When Illness Scripts Fail: A Mystery Case

In this special episode, Dr. Mitchell Charap, longtime IM residency program director and master clinician at NYU Langone, walks us through a mystery case that defies expectations. Together, he and host Emily Gutowski explore how illness scripts can both guide and sometimes mislead our diagnostic reasoning, and why the physical exam remains an indispensable tool.

Critical care attending Dr. Maria Sunseri and critical care pharmacist Dr. Brynna Crovetto join Emily Gutowski for a deep dive into sedation and analgesia in the ICU. They explain how to assess agitation, titrate sedation depth using the RASS scale, compare analgesia vs. anesthesia, and choose between agents like fentanyl, propofol, dexmedetomidine, and ketamine. They also share practical pearls for safe weaning from sedation and interdisciplinary extubation planning.

Dr. Matthew Pullen, infectious disease physician at the University of Minnesota, joins host Walker Redd to discuss blastomycosis, an often-overlooked endemic fungal infection. Through a case presentation, they explore epidemiology, classic histopathologic findings, and a variety of clinical manifestations, including pulmonary, cutaneous, CNS, and musculoskeletal. They also walk through diagnostic strategies and treatment approaches based on disease severity.

Dr. Vikramjit Mukherjee, critical care physician at NYU and Bellevue, joins Dr. Emily Gutowski for a review of septic shock management. They first review the diagnosis of SIRS vs. sepsis vs. severe sepsis vs. septic shock. Additional topics include identifying possible sources of infection, recognizing red flags, and initiating timely, adequate fluid resuscitation, including in special patient populations (e.g., CKD and CHF). Lastly, they briefly review the use of vasopressors in septic shock.Check out Sketchy's new fully immersive, real-life case simulations that challenge you to apply classroom knowledge to clinical decision-making today! First 10 users to use code RUNTHELIST will get a free year of cases access. https://tinyurl.com/sketchy-runthelist 

Dr. Walker Redd interviews Dr. Brooke Matson, endocrinologist at UNC Chapel Hill, about osteoporosis. Together, they review the diagnosis of osteoporosis and osteopenia, the use of the FRAX calculator, and the basics of antiresorptive and anabolic therapies. They also cover lifestyle changes that patients with osteoporosis can incorporate to prevent fractures.

In this episode, Dr. Emily Gutowski interviews Dr. Michael Janjigian about preoperative assessment and perioperative medicine. They discuss the recent updates to perioperative management guidelines, the Revised Cardiac Risk Index (RCRI) and Gupta scores, and integration of laboratory data into preoperative visits. This episode also helps identify patients who may need additional testing prior to surgery.

Dr. Ryan Bonner returns to explore cardiovascular-kidney-metabolic (CKM) syndrome and its clinical implications through the lens of chronic kidney disease. The discussion walks through atherosclerotic risk, weight management, hypertension, and heart failure, offering a multidisciplinary, practical approach to managing CKM.

Dr. Walker Redd interviews Dr. Ryan Bonner, nephrologist at UNC School of Medicine, about principles of managing a patient with CKD. They discuss best practices in assessing a patient's true renal function, review the major classes of medications in CKD, and go over some common pitfalls in treating these patients.

Dr. Allison Greco, pulmonary and critical care specialist at Bellevue Hospital, sits down with Dr. Emily Gutowski and discusses the initial presentation, workup, and management of a patient with a pulmonary embolism. They go through diagnostic modalities, scoring systems, and the various treatment options for patients depending on their risk profile. They discuss provoked vs. unprovoked PEs, and recommendations for longer term anticoagulation.

In part 2 of our series on gout, Dr. Michael Pillinger is back to talk about treatment strategies in the acute setting, as well as how to approach urate-lowering therapies in the outpatient setting. He and Dr. Gutowski discuss the impact of lifestyle changes on gout control, and review the elements that may trigger a gout attack.