#183 Diagnose the Clinician: Hoofbeats Segment

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’Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show NotesTimestamps:(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 HospitalTags: Primary care, Internal Medicine, Physician Assistant, Nurse Practitioner, Geriatrics, Autonomic Dysfunction, Syncope, Falls, Patient Safety, Medical EducationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 CompanionUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show NotesTimestamps:(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 LeaksTags: CoreIM, Internal Medicine, Pulmonology, Critical Care, Medical Education, 3-Chamber Drainage System, Endobronchial Valves and PleurodesisFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 CompanionUse the code "CORE25" for 25% off: 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 NeutropeniaTags: CoreIM, Internal Medicine, Oncology, Hematology, Medical Education, Physician Assistant, Nurse Practitioner, Neutropenic Fever Management, AntibioticsFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 CompanionUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript and Show NotesTimestamps:(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 MedicineTags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Narrative Medicine, HumanitiesFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 NotesTimestamps:(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 StepsTags: Clinical Reasoning, Internal Medicine, Diagnostic Accuracy, Hoofbeats, Cognitive Bias, Medical Education, Illness ScriptsFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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 CompanionUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript and Show NotesTags: Internal Medicine, Medical Education, Pulmonology, CoreIM, Clinical Reasoning, critical care, pulmFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Listen for some good laughs and relatable stories!In this episode, we share raw and real stories from July — from rapid responses to unexpected kindness — and reflect on the emotional weight of starting out in medicine.🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply! Due Aug 1, 2025🔹 Transcript and Show NotesPrior July Stories:July Stories 2.0 (2023)July Stories (2019)Timestamps:(00:32) | Dr. Ali Trainor's First Day as an Intern(03:00) | The Patient's Critical Condition and Emotional Response (07:12) | Dr. George Tran's First Night Shift (10:38) | Dr. Ali Trainor's Second Rotation Experience (14:01) | The Importance of Co-InternTags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Narrative Medicine, HumanitiesFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How much do beta blockers help after a heart attack, even when the heart’s pumping well? In this episode, we revisit the origins of beta blockers in post-MI care, examine how evidence evolved, and explore the REDUCE-AMI trial, which questions whether beta blockers are still needed for all.Listen to this latest episode of Beyond Journal Club, a collaboration between Core IM and NEJM Group, where we put research into context tracing the arc of evidence, dissecting the clinical question, and exploring what the findings could mean for real-world patient care🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply!🔹 Transcript and Show NotesTimestamps:(00:48) | Background on Beta Blockers and Their Mechanism(02:41) | Historical Context of Beta Blockers in Heart Disease(04:56) | Capricorn Trial and Its Impact(07:17) | Emergence of Doubts About Beta Blockers(10:09) | Introduction to the REDUCED-AMI Trial(15:52) | Discussion on Trial Interpretation and Clinical Implications(16:18) | Comparison with Other Trials and Future DirectionsTags:  CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Cardiology Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

🔹 What is invasive fungal disease, and who is most at risk for developing invasive fungal disease? (~ 02:46)🔹 What are the main classes of fungi? (~11:35)🔹 What are the pros and cons of B-D Glucan and Galactomannan (~19:16) 🔹 How to increase the yield of blood cultures? How to interpret yeast growth in sputum/BAL and urine cultures? (~ 30:42)🔹 How is invasive fungal disease treated? (~ 35:14)📌  Sponsor: Oakstone CME’s ACP MKSAP Audio CompanionUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP📌 Transcript & show notesTags: CoreIM, IMCore, Infectious Disease, Hospital Medicine, Hospitalist, ICU, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, moldFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

🔹What are clinically relevant limitations of an A1c vs. a CGM (1:40)🔹What do the different parts of the ambulatory glucose profile tell you? (09:59)🔹What are common pitfalls, medications, lifestyle patterns that are important to ask your patient about when seeing them for a visit to manage blood sugar? (15:19)🔹 How can you titrate insulin based on when you see the hypoglycemia on the ambulatory glucose profile (20:00)🔹 When there is too much hyperglycemia, how do you titrate insulin when adding on GLP-1 agonists? (26:30)📌 Sponsor:  NEJM Fellowship Program, click here to learn more and/or apply!📌 Transcript & show notesTags: CoreIM, IMCore, Endocrinology, Primary Care, Medical Education, Physician Assistant, Nurse Practitioner, Medical Student, diabetes management, insulin titrationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out Eko: https://ekohealth.com/COREIM* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Washington Red Raspberries: https://redrazz.orgAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy