The High-Yield Podcast

Approach to workup of cholangitis, chronic cholecystitis, Gallstone Ileus, Cholangiocarcinoma including Klatskin tumor, Carcinoma of GB and Pancreas At the end some house-cleaning on iatrogenic complications of gallstone disease after ERCP and other procedures are discussed (including bile duct injury and bile leak); For SOD refer to previous episode on cholecystitis management and complications of cholecystectomy.

Question-based Review of Cholecystitis workup and management followed by addressing the complications of cholecystectomy.

Both Pathophysiology and Clinical Aspects of gallstone disorders are discussed followed by important hints on differential diagnosis of gallstone disease from one another and from their complications, most specifically from cholecystitis and cholangitis.

Question-based review of workup for hepatic neoplasms.

Questions & cases regarding diagnostic workup and management for PBC, PSC, Alcoholic & Non-Alcoholic Fatty Liver Disease (steatosis, steatohepatitis), and Vascular Hepatopathy

High-Yield Question-based review & cases of conditions associated with abnormal iron & copper metabolism

Question-based review of differential diagnosis in chronic HBV vs HCV infection.

High-Yield question-based review of cases in hepatitis B pathophysiology.

Questions-based review of risk factors, differential diagnosis and management of acute viral hepatitis A, D , E . Included co-infection, Superinfection, diagnostic workup (screening and confirmatory) and management options with discussion of post-exposure prophylaxis for HAV infection.

High-Yield cases & Question-based Review of 2 important complications of Cirrhosis (SOAP format). (For other complications look at hepatic encephalopathy in Acute liver failure and for Peritonitis to the previous episode)

Following the SOAP approach, we review Subjective, Objective, Assessment & Plan for Ascites & Peritonitis. Exudative versus Transudative classification compared to new SAAG-based classification are discussed for differential diagnosis. Values of SAAG in relation to Protein content, Cell count, LDH and Glucose and pH values as well as major risk factors are discussed to differentiate primary (spontaneous) versus 2ndary bacterial peritonitis. and management guidelines provided. Needs some mathematical understanding of SAAG formula and couple exceptions to the rules (as discussed).

Following our SOAP format we have a question-based discussion of Subjective (epidemiology, risk factors, patients complaints), Objective (PhEx findings, lab assessment results), Assessment (of possible etiologic differential diagnosis) and Plan for management of cirrhosis.

Question-based review of Acute liver failure, staging of hepatic encephalopathy (per clinical & EEG criteria), management of ALF with understanding of the severity criteria, Stage-based management of hepatic encephalopathy, Indications & Eligibility requirement for Liver transplantation, and a brief discussion on acetaminophen toxicity at the end.

After an important question-based assessment of structural versus functional components of hepatocyte markers, we discuss high-yield cases of Hepatitic, cholestatic and mixed-pattern LFT abnormalities. This is prerequisite to entire liver & hepatobiliary system discussions.

Case-Based Review of Respiratory Failure Management. Please make sure you understand the indications & contraindications for supplemental versus active (invasive & non-invasive) modes of ventilatory support before going through cases.

Indications and contra-indications for common methods of non-invasive ventilation are discussed in quick question-based format with cases as a preparation to the next major episode (i.e. discussion of management options in different types & severities of respiratory failure)

Question-based and quick review of important subject of patients in need of invasive active airway intervention (as opposed to those who benefit from non-invasive intervention or those who just need supplemental oxygenation without a need for active airway). We discuss endotracheal intubation (including crash intubation, RSI, Elective ETI) and we discuss alternatives including crycothyrotomy versus long-term surgical airway indication (i.e. Tracheostomy).

Basics of approach to patient in need of respiratory support and airway management. Question-Based Discussion of "Hierarchical Ladder of Respiratory Support", patient stratification based on indications & contraindications to different modalities of respiratory support. This provides initial management considerations and framework for proper algorithmic approach when addressing the airway management in trauma or respiratory failure patients.

Brief but high-yield question-based approach to differential diagnosis in hypercapnic failure. Analyzing the differentials and management options based on the formula of Alveolar Minute Ventilation: Alveolar Minute Ventilation = Respiratory Rate x (Tidal Volume - Dead Space Volume) VA = RR x (Vt-Vd) DDxing of hypercapnia includes low RR (e.g. opiate use), Low Vt (e.g restrictive lung disease) or high Vd (COPD).

Discussion of initial workup, classification and differential diagnosis of hypoxia & Hypoxemic respiratory failure. 1- Please make sure you have the formulas ready in front of you (including PA-O2 formula, O2 delivery, O2 content and Fick's Formulas among others). 2- If you need to pause and repeat do so before moving on (it can save lives ....!)

Differential Diagnosis of metabolic Alkalosis and the overall approach to metabolic alkalosis with cases and step-up scenarios including Saline-Responsive and Unresponsive Types based on Urine Chloride; Brief yet high-yield review of compensation and how to make sense of compensation formulas in acid-base disorders. Also discussed: Syndrome of apparent mineralocorticoid excess (SAME, Including Liddle Syndrome), Gitelman & Bartter;

RTAs

Question-based discussion of the proper framework approach metabolic acidosis, serum versus urinary anion gap, categories of high-anion-gap versus normal anion-gap acidosis and are discussed.

Question-based Discussion of risk factors, workup and management of rhabdomyolysis.

Question-based Review on Differential Diagnosis of Hypercalcemia (Pseudohypercalcemia, PTH-dependent vs PTH-independent Hypercalcemia) and Hypocalcemia; Vitamin D abnormalities, Abnormalities of Phosphate. Also discussed: Workup & Management of Humoral Hypercalcemia of Malignancy, Familial Hypocalciuric Hypercalcemia, Pseudohypoparathyroidism, True Hypoparathyroidism, Primary, 2ndary and tertiary hyperparathyroidism, Medications Side-Effects causing abnormalities of Ca & P.

Question-based review on differential diagnosis and algorithmic approach to workup & management of hypokalemia followed by a discussion of magnesium abnormalities.

Question-based Approach to differential diagnosis and hierarchical management in hyperkalemia.

Differential Diagnosis of pseudohypernatremia, Hypovolemic, Euvolemic and Hypervolemic Hypernatremia as well as Differential Diagnosis of pseudohyponatremia vs true hyponatremia is discussed.

A High-yield fully question-based review of childhood vasculitides

The important question is when to suspect vasculitis based on clinical presentation? We discuss differentials and workup (with emphasis on ANCA positivity or negativity or markers of Glomerular involvement) as well as management options and complications (including Mono-neuritis multiplex) for most common classes of vasculitides including Medium-size & Small - vessel Vasculitides including Polyarteritis Nodosa (including updated 3/10 Diagnostic criteria of American College of Rheumatology), Buerger's Disease (Thromboangiitis Oblisterans) Wegener's Granulomatosis, Microscopic Polyangiitis, Churg-Strauss.

We discuss the general differential diagnosis & framework of workup for large-vessel, medium-vessel & small-vessel vasculitides, general treatment guidelines and prognostication for vasculitides; Then we focus (in this episode) on large-vessel vasculitides (Giant-cell & Takayasu arthritis)

Differential diagnosis and workup of primary versus 2ndary amyloidosis ( including indication for abdominal fat pad versus single-organ biopsy, required workup for plasma-cell dyscrasia in Biopsy-confirmed amyloidosis, Required organ-function tests in Amyloidosis ) as well as management for primary (AL) versus 2ndary (AA) amyloidosis.

In this episode we first finish the discussion of the remaining subtypes of SNSAPs (namely Reactive ARthritis & Entropathic arthropathies / IBD-related Arthropathies) while discussing the important differential diagnosis for each category. We finish with a high-yield subject of approach framework and step-up management options by comparing and contrasting proper treatment recommendations for each stage of management based on the most recent guidelines.

High-yield question-based review of clinical points regarding subjective, objective, assessment and plan (SOAP) approach to seronegatives; We first discuss the general points relevant to this category of inflammatory arthritides then we initiate an in-depth discussion of each individual disorder while remaining as brief as possible but not missing the high-yield points. This episode covers Ankylosing spondylitis and Psoriatic Arthritis.

General approach to preoperative functional assessment using American Society of Anesthesiology Functional & Preoperative Status guidelines , Metabolic Equivalent, Cardiac Risk Assessment of MACE based on risk of patient versus the risks of surgical procedures, Utilizing Revised Cardiac Risk Index in the approach.

We discuss surgical site infection (SSI), Wound disruption and dehiscence, Superficial & deep Fascial Disruption, as well as wound evisceration and ventral hernia.

Differential Diagnosis & Management Approach of common childhood seizures including some genetic & hereditary subtypes , like benign rollandic, juvenile myoclonic and childhood absence seizure; we finish with a DDxing of childhood hemiplegia. Please make sure you have reviewed our episode on febrile seizure before this one.

While the initial step in managing sleep disorders involves ruling out 2ndary causes, in most cases (including the primary sleep disorders) the first intervention includes sleep hygiene and behavioral modifications; it is crucial to know when CBT-Insomnia is the recommended initial intervention and when pharmacotherapy is indicated and what type of medications are used for each subtype of primary sleep disorders. We finish with discussing choice of pharmacotherapy in different sleep disorders while discussing first line treatment for cases of special population and comorbidities with sleep disorder (including pregnant patient, those with dementia, etc).

Differential Diagnosis of 7 major DSM-V categories of sleep disorders including Insomnia, Parasomnias (REM-related & Non-REM type), Sleep related breathing disorders, Sleep related movement disorders, Central Hypersomnia (including Narcolepsy), and Circadian-Rhythm Disorders / Sleep-Wake Phase disorders. High-Yield hints are provided for differentiating these conditions after a framework of initial medical & organic categories are ruled out.

We discuss definition of febrile seizure with required criteria, followed by discussing simple versus complex types as well as their workup and management with an in-depth discussion of how to address family concerns; we then finish with the important differential diagnosis approach between febrile seizure and meningitis.

An overview of prenatal screening during pregnancy; we discuss first prenatal visit, overall algorithm of prenatal assessment, types of infectious and non-infectious labs as well as general versus risk-specific panels of prenatal screening as a high-yield framework of prenatal care and follow up.

Question-Based Review of Reproductive Embryology (only clinically relevant points)

High-yield differential diagnosis of heart sounds abnormalities including changes in the intensity and splitting of S1, S2 as well as etiologies of S3 & S4 gallops with strategies to identify them.

Flashcard - style questions on precordial palpation and assessment of carotid and jugular (venous) pulse with discussion of important differential diagnosis of several conditions including venous wave abnormalities

Systematic questions on Radiologic anatomy and trauma assessment of cardiac box, auscultation for valvular heart disease, and ECG-correlations of coronary arteries

High Yield discussion for vaccination guidelines among patients with primary immunodeficiencies;

We discuss the following disorders of adaptive immune system resulting in primary immunodeficiency: B-cell disorders: Agammaglobulinemia (including Bruton's), Selective IG deficiency (including selective IgA deficiency), Common Variable Immunodeficiency T-cell Disorders: DiGeroge, IL-12 receptor pathway disorders (Mendelian Susceptibility to Mycobacterial Infection), Chronic Mucocutaneous Candidiasis Combined B & T cell disorders: Severe combined immunodeficiency (SCID), Autosomal- Dominant Hyper-IgE Syndrome, Wiskott-Aldrich, Ataxia-Telangiectasia, Hyper-IgM syndrome

These (HLH & ALPS) are the major syndromes of innate and adaptive immune dysregulation respectively resulting in primary immunodeficiency. For the discussion of complement system dysregulation refer to episode on innate immune deficiencies of innate immune system. Also compare HLH with MAS (macrophage activation syndrome) discussed in pharmacotherapy of Juvenile Rheumatoid Arthritis

Very clinically-oriented episode on important clues on subjective & Objective assessment of a patient to help clinically identify different types of primary immunodeficinecies; 

High-yield questions on Chronic Granulomatous Disease, Chédiak-Higashi Syndrome, Leukocyte Adhesion Deficiency and Complement disorders associated with primary immunodeficiencies. 

Review of different classes of immunologic agents such as monoclonal antibodies, Interleukin receptor agonists & antagonists and other agents with their clinical indications and side effect profile; prerequisite to this episode is the review of foundational basic science of immunosuppressive agents