This episode demystifies why the “bicarb” on a BMP never quite matches the bicarbonate on a blood gas. We explain how CO₂ exists in three forms (dissolved CO₂, carbonic acid, and bicarbonate), why blood gases calculate bicarbonate using pH and PCO₂ via Henderson–Hasselbalch, and how BMPs instead chemically measure total CO₂ after converting bicarbonate and carbonic acid to gas. You’ll learn why the BMP value is labeled CO₂, why it runs slightly higher than the blood gas bicarb, and why - since bicarbonate is ~90–95% of total CO₂ - that BMP CO₂ remains a reliable stand-in for your patient’s true bicarbonate level.
Source:
https://www.youtube.com/watch?v=cZ19dKHKWvs
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I love that the TTS AI voice nailed "coccidioides" but struggled with "candida."
This episode gives you a clean mental framework for invasive fungal infections by starting with the drugs.
We break down the three main antifungal classes - azoles (ergosterol synthesis blockade), polyenes (direct membrane attack via ergosterol binding), and echinocandins (beta-glucan cell wall inhibition) - and show how that pharmacology drives bedside choices.
You’ll hear a practical ICU approach to candidemia (start with an echinocandin, then step down to oral fluconazole when appropriate), first-line options for Aspergillus and when to move from voriconazole to newer azoles, and when you still need amphotericin despite its “shake and bake” toxicity.
We close by updating your geographic map of endemic fungi and highlighting climate-linked threats like multidrug-resistant Candida auris.
Source:
https://www.youtube.com/watch?v=9oey7A5m-JY
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The TTS AI voices just couldn't seem to get "terlipressin" right. Don't blame them.
This episode reframes hepatorenal syndrome as a circulatory problem, not a primary kidney disease.
We walk through the core pathophysiology - portal hypertension–driven vasodilation, low effective arterial volume, and intense renal vasoconstriction - and the high-yield labs that separate HRS from ATN: profound hyponatremia, FENa <0.1%, urine Na <20 despite diuretics, and why normal sodium, FENa >0.5%, or muddy brown casts argue against the diagnosis.
We then cover modern management: when (and when not) to give albumin, targeting a MAP rise of 10–15 mmHg with vasoconstrictors, practical use and risks of terlipressin vs midodrine/octreotide, permissive hypercreatinine while diuresing, and the crucial transplant angle - dialysis as a bridge only and how treating HRS can paradoxically worsen a patient’s MELD priority.
Source(s):
https://www.coreimpodcast.com/2025/10/15/hepatorenal-syndrome-5-pearls-segment/
https://www.coreimpodcast.com/2025/10/22/hepatorenal-syndrome-5-pearls-segment-part-2/
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This episode updates your COPD mental model from “FEV₁ and a LABA” to phenotype- and risk-driven care.
We review when fixed obstruction in a non-smoker should trigger CT chest and full PFTs, why GOLD 2025 now recommends universal alpha-1 antitrypsin screening, and how to use the ABE classification to choose between single bronchodilator, dual LABA/LAMA, and eosinophil-guided triple therapy.
We cover real-world tricks like “open triple” for cost, key side effects of each inhaler class, and why exacerbation history beats spirometry for predicting trajectory. We close with high-yield adjuncts - pulmonary rehab, oxygen, roflumilast, chronic azithromycin, and dupilumab for eosinophilic disease -plus the non-negotiables of smoking cessation, vaccines, and inhaler technique.
Source:
https://thecurbsiders.com/curbsiders-podcast/500-copd-update-with-cyrus-askin
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https://rokeefemd.substack.com
I love how the TTS AI voices struggle with saying "GERD".
This episode breaks reflux down to what actually matters at the bedside: clarifying what patients mean by “heartburn,” screening for true alarm features (dysphagia, bleeding/anemia, weight loss), and understanding when an 8-week PPI trial is appropriate.
We walk through the modern workup - PPI washout before endoscopy, which endoscopic findings lock in a GERD diagnosis, and when to use ambulatory pH monitoring to distinguish GERD from NERD and guide long-term therapy.
We also cover how to counsel patients on PPI safety, when de-prescribing or on-demand therapy makes sense, the role of alginates as a mechanical barrier to reflux, and which patients with hiatal hernia or regurgitation should actually be considered for anti-reflux surgery.
Source:
https://thecurbsiders.com/curbsiders-podcast/501-gerd-vs-nerd-reflux-updates-with-dr-james-callaway
Inflammatory bowel disease doesn’t always read like the textbook. In this episode, we walk through high-yield clinical pearls for recognizing atypical presentations (including constipation from Crohn’s), taking rectal bleeding seriously in young patients, and avoiding common diagnostic traps with CRP, fecal calprotectin, and small bowel disease.
We cover how to choose and monitor therapy with a “treat-to-target” approach focused on endoscopic healing - not just symptom control - and why patients can feel well despite active inflammation. We also hit the must-know basics of health maintenance (DEXA after prolonged steroids, IV iron for anemia in flares), a sensible approach to flare evaluation starting with stool studies and C. diff testing, and key steps in managing severe hospitalized flares, including early surgery involvement and when to escalate to rescue therapy.
Source: https://thecurbsiders.com/curbsiders-podcast/502-inflammatory-bowel-disease-with-dr-aline-charabaty
In this episode, we walk through a practical, pattern-based approach to jaundice. We cover why fractionating bilirubin is the key first step, how to quickly distinguish unconjugated from conjugated hyperbilirubinemia, and the red flags for ascending cholangitis and acute liver failure. You’ll learn how to interpret AST/ALT vs alkaline phosphatase, when to reach for RUQ ultrasound, MRCP, or ERCP, and how to recognize entities like Gilbert syndrome and drug-induced liver injury in the workup.
Nelson M, Mulani SR, Saguil A. Evaluation of Jaundice in Adults. Am Fam Physician. 2025;111(1):25-30.https://pubmed.ncbi.nlm.nih.gov/39823630/
Explore the gray zone between celiac disease, wheat allergy, and IBS in this episode on Non-Celiac Gluten Sensitivity (NCGS). We break down how to rigorously rule out celiac and wheat allergy, why gluten and FODMAPs (especially fructans) are so hard to tease apart, and how brain–gut interactions and the nocebo effect shape symptoms. You’ll learn a practical approach to diagnosis, the role of elimination and re-challenge diets, and when a broader low-FODMAP or IBS-oriented strategy may be more effective than strict gluten avoidance.
Biesiekierski JR, Jonkers D, Ciacci C, Aziz I. Non-coeliac gluten sensitivity. Lancet. Published online October 22, 2025. doi:10.1016/S0140-6736(25)01533-8
https://pubmed.ncbi.nlm.nih.gov/41138740/
In this episode, we break down why lung cancer in people who have never smoked is a completely different disease biology than tobacco-related lung cancer.
We walk through the dominance of adenocarcinoma in this population, the central role of single oncogenic drivers, and why EGFR, ALK, and other targetable alterations are so much more common in never-smokers.
We cover how and why to send broad molecular testing with NGS and liquid biopsy, how results should immediately reshape your treatment strategy, and what trials like ADAURA have taught us about adjuvant osimertinib in resected EGFR-mutated disease.
We also dig into the high risk of brain metastases in oncogene-driven tumors, the importance of CNS-penetrant TKIs, and why standard immunotherapy alone often underperforms in this setting. Finally, we zoom out to discuss resistance, why stage IV responses are rarely curative, and how this rapidly evolving field is reshaping what “lung cancer” means for never-smokers.
Source:
Murphy C, Pandya T, Swanton C, Solomon BJ. Lung Cancer in Nonsmoking Individuals: A Review. JAMA. Published online October 20, 2025. doi:10.1001/jama.2025.17695
https://pubmed.ncbi.nlm.nih.gov/41114991/
Substack:
https://rokeefemd.substack.com/
IM + Hospital Medicine Recaps:
https://open.spotify.com/show/0gBboJb5vEFKwzhDUeehQg?si=ce37e6506fb44787
Point of Care Podcast:
https://open.spotify.com/show/18KgVxJA2lLIcr4dOpOkqw?si=0325041a37584d91
This episode walks through how syphilis evolves over time - from the painless primary chancre to systemic secondary disease, silent latent phases, and destructive tertiary complications.
We break down how timing and symptoms define “early” vs “late” disease, how to use nontreponemal and treponemal tests (including the prozone phenomenon and early false negatives), and when to suspect or treat neurosyphilis.
We wrap with practical treatment strategies, penicillin allergy workarounds, Jarisch–Herxheimer vs true allergy, and how to interpret titers and “serofast” patients after therapy.
Source:
Chevalier FJ, Bacon O, Johnson KA, Cohen SE. Syphilis: A Review. JAMA. Published online October 16, 2025. doi:10.1001/jama.2025.17362
https://pubmed.ncbi.nlm.nih.gov/41100079/
Substack:
https://rokeefemd.substack.com/
IM + Hospital Medicine Recaps:
https://open.spotify.com/show/0gBboJb5vEFKwzhDUeehQg?si=ce37e6506fb44787
Point of Care Podcast:
https://open.spotify.com/show/18KgVxJA2lLIcr4dOpOkqw?si=0325041a37584d91
In this episode, we walk through the evolving concept of “stable ischemic heart disease” now reframed as Chronic Coronary Artery Disease (CCAD) - a long-term imbalance between myocardial oxygen supply and demand, usually from atherosclerotic coronary obstruction.
We break down how to estimate pre-test probability, when to use CAC scoring, CCTA, or functional stress testing (including recognizing INOCA), and how those decisions guide next steps.
Finally, we review evidence-based management: aggressive risk-factor control with statins, antiplatelets, SGLT2i/GLP-1 RA in the right patients, tailored anti-anginal therapy, when PCI is mainly for symptom relief, when CABG can improve survival, and why routine repeat imaging in stable, asymptomatic patients often does more harm than good.
Source:
Kittleson MM. Chronic Coronary Artery Disease. Ann Intern Med. 2025;178(10):ITC145-ITC160. doi:10.7326/ANNALS-25-03512
https://pubmed.ncbi.nlm.nih.gov/41082727/
Substack:
https://rokeefemd.substack.com/
IM + Hospital Medicine Recaps:
https://open.spotify.com/show/0gBboJb5vEFKwzhDUeehQg?si=ce37e6506fb44787
Point of Care Podcast:
https://open.spotify.com/show/18KgVxJA2lLIcr4dOpOkqw?si=0325041a37584d91
Get a clear framework for approaching female hair loss in clinic. This episode walks through how to quickly flag scarring alopecia that needs urgent derm, distinguish female-pattern hair loss from chronic telogen effluvium and alopecia areata, choose and monitor treatments like topical and oral minoxidil (with when to add antiandrogens), and support patients through the psychological impact and when to escalate to biopsy.
SourceOlsen EA. Hair Loss in Women. N Engl J Med. 2025;393(15):1509-1520. doi:10.1056/NEJMcp2412146Subscribe to the Point of Care Medicine Substack.
Get a practical handle on when superficial fungal infections need pills, not creams. This episode covers why terbinafine is first-line for tinea capitis and onychomycosis, how long to treat based on site, when (and how) to confirm the diagnosis before committing to months of therapy, why topical steroids can create tinea incognito, and what to do when standard terbinafine fails.
Source: Caplan AS, Gold JAW, Smith DJ, Ely JW. Diagnosis and Management of Tinea Infections. Am Fam Physician. 2025;112(4):382-392.
Learn how to quickly sort benign drug rashes from true dermatologic emergencies at the bedside. This episode walks through morbilliform eruptions, leukocytoclastic vasculitis, AGEP, phototoxic reactions, erythema multiforme, erythroderma, DRESS, and SJS/TEN - highlighting classic morphology, timing, red-flag features, and what to do next when you’re the first clinician to see the rash.
This episode reviews hyponatremia through a physiology-first lens, emphasizing that it is primarily a disorder of water balance rather than sodium itself. We discuss how urine sodium helps differentiate hypovolemic, hypervolemic, and euvolemic hyponatremia and why it often provides a more reliable assessment of effective volume status than the physical exam. The episode then focuses on SIADH, explaining how persistent ADH activity limits free water excretion, why salt tablets can worsen hyponatremia by increasing water intake, and how urea offers a more effective osmotic strategy. We also compare the roles and risks of vaptans versus hypertonic saline in acute, symptomatic cases and review the mechanism of “desalination,” where normal saline worsens sodium levels in unrecognized SIADH. The goal is to provide a clear, practical framework for evaluating and managing hyponatremia at the bedside.
This episode breaks down what MGUS truly represents and why it’s so often misunderstood. It explains how a small, silent monoclonal protein fits into the spectrum of plasma cell disorders, why most people with MGUS feel completely well, and what actually drives the risk of progression to myeloma or related conditions. The discussion walks through the essential diagnostic labs, the Mayo Clinic risk model, and how to distinguish harmless MGUS from cases where the protein begins to damage organs. It also explores smoldering myeloma, MGRS, and AL amyloidosis, helping listeners understand when a quiet lab finding becomes clinically significant.
Source:
Monoclonal Gammopathy of Undetermined Significance (Review) from NEJM