Welcome to #MedTweetorials

Doctors at a major US insurance company deny tens of thousands of claims a month without even looking at patients’ files.

“We literally click & submit,” a former Cigna doctor told @ProPublica & @Capitol_Forum. “It takes all of 10 seconds to do 50 at a time.”

The inside story 🧵

Let's talk about this trial see details below

Well, the envelopes have been opened. Tears (hopefully of joy) have been shed. And just like that, another Match Day is in the books.

And you know what that means.

Time to break it down, Winners & Losers™️ style.

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1/24 Welcome to this #CME #Tweetorial on hypertrophic cardiomyopathy (#HCM), supported by an educational grant from Bristol Myers Squibb, contributed by @DesaiMilindY, MD, HCM Center Director @ClevelandClinic
#MedTwitter #ACC23

Participate for credit: https://bit.ly/3kgBL40

🧵 demonstrating a few basic errors that can be made when working with a Bovie.

Note: I won't try to cover all of the science of surgical energy devices, as Twitter threads do have their limits...

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1/9 @ACCinTouch 2023- Summary of key Lp(a) presentations.

On search function, there are 63 hits for “lipoprotein(a)”, and in ~1/3rd it was the primary focus.

1- 10 moderated posters
2- 3 oral presentations
3- 30 posters
4- 1 standing room only session
5- 19 “other”

Reason # 76587 why lung #pocus is important: it can often give more information than CXR or CT Chest can. Case in point:

Elderly female on methotrexate and prednisone presenting with fever and cough.

Initial CXR:

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CASE STUDY

67 yo M with history of colon cancer presents to ED feeling unwell. He is disoriented with T 102F, BP 70/40, HR 120/min. Labs are shown in graphic. He is intubated, treated with fluids/pressors and Abx, and passes away 18 h later.

What stands out in the labs?

1/16 Welcome to this #CME #Tweetorial on immunotherapeutic advances in #RRMM, supported by an educational grant from Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC, & contributed by @JMikhaelMD.
Participate for credit: http://bit.ly/3m0D3AF
#MedTwitter

Short 🧵(for people going into critical care) regarding when a tracheostomy tube is the same 'size' as its endotracheal tube counterpart, and when it is not.

Warning: minutiae follows here...if you're not into critical care, get out now.
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1/Does trying to remember inferior frontal gyrus anatomy leave you speechless?

Do you get a Broca’s aphasia trying to name the parts?

Here’s a #tweetorial to help you remember the #anatomy of this important region

#medtwitter #meded #neurotwitter #neurorad #radtwitter #radres

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A young woman presents with bleeding from her nose and gums and the following skin rash.

CASE STUDY

1/11

74 yo F presents with CBC shown in graphic below. You will note she has macrocytic anemia, which has a wide differential diagnosis (also shown in graphic).

DERMATOMYOSITIS (DM)

Let’s spend some time in this #tweetorial on the dermatologic manifestations of this potentially paraneoplastic disease!

First, a question: What is necessary to make a diagnosis of DM?
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1/If all you know is: To Zanzibar By Motor Car—then you don’t even know half of facial nerve anatomy—literally!

Here’s a #tweetorial on the facial nerve anatomy you don’t know!

#medtwitter #neurotwitter #neurorad #radres #meded #FOAMed #neurosurgery #neurology #radtwitter

Ultrasound: “no evidence of cholecystitis”

Op report: “gangrenous cholecystitis with extremely friable tissue. Purulent drainage with manipulation of gallbladder.”

I've seen this many times.

Thread

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I’m no Cardiologist, but even I picked up some learning points after being on the inpt heart failure service for the past 5 wks 🤷‍♀️🫀 - A series of “🦪 📿” on a variety of heart failure topics for the internist.

First one is on GDMT in HFpEF!
#MedTwitter #CardioTwitter

1/18
🤔Why does the diagnosis of Streptococcus bovis bacteremia immediately raise the specter of colon cancer?

If colon cancer leads to barrier disruption and translocation of bacteria into the blood, shouldn't E. coli bacteremia raise the same concern?

Is S. bovis unique?

I’ve been seeing a lot of people quoting stats that show more athletes died in the last year than have died in the last 38 years. Is this true? No, let’s chat about it. A 🧵👇🏻

Here again are my #Top10 Infectious Diseases papers of 2022. Not in order (alphabetical by first author). Non-COVID (because >120,000 COVID papers in 2022). Have to be at least one of: Paradigm Shifting, Practice Changing or Dogma Challenging #IDtwitter 🧵

2022 PRACTICE-CHANGING CLINICAL TRIALS #recap

~~ a thread 🧵 ~~ 👇

So your older patient has a delirium and all you have to go on is a positive urinalysis

You know the boss rounding tomorrow is a cantankerous stickler with a penchant for clinical reasoning

How to say you think this is a UTI without copping a lecture on Bayes' Theorem?🧵 https://twitter.com/AlanaKinrich/status/1608107800449912833

1/THREAD

Why is the liver able to regenerate itself?

Somehow the liver has the incredible capacity to both heal itself after toxic injury and regrow after resection. No other solid organ in the body can regenerate like this.

#medtwitter #tweetorial

Patients with myelofibrosis (MF) often present with a large spleen.
👉significant burden for patients
👉challenge for clinical management
👉esp for many colleagues in BMT, which is still the only curative treatment for MF

So, let's talk about the spleen 🧵

#MedTwitter #mpnsm

A #Colonoscopy #Tweetorial: (1/10)
⭐️To make yours go well
⭐️To ACE the prep

Background:
👉🏼50 yrs: Past start CRC screening
👉🏼45 yrs: New start for average risk

https://tinyurl.com/y7u98crs

💠Just had first colonoscopy
💠Yeah, I know. Give grace!

My 1st time tips as a GI doc!

Idiopathic intracranial hypertension: MRI features.

#Neurology #Neurotwitter #MRI #educational #Tweetorial

🪡

1/🧵

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Many labs can be abnormally high OR low.

Others appear to have just one direction of abnormality. But some diagnoses may be suggested by the "reverse abnormality." For example, a...

↓aPTT
↓Alk phos
↓ALT
↑B12
↓HDL

...may mean something.

Let's have a look.

1/”I LOVE spinal cord syndromes!” is a phrase that has NEVER, EVER been said by anyone.
Never fear—here is a #tweetorial on all the incomplete #spinalcord syndromes!
#medtwitter #neurotwitter #neurology #neurosurgery #neurorad #radres #meded #FOAMed #FOAMrad #radtwitter #spine

I asked this question to see how you like to prescribe maintenance fluids

I NEVER give 83ml/h of fluid continuously

Here's what I do instead🧵

1/12 https://twitter.com/DrTobyGilbert/status/1601775815578234880

Are we still giving continuous fluids, in spite of all the drawbacks that are well know to every ward-based clinician, because we haven't yet had a mature conversation about how to use the EMR beyond it being digital paper?

What else are we doing wrong for this reason?

12/12

1 / What is Acute Kidney Injury?

🔶 Cr increase at least 1.5 times baseline OR
🔶 ≥ 0.3 mg/dl increase within 48 hours
(A Cr decrease of 0.3 cannot be used to diagnose AKI)
🔶 Urine volume < 0.5 ml/kg/h for 6 hrs🙄

That's easy. But what is baseline? THIS gets complicated...

1/Asking “How old are you” can be dicey—both in real life & on MRI! Do you know how to tell the age of blood on MRI?

Here’s a #tweetorial on how to date blood on MRI
#medtwitter #neurorad #radtwitter #RSNA2022 #RSNA22 #radres #neurosurgery #neurology #meded #neurotwitter #FOAMed

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