Run the List

Dr. Nadine Palermo, an endocrinologist and the Associate Director of the Acute Diabetes Care program at Brigham and Women’s Hospital, talks with Joyce Zhou (host) and Jakub Glowala (case presenter) to discuss the management of inpatient diabetes patients. Dr. Palermo begins by discussing the way to think about hyperglycemic patients in the hospital, how we can arrive at new diagnoses of diabetes, in addition to why treating inpatient dysglycemia matters. Dr. Palermo provides us with a brief detour on non-insulin agents, their associated side effects, and their potential use in particular hospitalized patients in the future. We are then taught about using a weight-based approach to hyperglycemic management, taking into consideration other comorbidities and feeding requirements, as well given an understanding of the various insulin agents (rapid-, intermediate-, and long-acting), in order to establish an individualized plan for the inpatient hyperglycemic patient.

Dr. Anna Goldman, an endocrinologist and medical educator at Brigham and Women’s Hospital, talks with Joyce Zhou (host) and Dr. Emily Gutowski (case presenter) to discuss diagnosis, management, and lifestyle considerations in patients with diabetes mellitus. They talk through a case of a patient with hypertension, hyperlipidemia, and a family history of T2DM. Dr. Goldman presents her framework for type 1 vs. type 2 DM and how to diagnose T2DM based on labs, physical exam findings, and clinical history. Moreover, Dr. Goldman teaches us about the various pharmacologic agents used in T2DM treatment (metformin, sulfonylureas, DPP4i, GLP1R agonists, SGLT2i) from their mechanisms of action and side effects to their different clinical uses. Dr. Goldman closes the conversation by discussing what her follow-up visit looks like both in history-taking and physical examination, in addition to any treatments that need to be considered.

Dr. OP Hamnvik, an endocrinologist and medical educator at Brigham and Women’s Hospital, joins Joyce Zhou (host) and Dr. Emily Gutowski (case presenter) to discuss hypocalcemia. They run through a case of a patient with a recent thyroidectomy who presents with perioral paresthesia and hypocalcemia. Dr. Hamnvik takes us through the many causes of hypocalcemia, from the PTH-dependent to the PTH-independent causes, in addition to ways in which we can test for hypocalcemia at the bedside through Chvostek's & Trousseau's signs. Dr. Hamnvik gives us a quick refresher on calcium homeostasis, vitamin D metabolism, and the various ways in which these can go awry to cause hypocalcemia. The conversation ends with a discussion of the classic hypocalcemia labs, treatment decision-making, and several clinical pearls from Emily & Dr. Hamnvik!

Run the List dedicates this episode to George Floyd, Ahmaud Arbery, Breonna Taylor, and others that have been tragically lost due to structural racism within our society.

In this important episode, Dr. Navin Kumar talks with Dr. Utibe Essien, an Assistant Professor of Medicine at the University of Pittsburgh School of Medicine and a researcher who dedicates much of his time to racial and ethnic health disparities. In it, Dr. Essien educates us on the discipline of health disparities, talking about its early history from 1899 through today, and advocates for its place in medical school curricula, as social determinants of health are a critical piece of disease pathophysiology. The two touch on the social structures that drive disease admissions and presentations, using COVID-19 as a prominent example of the social inequities that exist within our society. Moreover, they discuss structural racism and how we as a medical community can step up to respond and make an impact. We can’t go on as "business-as-usual” and Dr. Essien provides us with practical short-term and long-term steps to take in order to take better care of our patients and one another.

Dr. OP Hamnvik, an endocrinologist and medical educator at Brigham and Women’s Hospital, joins Emily Gutowski (host) and Joyce Zhou (case presenter) to discuss hypercalcemia. Through a case of an outpatient presenting with incidental hypercalcemia and no symptoms, Dr. Hamnvik walks through ways to differentiate the various causes of hypercalcemia, from primary hyperparathyroidism to non-PTH-mediated sources such as malignancy. Together, they discuss the normal regulation of calcium in the body and explore the ways in which various labs can be used in conjunction to pinpoint the diagnosis, paying attention to possible laboratory artifacts. The conversation closes with ways to manage both inpatient and outpatient hypercalcemia, in addition to learning several clinical pearls from Dr. Hamnvik!

Dr. Rachel Blair, an endocrinology fellow at Brigham and Women’s Hospital, joins Emily Gutowski (host) and Katie Kester (case presenter) to discuss hyperthyroidism. Together, they walk through a case of a young patient with suspected thyrotoxicosis and discuss the diagnostic workup, from physical exam and labs to radioactive iodine uptake studies. They talk through causes of primary and secondary hyperthyroidism, when thyrotoxicosis is considered an endocrine emergency, and how to provide initial empiric management of patients with suspected hyperthyroidism while awaiting thyroid antibody tests. The conversation closes with Dr. Blair’s three major clinical takeaways, but you’ll have to tune in to find out!

Dr. Rachel Blair, an endocrinology fellow at Brigham and Women’s Hospital, joins Dr. Navin Kumar (host) and Sarah Onorato (case presenter) to discuss hypothyroidism. Together, they use a sample case of a patient with hypothyroidism as a framework to guide discussion about primary vs. secondary hypothyroidism, associated lab findings, and management of unambiguous hypothyroidism vs. subclinical hypothyroidism. They wrap up their discussion with several clinical pearls, advocating for both a broad differential and panel of lab studies, assessed over time, to cinch the diagnosis.

Dr. Ari Moskowitz, the Associate ICU Director in the division of pulmonary and critical care medicine at Beth Israel Deaconess Medical Center, talks with Dr. Navin Kumar about the management of patients with severe COVID-19. The two examine which patients require escalation to ICU-level care, in addition to the complications of severe COVID-19 and which organ systems can be affected. They discuss how to identify hypoxemic respiratory failure, the utility of the physical exam in the process, and the need to avoid anchoring bias during diagnostic work-up. Lastly, Dr. Moskowitz covers the mainstays of ICU care in ARDS and severe COVID-19 patients, with a focus on physical maneuvers like proning, and an emphasis on evidence-based medicine.

Moses Murdock, a 5th year medical student at the Perelman School of Medicine at the University of Pennsylvania, is interviewed by Blake Smith, a 2nd year medical student at Harvard Medical School, about virtual learning during the COVID-19 pandemic. Together, they talk about what virtual learning means to medical students both now and in the future, in addition to ways to take charge of independent learning through identification of diverse learning formats that best suit oneself. In the episode, Moses offers a number virtual learning resources and breaks them down into three major categories: content, community building, and active learning. They also offer tips to those seeking to engage on #MedTwitter and ways to continue sharpening one's diagnostic skills, virtually.

Walker Redd, an internal medicine resident at Brigham and Women’s Hospital, chats with Emily Gutowski, a 4th year medical student at Harvard Medical School, about what to expect as an incoming intern amidst the current COVID-19 pandemic. They talk through adjustments that interns may be expected to make as part of the care team, in addition to mindset changes that can be adopted early on during this state of flux. Moreover, they discuss virtual learning opportunities that rising interns - as well as current residents and attending physicians - can use to think through and practice end of life discussions, enabling humanism during this uncertain time.