Internal Medicine

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Why do we feel cold (i.e., experience "chills") when we have a fever? Shouldn't we feel hot?

And what are rigors?

Answers to these questions will help us better understand when we should obtain blood cultures.

When do you think is the best time to draw them?

1/The Liver Blood Tests: A case exploration from Tuesday's Zoom (https://bit.ly/2ZyBjAc more in video!)

CC: 43 yo M with 3m of fatigue + pruritus
LCT: TPro 4.9/Alb 1.6 /TBil 27.8 /DBil 23.9 / AST 147 / ALT 152 / AlkPhos 1249
#MedEd #MedStudentTwitter
What is your impression?

1/ #medtwitter #tweetorial Raise your hand if you have ever inappropriately checked an ammonia level.🙋
1. Why is ammonia ⬆️ in liver failure and how is this connected w/ encephalopathy?
2. When should levels be checked?
3. Aside from cirrhosis, what other conditions ⬆️ammonia?

#Medtweetorial
It’s time for #SpacedRepetition: @CPSolvers
Student VMR 08/23/20: https://clinicalproblemsolving.com/morning-report-august-23-2020/
Chat recap of #ClinicalPearls #VirtualMorningReport
First week of Sub-I done!

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Why is our thirst immediately quenched after the ingestion of water?

As we'll note, it takes ~10 minutes for serum osmolarity to change. And yet thirst drops far more rapidly.

Something must be bypassing the blood...

1/ Thoughts on presenting on rounds #UncleBob - #5goodminutes

This is how I do rounds - would love questions and critiques.

I explain my expectations the first day on the service.

@WrayCharles @LisaWillett13 @iMedEducation #MedEd @ShreyaTrivediMD @AdamRodmanMD

1/ Approaching HCO3: A case exploration from Tuesday's Zoom (https://bit.ly/33lsOv9 video! Much more discussed there than here!)

CC: 55 yo M presenting with 3 months of DOE
BMP: Na 141/K 3.8/ Cl 99 / HCO3 31 / BUN 10 / Cr 0.9
What are your initial thoughts?

@medrants #meded

Which is your favorite hypertension syndrome #eponym?

#medstudenttwitter A review of syphilis testing
1/ Scenario 1: You are seeing a patient in clinic and obtain syphilis screening of HCM. For screening, a nontreponemaltest (RPR or VDRL) are usually sent first. What is the sensitivity of the RPR testing?

1/This week on the wards I learned more about diabetic myonecrosis as part of the differential of unilateral thigh swelling. Diabetic myonecrosis- muscle infarction due to microvascular disease. It is a rare complication of DM.
1. Associated with long-standing DM (1>2)

#Medtweetorial
It’s time for #SpacedRepetition: @CPSolvers
Student VMR 07/26/20: https://clinicalproblemsolving.com/morning-report-july-26-2020/
Chat recap of #ClinicalPearls #VirtualMorningReport
Back in clinic again…this time, Heme/Onc (continuing from before COVID)

Sunday Funday! And what's more fun than #evidencebasedmedicine?

A 58 yo M presents to your clinic with cough. Knowing nothing more, what is the probability that this patient has community acquired pneumonia (CAP)?

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💥 A Case of Hyponatremia

⚡️It is cool to see the ⬆️ in Plasma Sodium be close to the predicted value based on our calculation

⚡️Let’s review the case

💥An elderly man with metastatic cancer presents with Hyponatremia
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Honored to present another @CPSolvers #VMR (#99) to the amazing @Gurleen_Kaur96 @nsrosenberg @Sharminzi @ArsalanMedEd. Why do they still let me on here 🤣?
Here are some teaching points, co-authored by @KourtneyKing, about the final diagnosis. @TheRealDSrini @RosenelliEM

#Medtweetorial
It’s time for #SpacedRepetition: @CPSolvers
VMR 07/23/20: https://clinicalproblemsolving.com/morning-report-july-23-2020/
Chat recap of #ClinicalPearls #VirtualMorningReport
It seems like the two cases I have presented were completely out of left field. I’ll try for a more reasonable case next time!

1/ MetAcidosis & Management! Before we launch into this tweetorial, test yourself with a case: 30 yo F presents w/ weakness and this BMP - Na 138/K 1.6/Cl 118/HCO3 9/BUN 18/Cr 0.9.

Question: Do we treat this metabolic acidosis with bicarbonate therapy?
@medrants #meded #foamed

#Medtweetorial
It’s time for #SpacedRepetition: @CPSolvers
Student VMR 07/19/20: https://clinicalproblemsolving.com/morning-report-july-19-2020/
Chat recap of #ClinicalPearls #VirtualMorningReport
Sorry the newest @CPSolvers contributor is late again! Also I’ll be on @unremarkablelab tonight as a discussant!

#Medtweetorial
It’s time for #SpacedRepetition: @CPSolvers
Saturday VMR 07/18/20: https://clinicalproblemsolving.com/morning-report-july-18-2020/
Chat recap of #ClinicalPearls #VirtualMorningReport
And here comes a week of me (mostly) giving @RosenelliEM a vacation!

1/ #tweetorial #medstudenttwitter You are the admitting a a young female w/ paraesthesias and fatigue found to have a WBC 5.3, Hb 5.6 (MCV 110) and platelet count of 84k. Tbili is 2.1 (db .5), LDH 4579. Peripheral smear w/ schistocytes and macroovalocytes

@MedTweetorials #LECOMtweetorials

First Tweetorial! Here goes nothing. #MedTweetorials
#MedEd

How can a person be stiff and spasmy at the same time? Read on to find out...

1/ Clinical Reasoning Series – Cognitive Bias

Ever felt the thrill of making crucial diagnosis? The pain of missing a diagnosis? Yeah, us too

Clinical reasoning is hard, so let’s talk about it. Our 1st post in a new series starts today. Let’s talk about Biases.

#MedTwitter

#IgG4 #IgG4RD #Rheumatology #rheum #Immunology #RareDisease #MedTwitter #MedEd #tweetorial @IgG4RD @MedTweetorials @zach_wallace_md @USFQ_Ecuador

Why IgE and eosinophil elevation could be important for disease prediction in IgG4RD?

1/ Anion gap acidosis
#UncleBob loved Episode 30 - Anion gap metabolic acidosis https://clinicalproblemsolving.com/2019/05/01/episode-30-anion-gap-metabolic-acidosis/ via @CPSolvers Definitely worth #5goodminutes I have a slightly different schema and will use this tweetorial to present a complementary approach and provide some key refs

Back again for my 2nd #tweetorial on urine electrolytes. Next up is urine chloride (UCl).

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Attempting some #tweetorials on urine electrolytes with the hope of improving my understanding & appropriate clinical utility of these tests. I welcome any and all feedback. Without further ado, lets get started. First will be urine sodium (UNa).