Welcome to #MedTweetorials

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Coaching is a powerful medical educational paradigm.

Dr. @basakcoruhUW shared 5 practical steps to develop a coaching program for your trainees.

https://apccmpdscholars.org/2019/03/12/five-essentials-for-an-effective-coaching-program/

This summary #tweetorial was written by @AvrahamCooperMD and @MirnaMohanraj

#medtwitter #meded

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So many great guesses on the mysterious lesion!!!

Didn’t see it?
Check out ⬇️ and then read on!

A #tweetorial on mysterious lesions and radiology. @MedTweetorials https://twitter.com/caseyalbin/status/1483976126422728705

1/ This tweetorial tackles paradoxical clinical worsening with high PEEP...why might this happen?

See https://bit.ly/3IqUdNo for a deeper dive (written with the brilliant #andyluks), but summary below...

💥‘Pseudohyperkalemia’ Tweetorial

⚡️Pseudohyperkalemia
⚡️Seasonal Pseudohyperkalemia
⚡️Reverse Pseudohyperkalemia

Let’s review these conditions
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#Onconephrology
#Hyperkalemia

#Remdesivir new trial just published

Here are the clinical implications:
Canadian trial (CATCO) in hospitalized patients with #COVID19 https://bit.ly/33uktIf
Compared to ACTT-1 trial https://bit.ly/3msi1In in patients on supplemental O2 as recommended by guidelines
🧵1/

(1) Welcome to this #accredited #tweetorial, on recent & emerging data on finerenone, a non-steroidal mineralocorticoid receptor antagonist. We’ll discuss what it is, what evidence supports its use, & where it might fit into future #renal guidelines. I am @drkevinfernando.

Weekend Digest

Name the Pathogen

Five Clues
1. Gram-positive bacillus with tumbling motility
2. Food safety
3. Age, pregnancy and steroids
4. Rhombencephalitis
5. Ampicillin+Gentamicin

Type 2 diabetes (T2D) affects ~ 8-12% of adults!

❗️What changed in the treatment recently? What are the "new" drugs? How did it change the history and the life of pts? How does it affect other diseases' treatment?

This is a 🧵 about recent changes in T2D treatment!

(1/13)

1/ 🧵 21 yo F with neurofibromatosis is adm to ICU after a left suboccipital crani and C1-2 lami for resx of a neurofibroma at the cervicomedullary junction/C1-C2. No peri-op issues. BP 124/78, HR 80s, sat 100% on RA. Neuro intact.

~ 3 hours later: rapidly ⬆️⬆️ right neck mass

❗️Hungry Bone Syndrome is a complication of parathyroidectomy.

What is it? Why does it happen? How to diagnose? How to differ it from post-op hypoparathyroidism?

Follow the 🧵

Inspired by a case presented by @KannuBansalMD at @CPSolvers

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1/ Good morning #MedTwitter, it’s time for #ReadingRoom!

Let’s dive in. Take a look at these CT scans, which patient requires a #surgical consult?

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Why does cold air make my kids' noses runny?

A weekend of playing in the snow made me wonder. I didn't do a deep dive but thought I'd share what I learned.

How often do you check for Primary Aldosteronism (PA)?

Chances are, NOT nearly often enough!

VA study reveals widespread undertesting...can we do better?

https://www.acpjournals.org/doi/10.7326/M20-4873

If you've seen 10 pt's with HTN ➡️ you've probably seen PA!

Let's review in this #medtweetorial

1/15
Why is torsemide my preferred loop diuretic when treating heart failure?

As a follow-up to a recent tweetorial on furosemide and gut edema, let me offer a 3-part ode to torsemide.

1/ 🚨New Episode! 🚨

What is an “appropriate” Hgb bump?

Why do we usually say 1g/dL for 1 pRBC?

iTunes: http://bit.ly/coreimpodcast
Show Notes: https://bit.ly/3eUgyGw

First, let’s figure out how many grams of hemoglobin are donated?

#Medtwitter

In residency, I learned that deferoxamine (Fe chelation) can predispose to Yersinia sepsis but never understood why.

Why would taking away plasma Fe benefit Yersinia?

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1/17
[Why] is furosemide susceptible to malabsorption from "gut edema"?

When a patient with heart failure is hospitalized with congestion I often hear "let's use IV furosemide; they're probably not absorbing the PO."

It's a comment unique to furosemide.

But is it accurate?

(1) The massive number of infections in European countries is "real".
Yes, more people got tested for Christmas, and there have been some backlog issues in many countries.
But the 7-day positive rates have been rising rapidly, and nothing indicates that cases are "over-counted".

1/ COVID-19 Vaccine Associated Glomerulonephritis:
Hey #medtwitter,
What do we know about the COVID-19 vaccine associated with glomerulonephritis?

In our @JAMA_current editorial, we tackle a timely question in #CardioTwitter: should we recommend #apixaban or #rivaroxaban as first-line anticoagulant for #Afib?The two #DOACs are not interchangeable for bleeding or stroke. Let's review all RCTs & RWE🧵
https://jamanetwork.com/journals/jama/article-abstract/2787339

Multiple studies this wk on rel severity of Omi vs Delta. IMO the Imperial College report best distinguished intrinsic severity from prior immunity.

tl;dr:
- O ~25% less severe than D
- but more transmission
- & prob more severe than other variants (incl its ancestor)
🧵 1/14

1/ 🧵Ready to play a game #EmoryNCCTweetorials #Neurotwitter #FOAMncc ?

Review these images carefully. Poll in next tweet.

As requested, some squirm-worthy urology content! (And peer reviewed too, ooh la la!).

Lets talk PENILE FRACTURES.
A quick 🧵:

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Anisocoria

Many times when there is an asymmetry in the body the abnormal component is obvious. For example, right lower extremity edema.

But there are times where the first step is figuring out which component of the asymmetry is abnormal. For example, unequal pupil size.

60M presents with 3-months of change in facial appearance and hypertension. What would you be thinking?

Open this thread and I'll explain my approach.

@MedTweetorials
#MedTwitter #MedStudentTwitter
#MedEd #Tweetorial

@CPSolvers @Grepmeded @ManualOMedicine

ICU stories: Middle-aged pt w/o significant PMHx presented to the ED on a Friday afternoon w SOB/cough x 2 wks. Vaxed x2 but tested C19(+). BP 120/90, Sat 98% on 2 l/m. ECG: new-onset Afib/HR 140/QTc 500. CXR attached; read as RLL infiltrate. Labs: Na 125, BNP 800 (nl<100),

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A pt w/ ESRD on HD, a fib on coumadin is transferred after a 2 wk hosp for SDH/contusions + ESBL PNA w/ status epilepticus

Scan ⬇️

AEDs: fPHT 100mg Q8H, LEV 1g BID, LAC 100mg BID, VPA 750mg BID + propofol 30, midaz 5.

Admission VPA level 13 (tx range 50-~100)
🤔🤔🤔

Hey #medtwitter have a fascinating case to share, in the form of a #tweetorial of course! A 🧵 1/13

40F presents with a swelling in her neck. What would you be thinking?

Open this thread and I'll explain my thought process and reveal the final diagnosis.

@MedTweetorials
#MedTwitter #MedStudentTwitter
#MedEd #Tweetorial

@CPSolvers @Grepmeded @ManualOMedicine

Can you get high from nutmeg?

Yes*

*(Most people don’t describe the high as very pleasant and it lasts waaaay longer than you want it to)

A short nutmeg hallucination thread...
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20F presents with 1-week of sore throat, fever and malaise. You examine their throat and here's what you find.

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

#MedTwitter #MedStudentTwitter
@MedTweetorials

🧠 New Episode This Week! 🧠

The Curious Clinicians will examine why the nervous system is cross-wired, with each side of the brain controlling the opposite side of the body.

In the meantime, pre-read this #tweetorial by @AvrahamCooperMD https://twitter.com/AvrahamCooperMD/status/1262024531604103168

🧵If you had the choice, would you have a baby when you were 34 yrs+11 mos old or 35 yrs+1 mo old? Does it matter? It does! Our new paper on “advanced maternal age”, prenatal care, + perinatal mortality. @JAMAHealthForum (joint w @markaclapp @ckellrun)
https://ja.ma/3DpI20y

Last week a 50 y/o man is admitted to my service with alcohol withdrawal. No cardiopulmonary symptoms. Would you listen to his heart as part of your initial evaluation?

How to make your presentation or publication-figure #color_blind friendly. A🧵
Feel free to chime in with additional tricks and share for ⬆️awareness
#MedEd #AcademicTwitter @MedTweetorials @MayoClinicNeuro @mayoneurores #DiversityandInclusion @AcademicChatter #neurotwitter

24F presents with a facial rash.

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

#MedTwitter #MedStudentTwitter
@MedTweetorials
@Rheum2improve @BethanRichards3 @MithuRheum

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It was a delight to work with @caseyalbin to explore the incredibly diverse CNS complications of infective endocarditis!

An #infographic & #tweetorial investigating the radiographic & clinical findings in IE, with some management pearls.

#MedEd #Neurotwitter

1/13
Why does adrenal insufficiency (particularly adrenal crisis) lead to hypotension?

I don't think of glucocorticoids as "pressors" and yet when they're lacking patients are at great risk for shock.

Let's have a look.

❗️Thyroid storm treatment includes

- Beta-blocker
- Methimazole (MMI)/propylthiouracil (PTU)
- Iodine
- Corticosteroids

🤔There is a great discussion about which antithyroid drug to use in this setting

🧐This is a methimazole x propylthiouracil in thyroid storm 🧵

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Join me for a #dermtwitter #tweetorial on:

SCARS AND KELOIDS!

#MedEd #FOAMEd #medstudenttwitter #MedTwitter

Let's start ourselves off with a question: Which one of the following conditions will lead to scarring?

And that concludes our two week night float -- finished it off with some yummy breakfast at @First_Watch!

Lots of learning to be had. Follow for a brief 🧵 on some random, stream-of-conscious reflections by @azrathore_

1/n

🚨New work from our team in @JAMAInternalMed 🚨

18% of adults with #hypertension report using medications (💊) that may raise blood pressure.

Use of these 💊 associated with:
⬇️ odds of achieving BP control
⬆️ # of antihypertensives used

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2786014

Thread
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30M patient presents with red legs.

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

#MedEd #Tweetorial
#MedTwitter #MedStudentTwitter
@MedTweetorials