Podcast
Ninja Nerd
Hosted by Ninja Nerd · EN
Welcome to the official Ninja Nerd Podcast! Brought to you by Zach and Rob, we will be presenting on board exam content and highlighting the most important information you need in order to crush your exams and apply these concepts clinically.
33episodes
Episodes
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Hepatitis A
4d ago00:22:56Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob walk you through a high-yield, case-based approach to Hepatitis A, focusing on pattern recognition, clean diagnostic thinking, and the key red flags you cannot miss. This is one of those topics where boards and real life overlap perfectly, and we break it down into a simple, usable framework.We start with a classic case of acute viral hepatitis after a fecal-oral exposure, walking through the typical progression from a flu-like prodrome to jaundice. From there, we connect the symptoms to the underlying pathophysiology and show you how to recognize the hepatocellular injury pattern on labs and confirm the diagnosis with anti-HAV IgM. Next, we shift to management, emphasizing supportive care and how to decide who can be managed on an outpatient basis versus who requires hospital admission. We then escalate to a high-risk case of acute liver failure, highlighting the critical findings of elevated INR and encephalopathy that require urgent intervention and possible transplant evaluation. We close with high-yield prevention, including vaccination and post-exposure prophylaxis, giving you a concise, exam-ready approach to Hepatitis A from start to finish.Let’s get into it, Ninja Nerds!Support the show
Transcribe →Infective Endocarditis
1w ago01:02:42Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob walk you through a high-yield, case-based approach to infective endocarditis, one of the most important and frequently tested diagnoses across medicine, cardiology, infectious disease, and board exams. Using real clinical scenarios, we break down how this disease presents, how it hides, and how to think through it step by step when the clues are not so obvious.We start by building a clear clinical framework, defining infective endocarditis as an infection of the endocardium, most commonly affecting heart valves, and walking through the key distinctions between native and prosthetic valves and between acute and subacute disease. From there, we establish high-yield organism associations and patterns that help you quickly narrow your differential before labs even return. Next, we dive into a classic high-stakes case, an intravenous drug user presenting with fever, hypoxia, and pulmonary symptoms. This case serves as a foundation for understanding right-sided endocarditis, particularly tricuspid valve involvement, septic pulmonary emboli, and the role of Staphylococcus aureus as the dominant organism in acute disease. We also emphasize critical first steps, including obtaining multiple blood cultures before antibiotics and initiating appropriate imaging to confirm the diagnosis. From there, we shift into a slower, more subtle presentation following a dental procedure, highlighting subacute left-sided endocarditis caused by Streptococcus viridans. This case allows us to break down classic peripheral findings such as Janeway lesions, Osler nodes, splinter hemorrhages, and Roth spots, and more importantly, understand the mechanisms behind them, whether embolic or immune-mediated. We also introduce the Modified Duke criteria and walk through when to escalate from transthoracic to transesophageal echocardiography. We then escalate to a high-risk prosthetic valve case, focusing on early prosthetic valve endocarditis and the critical clue of a new conduction abnormality suggesting a perivalvular abscess. This section emphasizes biofilm-associated infections, the role of organisms like Staphylococcus epidermidis, and why certain patients require aggressive multidrug therapy and early surgical intervention. To reinforce key associations, we close with rapid-fire, high-yield scenarios covering organisms you cannot miss, including Enterococcus following genitourinary procedures, Streptococcus gallolyticus and its association with colorectal cancer, and fungal endocarditis in patients with indwelling devices or immunosuppression. Throughout, we highlight core management principles, including prolonged intravenous antibiotics, indications for surgery, and the importance of source control. This episode ties everything together into a practical, exam-ready framework, helping you recognize infective endocarditis early, avoid common traps, and confidently move from suspicion to diagnosis to management.Let’s get into it, Ninja Nerds!Support the show
Transcribe →C. diff
2w ago00:41:45Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob walk you through a high-yield, case-based approach to Clostridioides difficile infection, one of the most common and dangerous hospital-acquired infections you will encounter in clinical practice. Using a structured, algorithm-driven framework, we break down how to recognize true infection, avoid common diagnostic traps, and manage patients across the full spectrum from mild disease to life-threatening complications.We start by bringing in a classic case of antibiotic-associated diarrhea to reinforce the approach. Using a patient with profuse watery diarrhea and recent hospitalization, we show how to confirm the diagnosis, classify severity using laboratory markers, and initiate first-line therapy. Along the way, we highlight essential management steps such as stopping the inciting antibiotic, initiating fluid resuscitation, and implementing strict infection control precautions. We then shift into one of the most important diagnostic pitfalls, a patient with a positive PCR but minimal symptoms. This case emphasizes the critical distinction between colonization and active toxin-mediated disease, reinforcing the principle that you treat the patient, not an isolated test result. From there, we escalate to fulminant disease, walking through a high-stakes ICU scenario complicated by toxic megacolon. You will learn to recognize key red flags such as worsening abdominal distension, paradoxical cessation of diarrhea, leukocytosis, and rising lactate, and how these findings should immediately trigger aggressive medical management and early surgical consultation. We also cover life-threatening complications, such as perforation, and the importance of rapid recognition and intervention. Finally, we close with recurrent infection, one of the most frustrating aspects of C. difficile management. Using a case-based approach, we break down treatment options for first and subsequent recurrences, including fidaxomicin, vancomycin taper regimens, and fecal microbiota transplant, and discuss when to consider adjunctive therapies to reduce recurrence risk. Let’s get into it, Ninja Nerds!Support the show
Transcribe →COVID-19
3w ago00:52:13Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob walk you through a high-yield, case-based approach to COVID-19, built exactly the way you need it for exams and real clinical decision-making. Using three core cases, we break down how to recognize the disease, build a systematic diagnostic approach, and most importantly, match treatment to severity so you know exactly what to do in the moment.We start by building the clinical foundation with a patient presenting with early symptoms like fever, cough, and loss of taste. In this case, we walk through the pathophysiology of SARS-CoV-2, focusing on its spike protein binding to ACE2 receptors and how this explains the multisystem involvement seen in COVID. You will learn how infection progresses through distinct phases, from early viral replication to pulmonary disease and finally to the hyperinflammatory state that drives severe complications like acute respiratory distress syndrome and multiorgan failure. Next, we expand this framework by connecting pathophysiology to clinical complications. We break down why patients develop diffuse alveolar damage and refractory hypoxemia, as well as the hypercoagulable state that leads to deep vein thrombosis, pulmonary embolism, and stroke. We also highlight high-yield complications, including acute kidney injury, myocarditis, and long COVID, emphasizing the key clinical clues that help you recognize them quickly. From there, we shift into a systematic diagnostic approach using a high-risk patient with known exposure. You will learn how to choose between polymerase chain reaction testing and rapid antigen testing, when negative results require repeat testing, and how the physical exam becomes a critical tool for severity classification. We also walk through when to order laboratory studies and imaging, including inflammatory markers, coagulation studies, chest imaging, and arterial blood gases, and how each result directly informs clinical decision-making rather than just adding data. Finally, we bring everything together with a step-by-step treatment framework based on disease severity. Through a progression of cases, we show how to manage mild to moderate disease in high-risk outpatients with early antiviral therapy, how to treat severe disease with oxygen support, corticosteroids, antivirals, and anticoagulation, and how to escalate care in critical illness with advanced respiratory support and immunomodulators. We also cover key monitoring pitfalls, including drug interactions, hepatotoxicity, and complications of therapy. We close with a focused review of prevention strategies, including vaccine mechanisms and the role of pre-exposure prophylaxis in select immunocompromised patients, tying everything together into a practical framework you can use on exams and in the hospital.Let’s get into it, Ninja Nerds!Support the show
Transcribe →Influenza
4w ago00:32:05Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob walk you through a high-yield, case-based approach to influenza that goes far beyond “just the flu.” Using real clinical scenarios, we break down how this virus operates, who it hits hardest, and how to quickly recognize when a routine case is about to turn into something much more dangerous.We start with the foundation, understanding the viral structure and why influenza is so unpredictable. Through discussion of hemagglutinin and neuraminidase, along with their segmented RNA genome, we build the clinical logic behind antigenic drift and antigenic shift, and why these mechanisms drive seasonal outbreaks rather than global pandemics. Next, we bring in a high-risk patient, an older adult with chronic lung and cardiac disease presenting with fever, malaise, and myalgias. In this case, we walk through how to identify high-risk populations, when testing is necessary, and why influenza can rapidly destabilize underlying conditions such as chronic obstructive pulmonary disease and heart failure. We also break down when to order confirmatory testing and how to think through worsening respiratory status in a clinically meaningful way. From there, we proceed to one of the most important clinical decisions: differentiating primary influenza pneumonia from secondary bacterial pneumonia. Using imaging patterns, clinical timing, and disease progression, we show you how to recognize diffuse viral lung injury versus the classic biphasic crash seen with superimposed bacterial infections such as Streptococcus pneumoniae or methicillin-resistant Staphylococcus aureus. We then move into rapid-fire, high-yield complications that are frequently tested and often missed. Through classic presentations, we cover Reye syndrome in children, Guillain-Barré syndrome following infection, and influenza-associated rhabdomyolysis, emphasizing the mechanisms, key clinical clues, and the importance of early recognition. Finally, we close with a focused discussion on treatment and prevention. You will learn when to initiate antiviral therapy with neuraminidase inhibitors versus alternative agents, who benefits most from treatment, and how timing impacts outcomes. We also walk through vaccination strategies, including high-dose vaccines in older adults, contraindications to live attenuated vaccines, and approaches to post-exposure chemoprophylaxis in high-risk settings such as nursing homes. Let’s get into it, Ninja Nerds!Support the show
Transcribe →Tuberculosis
Apr 3000:44:07Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob break down tuberculosis as a high-yield clinical framework rather than a list of random facts, focusing on how tuberculosis is actually tested and managed on exams, wards, and in the intensive care unit.We begin with the classic active tuberculosis presentation and the first move that matters most, immediate airborne isolation. We then walk through how to confirm the diagnosis using the appropriate sequence of tests, including sputum acid-fast smear, nucleic acid amplification testing, and sputum culture. From there, we build the full treatment approach with rifampin, isoniazid, pyrazinamide, and ethambutol, plus the standard duration, and then hit a major exam trap, when cavitation and a persistently positive two-month culture force you to extend therapy beyond the usual timeline.Next, we run the toxicity gauntlet so you can spot and respond to the big adverse effects fast, including hepatitis patterns that require stopping the offending drugs, ethambutol optic neuritis with red-green color discrimination loss, isoniazid-related peripheral neuropathy that is preventable with pyridoxine, and pyrazinamide-associated hyperuricemia and gout. We also emphasize how to monitor patients during therapy and recognize when clinical or microbiologic nonresponse should trigger a reassessment for adherence issues, drug resistance, or an alternative diagnosis.We then pivot to latent tuberculosis screening and management, using realistic healthcare-style scenarios to review purified protein derivative interpretation thresholds, the next step after chest radiography, and practical latent treatment regimens. We also clarify how to think about tuberculosis risk stratification for immunocompromised patients, close contacts, and individuals from high-prevalence regions, since these details often determine which tests you order and how aggressively you treat. Finally, we close with the high-stakes extrapulmonary complications, why corticosteroids matter in tuberculous meningitis and pericarditis, and a classic drug interaction in which rifampin can undermine warfarin's effectiveness.Enjoy the podcast and support us below!Support the show
Transcribe →Upper Respiratory Tract Infections (URTIs)
Apr 2300:43:28Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob break down upper respiratory tract infections using a simple, case-based approach that always starts the same way: decide if the patient is unstable. We define instability as the presence of bedside red flags such as stridor, hypoxia, drooling, tripod positioning, muffled voice, trismus, severe neck swelling, or hemodynamic instability. If any are present, airway management takes priority and imaging waits. If the patient is stable, the next step is to localize the lesion to the nose and sinuses, the throat, or the larynx.We then move through the most common upper respiratory presentations. The common cold is managed only with supportive care. Rhinosinusitis is classified as viral or bacterial based on time course: viral disease improves within 10 days, whereas bacterial disease persists or worsens after initial improvement and is treated with amoxicillin-clavulanate. Tonsillopharyngitis is approached with targeted testing for Group A streptococcus using rapid antigen testing, with culture follow-up in children and teens if negative, and appropriate antibiotic treatment to prevent complications. Epstein-Barr virus is considered an important alternative when fatigue and posterior cervical lymphadenopathy are prominent.The episode then focuses on high-risk causes of stridor. Croup is identified by a barking cough and treated with dexamethasone, with racemic epinephrine added for more severe disease. Epiglottitis is characterized by the absence of cough and the presence of fever, drooling, tripod positioning, a muffled voice, and inspiratory stridor, with airway-first management and intravenous antibiotics and steroids.We close by reviewing downstream complications, including acute otitis media following a viral illness and dangerous deep neck infections signaled by trismus, muffled voice, drooling, and neck pain, reinforcing the need for early airway assessment and timely imaging when indicated.Enjoy the podcast, and please support us below!Support the show
Transcribe →Laryngeal Infections
Apr 1600:45:27Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob tackle laryngeal infections, a high-risk group of conditions where the key challenge is recognizing impending airway compromise rather than simply choosing an antibiotic. The episode is built around a case-based algorithm that helps listeners rapidly sort benign hoarseness from life-threatening obstruction.The discussion begins with acute laryngitis, emphasizing hoarseness after a viral upper respiratory infection, lack of stridor, and why supportive care is appropriate. From there, the episode moves into viral croup, highlighting the classic barking cough, hoarseness, biphasic stridor, and nocturnal worsening. Zach and Rob review severity assessment, universal steroid use, when to add racemic epinephrine, and the critical observation window to monitor for rebound symptoms.The conversation then escalates to epiglottitis, focusing on sudden onset of high fever, drooling, dysphagia, tripod positioning, and inspiratory stridor. They stress airway-first management, avoiding agitation, when imaging is appropriate, and definitive treatment with airway control, IV antibiotics, and steroids.The episode closes with bacterial tracheitis, the dangerous scenario where presumed croup worsens and becomes toxic. Zach and Rob break down why racemic epinephrine fails, how thick purulent secretions cause mechanical airway obstruction, and why these patients often require intubation, IV antibiotics, and bronchoscopy.The episode concludes with a rapid, high-yield comparison of laryngitis, croup, epiglottitis, and bacterial tracheitis to reinforce fast pattern recognition and airway-focused decision-making.Enjoy the podcast, and please support us below! Support the show
Transcribe →Deep Neck Infections
Apr 900:54:10Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob discuss deep neck infections, one of the highest-stakes topics in ENT, where missed details can rapidly lead to airway compromise, vascular involvement, or mediastinal spread. The focus is on building a single, reliable clinical algorithm that works on exams and in real patient care.The episode opens with a practical framework that prioritizes airway assessment before diagnosis, emphasizing red flags such as drooling, stridor, trismus, muffled voice, neck swelling, and signs of sepsis. From there, Zach and Rob walk through how targeted oral and neck exams help localize infection to specific deep neck spaces and guide next steps.They begin with peritonsillar abscess, highlighting the classic triad of trismus, hot potato voice, and contralateral uvula deviation, and reinforcing that drainage plus IV antibiotics is standard of care. The discussion then moves to parapharyngeal abscess, focusing on dental sources, lateral neck swelling below the jaw angle, the role of CT neck with contrast, and how abscess location relative to the carotid sheath determines surgical approach. Key complications such as Lemierre syndrome and septic pulmonary emboli are emphasized.Next, the episode covers retropharyngeal abscess, particularly in young children, highlighting refusal to extend the neck, posterior pharyngeal wall bulging, and the high risk of airway compromise. Zach and Rob discuss imaging, drainage thresholds, and the dangerous potential for descending necrotizing mediastinitis.The episode closes with Ludwig angina, a rapidly progressive floor-of-mouth infection most often linked to dental disease. They emphasize early airway planning, the role of awake fiberoptic intubation, IV antibiotics, and when surgical drainage is required.The episode concludes with a rapid, high-yield review of localization clues, imaging decisions, antibiotic choices, drainage indications, and life-threatening complications to help listeners lock in a clear, exam-ready approach to deep neck infections.Enjoy the podcast, and please support us below! Support the show
Transcribe →Throat Infections
Apr 200:47:53Tap to summarizeSend us Fan MailNinja Nerds!In this episode of the Ninja Nerd Podcast, Zach and Rob deliver a high-yield, case-based breakdown of throat infections, focusing on how sore throat presentations should be approached on exams and in real clinical decision-making. Rather than memorizing organisms, the episode builds a clear mental framework to distinguish uncomplicated disease from airway-threatening and toxin-mediated conditions.The discussion begins with viral tonsillopharyngitis, highlighting classic features such as cough, coryza, conjunctivitis, and mild pharyngeal findings, and reinforcing why supportive care is appropriate and antibiotics provide no benefit. The episode then transitions to group A streptococcal tonsillopharyngitis, reviewing the key clinical features, use of the Modified Centor Criteria, appropriate testing strategies, and why antibiotic treatment matters for preventing complications like rheumatic fever and deep neck infections.Next, Zach and Rob cover infectious mononucleosis, focusing on prolonged fatigue, posterior cervical lymphadenopathy, splenomegaly, diagnostic testing, the amoxicillin rash pitfall, and the importance of activity restriction to reduce splenic rupture risk.The episode then escalates to deep neck infections, using peritonsillar abscess to emphasize red flags such as trismus, muffled voice, drooling, and uvular deviation, along with the need for airway assessment, imaging, IV antibiotics, and urgent ENT intervention.The discussion closes with diphtheria, highlighting the gray pseudomembrane that bleeds when scraped, risk of airway obstruction and myocarditis, and the critical need for immediate antitoxin administration and antibiotics without waiting for confirmation.We conclude with a concise algorithm that ties together red flags, testing decisions, and management priorities for throat infections.Enjoy the podcast, and please support us below! Support the show
Transcribe →