UCONN IM Residency

Benign prostate hyperplasia and lower urinary tract symptoms are commonly associated with one another. Take a listen to get a better understanding of the difference between the two! We walk through important considerations in the history and physical exam, discuss workup and when referral to urology is recommended, and we discuss management options! Thank you for listening! Author: Nickolas Coombs, DO & Rob Harmon, DO Host/Editor: Rob Harmon, DO

There are many options available to our patients who are interested in trying to lose weight. Outside of diet, exercise and medications what other options can we counsel our patients on? Well there are surgical weight loss options that may be of interest to our patients and today we will talk about a couple types of bariatric surgery that are available including a brief discussion on indications and complications. Thanks for listening! Author/Host/Editor: Rob Harmon, DO

The presence of LAD can be frightening for your patients. With this framework, hopefully you are able to work through a comprehensive differential diagnosis and you are comfortable knowing when something is more likely to be more benign versus when you should be more concerned for your patient. Thank you again for listening today, I hope you have a wonderful day! Author: Nickolas Coombs, DO & Rob Harmon, DO Host/Editor: Rob Harmon, DO

Thank you for joining us, today we will be reviewing prostate cancer screening and potential benefits as well as any associated controversies. The main focus of our discussion today revolves around PSA, or prostate-specific antigen. Although treating prostate cancer at an early stage to avoid long-term consequences, including potential metastatic disease, is important, we must acknowledge that our screening tools are imperfect. We don’t want to diminish the importance of treating an aggressive prostate cancer, but simply want to highlight that screening should not be done without a thorough explanation between you and your patient. Author: Nickolas Coombs, DO Host/Editor: Rob Harmon, DO

When it comes to respiratory illness, it can be challenging to evaluate and triage patients in the outpatient setting. In this episode we work through some clinical pearls that can help you evaluate your patients. Remember that completing a thorough history and physical exam can be extremely helpful in guiding you in your diagnosis and management of pneumonia in the outpatient setting. Author/Host/Editor: Rob Harmon, DO

We commonly diagnose and treat patients with hypertension in the outpatient setting. There are many classes of medications and related disease processes that we could talk about; however, today we will be primarily focusing on diagnosis and non-pharmacological management. Thank you for listening! Author/Host/Editor: Rob Harmon, DO

Continuing on with our ambulatory series, today we will explore the topic of anemia. We cover everything from the history and physical exam to treatment of anemia in the outpatient setting with a focus on microcytic anemias, specifically: iron deficiency anemia. Thanks for listening!

Channel your inner neuro critical care specialist in this episode wherein Dr. Grover teaches us how to manage neurologic emergencies commonly seen in the ICU. Author: Dr. Mari-Elena Pino, Internal Medicine PGY-3, UCONN Host: Dr. Ritika Kompella, Internal Medicine PGY-3, UCONN Guest speaker: Dr. Prashant Grover, Pulmonary Critical Care, St. Francis Hospital Editor: Dr. Robert Harmon, Chief Medical Resident, UCONN

Welcome back to the UConn IM Podcast, this week we are taking a break from the pulmonary and critical care mini-series to kick off our ambulatory series! Today we will review vision loss in the primary care setting. We review the most common types of vision loss and discuss key components of the physical exam as well as treatment options. Thank you for listening! Author/Host/Editor: Rob Harmon, DO

Understanding right heart catheterizations got you down? In this episode, Dr. Parikh takes us on a deep dive of pulmonary hypertension, giving you the tools to crush your next CCU, ICU and pulm rotations. Author: Dr. Mari-Elena Pino, Internal Medicine PGY-3, UCONN Host: Dr. Ritika Kompella, Internal Medicine PGY-3, UCONN Guest speaker: Dr. Raj Parikh, Pulmonary Critical Care, Hartford Hospital Editor: Dr. Robert Harmon, Chief Medical Resident at UCONN.

Develop your bartending skills in the ICU by learning how to create the ideal sedation cocktail. We sat down with Dr. Grover, one of the program’s favorite educators, to discuss how to achieve RASS goals and more. Author: Dr. Siddharth Venkat Ramanan, Internal Medicine PGY-3, UCONN Host: Dr. Ritika Kompella, Internal Medicine PGY-3, UCONN Guest speaker: Dr. Prashant Grover, Pulmonary Critical Care, St. Francis Hospital Editor: Dr. Robert Harmon, Chief Medical Resident at UCONN. ————————————————————-

Host/Editor: Dr. Robert Harmon, Chief Medical Resident at UCONN. With this episode we will wrap up the ambulatory series for the 2022-2023 academic year. Huge shoutout to Alla Turshudzhyan for all of the work that she put into the podcast over the last year. We are very excited for her as she moves on to the next phase of her career! For my inaugural episode, we will be discussing medical abortion. There are two medications that are approved by the FDA for medical abortion; mifepristone and misoprostol. Most commonly these are administered as part of a combined regimen in which misoprostol is administered 24-28 hours after mifepristone. It is important to know that patients can resume any form of contraception after medical abortion and fertility is not effected by past medical abortion! Patients are eligible for medical abortion up until 70 days of gestation, which is determined by the patient's first day of their last menstrual cycle. Ultrasound is not required unless gestational age is not able to be determined, the patient is at high risk for ectopic pregnancy or has clinical signs of an ectopic pregnancy. I look forward to putting out some exciting content this year! Thank you for listening.

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Understanding the difference between palliative care and hospice is crucial. Many patients and their families equate palliative care with end-of-life care. Palliative care focuses on symptom management and unlike hospice, it is provided based on patient’s needs, not based on prognosis. Palliative care is frequently done along with a curative therapy. In contrast with palliative care, hospice is a highly regulated Medicare benefit that is prognosis dependent and only applies to patients with survival prognosis of less than six months. Primary care providers can refer directly to hospice and can even function as a medical director on the case if they choose to do so. Lastly, keep an eye out for caregiver burn out and refer families to hospice or palliative care social worker for local resources available. Thank you for listening.

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Let's talk about how to work up anorectal disease in the ambulatory setting. As primary care physicians, we have a unique opportunity to be the first ones to recognize anorectal pathology and start appropriate and timely work up. Thank you for listening.

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Urinary incontinence is extremely common and is an underreported condition because of embarrassment associated with its symptoms and lack of knowledge about treatment options. There are many risk factors for urinary incontinence and some of them are modifiable, so it is crucial that we educate our patients about them. The main types of urinary incontinence are stress, urgency, and overflow incontinence. Patient with a combination of stress and urgency incontinence are described as having mixed urinary incontinence. When evaluating a patient with urinary incontinence, make sure to screen for other treatable causes such as vaginal atrophy, urinary tract infection; as well as reversible causes such as alcohol use, excessive caffeine intake, and severe constipation. Ask your patient to keep a voiding diary to help you better understand their voiding patterns. Bladder stress test can help you diagnose stress incontinence and post void residual can help you diagnose overflow incontinence. Urodynamic testing is reserved for cases with diagnostic uncertainty. Lastly, refer to urology when clinically indicated. Thank you for listening.

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Working up shoulder pain can be deceivingly simple - you have to consider traumatic vs non-traumatic, extrinsic vs intrinsic shoulder pathology, and glenohumeral vs extra-glenohumeral pathology. Further diagnostic imaging should be guided by history, physical exam, and special tests. Consider ordering an US if your facility offers one as its diagnostic value is similar to MRI when assessing muscles and tendons around the shoulder. Make sure to refer your younger patients with acute rotator cuff tears for a surgical evaluation within 8 weeks of the symptom onset. Partial rotator cuff tears, complete tears under 1 cm or chronic degenerative tears should be managed conservatively while complete tears over 1 cm should be referred to orthopedic surgery for management. Thank you for listening.

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Let's follow the White Rabbit down to the Wonderland that is DSM-5 and review criteria for personality disorders together! Music for this episode is by Aleksey Chistilin and the opening quote is from Alice in Wonderland (the movie). Thank you for listening.

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Majority of peripheral disease (PAD) cases are asymptomatic with only about 25% of patients presenting with claudication, rest pain, gangrene, and limb ulcerations. Ankle-brachial index (ABI) is a first-line diagnostic test. ABI of less than 0.9 is consistent with PAD. ABI greater than 1.3 is a sign of noncompressible calcified vessels. If patient’s story and exam are highly concerning for PAD, but ABI is normal, consider post-exercise ABI or a toe-brachial index. Use duplex US to help you identify location and severity of PAD. More advanced imaging may be warranted if non-invasive modalities are non-diagnostic or if patient needs an intervention. For symptomatic PAD patients, it is reasonable to consider clopidogrel over aspirin or low-dose rivaroxaban plus aspirin (while keeping in mind that rivaroxaban + ASA carries an increased risk of bleeding when compared to ASA alone). Antiplatelet therapy use in asymptomatic PAD is not routinely recommended. Treat claudication with supervised exercise program, followed by cilostazol or naftidrofuryl. If your patient progressed to the point that their symptoms are constant, disabling, and no longer responsive to lifestyle modification and pharmacotherapy, revascularization may be indicated. There are two options for revascularization – percutaneous and surgical. Most cases can be done percutaneously. Surgery is reserved for patient with long segment stenosis, multifocal stenosis, eccentric, calcified stenosis, or long segment occlusions. We hope you enjoy this episode! Thank you for listening.

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. PCOS is a complex condition and is quite common. It’s presenting symptoms are ovulatory and menstrual irregularity, subfertility or infertility, clinical hyperandrogenism, metabolic dysfunction, and/or polycystic ovaries. Since the condition was first described in 1935, a lot has changed in our understanding of the pathophysiology. Diagnosis of PCOS can be made by Rotterdam Criteria. More specifically, two out of three of the following criteria have to be met – 1) oligomenorrhea and/or anovulation, 2) clinical and/or biochemical signs of hyperandrogenism, 3) polycystic ovaries on TVUS. Important take away here is you don’t have to visualize polycystic ovaries to make the diagnosis. We no longer use LH:FSH ratio in working up PCOS. If patient has hyperandrogenic features, you can order a total testosterone. In cases where patient has virilization and severely elevated testosterone, other causes need to be investigated. If your patient also has oligomenorrhea, you should add an early morning 17-hydroxyprogesterone to rule out nonclassic congenital adrenal hyperplasia. Measurements of DHEA or free testosterone are not routinely recommended. You can consider adding hCG, TSH, FSH to your lab work. Treatment options will vary based on whether or not the patient is pursuing pregnancy. If pregnancy is not desired, COC should be prescribed for menstrual dysfunction, endometrial protection, and contraception. Metformin can be added if patient has glucose intolerance. Spironolactone or other antiandrogen medications can be added for androgen excess manifestations if COC are not enough. Weigh loss is another key component of PCOS treatment. Pay close attention to signs of depression or anxiety in your patients with PCOS. If your patients desire pregnancy, there are ovulation induction medications that can be tried first followed by laparoscopic surgery or exogenous gonadotropins. If all those steps fail, patients should be referred to IVF for further options. We hope you enjoy this episode! Thank you for listening.

Host/Editor: Dr. Alla Turshudzhyan, Chief Medical Resident at UCONN. Kidney stones are common and majority of the stones are made up of calcium oxalate, followed by calcium phosphate, uric acid, cystine, and struvite stones. The recurrence rate of kidney stones is quite high, but there are a lot of modifiable risk factors that are crucial we educate our patients about. Some of the modifiable risk factors include decreased fluid intake, low calcium diets, increased oxalate and Vitamin C ingestion, diets low in potassium, high dietary sodium, high dietary non-diary animal protein. When managing a case of kidney stones, it is important to assess patient's discomfort level and escalate pain management as needed starting with NSAIDs. Indications for inpatient admission are poor pain control, inability to tolerate PO, or fever. Stones that are 5-10mm may need an alpha blocker, CCB, or a PDE5 inhibitor to facilitate passage. If stone does not pass after 4 weeks or if stone is more than 10mm, urology consult is indicated. CT abdomen remains the modality of choice for initial image, unless your patient is pregnant. Follow up imaging to confirm stone passage can be done with digital tomosynthesis coupled with an US. We hope you enjoy this episode! Thank you for listening.