Harrison's PodClass: Internal Medicine Cases and Board Prep

A young college student worries after an incidental bilirubin rise. Conversation covers when jaundice appears and how bilirubin is made and cleared. They explain direct versus indirect bilirubin and which lab patterns point to hemolysis, drugs, or inherited conditions. The discussion narrows to benign inherited causes like Gilbert, plus rare conjugated disorders and why serious liver or biliary disease is unlikely.

A deep dive into complications from worsening renal dysfunction. They cover when to start goals-of-care discussions as kidney function declines. Conversation highlights vitamin D activation failure, hypocalcemia signs, and FGF23’s role in phosphate handling. Management topics include phosphate restriction, activated vitamin D, binders, and monitoring PTH and magnesium.

A 45-year-old with incidental high calcium sparks a clinical workup of hypercalcemia. They explore lab correction for albumin and confirm ionized calcium elevation. The conversation covers calcium homeostasis, PTH versus PTHrP mechanisms, effects of lithium and familial hypocalciuric hypercalcemia, and malignancy-related pathways like squamous cell carcinoma secreting PTHrP.

A case about an 89-year-old with poor appetite and weight loss sparks a deep dive into aging biology and why normal aging is often asymptomatic. The five M's of geriatrics are explained and multimorbidity challenges are explored. Discussion covers underdiagnosed reversible conditions, common cognitive and mood disorders, and the importance of social support and patient preferences.

A clinical case of a 65-year-old with new anemia and cirrhosis prompts a deep dive into peripheral blood smears. Listeners hear practical tips on smear technique and key red cell morphologies. The conversation contrasts MCV and RDW patterns and differentiates spherocytes, schistocytes, target cells, and Howell-Jolly bodies. Antibiotic-associated autoimmune hemolysis and hemolysis patterns are highlighted.

A 75-year-old with fever and acute confusion after mosquito exposure sparks a deep dive into encephalitis signs and diagnostic reasoning. The discussion highlights why West Nile virus is high on the differential and how CSF testing guides diagnosis. Imaging limits and the role of empiric antiviral therapy are reviewed. Recovery timelines and possible long-term neurologic effects are also covered.

A 64-year-old colonoscopy finds diverticulosis and sparks a deep dive into diverticular disease. Topics include rising global incidence and who is most affected. They cover risk factors beyond diet, common locations in the colon, and main complications like bleeding and diverticulitis. Practical points include diagnosis with CT, outpatient management, antibiotic use, and diet myths about nuts and seeds.

A clinical case about a 64-year-old with fatigue, low fevers, and weight loss sparks a discussion of a new holosystolic murmur at the apex radiating to the axilla. Conversation covers murmur timing, causes, grading, and how maneuvers like hand grip, inspiration, and Valsalva change murmur intensity. They conclude the findings suggest mitral regurgitation and discuss concern for endocarditis.

A deep dive into fever of unknown origin and unexplained inflammation. They walk through modern criteria, baseline testing, and when a case truly qualifies. Geographic differences in causes and the FUO paradox get attention. The conversation covers diagnostic strategies, value of second opinions, and when therapeutic trials may be considered.

The discussion revolves around the complex nature of fatigue, distinguishing it from weakness and assessing its causes. The hosts share insights on patient history, physical exams, and differential diagnoses, emphasizing common conditions such as depression and hypothyroidism. They highlight the importance of a targeted approach to laboratory evaluations and recommend structured exercise as part of management. Listeners gain a deeper understanding of fatigue's multifaceted challenges in primary care and the necessity for individualized care.