Welcome to #MedTweetorials

ESR-CRP discordance,a #MedTwitter #tweetorial

First off, let’s talk about ESR physiology.
ESR is the rate at which RBCs settle in plasma of an anti coagulated blood sample.
(-) charged RBCs repel each other thus ⬇️ ESR.

(1/12)

1/
You suspect pneumonia, but the CXR shows no opacities.

Q: When should you obtain a chest CT?

Pick your answer, then read on for a short explanation

(PTP = pretest probability)

You see a patient on the ward with an exacerbation of heart failure.

The team has inserted a urinary catheter for fluid monitoring. What would you do?

Open this thread and I'll share my approach.

#MedEd #Tweetorials
@MedTweetorials @SocietyHospMed
@tony_breu @AndreMansoor

1/13
🤔 Why do patients with acute myocardial infarction often present with diaphoresis (sweating)?

And, is there any significance when this symptom is present?

🎟️Let's have a look.

1) Welcome to a new #accredited #tweetorial, Prevention and Management of Heart Failure in T2 Diabetes: The Diabetologist’s Perspective! Our expert author is Melanie J Davies CBE FMedSci @profmjdavies, Prof of Diabetes Medicine, U Leicester, Leicester Diabetes Unit @LDC_Tweets

A patient presents with shortness of breath. You're asked to examine their respiratory system.

Looking at their hands you notice something different about their fingernails.

What would you thinking?

#MedEd #Tweetorials
@MedTweetorials
@AndreMansoor @PeteSullivanPDx

1/
My fellows complained they hate memorizing classifications, like LeFort. I thought, “There must be a better way—maybe understanding instead of memorizing.”

A #tweetorial about understanding the LeFort classification. #FOAMed #medtwitter #Medstudenttwitter @medtweetorials

1/
Awhile ago, on a triage call: “I’ve got a guy here, pretty young, came in looking terrible. GCS 4, we intubated him. Scan shows a big bleed. ICH score 4. Not sure much you’ll be able to do, but need to transfer him.”

A #tweetorial about the ICH score. @medtweetorials

1/10
What is a “clinical pearl” exactly? Diagnostic criteria and framework, a thread 🧵:

1/During case conference (& on rounds), we often see master clinicians come up w/ brilliant diagnoses before the HPI is even finished.

But how did they get there?
And how can you teach yourself & others those skills?

This week: how to teach diagnostic reasoning more explicitly

#Medtwitter, last week I posted about a talk I gave on teaching #clinicalreasoning

As promised, the accompanying #tweetorial

Come explore with me!
1/10
https://twitter.com/AnandJag1/status/1519499322236178433?s=20&t=XFdniGzBgA8tQ3tB4LcW6g

Should you give albumin with loop diuretics to augment diuresis?

I've been asked this three different times today so a quick🧵of my thoughts

#nephtwitter #MedTwitter @MedTweetorials

#NeudrawlogyMigraineEdition, part 6! 🤕🧠

Did you know that migraine has different presentations in children 🍭 compared to adults? 🧵 (1/12)

#NeuroTwitterNetwork #NeuroTwitter #FOAMed #MedEd #MedTweetorial

1/ Happy Tweetorial Tuesday from @ChrisDJacksonMD!

Clinical pearls? Evidence based medicine? Are we trying to mix oil and water?

Don't worry, your #MedEdTwagTeam crew is here to help with this week's thread!

1/ Hello #Medtwitter #NephTwitter.
Different urine colors and the pathology it signifies is amazing!
Milky white urine is one such color we dread. What does it signify? Lets read on🧵
#ASPNFOAMgroup @ASPNeph #ASPNeph #pedneph #chyluria

Hang around #MedTwitter for a while, and you’ll find someone claiming that there aren’t enough residency positions for U.S. medical students, or that residency positions aren’t growing at the same rate as medical school graduates.

Trouble is, neither is true.

(a 🧵)

🤔 Does metformin cause vitB12 deficiency?

❗️Metformin is the most prescribed drug for type 2 diabetes. Should you monitor vit B12 in pts taking it?

Follow the🧵

#MedTwitter #tweetorial #Endotip

60M has an incidental finding of a raised haemaglobin. How would you investigate?

Open this thread and I'll share my approach.

@MedTweetorials
#MedTwitter #MedStudentTwitter
#MedEd #Tweetorial

@CPSolvers @Grepmeded
@ManualOMedicine @AnandJag1

ILD clues for the internist: here's a 🧵with some quick hits!

Framework by @DrEricStrong:

https://www.youtube.com/watch?v=EqGT7IgUHU8

1/12

Re- expansion pulmonary Edema post plural drainage . 🫁
(Thread)#1

🔅incidence 1%
🔅mortality 5-20%

🔅RF:
DM , collapsed lunge >3days , plural effusion , size of PTX

#MedEd
#MedTwitter
#tweetorial
@MedTweetorials

What’s the next step in management?
(Poll in subsequent tweet)
A. CT chest
B. Pigtail catheter
C. Lung US
D. Other (comment below)

40F presents with fatigue and itching. Bloods show raised ALP and GGT with a normal bilirubin.

What's your approach? Open this thread and I'll share mine.

@MedTweetorials
#MedTwitter #MedStudentTwitter
#MedEd #Tweetorial

@Grepmeded @ManualOMedicine
@ebtapper @drkeithsiau

Approaching a new application cycle! Students asking “What do I need to know about Preference Signaling?” Signaling going live in 15 specialties, anticipated to impact > 80% of applicants (and their advisors!). Here’s the skinny on Signaling 1/21 #MedEd #Match2023 #MedTwitter

1/6 Great case by @deboracloureiro and discussion with @AnnKumfer for @CPSolvers Student VMR
"All that wheezes is not asthma"
few DDx of asthma:
Chronic eosinophilic pneumonia
ABPA
EGPA
Sarcoidosis
Hypersensivity pneumonitis
CF
CHF ( Cardiac asthma)
(Schema courtesy @AnnKumfer )

Yesterday, I discussed a pt who had subacute chest pain and dyspnea w/a group of learners

A pivot point in the case gave me some insight into the process of teaching reasoning

I'd love to share my experience #medtwitter #teachdx 1/

1/
There have been a lot of “❓cerebritis” on the neuroICU signouts this year.

I, too, have some questions re: cerebritis… mainly, like what the heck is cerebritis and how are these “cerebritis” pictures related?

A #tweetorial #EmoryNCCTweetorials @MedTweetorials

Approach to a (+) Rheumatoid Factor (RF)!

As we've all heard, RF is poorly named because (+) RF does not always = RA.

So, what is RF?

1/
How many hours of sleep a night do you get? What kind of effects does your sleep schedule have on your body and does sleeping longer help with weight loss? #MedEd #Medtwitter @RosenelliEM

1/16
Why do we use 100,000 CFU/mL as our cut-off for true bacteriuria?

This question was posed to me by @BryanCiccarelli. The answer has an interesting history so I thought I'd share it here.

1/8
This previously healthy woman presents with fatigue and weight gain. We walk into the room to meet her.

What findings are present?

These findings should generate a hypothesis.

1/16
Why are most cold agglutinins IgM? And why would any antibody adhere better at temperatures far below our own?

Part of the answer is an echo of our evolutionary past.

#tweetorial #medtwitter

31M presents for a routine health assessment. You notice a scar in the RLQ. What would you be thinking?

Open this thread and I'll share my approach.

@MedTweetorials #MedTwitter
@AndreMansoor @grepmed @geekymedics

1/
How long does it take to develop "ICU-acquired weakness" (ICUAW)?

What is the primary neuro manifestation of SIRS?

What is PICS?

I gave a presentation on neuromuscular weakness while on ICU service last week. Here are some highlights🧵

#Physiatry #Neurology #CriticalCare

Congrats to those who matched Ortho! It’s the greatest specialty in the world! #orthomatch
For those #unmatchedMDand #unmatchedDO ,I’m sorry. I’ve been there. Here’s my experience and my advice:
I didn’t get match coming out of med school. Did a Gen Surg internship.
(Thread)

80M presents to you with a stooped posture. You find an exaggerated thoracic kyphosis.

What would you be thinking? Open this thread and I'll share my approach.

@MedTweetorials
#MedTwitter #MedStudentTwitter
#MedEd #Tweetorial

@Grepmeded @ManualOMedicine
@tony_breu @RosenelliEM

30F presents with episodic discolouration of their fingers.

What would you be thinking? Open this thread and I'll share my approach.

#MedEd #Tweetorial
#MedTwitter #MedStudentTwitter
@MedTweetorials

@Grepmeded @ManualOMedicine
@tony_breu @RosenelliEM

1/ You see a 56 y.o man with a h/o HTN, DM2 & HLD in your clinic. He’s been out of care for a while and you’re concerned about his ASCVD risk. You order a lipid panel, but wonder, “should I also add an ApoB level?”

Keep reading this @CardioNerds #tweetorial to learn more…!

#AKIConsultSeries 👨 w PMH of Kidney Transplant 5y ago. Came w severe ⬆️Ca+ and AKI. CT scan and liver biopsy revealed Post-transplant lymphoproliferative disease. Initially resuscitated with generous IV crystalloid with improvement in Cr and Ca+.

Rituximab was started 1/12

1/10. Wat is the most important driver of worsening renal function in #HeartFailure ?

Look at #Tweetorial on central hemodynamic derangements in heart failure

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR

Here’s a situation many of us have seen in the ICU or ED: “It looked like there was ST elevation on the monitor but when I took a 12 lead it was gone?!”

A STEMI went MIA? Here’s a #tweetorial all about why ST segments look different on monitors.

#FOAMed #FOAMcc
1/

1/ After reading #MedEdTwagTeam @JenniferSpicer4's #TweetorialTuesday last week, you’ve decided to teach exam skills at the bedside.

Awesome! Now how do you structure your exam skills teaching? We will review some strategies this week!

#MedTwitter #MedEd

MINOCA :
MINOCA terminology came when has been recongnozed that angiograpghy may identified no signficant ( < 50% ) diseases artery in pts with MI

It’s 5-10% of all MI
Incidence 50000-100000 / year US

ICU stories: Middle-aged pt w remote hx of seizures had grand-mal sz at home & in the ambulance. Intubated for airway protection in ED; transferred to ICU. Placed on propofol. Overnight received 5 l NS & norepi gtt @ 0.1 & (ABx + steroids) for septic shock due to aspiration PNA.

🚨STAT 📟 I received recently in the @mghmedres CCU: “balloon pump helium leak alarm, blood in driveline.” In other words, the balloon had RUPRTURED. What do you do?

Here’s a quick primer on intra-aortic balloon pumps for your next rotation in the CCU! #CardioTwitter