Tony Breu, MD

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?

1/10
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.

1/18
🤔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?

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?

1/16
🤔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?

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!

1/13
🤔Why does multiple myeloma cause anemia and not pancytopenia?

If the issue is infiltration of the bone marrow with plasma cells, wouldn't all cell lines be low?

Let's have a look.

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.

1/16
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.

1/16
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

1/
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.

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.

1/17
[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?

🧠 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

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.

1/15
Why are statins administered at night?

In this tweetorial I'll discuss the mechanistic and historical reasons for the frequently used QHS dosing schedule. And why it's often unnecessary.

But before we get there, I'm curious: when do you prescribe/order/take statins?

1/16
Why do we use a vaccine (BCG) to treat an unrelated malignancy (bladder cancer)?

Can infections really prevent/treat cancer?

Let's find out.

1/15
Why does clostridium difficile infection (CDI) cause marked leukocytosis?

Many of you have likely seen a new WBC >20k and wondered "could this patient have CDI?"

Are you right to wonder? If so, why?