Hoofbeats: A 29M with Cough, Abdominal Pain, Fever

Core IM

First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.

Core IM’s Hoofbeats challenges listeners to solve diagnostically difficult real world cases alongside experienced clinicians. This episode's patient is a 29-year-old man whose chief complaints are cough, abdominal pain, and fever.


Up to 0.75 AMA PRA Category 1 Credits ™ and MOC Points
Expires November 25, 2023   active


Free to Members


Podcasts and Audio Content


Core IM

Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.

  1. Hypereosinophilia is defined as an absolute eosinophil count > 1.5 x 109/L (or >1500 cells/microL) in the peripheral blood on two examinations separated in time by at least one month and/or pathologic confirmation of tissue hypereosinophilia. Hypereosinophilic syndrome is defined by the association of hypereosinophilia with eosinophil-mediated organ damage and/or dysfunction.
  2. Mnemonics and schemata are both mental tools that can aid memory formation, organization, and retrieval. Mnemonics are useful for quick recall of information especially in a large quantity. Wherera storage of data using schemata is bound by meaning and often provides a systematic approach to a clinical problem. While Mnemonics are powerful tools in early medical education and can pack a lot of information, it is important to remember to explore material not limited to existing mnemonics if we wish to master the particular subjects.
  3. Framing bias in medicine is often loosely defined as “The manner in which data is presented can affect decision making.” There are in fact different types of framing including risky-choice, attribute framing, and goal framing. The different types of framing have not been thoroughly studied in medicine and it is difficult to measure how prevalent and pervasive framing bias is in our everyday clinical practice. 
  4. While a data value lands on the extreme end of the spectrum, it often but not always carries significant clinical importance. Knowing that we tend to be intrinsically sensitive to rare findings, caution is needed when we assign such findings appropriate diagnostic weight.
  5. Hypereosinophilia in malignancy can be reactive or secondary in solid tumors, versus primary or clonal from myeloproliferative neoplasms. Eosinophilia in solid tumors is rare but has been reported in many types of neoplasms including lung, gastrointestinal, hepatocellular, thyroid, and soft tissue sarcomas.


Cindy Fang, MD - Host, Editor

John Hwang, MD - Host, Editor

Solon Kellehar, MD - Host, Case narration

Anand Viswanathan, MD, PhD - Guest


Ann Marie Kumfer, MD*

Ashley Meyer, PhD

Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

*Dr. Kumfer reports receiving honoraria from the Human Diagnosis Project. This relationship is not relevant to the content she is controlling.

Release Date: November 25, 2020

Expiration Date: November 25, 2023

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the Core IM.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 0.75 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz. To claim CME credit and MOC points you must achieve a minimum passing score of 66%. You may take the quiz multiple times to achieve a passing score.