Internal Medicine

1/ Just finished reading this CP solving article which I highly recomend:(https://www.nejm.org/doi/full/10.1056/NEJMcps2002083)
This thread will contain spoilers.
Since the article did not analyze the labs, I wanted to take some time to review how the "non-specific labs" can help to narrow the ddx.

1/12 Giving a talk to our UCLA IM Residents in the Med Ed Pathway @uclaimchiefs @PamelaTsing inspired me to make a thread on how to construct questions to maximize learning! Thanks @rktsevat and your group for the inspiration behind this example!

#MedEd #FOAMEd #MedTwitter

Last night on @UnremarkableLab w/ @UABIMRes
and @medrants there was a patient who presented with aphasia and his BP was extremely elevated >250 systolic. What is the ddx here?

1. Hemorrhagic stroke
2. Posterior Reversible Encephalopathy Syndrome
3. Hypertensive Emergency

Splenomegaly in Crohn’s disease? Something I learned in @CPSolvers #VMR yesterday with @rabihmgeha @DxRxEdu from a case by @BJegorovic association of the spleen has been recorded on only a few previous occasions.

Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha @sargsyanz @StephVSherman @hraza222 @RachelPauleyIM @mariosuitofmd

#ClinicalPearls #VirtualMorningReport

Ep165: 10.14.2020 https://clinicalproblemsolving.com/morning-report-october-14-2020/

A 40-year-old female h/o a prolactinoma p/w 3wks of CP & cough

What is a rheumatoid factor anyway?

RF is a polyclonal antibody that is against the Fc portion of IgG. Normally, IgM is the only RF Ab measured, however, there are RFs of the other Ig classes. What is the most specific antibody for rheumatoid arthritis?
#MedTwitter #meded

If you have not listened to the @CuriousClinPod most recent podcast (Episode 10: Why does metronidazole treat both bacterial and parasitic infections?) then I suggest you tune in.

http://curiousclinicians.com/2020/09/30/why-does-metronidazole-treat-both-bacterial-and-parasitic-infections/

I'll summarize their show notes here in short #medtweetorial

#ScholarlySunday
Case by @cristinacorsini

63F. AML s/p BMT. Chronic back pain Rx transdermal patch.

Cellulitis. Blood Cx: MRSA
Rx: Dapto —> linezolid. 5d later: fever, sweats, tremors, abd pain, N/V/diarrhea. BP 130/85 P113. Cellulitis improving

What is the cause? #MayoIDQ

I don't often post @MedTweetorials but when I do, it is cause I am bias! This is a great guideline! The new VA lipid guidelines. Let's take a brief look at major recommendations and some reasons behind them.
#FOAMed #medicine #cholesterol
@AnnalsofIM

https://www.acpjournals.org/doi/10.7326/M20-4648

1/14
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!

1/
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