The Curbsiders podcast

2018 Recap Extravaganza: The Curbsiders Favorite Pearls

December 31, 2018 | By

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.

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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

Goals and Learning Objectives


Listeners will review clinical pearls and content highlights from 2018 Curbsiders episodes.

Learning objectives

After listening to this episode listeners will…

  • Recall important clinical advice from Curbsiders guests and hosts
  • Identify usable strategies to improve diagnostic and clinical reasoning
  • Reflect on the value of social media and free open-access medical education
  • Understand that the Venn diagram of people who are bitten by spiders and people who skip the Curbsiders introductory banter is, in fact, a circle

The Curbsiders’ Favorite Pearls

Clinical Reasoning: Kashlak Morning Report with Human Dx (episodes #126, #131, and #132) and episodes #103 ‘Train Your Brain and #90 ‘Clinical Reasoning: Become an expert diagnostician’

  • Diagnostic reasoning is a skill taught by example (focus on why, not what)
  • Training for clinical expertise requires deliberate practice and reflection
  • Develop your diagnostic schema and conduct a ‘cognitive autopsy’
  • Don’t be afraid to google!
  • Honest peer feedback is necessary (5:1 positive:negative feedback ratio)
  • Simulation is necessary, the more cases the better (see Human Dx)
  • Microquizzing, multimodal learning and teaching help consolidate new pearls of knowledge and wisdom
  • “I don’t need to know all the articles, I just need to know about the articles.”

Pulmonary Hypertension: episode #80 ‘Pulmonary Hypertension, freeways, and cows in heart failure’

  • 90% of pulmonary hypertension => due to left heart disease (60%), chronic hypoxic lung disease (20%), or combination of both (10%). To differentiate, “look at the company it keeps”.
  • Don’t miss Chronic Thromboembolic Pulmonary Hypertension (CTEPH) as it’s the only curable cause with pulmonary endarterectomy.
  • Pulmonary arterial hypertension (PAH aka Group 1) specific therapies don’t cause systemic vasodilation or postural hypotension.
  • Don’t use PAH-specific therapies with other PH groups besides Group 1.
  • Check out this sweet infographic
Pulmonary Hypertension Algorithm and Infographic by Matthew Watto MD

Women in Medicine: episodes #107 ‘WIM, Be Bold’ and #130 ‘Work-Life Fit’

  • Mentorship and sponsorship are different; both are important to success
  • Be bold and take risks, especially early-on in your career
  • There is never a ‘good’ time to have kids (or for other major life events to happen) and that’s okay (also discussed in episode #118)
  • Find partners, workplaces, and training environments (e.g. residency) that support and enable your personal and career goals

Iron deficiency: episode #84 ‘Anemia, Iron Deficiency, IV iron and Tony Stark’

  • Be more aggressive with IV iron infusions; serious reactions are rare
  • Oral iron should be dosed every other day (or “Thrice Weekly”)
  • Soluble transferrin receptor (sTfR) is elevated in iron deficiency (it’s not an acute phase reactant) and can be helpful in differentiating with Anemias of Chronic Inflammation (sTfR not elevated) .

Infectious diseases

Episode #105 ‘Lyme Disease and Tick-Borne Illness’

  • Lyme: Treat without sending labs if suspicion is high (if the story fits), “Doxycycline deficiency must be treated”
  • Enzyme immunoassay (EIA) has a high false positive rate for Lyme
  • Give Prophylactic doxy if tick attached, and consider post-exposure prophylaxis for hyperendemic areas and work outside
  • There is a “Mass psychosis that MRSA abscesses are spider bites.” They’re not!

Episode #127 ‘STIs: Syphilis, Gonorrhea and Chlamydia’

  • Make the sexual history routine. Leave the “screening door open” => “If anything ever changes, they can come to you”
  • Syphilis is the “Great Pretender” and should be on more differentials
  • See Bryan’s “Stages of Syphilis” Infographic
  • GC/CT NAAT: Urine for men, endocervical/vaginal for women (self collect okay), throat or rectal swabs for oral or anal receptive intercourse.
  • Syphilis Reverse Algorithm
Syphilis Reverse Algorithm by Bryan Brown MD

Physical Exam: episodes #98, Knee pain with Dr. Ted Parks and #124, The Shoulder – Simplify your approach

Things We Do For No Reason: Episode #109, Things We Do For No Reason

  • Prealbumin (aka Transthyretin) and albumin are negative acute phase reactants. Thus, low values more suggest inflammation, not malnutrition.
  • Folate deficiency is rare. Checking levels is low value care.
  • Shellfish allergy is not a risk for IV contrast allergy.

November Hotcakes: Exercise, Aspirin, Fish Oil and Hypertension

  • Acute lowering of BP in Hypertensive Urgency is unnecessary. It may even be harmful.
  • Don’t extrapolate Hypertensive Emergency to Hypertensive Urgency.

2018 Recap Extravaganza Host Picks

The Curbsiders are…

  • Dr. Matthew Watto
  • Dr. Stuart Brigham
  • Dr. Paul Williams
  • Jen Watto, Marketing Director and Consultant
  • Dr. Shreya Trivedi
  • Dr. Leah Witt
  • Dr. Molly Heublein
  • Dr. Carolyn Chan
  • Dr. Justin Berk
  • Dr. Bryan Brown
  • Dr. Cyrus Askin
  • Dr. Fatima Syed
  • Dr. Kate Grant
  • Nora Taranto
  • Hannah R Abrams
  • Beth Garbitelli
  • Sarah Phoebe Roberts
  • Elena Gibson
  • Dr. Chris “The Chiu Man” Chiu
  • Other contributors from 2018: Jordana Kozupsky, Chris Thrash, Neela Bhajandas
  • Chief of Medicine: Dr. “Uncle Bob” Centor
  • Chief of Nephrology: Dr. Joel “The Salt Whisperer” Topf
  • Chief of POCUS: Dr. Renee Dversdal


The Curbsiders report no relevant financial disclosures. Financial disclosures for guests mentioned in the 2018 recap can be viewed in the show notes for each specific episode.


“2018 Recap Extravaganza”. The Curbsiders Internal Medicine Podcast December 31, 2018.  URL

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The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit and search for this episode to claim credit.

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