Core IM | Internal Medicine Podcast

A dialysis patient with a chronic cough: is it COPD, or are they still volume overloaded?
A patient with AKI and hyperkalemia says they’re still peeing — does that rule out post-obstructive AKI?
A patient arrives in the ED with uremic symptoms and a newly created AV fistula. Can you safely use it, or do you need to place a temporary dialysis catheter?
And the classic inpatient dilemma: your heart failure patient looks better after diuresis, but the creatinine is rising. Is it time to stop, or should you keep going?

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🔹Transcript and Shownotes:

00:52 | What is NephMadness?
02:19 | Detecting post-renal obstruction in a patient who reported normal urination
11:26 | POCUS for discharge or continue diurese
17:25 | Distinguishing COPD from volume overload in a dialysis patient using lung ultrasound
23:55 | Assessing AV fistula maturity at the bedside to potentially avoid placing a temporary dialysis line

Along the way, we discuss practical ways clinicians can use renal, lung, and venous ultrasound to clarify uncertain clinical situations and make faster decisions at the bedside.

If you’ve ever paused on rounds, wondering “what should we do next?” in a patient with kidney disease, this episode explores how POCUS can help answer that question.

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, AKI Management, POCUS

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Most clinicians see dementia medications on the med rec, but many of us aren’t sure how much they actually help. In this episode we break down donepezil, memantine, and the new anti-amyloid drugs, and when to stop them.
• Do cholinesterase inhibitors really work?
• What should clinicians know about lecanemab and donanemab before referring patients?
• How much benefit should we expect and for how long?
• When should you deprescribe dementia medications?

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🔹Transcript and Shownotes
02:27 | Deep Dive 1: How do we deliver the news of a diagnosis of dementia?
09:41 | Deep Dive 2: Prescribing medications for cognitive decline
29:30 | Deep Dive 3: Patient-centered management for a patient with cognitive decline
35:46 | Deep Dive 4: Planning for an uncertain future

Tags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistant

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Cognitive decline is tough for all parties. What are the high-yield questions to ask? What should you add to your one-liner? When do you stop using MOCA and try to clearly describe their functional status? Do all patients with cognitive decline need an MRI?

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🔹Transcript & Shownotes:

01:12 | Cognitive Concerns During a Routine Follow-Up
03:41 | Deep Dive 1: How do you pivot when you recognize unexpected memory issues?
15:08 | Deep Dive 2: What tools should we use to characterize and stage cognitive decline?
31:09 | Deep Dive 3: How do we determine the etiology of cognitive decline?

Tags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistant

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From metformin to basal insulin to overlooked older medications, this episode reviews the T2D medication toolkit clinicians use every day. We then dive into new evidence on once-weekly insulin to help you individualize therapy while reducing treatment burden.

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🔹Transcript and Shownotes:
00.58 | Insulin Hx & Types
06:00 | Indications for Insulin and the Burden on Patients
08:26 | What is the QWINT-1 Trial?
16:18 | Discussion

Tags: CoreIM, Internal Medicine, Evidence-Based Medicine, Insulin Resistance, Clinical Reasoning, Hospital Medicine, Medical Education, Endocrine, Endocrinology

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Is patient confidentiality absolute or conditional? When does protecting privacy put others at risk? Can you follow a former patient in the EHR for learning? Should you post a compelling case online even if it’s “de-identified”? And when does the law force you to betray patient trust? In this episode of At the Bedside, learn how clinicians should act when ethics, law, and trust collide.

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🔹Transcript and Shownotes:
03:51 | What is the difference between Privacy and Confidentiality?
05:50 | Guidelines and laws
10:06 | Limits/appropriate breaches (competing principles/obligations) 
22:03 | Privacy vs education
35:34 | Conclusion

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