Welcome to #MedTweetorials

Q: Which of the following electrolyte abnormality is more common in peritoneal dialysis (PD) patients?

A) Hypokalemia
B) Hyperkalemia

What should you call that elevated troponin?

This is NOT taught well and impacts more than you think.

Understand it in 2 minutes:

The prevalence of #rheumatoidarthritis 🌍 ~1%

🙀 So ~14 million suffer from RA!

So we 👩‍⚕️ have to deal with special situations while managing this fairly common disease!

#MedTwitter #MedEd #rheumatology #RheumTwitter

@MedTweetorials @nihardesai7

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1/Hate it when one radiologist called the stenosis mild, the next one said moderate--but it was unchanged?!

Here’s a #tweetorial of a lumbar grading system that’s easy, reproducible & evidence-based

#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad

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🤔Why does heart failure with preserved ejection fraction (HFpEF) lead to sodium retention?

With reduced ejection fraction (HFrEF), decreased cardiac output (CO) leads to neurohormonal activation and sodium avidity.

If CO is preserved in HFpEF, what's the inciting event?

Picture this:

A young man presents with a WBC of 100k, and you find this 👇 on your evaluation.

Why (and how) is this an emergency? 🤔

A #tweetorial 🧵 1/6

1/THREAD
Have you ever wondered why Pseudomonas aeruginosa smells like grapes 🍇?

The answer relates to the ability of Pseudomonas to cause chronic airway infections and also coincidentally explains certain spoiled wine flavors.

#medtwitter #tweetorial

1) Welcome to this new #accredited #tweetorial on “Strategies to Apply Current Clinical Trial Data for SGLT2i to Reduce the Progression of CKD,” authored by our ⭐️tweetorialist Edgar V. Lerma 🇵🇭 @edgarvlermamd

1/8 - Can we predict response to BCG therapy in patients with high-risk NMIBC? Read our new study on BCG response in @EUplatinum #tweetorial @LDyrskjot @moma_dk

Twitter is free education for those in medicine...

but you have to follow the right people.

Here are my 9 recommendations.

1/When it comes to brachial plexus pathology, you shouldn’t have to wing it! A #tweetorial to help you figure out #brachialplexus injuries
#medtwitter #meded #neurosurgery #orthotwitter #orthopedics #neurorad #radres #medstudent #FOAMed #FOAMrad #spine #radiology #neurotwitter

1/THREAD
Why would adenosine, a purine nucleoside, be able to treat supraventricular tachycardias (SVT)?

And why are its effects so short lived (e.g. <2 seconds)?

The answers will change the way you think about this drug.

#tweetorial #medtwitter

1/14
🤔Why does it take weeks for the radiographic evidence of pneumonia to clear?

Patients often feel better DAYS after starting treatment.

And yet the chest x-ray takes WEEKS to return to normal.

Why the delay?

1/26
Which beverage is best for your liver?
a. Coffee
b. Tea
c. Green tea
d. Green juice detox
e. Green coffee

The answer of course in good old coffee, because...
...here is a thread on it

Spoiler alert: Its not just good for the liver
There is so much more.

1/🧵

Ever wonder why severe hypertriglyceridemia causes acute pancreatitis?

Are triglycerides themselves toxic to the pancreas or is there something else going on?

#tweetorial #medtwitter

You've seen rashes and called them all "maculopapular," because, why not?

Does describing something accurately really make a difference?

9 words to improve your life... when calling a derm consult.

1/ Tirzepatide (Mounjaro) is "shifting -tides"🌊 as the new "miracle drug" for weight loss and glycemic control in Type 2 Diabetes.

But what is the evidence and how does it compare to Semaglutide?

http://mounjaro.com

(1/6) Hey #match2023 applicants! Here’s a thread of helpful personal statement tips we’ve come across.

Spent yesterday reviewing some common coagulation 🩸labs and their interpretations.

Here is a graphic I made as a refresher🙂

Keep reading for a few additional points on PT and PTT. /1

🧵 1/7 Ever wondered why the Osborn wave looks the way it does? Stay with me during my newest #tweetorial. A thread 🧵1/7
#cardiotwitter #EPeeps #CardioEd #MedTwitter @TRassafMD @YoungDgk @DGK_org @YoungDZHK @AaronGoodman33 @Steph_Achenbach @fuzzymittens @AvrahamCooperMD

Features of Normal Pressure Hydrocephalus:
1/🧵
Evans Index >0.3 (x/y)

Young pt ➡️ 🏥 worsening shortness of breath

PMH: ESRD. Only 1 HD session/week. However, residual urine volume has now decreased substantially

On exam: BP 134/94, 2L O2,🧠✅, elevated JVP, decreased 🫁 sounds at bases, No murmurs, very mild edema. Functional left BC AVF

1/13

💥 Monoclonal Gammopathies of Clinical Significance! 💥

Everyone knows MGUS.

Monoclonal proteins are simply blameless protein markers until clonal B-cells progress to Myeloma, Waldenstrom's, or another disorder, right?

...It turns out, not quite!

Let's explore!

1/🧵
Why is a ketogenic diet a potentially effective treatment for refractory epilepsy?

There's something almost magical about the idea that a specific type of diet could reduce the risk of epileptic seizures.

Let's explore why that might be.

#medtwitter #tweetorial

🧵regarding the chromic suture: a 'classic' older suture material that still remains in use today.

We'll go over some properties, a little history, and some of what each of the sizes are (and were) used for.

(1/ )

🧵of 🧵's.
We've done chromic...now for one of the most versatile of all sutures...polydioxanone or PDS.

As usual, we'll go over some properties, a little history, and some of what each of the sizes are used for.

🧵of 🧵...we've done chromic and PDS (links at the end).
Now we'll cover the Nickelback of suture material...silk.
I use the analogy because silk has been around a long time: it's irritating, no one admits to using it, but they do; and you think it'll never go away, but it does.

1/Time is brain! So you don’t have time to struggle w/that "stroke alert" head CT
Here’s a #tweetorial to help you with the CT findings in acute stroke #medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radres @medtweetorials #stroke #neurology #Neurosurgery

💡💡 New Publication Alert‼️ 💡💡

Of interest to all those who love Diagnostic Reasoning!!!

(And chief residents and others who run Medicine Morning Reports or teach courses in clinical reasoning!!)

https://pubmed.ncbi.nlm.nih.gov/35942949/

270,000 Americans die of sepsis each year.

But we can't agree on how to diagnose it.

The problem is more complex than you think...

A thread 🧵

1/16
🤔Why does subarachnoid hemorrhage lead to deep/inverted "cerebral T-waves"?

This ECG finding is so dramatic. But as we will see, these patients often have normal hearts.

Why does an issue in the brain manifest on a test of the heart?

Hey #MedTwitter, these are 100 of my #MedEd tweets compiled for some quick #hematology revision. I hope you find it useful 👍

@MedTweetorials @EHA_Hematology @NicoGagelmann @pankti4299 @AbbasiMuqtadir

⚡️ “Hematology Tweets & Threads !!” by @nihardesai7 https://twitter.com/i/events/1391373171140354052

How does Cushing cause hypokalemia?

- One of the many questions that came up during today's @CPSolvers VMR weekly recap.😁

@rabihmgeha @MadellenaC @Rafameed @rav7ks @deboracloureiro 💙

For the answer, follow this thread 🙂

ICU stories: Walking to the ICU early am & before getting sign-out from the nocturnist covering the ICU, I'm greeted by the nurse of the pt in room 428
– Can u take a look at this pt? I keep going up on levo, now @ 0.15. Middle-age pt w hx of ESRD on HD/afib/CHF/cirrhosis etc etc

Middle aged person comes in with headache. CT (from https://www.cureus.com/articles/68994-nonepileptic-stereotypical-and-intermittent-symptoms-after-subdural-hematoma-evacuation and for illustrative purpose only) with acute #SDH. GCS 15 and non focal exam. Patient on Xarelto. A 🧵on SDH:
1/

Here is the thread containg all master classes by @Lpa_Doc

When applying to residency, most people dread writing personal statements.

Having written and given feedback on many personal essays over the years, here are 5 tips that I think can make it a little easier. // 🧵

1/ Do you take care of pts with aneurysmal SAH (aSAH)? How many of them experience vasospasm (VSP) / delayed cerebral ischemia (DCI)? A thread on pathophysiology and novel strategies

ICU stories: Eldelry pt w CAD s/p multi-vessel PCI / DM2 / HTN presented to the ED w epigastric "burning". Symptoms much worse with laying down & while eating. No relief w iv famotidine; got relief with morphine. Troponin I elevated and peaked at 1,000 (nl <15). ECG:

Hypercalcemia: A Tweetorial for Internist

Calcium regulated to levels between 9-10.5 mg/dL

↑PTH = ↑calcium
↑Calcitonin = ↓calcium

PTH produced by the chief cells in parathyroid glands
Calcitonin produced by the parafollicular cells in thyroid

1/ “Now listen carefully!” Does the word “tbone” make you think of a tough guy nickname before ear anatomy? Do you know the CT ice cream cone & then nada? Then you need this #tweetorial on tbone anatomy! #medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres @medtweetorials

Finishing the series on scalpel blades (we’ll get to other stuff, I promise).

In this 🧵 we’ll explore the difference between plastic disposable scalpels and ‘real’ steel surgical scalpels.

Or is there a difference?

1/12
🤔Why does iron deficiency cause fatigue, even in the absence of anemia?

I have often equated iron with hemoglobin and oxygen-carrying capacity.

But there is so much more to it!

1/🧵
Ever wonder why tick bites can lead to a red meat allergy, including even anaphylaxis?

The answer requires us to examine sugars, tick saliva, and an anti-cancer drug.

#medtwitter #tweetorial

Today's 🧵continues our exploration of scalpel blades with an opinion about a simple and common surgical maneuver.

Very often, you have a small skin incision and you need to make it a little bit longer. Yet even that simple move often goes wrong.

A patient comes in for these skin findings. He says he’s getting darker everywhere. He’s frustrated because he moved to the countryside a few years ago to “get away from the stress of the city,” & now keeps getting headaches!

Diagnosis?

#dermtwitter #medtwitter #meded #FOAMed