2018 Recap Extravaganza: The Curbsiders Favorite Pearls

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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Credits

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

Goal

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

30 second knee exam: How to do McMurray’s Test (YouTube)
See high-yield shoulder exam demonstrated on YouTube (debut of Radovan Anzulovic’s 8-bit into)

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

Most people don’t have a true penicillin allergy
Grandfather clocks (we discovered in episode #88 that Joel Topf’s grandfather clock chimes every 12 minutes. We’ve never gotten a reasonable answer why and suspect we never will).
Jump Rope was Matt’s Pick of the Year 2017
The Anti-Pick: The Resident (TV Show)
ASPIRIN! – Overused in Primary Prevention
Sleep apnea – Home sleep studies should be used more often. OSA should be treated with Auto-CPAP at 8-16 cmH2O.
Olmesartan – The ARB that can cause drug-induced enteropathy. This condition mimics celiac disease.
Suicide and mental health among clinicians

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

Disclosures

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.

Links from the show

“2018 Recap Extravaganza”. The Curbsiders Internal Medicine Podcast http://thecurbsiders.com. December 31, 2018. URL

CME Partner

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

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