Ryan O'Keefe
@rokeefemd.bsky.social
MD/MBA PennMedicine/Wharton | Hospitalist | Onc, Pall Care, MedEd | Creator Point of Care Medicine | Clinical threads and pearls
Daily Pearl:
New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.
New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.
December 19, 2025 at 10:00 PM
Daily Pearl:
New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.
New-onset nephrotic syndrome in an older adult, especially with signs of multi-organ dysfunction (cardiac, hepatic), should immediately raise suspicion for AL amyloidosis.
Daily Pearl:
Mild elevations in ALT and AST without elevations in bilirubin, alk phos, or GGT should reflex to a CK to assess for extra-hepatic source of elevation such as muscle damage especially in patients where NAFLD, alcohol use, and DILI is less likely.
Mild elevations in ALT and AST without elevations in bilirubin, alk phos, or GGT should reflex to a CK to assess for extra-hepatic source of elevation such as muscle damage especially in patients where NAFLD, alcohol use, and DILI is less likely.
December 18, 2025 at 10:00 PM
Daily Pearl:
Mild elevations in ALT and AST without elevations in bilirubin, alk phos, or GGT should reflex to a CK to assess for extra-hepatic source of elevation such as muscle damage especially in patients where NAFLD, alcohol use, and DILI is less likely.
Mild elevations in ALT and AST without elevations in bilirubin, alk phos, or GGT should reflex to a CK to assess for extra-hepatic source of elevation such as muscle damage especially in patients where NAFLD, alcohol use, and DILI is less likely.
Daily Pearl:
Syphilitic osteomyelitis is a rare but classic presentation where the infection has a known tropism for the skull.
Source: CPS, Episode 429 – RLR – Forehead Bump
Syphilitic osteomyelitis is a rare but classic presentation where the infection has a known tropism for the skull.
Source: CPS, Episode 429 – RLR – Forehead Bump
December 17, 2025 at 10:00 PM
Daily Pearl:
Syphilitic osteomyelitis is a rare but classic presentation where the infection has a known tropism for the skull.
Source: CPS, Episode 429 – RLR – Forehead Bump
Syphilitic osteomyelitis is a rare but classic presentation where the infection has a known tropism for the skull.
Source: CPS, Episode 429 – RLR – Forehead Bump
Daily Pearl:
A creatinine level >10 mg/dL should always be considered post-renal obstruction until proven otherwise.
The absence of hydronephrosis on imaging does not rule out obstruction, especially from chronic, infiltrative processes like TB or retroperitoneal fibrosis that encase the ureter.
A creatinine level >10 mg/dL should always be considered post-renal obstruction until proven otherwise.
The absence of hydronephrosis on imaging does not rule out obstruction, especially from chronic, infiltrative processes like TB or retroperitoneal fibrosis that encase the ureter.
December 16, 2025 at 10:00 PM
Daily Pearl:
A creatinine level >10 mg/dL should always be considered post-renal obstruction until proven otherwise.
The absence of hydronephrosis on imaging does not rule out obstruction, especially from chronic, infiltrative processes like TB or retroperitoneal fibrosis that encase the ureter.
A creatinine level >10 mg/dL should always be considered post-renal obstruction until proven otherwise.
The absence of hydronephrosis on imaging does not rule out obstruction, especially from chronic, infiltrative processes like TB or retroperitoneal fibrosis that encase the ureter.
Daily Pearl:
Bell’s palsy presents over hours to a few days with weakness of all muscles of facial expression on one side, including the forehead.
However, a rare stroke location can produce a similar clinical deficit.
Bell’s palsy presents over hours to a few days with weakness of all muscles of facial expression on one side, including the forehead.
However, a rare stroke location can produce a similar clinical deficit.
December 15, 2025 at 10:00 PM
Daily Pearl:
Bell’s palsy presents over hours to a few days with weakness of all muscles of facial expression on one side, including the forehead.
However, a rare stroke location can produce a similar clinical deficit.
Bell’s palsy presents over hours to a few days with weakness of all muscles of facial expression on one side, including the forehead.
However, a rare stroke location can produce a similar clinical deficit.
Daily Pearl:
In aortic stenosis (AS), exertional syncope occurs due to profound cerebral hypoperfusion when vasodilation in exercising muscles is not matched by a sufficient increase in cardiac output across the fixed obstruction (the stenosed valve).
In aortic stenosis (AS), exertional syncope occurs due to profound cerebral hypoperfusion when vasodilation in exercising muscles is not matched by a sufficient increase in cardiac output across the fixed obstruction (the stenosed valve).
December 14, 2025 at 10:00 PM
Daily Pearl:
In aortic stenosis (AS), exertional syncope occurs due to profound cerebral hypoperfusion when vasodilation in exercising muscles is not matched by a sufficient increase in cardiac output across the fixed obstruction (the stenosed valve).
In aortic stenosis (AS), exertional syncope occurs due to profound cerebral hypoperfusion when vasodilation in exercising muscles is not matched by a sufficient increase in cardiac output across the fixed obstruction (the stenosed valve).
Daily Pearl:
Chilaiditi’s syndrome is a rare condition where a segment of the colon (typically the hepatic flexure or transverse colon) becomes trapped between the liver and the right hemidiaphragm.
Chilaiditi’s syndrome is a rare condition where a segment of the colon (typically the hepatic flexure or transverse colon) becomes trapped between the liver and the right hemidiaphragm.
December 13, 2025 at 10:00 PM
Daily Pearl:
Chilaiditi’s syndrome is a rare condition where a segment of the colon (typically the hepatic flexure or transverse colon) becomes trapped between the liver and the right hemidiaphragm.
Chilaiditi’s syndrome is a rare condition where a segment of the colon (typically the hepatic flexure or transverse colon) becomes trapped between the liver and the right hemidiaphragm.
Daily Pearl:
Organophosphate poisoning presents with muscarinic effects (diarrhea, urination, miosis, bronchospasm, bronchorrhea, emesis, lacrimation, salivation - “DUMBELS”) and nicotinic effects (muscle fasciculations, cramping, weakness, paralysis, tachycardia, hypertension).
Organophosphate poisoning presents with muscarinic effects (diarrhea, urination, miosis, bronchospasm, bronchorrhea, emesis, lacrimation, salivation - “DUMBELS”) and nicotinic effects (muscle fasciculations, cramping, weakness, paralysis, tachycardia, hypertension).
December 12, 2025 at 10:00 PM
Daily Pearl:
Organophosphate poisoning presents with muscarinic effects (diarrhea, urination, miosis, bronchospasm, bronchorrhea, emesis, lacrimation, salivation - “DUMBELS”) and nicotinic effects (muscle fasciculations, cramping, weakness, paralysis, tachycardia, hypertension).
Organophosphate poisoning presents with muscarinic effects (diarrhea, urination, miosis, bronchospasm, bronchorrhea, emesis, lacrimation, salivation - “DUMBELS”) and nicotinic effects (muscle fasciculations, cramping, weakness, paralysis, tachycardia, hypertension).
Daily Pearl:
Severe, unexplained thrombocytopenia or other cytopenias can be the presenting manifestation of disseminated TB due to bone marrow infiltration.
Source: CPS, October 14, 2025 VMR with Ravi & Deb - worsening SOB for 15 days
Severe, unexplained thrombocytopenia or other cytopenias can be the presenting manifestation of disseminated TB due to bone marrow infiltration.
Source: CPS, October 14, 2025 VMR with Ravi & Deb - worsening SOB for 15 days
December 11, 2025 at 10:00 PM
Daily Pearl:
Severe, unexplained thrombocytopenia or other cytopenias can be the presenting manifestation of disseminated TB due to bone marrow infiltration.
Source: CPS, October 14, 2025 VMR with Ravi & Deb - worsening SOB for 15 days
Severe, unexplained thrombocytopenia or other cytopenias can be the presenting manifestation of disseminated TB due to bone marrow infiltration.
Source: CPS, October 14, 2025 VMR with Ravi & Deb - worsening SOB for 15 days
Daily Pearl:
Flash pulmonary edema is a disease of afterload mismatch, making vasodilation (afterload reduction via nicardipine, nitroglycerin, etc.) the cornerstone of therapy.
Flash pulmonary edema is a disease of afterload mismatch, making vasodilation (afterload reduction via nicardipine, nitroglycerin, etc.) the cornerstone of therapy.
December 10, 2025 at 10:00 PM
Daily Pearl:
Flash pulmonary edema is a disease of afterload mismatch, making vasodilation (afterload reduction via nicardipine, nitroglycerin, etc.) the cornerstone of therapy.
Flash pulmonary edema is a disease of afterload mismatch, making vasodilation (afterload reduction via nicardipine, nitroglycerin, etc.) the cornerstone of therapy.
Daily Pearl:
In aspiration PNA, elderly patients may present with atypical signs of infection, such as functional decline, confusion, or tachypnea, in the absence of fever due to immunosenescence.
Source: CPS, October 3, 2025 VMR with Rabih & Seeme - productive cough and dyspnea for 3 days
In aspiration PNA, elderly patients may present with atypical signs of infection, such as functional decline, confusion, or tachypnea, in the absence of fever due to immunosenescence.
Source: CPS, October 3, 2025 VMR with Rabih & Seeme - productive cough and dyspnea for 3 days
December 9, 2025 at 10:00 PM
Daily Pearl:
In aspiration PNA, elderly patients may present with atypical signs of infection, such as functional decline, confusion, or tachypnea, in the absence of fever due to immunosenescence.
Source: CPS, October 3, 2025 VMR with Rabih & Seeme - productive cough and dyspnea for 3 days
In aspiration PNA, elderly patients may present with atypical signs of infection, such as functional decline, confusion, or tachypnea, in the absence of fever due to immunosenescence.
Source: CPS, October 3, 2025 VMR with Rabih & Seeme - productive cough and dyspnea for 3 days
Daily Pearl:
A “mural abscess” in the colon wall on imaging in a patient with a history of malignancy should raise suspicion for a recurrent, necrotic tumor.
Source: CPS; October 1, 2025 VMR with Steph & Zaven - 1 week of constipation
A “mural abscess” in the colon wall on imaging in a patient with a history of malignancy should raise suspicion for a recurrent, necrotic tumor.
Source: CPS; October 1, 2025 VMR with Steph & Zaven - 1 week of constipation
December 8, 2025 at 10:00 PM
Daily Pearl:
A “mural abscess” in the colon wall on imaging in a patient with a history of malignancy should raise suspicion for a recurrent, necrotic tumor.
Source: CPS; October 1, 2025 VMR with Steph & Zaven - 1 week of constipation
A “mural abscess” in the colon wall on imaging in a patient with a history of malignancy should raise suspicion for a recurrent, necrotic tumor.
Source: CPS; October 1, 2025 VMR with Steph & Zaven - 1 week of constipation
Best of Clinical Cases from October 2025!
IM and Hospital Medicine Recap
Check out the most recent Substack post published this AM!
My favorite lessons and pearls from the best clinical cases from @CPSolvers @Dx_Atypia @runthelistpod @NEJM
Zero fluff, high-yield.
Link below!
IM and Hospital Medicine Recap
Check out the most recent Substack post published this AM!
My favorite lessons and pearls from the best clinical cases from @CPSolvers @Dx_Atypia @runthelistpod @NEJM
Zero fluff, high-yield.
Link below!
December 7, 2025 at 10:00 PM
Best of Clinical Cases from October 2025!
IM and Hospital Medicine Recap
Check out the most recent Substack post published this AM!
My favorite lessons and pearls from the best clinical cases from @CPSolvers @Dx_Atypia @runthelistpod @NEJM
Zero fluff, high-yield.
Link below!
IM and Hospital Medicine Recap
Check out the most recent Substack post published this AM!
My favorite lessons and pearls from the best clinical cases from @CPSolvers @Dx_Atypia @runthelistpod @NEJM
Zero fluff, high-yield.
Link below!
Chronic Coronary Artery Disease (Annals of Internal Medicine)
November 27, 2025 at 1:00 PM
Chronic Coronary Artery Disease (Annals of Internal Medicine)
Syphilis: A Review (JAMA)
November 26, 2025 at 10:00 PM
Syphilis: A Review (JAMA)
Lung-Cancer in Non-Smoking Individuals (JAMA)
November 25, 2025 at 10:00 PM
Lung-Cancer in Non-Smoking Individuals (JAMA)
Gluten vs fructans as a source of abdominal symptoms
Non-celiac gluten sensitivity Review (Lancet)
Non-celiac gluten sensitivity Review (Lancet)
November 24, 2025 at 10:00 PM
Gluten vs fructans as a source of abdominal symptoms
Non-celiac gluten sensitivity Review (Lancet)
Non-celiac gluten sensitivity Review (Lancet)
Evaluation Of Jaundice In Adults Review (AAFP)
November 23, 2025 at 10:00 PM
Evaluation Of Jaundice In Adults Review (AAFP)
New Substack post!
IM and Hospital Medicine Recap - Clinical Reviews (October, Part 2)
The best lessons and pearls from clinical reviews featuring Chronic CAD, syphilis, lung cancer in non-smokers, non-celiac gluten sensitivity, and evaluation of jaundice!
rokeefemd.substack.com/p/im-and-ho...
IM and Hospital Medicine Recap - Clinical Reviews (October, Part 2)
The best lessons and pearls from clinical reviews featuring Chronic CAD, syphilis, lung cancer in non-smokers, non-celiac gluten sensitivity, and evaluation of jaundice!
rokeefemd.substack.com/p/im-and-ho...
November 23, 2025 at 5:41 PM
New Substack post!
IM and Hospital Medicine Recap - Clinical Reviews (October, Part 2)
The best lessons and pearls from clinical reviews featuring Chronic CAD, syphilis, lung cancer in non-smokers, non-celiac gluten sensitivity, and evaluation of jaundice!
rokeefemd.substack.com/p/im-and-ho...
IM and Hospital Medicine Recap - Clinical Reviews (October, Part 2)
The best lessons and pearls from clinical reviews featuring Chronic CAD, syphilis, lung cancer in non-smokers, non-celiac gluten sensitivity, and evaluation of jaundice!
rokeefemd.substack.com/p/im-and-ho...
MGUS is common - it’s present in 5% of the adult population over 50!
Learn more about this topic in the most recent Substack post!
x.com/ROKeefeMD/s...
Learn more about this topic in the most recent Substack post!
x.com/ROKeefeMD/s...
November 17, 2025 at 10:01 PM
MGUS is common - it’s present in 5% of the adult population over 50!
Learn more about this topic in the most recent Substack post!
x.com/ROKeefeMD/s...
Learn more about this topic in the most recent Substack post!
x.com/ROKeefeMD/s...
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
November 17, 2025 at 1:30 AM
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
⚕️September IM and Hospitalist Recap!⚕️
Hepatitis C: Are We There Yet? (UCSF Grand Rounds)
Such a fascinating history - we've come a long way, and yet there is so much to be done!
My favorite lessons below.
www.youtube.com/watch?v=XrJ...
Hepatitis C: Are We There Yet? (UCSF Grand Rounds)
Such a fascinating history - we've come a long way, and yet there is so much to be done!
My favorite lessons below.
www.youtube.com/watch?v=XrJ...
Hepatitis C: Are We There Yet? Updates and the Road Ahead
Although curative therapies have transformed hepatitis C care, gaps in diagnosis, access, and prevention still stand in the way of its elimination. In this G...
www.youtube.com
October 30, 2025 at 8:58 PM
⚕️September IM and Hospitalist Recap!⚕️
Hepatitis C: Are We There Yet? (UCSF Grand Rounds)
Such a fascinating history - we've come a long way, and yet there is so much to be done!
My favorite lessons below.
www.youtube.com/watch?v=XrJ...
Hepatitis C: Are We There Yet? (UCSF Grand Rounds)
Such a fascinating history - we've come a long way, and yet there is so much to be done!
My favorite lessons below.
www.youtube.com/watch?v=XrJ...
⚕️September IM and Hospitalist Recap!⚕️
All things HFpEF!
An oldie but a goodie! Glad this one got revisited!
Check out the linked @thecurbsiders post, and then some of my top takeaways below.
x.com/thecurbside...
All things HFpEF!
An oldie but a goodie! Glad this one got revisited!
Check out the linked @thecurbsiders post, and then some of my top takeaways below.
x.com/thecurbside...
October 29, 2025 at 9:00 PM
⚕️September IM and Hospitalist Recap!⚕️
All things HFpEF!
An oldie but a goodie! Glad this one got revisited!
Check out the linked @thecurbsiders post, and then some of my top takeaways below.
x.com/thecurbside...
All things HFpEF!
An oldie but a goodie! Glad this one got revisited!
Check out the linked @thecurbsiders post, and then some of my top takeaways below.
x.com/thecurbside...
Questions from the Wards!
Check out the most recent Substack post published this AM!
After each month working in the hospital, I try to do a deep dive into a few topics / questions that came up. Here are a few of my recent favorites!
Zero fluff, high-yield. Subscribe for more to come.
Link below
Check out the most recent Substack post published this AM!
After each month working in the hospital, I try to do a deep dive into a few topics / questions that came up. Here are a few of my recent favorites!
Zero fluff, high-yield. Subscribe for more to come.
Link below
October 29, 2025 at 4:00 PM
Questions from the Wards!
Check out the most recent Substack post published this AM!
After each month working in the hospital, I try to do a deep dive into a few topics / questions that came up. Here are a few of my recent favorites!
Zero fluff, high-yield. Subscribe for more to come.
Link below
Check out the most recent Substack post published this AM!
After each month working in the hospital, I try to do a deep dive into a few topics / questions that came up. Here are a few of my recent favorites!
Zero fluff, high-yield. Subscribe for more to come.
Link below
⚕️September IM and Hospitalist Recap!⚕️
One Detail Completely Changed This Case (An Unexpected Outcome) - Conan Liu MD
My takeaways, and additional thoughts on approaching hypoalbuminemia below!
www.youtube.com/watch?v=KB_...
One Detail Completely Changed This Case (An Unexpected Outcome) - Conan Liu MD
My takeaways, and additional thoughts on approaching hypoalbuminemia below!
www.youtube.com/watch?v=KB_...
One Detail Completely Changed This Case (An Unexpected Outcome)
Sometimes you will run across a case where one small detail completely changes the diagnostic momentum, and results in an entirely different outcome. Here is...
www.youtube.com
October 28, 2025 at 8:58 PM
⚕️September IM and Hospitalist Recap!⚕️
One Detail Completely Changed This Case (An Unexpected Outcome) - Conan Liu MD
My takeaways, and additional thoughts on approaching hypoalbuminemia below!
www.youtube.com/watch?v=KB_...
One Detail Completely Changed This Case (An Unexpected Outcome) - Conan Liu MD
My takeaways, and additional thoughts on approaching hypoalbuminemia below!
www.youtube.com/watch?v=KB_...