Discover and read the best of Twitter Threads about #IDconsults
Most recents (3)
50yo F p/w acute onset fever, diarrhea. On exam is hypotensive and mildly confused. Sx started 2 days after return from Zambia. No malaria ppx. Smear w/ 30% P falciparum parasitemia. MICU concerned for cerebral malaria (CM). How can we confirm on #PhysicalExam ?#IDConsults 
Cerebral malaria is defined by WHO as coma with peripheral parasitemia after other causes ruled out. In endemic regions this predominantly affects young kids due to immunologic naivety. Unfortunately, this defn is nonspecific as 40-70% of asymptomatic ppl may be parasitemic 2/
Pathophys of cerebral malaria is related to sequestration of parasitized RBCs in the CNS blood vessels...thanks to Hermann von Helmholtz’s invention of the ophthalmoscope in 1851 (with just a few updates from the original), we have a window to the vasculature of the CNS! 3/
42yo with nasopharyngeal CA (in remission) s/p chemo/rad presents with 3 months of progressive posterior head/neck pain, and slurred speech. On PE, you notice the following. What are you seeing? What’s your ddx? (consent obtained). #PhysicalExam #IDConsults 1/
In this video, you see right sided atrophy, right sided deviation, and fasiculations R>L, indicating a peripheral 12th nerve palsy. He also had some slurred speech. Remainder of neuro exam WNL. Remember: atrophy and fasiculations = LMN process! 2/
This patient had difficulty with certain sounds and with slurring words. Dysarthria means a difficulty producing speech: cranial nerves VII, IX/X, & XII are vital to producing speech and these can be tested by asking the patient to say different sounds. 3/
50ish man w/ DM s/p renal tx p/w pneumonia & delirium. RN puts on mitts. Next day, his finger hurts. On physical exam, you note fusiform swelling, tenderness along palmar aspect of the finger, and pain with passive extension. What’s your ddx? #Physicalexamfriday #IDconsults
The patient met 3 out of 4 Kanavel criteria for pyogenic flexor tenosynovitis (fusiform swelling, tenderness over the tendon, pain with passive extension, finger in slight flexion). MRI confirmed the diagnosis and orthopedic surgery took him to surgery for debridement...
Dr. Kanavel was a surgeon at Cook County who described the signs in 1912. They have been used ever since and were finally validated over a hundred years later in 2017 (Hand (N Y). 2017 Nov;12(6):585-590). I got my hands on a copy of his original book!
