Ali Araghi, MD
Exploring Clinical Medicine Through Pathophysiology, Evidence & Education
A physician-educator’s collection of clinical insights, lectures, reviews, illustrations, and teaching resources in pulmonary, critical care, sleep, obesity, and internal medicine.
Areas of Focus
Five clinical disciplines connected by physiology, pathophysiology, evidence, and bedside reasoning.
Pulmonary Medicine
Respiratory physiology, PFT, CPET, pulmonary disease and procedures.
Critical Care
Mechanical ventilation, shock, hemodynamics, ultrasound and ICU physiology.
Sleep Medicine
Sleep physiology, OSA, PAP therapy, insomnia, circadian disorders and testing.
Obesity Medicine
Metabolism, pharmacotherapy, nutrition, exercise, sleep and behavioral science.
Internal Medicine
Diagnostic reasoning, common medical problems, clinical decision-making and teaching.
Clinical Pearls
Pulmonary
Not every COPD exacerbation needs antibiotics
Antibiotics are most useful when a COPD exacerbation has clinical features suggesting bacterial infection—not simply because cough and…
Critical Care
A plethoric IVC can mean congestion without proving fluid responsiveness
IVC size answers a different question when used for congestion than when used to predict fluid responsiveness.
Sleep
PAP adherence problems are often interface and pressure problems — not motivation problems
Before labeling a patient ‘noncompliant,’ look for a fixable barrier such as mask leak, nasal obstruction, pressure intolerance,…
Obesity
Stopping obesity medication often removes the biologic support that maintained the weight loss
When weight returns after an effective obesity medication is stopped, that does not necessarily mean the treatment failed—it…
Internal Medicine
Premature closure is often a failure to reopen the case when new data no longer fit
The dangerous moment is not always when the first diagnosis is made—it is when contradictory evidence appears and…
Featured Teaching
Pulmonary
COPD is not just airflow obstruction
COPD is a heterogeneous physiologic syndrome in which airflow obstruction is only one part of the disease. FEV₁ matters, but…
Critical Care
In sepsis, fluid responsiveness is only half the question
A septic patient may increase cardiac output after fluid and still be harmed by the volume. Precision fluid therapy requires…
Sleep
OSA is not one disease — it is a collection of physiologic failure modes
The same apnea-hypopnea index can emerge from very different combinations of airway anatomy, ventilatory control, arousal biology, and upper-airway muscle…
Obesity
Why weight comes back: obesity is a biologically defended state
After weight loss, the body often responds as if it is protecting a prior weight—by increasing hunger, lowering energy expenditure,…
Internal Medicine
Clinical reasoning is not a checklist — it is a process of updating probabilities
Good clinical reasoning is the disciplined conversion of incomplete information into an evolving probability map—not the mechanical completion of a…
Teaching Philosophy
Learn deeply. Stay curious. Follow the evidence.
This website is built around the idea that durable medical knowledge comes from understanding, not memorization. The goal is to ask why a disease behaves the way it does, how physiology becomes pathophysiology, and how those mechanisms explain the findings we see at the bedside. Curiosity is treated as a clinical skill: the habit of questioning assumptions, exploring alternatives, and looking beneath labels for the mechanisms that make a patient’s presentation coherent.
Evidence matters because intuition alone is not enough. Good clinical reasoning requires moving between mechanism and data—building a problem representation, estimating probabilities, testing competing explanations, and changing course when new evidence no longer fits the original hypothesis. The aim of the material here is therefore not simply to provide answers, but to strengthen the reasoning process that produces better questions, better interpretations, and better decisions.
Artificial intelligence can be a powerful tutor and research partner. Used wisely, it can help explain difficult concepts, generate alternative hypotheses, summarize literature, and accelerate exploration of the evidence. But it should augment—not replace—critical thinking. Clinical judgment remains the clinician’s responsibility: verify important claims, return to primary sources when decisions matter, recognize uncertainty, and never surrender reasoning or decision-making to an algorithm.
