Core IM | Internal Medicine Podcast

Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In this episode, we walk through the BALANCE trial and use it as a lens to revisit how 1) host, 2) organism, and 3) source should guide treatment. When shorter really is enough, and when it isn’t?🔹 Sponsor: Oakstone CMEUse the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 🔹 Transcript and ShownotesTimestamp(02:58) | Host, Organism, Source: The Core Framework Behind Duration(09:02) | How Evidence Shifted Practice(11:27) | The BALANCE Trial: Short-Course vs Standard-Course Therapy(18:55) | Where does this leave us?Tags: CoreIM, Internal Medicine, Infectious disease, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical EducationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS: https://wearfigs.com* Click for 15% off Premium Starter Kit at Branch Basics: https://branchbasics.com/COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Why is venous congestion not the same as volume overload? How can looking at IVC as well as doppler on the hepatic vein, portal vein, and/or intrarenal vein help? Can venous congestion explain someone's delirium? Or be at play in septic shock? What are the limitations of the VEXUS score?🔹 Sponsor: Oakstone CMEUse the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 🔹Transcript and Shownotes(00:00) | Volume overload vs. Venous Congestion(05:49) | Venous Congestion and AKI, mortality, possible delirium(10:10) | Measuring Venous Congestion and the Role of VEXUS(15:05) | Common Mistakes and Best Practices of VEXUS score(23:13) | Assessing Fluid Tolerance and Risks with Venous Doppler in Acute Care(25:29) | Fluid vs. Vasopressor Strategy Guided by Venous Assessment Tags: CoreIM, Internal Medicine, Critical Care, Nephrology, Cardiology, Fluid Management, POCUS, Ultrasound, Doppler, Hospital Medicine, Clinical Reasoning, Medical EducationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS: https://wearfigs.com* Click for 15% off Premium Starter Kit at Branch Basics: https://branchbasics.com/COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What really works when treating HRS? Vasoconstrictors like terlipressin vs. norepinephrine vs. midodrine: how do we decide which to use? Do you give albumin? When do you give Lasix or another diuretic? When is the better choice transplant, dialysis, or even palliative care?🔹 Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show NotesTimestamps: (00:12) | Introduction and Overview of Hepatorenal Treatment (03:38) | Vasoconstrictors Focus: Terlipressin, Norepinephrine, and Midodrine (12:32) | Finding the Right Dose of Albumin and Knowing When to Stop (15:06) | Volume Management: Balancing MAP, Diuretics, and Creatinine (21:42) | Understanding the High Mortality of HRS-AKI (32:30) | Transplant, Dialysis, or Palliation CareTags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Hepatorenal Syndrome, HRS-AKI, Cirrhosis, Nephrology, Liver DiseaseFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS: https://wearfigs.com* Click for 15% off Premium Starter Kit at Branch Basics: https://branchbasics.com/COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Who’s really at risk for fractures, and how should we be treating them? Most fragility fractures occur in patients without osteoporosis. Should we rethink who gets treated? And could just one or two IV infusions (spread years apart) of zoledronate prevent fractures for years? Have the concerns about bisphosphonates been overblown?Find out all the nuances on this episode of Beyond Journal Club, a series brought to you by Core IM in collaboration with NEJM Group.🔹 Sponsor: Oakstone CMEUse the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show NotesTimestamps:(00:59) | Diagnosing Osteoporosis and Hidden Fracture Risk(05:38) | Evolution of Bisphosphonate Use in Osteoporosis Treatment(07:51) | Current Use of Bisphosphonates: Benefits, Risks, and Side Effects(10:31) | Exploring Non-Bisphosphonate Options for Fracture Prevention(11:44) | Teriparatide and Alternative Osteoporosis Medications(14:53) | Inside the Latest Bisphosphonate Clinical Trial(18:07) | Key Findings from the Zoledronate Fracture Prevention Study(22:38) | Public Health Impact of Fracture Prevention Strategies(24:24) | Final Takeaways and Expert Perspectives on Osteoporosis CareTags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Osteoporosis, Fragility Fractures, Zoledronate, Bone HealthFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS: https://wearfigs.com* Click for 15% off Premium Starter Kit at Branch Basics: https://branchbasics.com/COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Learn specific, practical ways to counsel patients on non-pharmacologic interventions. What is our goal with OH treatment? Is it the blood pressure number that matters? How do we avoid missing neurogenic causes of orthostatic hypotension (OH)? 🔹 Sponsor: Oakstone CME’Use the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show NotesTimestamps:(00:05) | Case Presentation: Urinary Retention → Lightheadedness(02:37) | Defining Orthostatic Hypotension & Prevalence(04:10) | Why Diagnosis Is Harder Than It Seems(06:20) | How (and When) to Measure Orthostatic Vitals(10:06) | Role of Heart Rate in Narrowing the Differential(14:41) | Rethinking Treatment Goals: Function > Numbers(17:52) | Recognizing Orthostatic Intolerance Symptoms(22:14) | Non-Pharmacologic Strategies in the HospitalTags: Primary care, Internal Medicine, Physician Assistant, Nurse Practitioner, Geriatrics, Autonomic Dysfunction, Syncope, Falls, Patient Safety, Medical EducationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS: https://wearfigs.com* Click for 15% off Premium Starter Kit at Branch Basics: https://branchbasics.com/COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How do you work up neutropenia? When is neutropenia benign? When do neutrophils recover? How can you diagnose neutropenic fever in the first 15 minutes and start antibiotics in the first 60 minutes? Do you always add MRSA coverages? Only Pseudomonas coverage? When do you add fungal coverage?🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio CompanionUse the code "CORE30" for 30% off effective 11/1/25 through 1/31/26: https://www.coreimpodcast.com/MKSAP🔹 Transcript & Show Notes Timestamps:(02:24) | Approach to Neutropenia & Duffy Null(11:38) | Dose and duration-dependent neutropenia vs. immune-mediated neutropenia(19:46) | When do neutrophils recover?(29:56) | Classifying Neutropenic Fever Syndromes(29:53) | Strategies for Managing Low-Risk Neutropenic Fever(33:02) | Antimicrobial Therapy and Duration in Febrile NeutropeniaTags: CoreIM, Internal Medicine, Oncology, Hematology, Medical Education, Physician Assistant, Nurse Practitioner, Neutropenic Fever Management, AntibioticsFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS: https://wearfigs.com* Click for 15% off Premium Starter Kit at Branch Basics: https://branchbasics.com/COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

What went wrong? What were the reasoning or contextual missteps that led us astray?🔹 Sponsor: NEJM Fellowship Program, click here to learn more and/or apply! Due Aug 1, 2025🔹 Transcript and Show NotesTimestamps:(00:02) | Case Presentation and Initial Diagnosis(02:47) | Tachycardia and Early Impressions(04:10) | Clinical Deterioration and New Clues(07:19) | Problem Representation and Reflection(21:45) | Lessons on Reasoning and Bias(26:55) | Final Takeaways and Action StepsTags: Clinical Reasoning, Internal Medicine, Diagnostic Accuracy, Hoofbeats, Cognitive Bias, Medical Education, Illness ScriptsFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS: https://wearfigs.com* Click for 15% off Premium Starter Kit at Branch Basics: https://branchbasics.com/COREIMAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy