin; plus, Hepatorenal physiology explained 79:04 Hepatic encephalopathy is a shunt phenomen; how to evaluate for causes; treatment of HE 87:58 Rifaximin 89:10 Take home points 91:02 Outro

#141 Wound Care Pearls

Demystify chronic wound care management with high yield pearls from wound care expert Dr. Elizabeth (Foy) White-Chu. She takes us through a simple yet thorough approach to manage complex chronic wounds. We discuss everything from selecting a dressing, to pain management, and what kind of water should you really use when cleansing a wound. Answers to all of these burning questions and more await you, so don’t waste anymore time! Press play and let Dr. White-Chu take you on a journey through evidence based practices for the management of chronic wounds. 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 by: Carolyn Chan MD CME questions by: Justin Berk MD Produced by: Matthew Watto MD Hosts: Matthew Watto MD, Paul Williams MD, Carolyn Chan MD Guest: Dr. Elizabeth (Foy) White-Chu Sponsor Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18. Time Stamps 00:00 Sponsor - ACPs MKSAP 18 00:25 Disclaimer, intro, guest bio 03:58 Guest one-liner, movie recommendation, favorite failure, career advice 11:40 Picks of the week 15:58 Sponsor - ACPs Medical Knowledge Self Assessment 18 17:50 Clinical case of lower extremity ulcer; describing a wound 21:04 Taking a wound focused history 26:28 Differentiating wound types 29:04 Edema and compression therapy; Should diuretics be used? 36:43 Description of the multi-component wrap 38:10 Counseling a patient about wound care and setting expectations for healing 41:29 High value options for each wound type 44:35 Gardening and wound bed preparation 51:32 A bit on silver therapy 53:40 Back to the case; Red flags in wound care 55:40 Culturing a wound 58:17 Instructions on how to write wound care orders 62:00 Rundown of topical therapies for wound care 65:04 Negative pressure wound therapy aka “wound vac” 66:14 How often are dressing changes needed? 68:27 Take home points 70:20 Outro 71:30 Carolyn gives a wound care PUN!

#139 Genetic Testing in Primary 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. Time Stamps 00:00 Announcement 00:37 Sponsor: ACP’s MKSAP 18 01:04 Disclaimer, intro, guest bio 06:31 Guest one liner, book recommendations, career advice 12:23 Cohost picks of the week 16:22 Sponsor: ACP’s MKSAP 18 18:12 Dr Reed walks us through the genetic machinery from the top down (genome, chromosomes, exons, genes, SNPs, and epigenetics) 26:18 A clinical case of Jeanne Sequence; What are the indications for genetic testing? 29:54 What is actually being tested? 33:57 What is the turnaround time for testing? What resources are available for counseling? Why is this challenging in primary care? 38:58 Variant of Uncertain Significance 41:22 Direct to consumer genetic testing 44:54 Back to our case of Jeanne Sequence; How to take a history for patients with family history of breast cancer. 50:41 Guidelines on use of genetic testing; Deciding which family member to test 59:49 Laws about genetic testing and discrimination; How does this effect life insurance or disability insurance eligibility 63:47 Is routine whole genome testing practical? Will this be commonplace in the future? 68:22 What genetics resources are useful for primary care practitioners? 72:13 Cost of genetic testing 77:32 Take home points 82:57 Outro

#137 Hyperkalemia Master Class with Joel Topf MD

Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis. 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 Join us at ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there! Credits Written and produced by: Matthew Watto, MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Infographic: Matthew Watto MD Edited by: Matthew Watto MD Guest: Dr Joel Topf MD   Time Stamps 00:00 Ad disclaimer, intro and guest bio 05:11 Guest one-liner and picks of the week —Peloton indoor cycle, “your local library”, The Nice Guys (film) by Shane Black, and Forgotten Hand (PS4 game) 11:17 ACP Internal Medicine Meeting 2019 details 12:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia 19:55 Hyperkalemia and the EKG 23:38 Threshold for treatment of hyperkalemia 27:20 Use of telemetry and the U-shaped curve for potassium and mortality 30:11 Choice of therapy for acute hyperkalemia 33:13 Albuterol for hyperkalemia 34:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring 39:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron 43:10 Fludrocortisone for hyperkalemia 45:05 Calcium for elevated potassium 48:43 SPS, potassium binding resin 52:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis 58:28 Sodium bicarbonate for acute and chronic hyperkalemia 61:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia 63:05 Threshold for admission; Diet and potassium 65:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods 68:45 Patiromer and sodium zirconium 71:51 Loop diuretics and empiric potassium supplementation 74:12 Can diet alone be used to treat HYPOkalemia? 75:26 Take home points 77:40 NephMadness is coming! March 2019 79:53 Outro 81:00 More Kidney Boy!

#135 Perioperative Medicine

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

2018 Recap Extravaganza

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

#132 A Case of Abdominal Pain

Sharpen your diagnostic schema for abdominal pain and eosinophilia with this mystery case http://hdx.org/Rxg (click link to follow along). Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx attempts to solve this challenging case with the help of The Curbsiders. Use this link http://hdx.org/Rxg to follow along with the case on the Human Dx app and check out more Global Morning Report cases. 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: Hannah R Abrams Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto MD Guest: Reza Manesh MD Special thanks to: Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing and editing the cases; and to Tyler Brandon for helping to coordinate these wonderful episodes. Time Stamps 00:00 Announcement, disclaimer, intro, guest bio 01:20 Picks of the week 05:42 How Reza fell in love with clinical reasoning 08:58 Case of 50 yo male with abdominal pain 21:14 Some unexpected findings 43:00 Case conclusion/answer, cognitive autopsy and Reza’s take home points 48:35 Outro

#130 Work-Life Fit: Women In Medicine

Create a successful partnership and career withs tips from Wonder Woman, Sue Hingle MD of ACP.  Work-Life Balance: is it a myth, or attainable if we could just find the right fit? In this episode, we chat with Dr. Susan Hingle about identifying our work-life priorities and re-evaluating these priorities throughout our lives. We strategize about achieving personal and professional goals (pro tip: stop worrying about what others think!). Dr. Hingle is Professor in the Department of Internal Medicine and Vice Chair of Education and Faculty Development and Associate Internal Medicine Residency Program Director at Southern Illinois University. She is also the Immediate Past Chair of the Board of Regents of the American College of Physicians (ACP). She has served at the ACP in a variety of ways, including as a member of the ACP Women’s Task Force. Her clinical expertise is in women’s health, health promotion, and disease prevention. Enjoy the episode! 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. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4, Shreya Trivedi MD, Leah Witt MD, Sarah P. Roberts MPH. CME Questions by: Shreya Trivedi MD Editors: Matthew Watto MD and Chris Chiu MD Hosts: Shreya Trivedi MD, Paul Williams MD, Leah Witt MD Guest: Susan Hingle MD Time Stamps 00:00 Disclaimer, intro and guest bio 02:52 Guest one liner, WIM Moment of awakening, advice for her younger self 07:45 Picks of the week 10:30 Physician with family and caregiver responsibility; How to plan for personal and professional goals 18:20 What to look for in a partner, how to work with them to achieve work life fit, and non-traditional roles 28:35 Advice on family planning 31:40 Residency programs and life events 32:55 Should you go part-time? 39:43 Work life balance? Or work life fit? And some examples/tips for success 49:54 Take home points 50:45 Outro 52:22 Bonus story

#128 Aspirin Overhyped and Overused

Aspirin’ to figure out if ASA can help prevent a heart attack? Interpreting all the new trials doesn’t have to cause chest pain! Join Dr. Ambarish Pandey from UT Southwestern as he helps The Curbsiders ASCEND the mountains of the latest studies to ARRIVE at some well-informed conclusions on the role of aspirin in primary prevention for cardiac events. The team also discusses secondary prevention, aspirin and dual (or triple) antiplatelet therapy, and whether it’s okay to stop giving aspirin to older adults without known CAD (Spoiler alert: it’s okay). 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: Justin Berk MD, Matthew Watto MD CME questions by: Justin Berk MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto MD and Chris Chiu MD Guest: Dr. Ambarish Pandey MD Time Stamps 00:00 Disclaimer, intro and guest bio 04:15 Guest one liner, book recommendation, career and research advice 11:07 Case of aspirin for primary prevention, aspirin’s public persona, and nocebo effects of statins 21:40 ARRIVE and ASCEND trials 28:14 Aspree trial 32:38 Coronary artery calcium; aspirin use for secondary prevention 37:42 Dual antiplatelet therapy and the DAPT score 41:25 Should we continue aspirin when a patient also needs a DOAC? 46:14 Should we continue DAPT in a patient who needs a DOAC (or warfarin)? 49:40 Deprescribing aspirin for primary prevention in older adults? 50:51 Closing remarks 52:33 Outro

#127 STIs: Syphilis, Gonorrhea and Chlamydia

Master the diagnosis and management of common STIs (sexually transmitted infections) with tips from expert, Dana Dunne MD, Associate Professor of Medicine in Infectious Diseases at Yale. Topics include: the stages and many presentations of syphilis, syphilis treatment and counseling, the natural history, diagnosis, and screening guidelines for gonorrhea and chlamydia, treatment options in the age of growing resistance, and a discussion of partner notification and treatment. 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: Bryan Brown MD Hosts: Bryan Brown MD, Paul Williams MD, Matthew Watto MD Guest: Dana Dunne MD Special thanks to Kate Grant MBChB, Dip GUMed for her contribution of knowledge and artwork. Time Stamps 00:00 Announcement, disclaimer, intro and guest bio 04:29 Guest onliner, book recommendation, advice for learners/teacher, and picks of the week 11:00 A case of syphilis, clinical manifestations and discussion of the stages 26:05 Testing for syphilis 39:05 Mandatory reporting and partner tracing 42:40 Counseling patients with syphilis 44:44 A case of gonorrhea and chlamydia, clinical manifestations, screening guidelines 52:30 How to counsel patients to obtain samples from urethra, rectum, vagina, oropharynx; Mycoplasma genitalium 59:40 CDC treatment guidelines, Super gonorrhea, test of cure, and treatment of partners 72:35 Take home points 74:30 Outro

#125 Hidden Curriculum

Check out this audio treasure map to find the hidden curriculum and learn how it can change your practice. Learn how positive teaching spans not just the classroom or bedside but, how we simply talk about patients. Sanjay Desai MD, coauthor of ACP’s Position Paper on Hidden Curriculum and Internal Medicine program director at Johns Hopkins guides us through several cases that illustrate how our institutional norms can shape the practice of medicine...for better or worse. 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: Sanjay Desai MD; Justin Berk MD, MPH, MBA; Matthew Watto MD CME questions by: Justin Berk MD Editors: Chris Chiu MD & Matthew Watto MD Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD Guest: Sanjay Desai MD Time Stamps 00:00 Disclaimer, Intro and guest bio 04:00 Guest one liner, book recommendations, career advice 10:50 Intro to the hidden curriculum and ACP’s three recommendations 22:00 Case #1: A patient with schizophrenia 32:10 Case #2: The iPatient 38:07 Case #3: Attending forgets to wash their hands 41:10 Case #4: A dying patient’s primary care doctor saves the day 46:26 Case #5: A case of violating duty hours 60:10 Take home points 62:00 Outro

#123 Sleep Apnea Pearls and Pitfalls

The sleep apnea episode that won’t put you to sleep. Become a sleep apnea guru with incredible insights from Barbara Phillips MD, MSPH, FCCP an expert in pulmonary medicine, critical care and sleep medicine who is also a past president of CHEST! We discuss high-yield topics in the world of obstructive sleep apnea including: home sleep studies vs in-lab polysomnography, the importance of oxygen saturation (the T90 and ODI) when interpreting sleep study results, tricks to improve CPAP adherence, and alternatives therapies for obstructive sleep apnea. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes. 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: Cyrus Askin MD CME questions by: Cyrus Askin MD Editor: Chris Chiu MD & Matthew Watto MD Hosts: Cyrus Askin MD & Matthew Watto MD Guest: Barbara Phillips, MD Cover-Art & Infographic - Beth Garbitelli, MS1 Time Stamps 00:00 Disclaimer, intro, guest bio 03:00 Guest one liner, book recommendation, advice for trainees 08:10 Clinical case of sleep apnea, some basic stats, and key predictors of sleep apnea 12:38 Barriers to diagnosis and treatment of OSA 15:23 Discussion of T90, hypoxemia and sleep fragmentation 17:05 How to read a sleep study report 21:55 Home sleep apnea testing 24:15 What are the consequences of sleep apnea 28:30 What is the efficacy of cpap for lowering blood pressure and mortality 31:45 Counseling a patient who is new to cpap 33:45 Choice of mask 40:10 Do alternatives to cpap work? e.g. surgery, mandibular advancement devices 44:17 Modafinil and z-drugs 47:15 Driver’s license issues in sleep apnea 48:35 Future of sleep medicine and take home points 51:15 Outro

#121 HIV Care for the Internist

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

#119 Nutrition Pearls, Heart Health and Bacon

Nutrition pearls from integrative cardiologist, Steven Devries MD, Associate Professor of Medicine, Northwestern Feinberg School of Medicine, Executive Director of The Gaples Institute. Clinicians receive little formal nutritional training in medical school and residency. It’s time to fill that gap! We discuss the strength of the literature supporting dietary interventions for cardiovascular health and review practical tips to help patients achieve healthy eating patterns. Patients need to hear from us that nutrition matters! 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: Molly Heublein MD Hosts: Matthew Watto MD, Paul Williams MD, Molly Heublein MD Guest: Stephen Devries MD Editor: Matthew Watto MD Special thanks to Elena Gibson MS4 for writing our show notes Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 02:40 Guest one-liner, book recommendation, favorite failure, nontraditional career path 10:10 Nutrition and medical education 12:45 Evidence for how nutrition can improve health outcomes 15:33 How to describe a heart healthy or Mediterranean diet to patients 25:16 Discussion of fats and oils 31:44 Food deserts, healthy snacking options 37:15 Calorie counting and use of healthy eating apps 40:55 How to frame the discussion about a healthful eating pattern with patients 47:18 Macronutrient content. Does it matter? 52:50 Intermittent fasting 54:24 A free resource for patients to learn about nutrition  

#117 Clostridium Difficile: IDSA Guidelines, Bad Puns, and Random Pearls

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 Time Stamps 00:00 Intro, disclaimer, guest bio 02:19 Getting to know our guest, recommendations for reading, career advice 06:40 Clinical case and CDI testing 09:30 Testing for CDI: PCR and Two step testing 16:30 Testing after treatment 20:00 Treatment of initial CDI episodes, metronidazole pharmacokinetics 24:15 Classification of CDI severity 29:30 Fidaxomicin pearls: when to use, cost, and tapers 34:10 Vancomycin tapers 36:05 Fecal transplant pearls: freeze dried capsules, c-scopes, treating fulminant CDI 44:44 Infection control: counseling homegoing patients, hand washing, and baths 47:50 Social media questions: immodium and toxic megacolon, antibiotics less likely to promote CDI, probiotics, and more! 59:14 Best CDI joke in the history of time 60:00 Take home points 62:42 Outro Tags Clostridium, difficile, cdi, C.Diff, infectious, diseases, diarrhea, IDSA, guideline, antibiotics, vancomycin, fidaxomicin, fmt, transplant, fecal, stool, toxin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#115 Geriatric Depression

Summary Geriatric depression got you down? Boost your spirits with tips and tactics from Geriatric Psychiatrist, Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: suicide in the older adults; how to diagnosis depression in older adults; how to counsel patients about antidepressants, how to choose an antidepressant, how to monitor and titrate medications, and how long to continue therapy. Stay tuned for part two of our discussion with Dr Popeo on managing sleep and behavioral problems in older adult patients with dementia. 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: Jordana Kozupsky NP, Matthew Watto MD Artwork by: Kate Grant MD Hosts: Jordana Kozupsky NP, Matthew Watto MD Editor: Matthew Watto MD Guest: Dennis Popeo, MD Time Stamps 00:00 A question for you, the listeners 01:12 Disclaimer, intro and guest bio 05:00 Getting to know our guest, recommendations for reading, and career advice 14:13 Case of geriatric depression; effective history taking; recognizing associated symptoms; depression scales 19:03 Suicide in older adults; firearm safety 24:26 Choice of therapy; Pharmacologic agents; Counseling patients and managing expectations; Dose titration and tracking symptoms 34:41 Augmenting therapy versus cross-titration to another agent; When is it okay to stop an antidepressant 40:50 Take home points 44:40 Outro Tags: psychiatry, psych, geri, geriatrics, depression, mdd, sleep, insomnia, appetite, agitation, suicide, SSRIs, side, effects, therapy, diagnosis, serotonin, mirtazapine, bupropion, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#113 Gout: Uric acid targets, urate lowering therapy, and random questions from social media

Master the management of gout with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. Topics include: how to initiate and titrate urate lowering therapy, guidelines controversy over uric acid targets, colchicine & NSAIDS for anti-inflammatory prophylaxis, uricosuric agents, febuxostat, HLA B5801, use of uric acid levels in the acute setting and more random gout facts. 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: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Tuhina Neogi MD, PhD Time Stamps 00:00 Intro and guest bio 01:30 Allopurinol initiation and titration 07:10 Uricosuric therapy 09:10 Controversy over uric acid targets for gout 17:40 Parachutes and randomized controlled trials 19:15 Colchicine or NSAIDS for prophylaxis 23:20 Who needs febuxostat? 26:20 When to refer for gout, HLA B5801, and checking uric acid levels in the acute setting   33:29 Take home points 36:15 Outro Tags: allopurinol, uric, urate, acid, level, therapy, management, gout, flare, crystal, arthritis, titration, probenecid, febuxostat, target, acr, acp, guidelines, nsaids, colchicine, hla b5801, septic, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#111: Hotcakes - Complementary Medicine in Cancer, Dosing Aspirin by Body Weight, Marijuana & Respiratory Symptoms, Penicillin Allergies and More!

Dr. Neda Frayha (@nedafrayha) of Primary Care RAP (Hippo Education) joins us this month for our thoughts and analysis of some recent (and not so recent) journal articles that interested us this month. Our articles spanned topics that include at cancer survival among patients pursuing treatment with complementary medicine, the effect of body weight on effectiveness of preventive aspirin dosing, strategies to promote physician leadership, respiratory symptoms in those with marijuana use and MRSA risk among patients with penicillin allergies. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date). Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.   Credits: Written by: Sarah Phoebe Roberts MPH, Neda Frayha MD, Christopher Chiu MD Producers: Sarah Phoebe Roberts MPH, Christopher Chiu MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD Editor: Matthew Watto MD  Time stamps: 00:00 Disclaimer, intro, guest bio 05:05 Do patients using complementary medicine for cancer therapy have worse outcomes? 13:11 Does low dose aspirin work for primary prevention of major adverse cardiac events? 19:16 Do physicians make better leaders? 24:55 Does marijuana cause respiratory symptoms? 30:40 Does penicillin allergy confer increased risk for C Diff and MRSA infection? 38:40 Wrap-up and outro Tags:​ aspirin, cardiac risk, mortality, cancer, complementary, alternative, conventional, therapy, marijuana, cannabis, respiratory, symptoms, leader, leadership, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#109: Things We Do For No Reason: A High Value Episode

Things We Do For No Reason #TWDFNR highlights some widespread practices that are difficult to justify based on lack of proven health benefits, but significant cost (both financial and non-financial harms). Avoid these low value practices and inflated medical bills with tips from expert, Dr Lenny Feldman, MD, FACP, Associate Professor of Medicine Johns Hopkins. Topics include: renal ultrasound and urine electrolytes in acute kidney injury (AKI), folate deficiency and anemia work-up, prealbumin and malnutrition, blood transfusions, shellfish and contrast allergies, monitoring after switch from IV or oral antibiotics, and “against medical advice” discharges. Don't forget to check out Clinicwiki.org a free, online resource for teaching ambulatory medicine. 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: Justin Berk MD, MPH, MBA Editor: Matthew Watto, MD Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD, FACP Guest: Lenny Feldman MD, FACP Goal: Listeners will recognize things we do for now reason aka low value practices with an unfavorable ratio of benefits to cost and/or harm. Learning objectives: After listening to this episode listeners will… Determine if renal ultrasound is indicated in acute kidney injury Recognize the limitations of urine electrolytes in AKI. Identify the shortcomings of folate testing. Explain the significance of low albumin and prealbumin. Identify patients at risk for serious allergic reactions from IV contrast administration Explain the futility in discharge Against Medical Advice (AMA) paperwork Counsel patients on harm reduction in “AMA” discharges Rationalize discharging patients immediately after switching from IV to  oral (PO) antibiotics. Time Stamps 00:00 Announcements 00:38 Disclaimer, intro, and guest bio 03:53 Guest one liner, some recommendations, and advice 08:35 Defining high value care and things we do for no reason (TWDFNR) 12:40 Why do clinicians order useless testing? 14:58 Urine electrolytes for acute kidney injury 20:30 Renal ultrasound for acute kidney injury 25:54 Stop ordering folate for anemia workup 31:47 How many units should I transfuse? 34:40 Prealbumin and albumin for malnourishment. 43:24 Iodine, shellfish and contrast allergy 50:28 Patient leaving against medical advice 56:45 Switching from IV to oral antibiotics 63:27 Dr Feldman’s plugs 65:36 Outro  Tags: high, value, choosing, wisely, acute, kidney, injury, renal, ultrasound, transfusion, AKI, malnutrition, folate, prealbumin, albumin contrast, allergy, antibiotics, AMA, TWDFNR, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#107: Women in Medicine, Be Bold

“Women in medicine, be bold.” Medical World, powerful women are here to stay. Dr. Vineet (Vinny) Arora, Professor of Medicine at University of Chicago, an exemplary Woman in Medicine and Leadership, shares snippets of her own story, valuable career advice to folks at all levels of training, and fascinating data about the gender disparities that exist in training, promotion, and pay.  We hope you’ll learn from this episode, whether you have faced or anticipate facing these struggles as a Woman in Medicine or as a member of another marginalized group, or whether you’re an ally and want to learn more about the issue. Women are entering medical school now more than ever, and are learning to provide the best possible care to patients (didn’t you see that patients of female physicians have significantly lower mortality rates than patients of male physicians? (Tsugawa et al., 2016)).  The modern medical woman wants to teach, mentor, and lead--and be fairly evaluated, and promoted. That’s where We In Medicine (both women and men) have some work to do.  Because gender disparities (and other disparities hinging on identity) do exist. N.b. This episode is our inaugural in what we hope will be a Women in Medicine series for the Curbsiders.  We have many more topics with which we’d like to engage, from career trajectory to imposter syndrome to sexual harassment to balancing career and personal lives (as inequity is not only at work (Khullar. Being a Doctor is Hard. It’s Harder for Women. NYT 2017)), to conversations about race, gender, and LGBTQ identity in medicine.  We’re passionate, at The Curbsiders, about all these topics, and we want to dive deep into how to make Medicine a more welcoming and ceiling-less place for all.  We can’t wait to bring this series to you, not to mention to bring some more fabulous female experts on air. 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: Leah Witt MD, Shreya P. Trivedi MD, Nora Taranto AB, Sarah Phoebe Roberts MPH, Molly Heublein MD, Beth Garbitelli, Hannah R Abrams, Images by: Beth Garbitelli and Hannah Abrams Editor: Matthew Watto MD Hosts: Leah Witt MD, Shreya P. Trivedi MD, Matthew Watto MD Guest: Vineet Arora MD Time Stamps 00:00 Disclaimer and intro 03:15 Guest bio, and one liner 05:55 Dr Arora’s Women in medicine moment of awakening 11:05 Advice to young women, “Be bold” 13:20 Picks of the week 16:45 Mistaken identity. Women not recognized as physicians due to appearance 22:05 Gender bias starts early in training and why it's important to shout-out accomplishments 31:24 Contracts, promotions and the leaky pipeline 38:32 Defining coaches, sponsors, and mentors 44:06 How to use your team and shout-out your accomplishments 52:04 How to write effective evaluations and letters that avoid gender bias 53:55 Take home points 57:00 Outro Tags: women, medicine, wim, LeanIn, leadership, mentorship, doctor, education, family, assistant, career, sponsorship, vineet, arora, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#105: Lyme Disease and Tick-Borne Illness with ID Expert Paul Sax: Why you should never go outside or to Boston in the summer

Lyme disease and tick-borne illness deconstructed by Infectious Diseases expert, Paul E. Sax MD, of episode 78 fame. Oh, Summer Nights. The time for romance between Danny Zuko and good girl Sandy, the time to sit in the backyard around the bonfire, the time for sunset hikes in the woods and mountains…..and don’t forget, it’s also the time for those pesky woodland ticks who’ll go for a ride on you and maybe suck your blood (gross!). Dr. Sax takes us through the essentials of tick-borne illness, with a focus on Lyme Disease: diagnosing it, treating it, identifying possible co-infections, and managing Post-Lyme residual symptoms.   Our (And Dr. Sax’s) Disclaimer about this episode, and the shownotes: Tick-borne illness is a very serious problem in public health in the US, but management is quite a controversial issue. We’ve done our best with this episode to stay as evidence-based as possible. Moreover, given the limited time we have on air, we have tried to focus on what we think is most clinically relevant. 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: Shreya P. Trivedi MD, Nora Taranto AB Produced by: Shreya P. Trivedi MD, Nora Taranto AB Editor: Matthew Watto MD Images by:  Hannah R. Abrams Hosts: Shreya P. Trivedi MD, Matthew Watto MD, Paul Williams MD Guest: Paul E. Sax MD Time Stamps 00:00 Intro 02:17 Disclaimer 03:19 Guest bio 05:17 Getting to know Guest 08:33 Favorite hiking experiences 12:20 Disclaimer of Tick-borne illness 12:28 Clinical case of recent hiking in endemic area with a rash 20:59 Lyme testing limitations 27:38 Patient education to doxycycline 30:16 Case of elderly outdoorsy healthy male with flu-like symptoms in the summer 32:39 Differentiating anaplasmosis and babesiosis 33:17 Workup for patient with possible tick co-infections 39:22  Post-lyme disease residual symptoms 48:02  Case of tick attached to patient 56:19  Outro Tags: lyme, disease, anaplasmosis, babesiosis, treatment, prevention, coinfection, doxycycline, paul, sax, infectious, diseases, nejm, harvard, pcr, antibody, tick, borne, illness, chronic, post, syndrome, removal, endemic, anatomical, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

#103: Train Your Brain: Mapping out your road to expertise

Expert diagnostician, Dr. Gurpreet Dhaliwal, again joins The Curbsiders to dive deeper into the topic of clinical expertise.  Topics include, and are mainly focused on, Dr. Dhaliwal’s “training regimen:” feedback, simulation, quizzing, learning from consultants, and how to read the medical literature as a clinician.  While we found this episode to be incredibly useful (and entertaining to record), don’t let our bias sway your opinion! In fact, just listen to the episode and listen for practical advise on how to improve your own clinical acumen.   Dr Brigham’s comment:  Be forewarned, much of what we talk about is seemingly common sense, but, upon listening to the episode many times, I realize that we have, over time, overly complicated the fundamentals of expertise.  I’m just as guilty as the next physician. 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:  Stuart Brigham MD Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD Guest: Gurpreet Dhaliwal MD Images by: Beth Garbitelli Edited by:  Matthew Watto MD Time Stamps 00:00 Disclaimer, Intro 02:25 Guest Bio 03:57 Pun 04:25 Dr. Dhaliwal 05:57 Pick of the Week - Move, “Jiro Dreams of Sushi” 08:00 Pick of the Week - Podcast, “Unspooled” 09:06 Pick of the Week - Water Putty, “Durham’s Rock Hard Water Putty” 10:20 “Clinical Case” Introduction 12:00 Developing expertise, introduction 15:50 Developing a patient log 21:30 Asking the wrong question leads to the wrong answer 23:35 Telling a colleague they were wrong 26:00 Five to one ratio 28:58 Understanding the why 33:57 Simulation in practice 37:35 Quote on learning… Just listen. 41:00 Quizzing and consolidating memory 44:24 Reading the literature as a clinician 50:10 Bottom line 57:10 Outro Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student

#101: Cirrhosis: Medications, decompensation, complications

Cirrhosis. Take control of cirrhosis and treat your patients like the pros! In this episode of The Curbsiders, Dr. Scott Matherly, assistant professor in the Dept of Medicine at Virginia Commonwealth University and board certified hepatologist, builds upon his introduction to cirrhosis. You already know what to look out for and how to diagnose these patients, now it’s time to build your knowledge and medical repertoire against this deadly condition! Topics include: high protein diet, ascites, diuretics, hepatic encephalopathy, lactulose vs rifaximin, portal hypertension, esophageal varices, beta blockers, spontaneous bacterial peritonitis prophylaxis and more pathophysiology! 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: Cyrus Askin MD Infographics: Beth Garbitelli Produced by: Cyrus Askin MD and Matthew Watto MD Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Scott Matherly MD Time Stamps 00:00 Announcements 00:54 Disclaimer 01:30 Guest bio 02:28 NASH, diet, vitamin E, pioglitazone and prevention of cirrhosis 06:56 Clinical case of decompensated cirrhosis 09:02 Pathophysiology of circulatory dysfunction in cirrhosis and use of diuretics 18:25 Hepatic encephalopathy, ammonia, lactulose and rifaximin 25:10 Timing of medical therapy 26:39 MAP of 82 mmHg, beta blockers and variceal bleeding 31:04 Use of midodrine for hypotension 33:45 Prophylaxis of SBP 36:05 Take home points 38:04 Outro Tags: cirrhosis, liver, high, protein, diet, sodium, restriction, ascites, diuretics, furosemide, spironolactone, hepatic, encephalopathy, lactulose, rifaximin, portal, hypertension, esophageal, varices, beta, blockers, spontaneous, bacterial, peritonitis, prophylaxis, pathophysiology, sbp, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student