
Hospitalist and Director of Resident Education, VA Boston. Faculty, @HMSbioethics. Mets fan. Usually at #AMreport and thinking about #TWDFNR. Views are my own.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Gastroenterology #GI #InfectiousDisease
Topics: #ColonCancer #StrepBovis #StreptococcusGallolyticus
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?
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #MedEd
Specialty: #InternalMedicine #IM
Topics: #LowaPTT #LowAlkPhos #LowAlk #LowALT #LowHDL #ElevatedB12 #aPTT #ALP #B12 #HDL
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.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Cardiology #Nephrology
Topics: #HFpEF #HeartFailurewithPreservedEjectionFraction #Aldosterone #Obesity

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?
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Pulmonology #Radiology #Rads #Pulm #InternalMedicine #IM
Topics: #Pneumonia #ChestXray #CXR

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?
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Cardiology #Neurology
Topics: #SAH #SubarachnoidHemorrhage #Twaves #ECG #EKG #CerebralTwaves

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?
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Hematology #Heme #IM #InternalMedicine
Topics: #IronDeficiency #Iron #Fatigue #Hemoglobin #Mitochondria
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!
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #IM #InternalMedicine #Hematology #Oncology #HemeOnc
Topics: #MultipleMyeloma #MM #BoneMorphogenicProtein2 #Hepcidin #Anemia #AnemiaofChronicDisease #IL6

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.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Cardiology #CardioTwitter
Topics: #AMI #MI #STEMI #Diaphoresis #MyocardialInfarction
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.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #HistMed #Question
Specialty: #ID #InfectiousDisease
Topics: #Bacteriuria #UTI #UrinaryTractInfection #Pyelonephritis #AsymptomaticBacteriruia

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.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #InternalMedicine #Hematology #HemeOnc
Topics: #ColdAgglutinins #IgM #AIHA

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
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Otolaryngology #ENT #Allergy #Immunology
Topics: #RunnyNose #ColdInducedRhinnorhea #Rhinorrhea #MastCells #Basophils #CapsaicinSensitiveNociceptorNerves #Hyperosmolarity

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.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #MedEd #Physiology
Specialty: #Nephrology #Neph #Cardiology #IM #InternalMedicine
Topics: #Torsemide #Lasix #LoopDiuretic #Furosemide
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.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #MedEd #Pathophysiology
Specialty: #Cardiology #Cards #Pharmacology
Topics: #LoopDiuretics #Furosemide #Lasix #GutEdema #CHF #CongestiveHeartFailure #Pharmakokinetics
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?
Get ready for it! Check out the #medtweetorial by @AvrahamCooperMD before you listen @CuriousClinPod @tony_breu @HannahRAbrams
🧠 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
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Endo #IM #Endocrinology #InternalMedicine
Topics: #AdrenalInsufficiency #AI #Steroids #Epinepherine #Pressor #Glucocorticoids
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.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Physiology #MedEd
Specialty: #FamilyMedicine #InternalMedicine #Cardiology
Topics: #Statins #HMGCoAReductace #mevalonate #Cholesterol
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?
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #Pathophysiology
Specialty: #Immunology #Oncology #InfectiousDisease #Urology
Topics: #BCGVaccine #BladderCancer #BCG #BacillusCalmetteGuérinVaccine
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.
MedTweetorial: #Tweetorial
Author: @tony_breu
Type: #MedEd #Pathophysiology
Specialty: #InternalMedicine #IM #ID #InfectiousDisease
Topics: #Leukocytosis #ClostridiumDifficile #CDI #CDiff

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?
Titles | #Tags |
---|---|
What is the mechanism of night sweats? | #pathophysiology #tweetorial #nightsweats #fever |
Why is the chancre of primary syphilis painless? | #pathophysiology #physiology #ID #InfectiousDisease #syphilis #historyofmedicine #historyofmed #bedsiderounds |
Why do we use multiple drugs to active treat tuberculosis (TB)? | #pathophysiology #physiology #ID #InfectiousDisease #pharmacology #medications #tuberculosis #TB #MTB #drugresistance |
Why, if thrombocytopenia leads to petechiae, do we not see the same with aspirin? | #pathophysiology #physiology #hematology #hemeOnc #coagulation #bleeding #clotting #asapirin #ASA |
Why do thiazide diuretics cause more hypokalemia than loop diuretics? | #pathophysiology #physiology #renal #nephrology #thiazides #thiazide #loopdiuretic #furosemide #HCTZ #chlorthalidone #hypoK #hypokalemia #hypertension |
How does the drug name Sinemet (carbidopa/levodopa) provide insights into why it was developed and its mechanism of action? | #pathophysiology #physiology #pharmacology #pharmacy #medications #neurology #parkinsons #PD #sinemet #carbidopa #levodopa #etymology #dopamine #BBB |
Why do we administer potassium to a goal of ≥4.0 mEq/L? | #pathophysiology #physiology #cardiology #nephrology #renal #hypokalemia #AMI #acuteMI #myocardialinfarction #potassium #repletion |
How does alcohol cause macrocytosis? | #pathophysiology #physiology #hematology #macrocytosis #alcohol #EtOH #MCV #acetealdehyde #adducts |
Why are right-sided pleural effusions more common in patients with cirrhosis? | #pathophysiology #physiology #hepatology #GI #gastroenterology #pulmonary #pulmonology #pleuraleffusions #hydrothorax #hepatichydrothorax #cirrhosis |
Why does albumin decrease in inflammatory conditions? | #pathophysiology #physiology #nephrology #renal #Rheumatology #albumin #CRP #ESR #acutephasereactant #acutephaseprotein |
Why do patients with immune thrombocytopenia (ITP) appear to have less severe bleeding than patients with equivalent platelet counts due to bone marrow suppression? | #pathophysiology #physiology #hematology #coagulopathy #ITP #immunethrombocytopenia #bleeding #thrombosis #platelets #platelet #PLT #MPV #IPF |
Why do we use urine antigen tests to diagnose respiratory pathogens | #pathophysiology #physiology #ID #InfectiousDisease #renal #nephrology #pulmonary #pulmonology #urinaryantigen #urinaryAg #strep #legionella #respiratory #pneumonia |
How does acetaminophen decrease fever and pain, without affecting inflammation? | #pathophysiology #physiology #MedEd #Medications #Medication #pharmacy #acetaminophen #APAP #NSAIDs #fever #pain #inflammation #analgesia #antipyretic #PGE2 #COX #cyclooxygenase #peroxidase |
What causes the increase in pCO₂ in patients with acute COPD exacerbation treated with supplemental oxygen? | #pathophysiology #physiolog y#MedEd #pulmonary #Pulmonology #COPD #emphysema #hypercarbia #hypercapnea #oxygen #carbondioxide #O2 #CO2 #haldaneeffect #haldane #bohreffect #bohr #hypoxemia #vasoconstriction |
Does the tryptophan in turkey really cause a food coma? | #pathophysiology #physiology #MedEd #neurology #sleep #tryptophan #thanksgiving #foodcoma #LNAA #largeneutralaminoacids |
How do thiazides (e.g., hydrochlorothiazide/HCTZ) lower blood pressure? | #pathophysiology #physiology #MedEd #renal #nephrology #hypertension #diuretics #HCTZ #thiazides #thiazide #chlorthalidone #SVR #CO #cardiacoutput |
Why do we need to correct hypomagnesemia in order to correct hypokalemia? | #pathophysiology #physiology #MedEd #renal #nephrology #hypokalemia #hypoK #hypomagnesemia #hypoMg #potassium #magnesium #repletion #ROMK |
How do steroids cause an increase in the white blood cell (WBC) count (i.e., leukocytosis)? | #pathophysiology #physiology #MedEd #hematology #immunology #ID #InfectiousDisease #steroids #corticosteroids #glucocorticoids #leukocytosis #WBC #demargination #neutrophils #neutrophilia |
Is there a mechanistic rationale for the use of sanatoria in the treatment of tuberculosis? | #pathophysiology #MedEd #historyofmedicine #ID #InfectiousDisease #TB #MTB #tuberculosis #sanitorium #sanitoria #satitarium #BedsideRounds #VitaminD |
Why is the AST/ALT ratio >2 in alcoholic liver disease? | #pathophysiology #physiology #MedEd #hematology #GI #gastroenterology #ALT #AST #transaminitis #alcoholicliverdisease |
Why does cirrhosis predispose to “bacterial translocation”? | #pathophysiology #physiology #Gastroenterology #GI #hepatology #SBP #Ascites #Cirrhosis #Translocatin #BacterialOvergrowth #Paracentesis #Peritonitis #Permeability |
How do calcium channel blocks (e.g., amlodipine) cause edema? | #pathophysiology #physiology #cardiology #cardiotwitter #Nephrology #renal #Neph #edema #CCB #amlodipine #Starling #cirrhosis |
How does diabetes mellitus (DM) lead to an increased risk of infection? | #pathophysiology #endocrinology #endo #InfectiousDisease #ID #Diabetes #DM #Sorbitol #Polyol #NADPH |
Why do we use Vitamin C (ascorbic acid) to promote iron absorption? | #pathophysiology #hematology #iron #ironabsorption #VitaminC #ascorbicacid #PPI |
Why does influenza have a “seasonal” trend with a winter peak | #MedEd #histmed #question #pulmonology #ID #InfectiousDisease #pulm #influenza #flu #FluSeason |
Why is cancer associated with elevated lactate dehydrogenase (LDH)? | #pathophysiology #HemeOnc #oncology #IM #cancer #lactate #dehydrogenase #LDH #pyruvate #lactate #glycolysis #glucose |
How can we make use of the MCH and MCHC provided with most complete blood counts? | #Pathophysiology #Hematology #Heme #HemeOnc #MCH #MCHC #MeanCorpuscularHemoglobin #MeanCorpuscularHemogloblinConcentration #CBC |
Why is too much oxygen (hyperoxia) harmful? | #Pathophysiology #Pulmonology #Pulm #Anesthesiology #Hyperoxia #SupplementalO2 #SupplementalOxygen #OxygenToxicity #Oxygyen |
Why is tricuspid valve (TV) endocarditis more common in those who use intravenous drugs? | #Pathophysiology #Nephrology #Renal #Neph #Endocarditis #TricuspidValve #TVendocarditis #IVDU #IVdrugUser |
Why does acute pulmonary embolism (PE) cause hypoxia? | #Pathophysiology #Hematology #Heme #HemeOnc #Pulmonology #Pulm #Hypoxia #PE #PulmonaryEmbolism |
Why makes cancer a hypercoagulable state? | #Pathophysiology #Hematology #Heme #HemeOnc #Cancer #Hypercoagulable |
Why does alcohol make you urinate so much? And, is there any truth to the bar admonition: “don’t break the seal!”? | #Pathophysiology #Nephrology #Renal #Neph #Alcohol #IncreasedUrineOutput #ADH #Vasopressin #AntiDiureticHormone |
Why hasn’t group A strep (GAS) developed resistance to penicillin? | #Pathophysiology #InfectiousDisease #ID #Syphilis #Penicillin #PenicillinResistance #PCN #TreponemaPallidum |
Why does giant cell arteritis (GCA) have a predilection for the temporal artery? | #Pathophysiology #Rheumatology #Rheum #VascularSurgery #Vascular #GCA #GiantCellArteritis #TemporalArteritis #Vasculitis |
Why doesn’t unfractionated heparin (UFH) increase the PT/INR? | #Pathophysiology #Hematology #Heme #HemeOnc #Heparin #PTINR #PT #UnfractionatedHeparin |
Why does it seem like MRSA is more virulent than MSSA? | #Pathophysiology #Nephrology #Renal #Neph#MRSA #MSSA #StaphAureus #Staph |
Why does gout preferentially affect the big toe? | #Pathophysiology #Rheumatology #Rheum #Gout #BigToe #GreatToe #GoutyArthritits |
Should I consider atrial fibrillation a risk factor for pulmonary embolism? | #Pathophysiology #Cardiology #CardioTwitter #Afib #AtrialFibrillation #PulmonaryEmbolism #PE #Anticoagulation |
“Why do my fingers get all wrinkly when I take a bath?” This was the question my 3-year-old daughter asked me recently after bath time. | #Pathophysiology #Vascular #Vasoconstriction #WrinkledFingerTips |
Why hasn’t syphilis developed resistance to penicillin (PCN)? | #Pathophysiology #InfectiousDisease #ID #Syphilis #Penicillin #PenicillinResistance #PCN #TreponemaPallidum |
Have you ever wondered by we don’t use steroids to treat acute pancreatitis (AP)? I have! | #Pathophysiology #EBM #Gastroenterology #GI #Surgery #GenSurg #Pancreatitis #Steroids #cytokines #AcutePancreatitis |
How does an understanding of the [Na+] of normal saline inform the concept of “pseudohyponatremia”? | #Pathophysiology #Nephrology #Renal #Neph #pseudohyponatremia #hyponatremia #normalsaline #NS |
Why do patients with hyperbilirubinemia become jaundiced? Patients with hemochromatosis don’t get “scleral bronze”. Why does bilirubin “do” what it does? | #Pathophysiology #Gastroenterology #GI #Hyperbilirubinemia #Jaundice #hemochromatosis |
Why does herpes simplex virus type 1 (HSV-1) encephalitis localize to the temporal lobe? | #Pathophysiology #InfectiousDisease #ID #Neurology #Neuro #HSV #HSVencephalitis #Encephalitis #HSV1 #temporallobe |
Why doesn’t pneumonia (or other issues with gas diffusion) lead to increased pCO₂? | #Pathophysiology #question #Pulmonology #Pulm #Pneumonia #Hypoxia #pCO2 #gasdiffusion #hypoxemia #hypercapnia #pO2 |
Why doesn’t the stomach digest itself? | #Pathophysiology #Gastroenterology #GI #StomachAcid #GastricAcid |
Why does nephrotic syndrome (NS) present with periorbital edema? | #Pathophysiology #Nephrology #Renal #Neph #NephroticSyndrome #PeriorbitalEdema |
Ever wonder: Why are abdominal aortic aneurysms (AAAs) more common than thoracic aortic aneurysms (TAAs)? | #Pathophysiology #VascularSurgery #Vascular #Cardiology #CardioTwitter #AAA #TAA #AbdominalAorticAneurysms #ThoracicAorticAneurysms |
Why do patients with acute hemorrhage become anemic? | #Pathophysiology #EmergencyMedicine #EM #Surgery #GenSurg #Hemorrhage #Anemia #AcuteHemorrhage |
Why isn’t insulin administered orally? | #pathophysiology #endocrinology #IM #insulin #diabetes #big #peptide #hydrophillic |
Why does HIV cause an elevated protein gap? | #PAthophysiology #Infectiousdisease #ID #HIV #AIDS #ProteinGap #Hypergammaglobulinemia |
How does aortic stenosis cause syncope? | #Pathophysiology #Cardiology #CardioTwitter #Syncope #AorticStenosis |
How does one create a Tweetorial? This is thread ONE of a THREE PART series. | #MedEd #MedTweetorial #Research #CreatingTweetorialsPart1 |
How does one create a Tweetorial? This is thread TWO of a THREE PART series. | #MedEd #MedTweetorial #Research #CreatingTweetorialsPart2 |
Why does E. coli clear from the blood faster than S. aureus? | #Pathophysiology #InfectiousDisease #ID #EColi #StaphAureus #Staph #ReticuloendothelialSystem #MPS #MononuclearPhagocyteSystem |
How does one create a Tweetorial? This is thread THREE of a THREE PART series. III. Tools I use when creating a Tweetorial | #MedEd #MedTweetorial #Research #CreatingTweetorialsPart3 |
How do diuretics lead to metabolic alkalosis? | #Physiology #Cardiology #CardioTwitter #Nephrology #Renal #Neph #Diuretics #MetabolicAlkalosis #ContractionAlkalosis |