Discover and read the best of Twitter Threads about #InternalMedicine

@ContinuumAEP

Lactante, un mes de vida: fiebre, placa en la cara ligeramente sobreelevada, eritematosa, con coloración anaranjada periférica, delimitada, y con aumento de temperatura a la palpación
1/7

🖊️F Rivera y col. continuum.aeped.es/courses/info/9… @ContinuumAEP @aepediatria
#AtencionPrimaria

@ContinuumAEP

@ContinuumAEP @aepediatria ERISIPELA
✔️infección superficial que afecta a la dermis superior, el tejido celular subcutáneo y a veces al sistema linfático,
✔️causada en la mayoría de los casos por S. pyogenes o estreptococos de los grupos B, C o G.
2/7

#urgencias #microbiología

@ContinuumAEP

@ContinuumAEP @aepediatria Origen: interrupción de la barrera cutánea por picaduras de insecto, erosiones, etc.
Comienzo: agudo
Placa eritematosa con bordes bien definidos y ligeramente elevados
Localización predilecta: miembros inferiores y cara
Frecuente: adenopatías regionales.
3/7

#pediatria #MIR

An 85-YO in rural Mississippi: months of tender, erythematous plaques & edema on bilateral hands extending to the elbows & on feet extending below the knees with significant pain

🔬skin granulomatous inflammation & numerous AFB
Mycobacterial🧫:➖
1/19

#IDtwitter #dermatology

A repeat skin extensive granulomatous inflammation (A), with Ziehl-Neelsen stain clusters of acid-fast bacilli throughout the dermis (B).
Kinyoun stain >9 AFB/high-power field (C & D).
2/19

DOI: doi.org/10.1128/jcm.00…
#dermpath #microbiology

Molecular identification: 100% identity to multiple Mycobacterium leprae

BORDERLINE LEPROMATOUS LEPROSY WITH REVERSAL REACTION
3/19

#MedTwitter #MolBiol

Read 19 tweets

cardio-met

@cardiomet_CE

1) Welcome to Part 2 of a new #accredited #tweetorial in our series of educational programs on #hypertrophic #cardiomyopathy #HCM. DOn't miss Part 1, still available for 🆓CE/#CME, at cardiometabolic-ce.com/hcm5a/.
Now you can learn more, and EARN MORE credit, by following this 🧵!

@pabeda1

2) Our expert author is again Sergio Kaiser MD PhD FACC FESC 🇧🇷🇮🇱 @pabeda1, cardiologist 🫀, Professor 🎓 of #InternalMedicine, Rio de Janeiro State University. He brings the general cardiologist's perspective to our #HCM discussions. Read and learn!
#FOAMed #CardioTwitter

@academiccme

3) This program is supported by an unrestricted educational grant from Bristol Myers Squibb. Statement of accreditation and faculty disclosures at cardiometabolic-ce.com/disclosures/. Credit for #physicians #nursepractitioners #physicianassociates #nurses #pharmacists from @academiccme.

Read 62 tweets

cardio-met

@cardiomet_CE

1) Welcome to Part 1 of a new #accredited #tweetorial in our series of educational programs on #hypertrophic #cardiomyopathy #HCM. Previous programs, still available for 🆓CE/#CME, are at cardiometabolic-ce.com/category/hcm/.
Now you can earn another 1.5hr credit by following ALL of this 🧵!

@pabeda1

2) Our expert author is Sergio Kaiser MD PhD FACC FESC 🇧🇷🇮🇱 @pabeda1, cardiologist 🫀, Professor 🎓 of #InternalMedicine, Rio de Janeiro State University. He brings the general cardiologist's perspective to our #HCM discussions. Read and learn!
#FOAMed #CardioTwitter

@academiccme

Read 68 tweets

A 58-YO♂️, DM, fever & L lower quadrant abdominal pain 2 months prior: acute R-sided back pain, & 3/6 diastolic murmur at R upper sternal border.

CT: a R renal infarction & splenic embolism

MR: multiple infarctions
1/7

doi.org/10.1016/j.idcr…
#Cardiology #medicine #cardiologia

Transesophageal echocardiography: a vegetation and severe aortic regurgitation.

Blood 🧫: Cardiobacterium hominis

CARDIOBACTERIUM HOMINIS ENDOCARDITIS ASSOCIATED WITH CEREBRAL, RENAL, AND SPLENIC INFARCTIONS
2/7

#IDtwitter #microbiology

The patient received antibiotic therapy and surgical aortic valve replacement, and he was doing well without major complications.
3/7

#infecciosas #MedTwitter #Doctor

Andreas Charidimou MD, PhD

@a_charidimou

Beating Clinical MCQs in #USMLE or #boards2023 when you don’t know the answer! 🩺📝

🧵👇Check out 10 strategies to approach this challenge

#MedTwitter #MedEd #IMG #ECFMG #foamed #medicalstudent #internalmedicine #BoardExams #medicaleducation

Don't panic! 😱

Try to work through the question, use strategies below to narrow down the choices and make an educated guess. 💪🤔💡

1/10

General approach to MCQs: Reverse reading 📖🔙💭

a) read the MCQ starting at the last sentence in the stem (the actual question)
b) glance over the answer options
c) then work your way back to the stem

🧠I find this an effective technique to prompt & orient the brain.

2/10

Read 11 tweets

A 50-YO ♀️ bitten by her pet rat: fever, myalgia, sore throat, headaches a nonpruritic rash on extremities including palms & soles, arthralgias, knees arthritis.

A punctate wound with central necrosis on L palm, & her R thumb.
1/9

#rheumatology #internalmedicine #dermatology

Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
✔️Gram stain: scant pleomorphic gram-negative bacilli in chains with lateral bulbar swellings
2/9

doi.org/10.1093/cid/ci…
#microbiology #rheumatologist

Synovial fluid 🧫culture: Streptobacillus moniliformis identified by biochemical testing & confirmed by MALDI-TOF.

RAT BITE FEVER (RBF) WITH SEPTIC ARTHRITIS DUE STREPTOBACILLUS MONILIFORMIS
3/9

#bacteriology #IDtwitter #microbiología

Read 9 tweets

A 29-YO♂️, 6 months before, HIV + & non–drug-resistant pulmonary tuberculosis, antiretroviral & 4-drug antituberculous therapy initiated but soon reduced to rifampin & isoniazid only: abdominal pain on the L side
CT: ?
1/5

DOI: 10.1056/NEJMicm2206174
#radiologist #GITwitter

CT: an enlarged spleen with numerous hypodense lesions (A).
CD4 cell count: 119/mm3
VIH viral load: 1778 copies/mm3

A splenectomy was performed to evaluate for cancer:
numerous necrotic nodules with purulent discharge (B).
2/5

#microbiology #gastroenterology #IDtwitter

🔬granulomatous inflammation with caseous necrosis (C) and acid-fast bacilli (D, arrowheads).
A tissue🧫: ➖

PCR: ➕for Mycobacterium tuberculosis

SPLENIC TUBERCULOSIS
3/5

#bacteriology #MedTwitter #GIPath

A 50-YO♂️of North India, visited bat caves & a bird sanctuary in Thailand: multiple plaques & nodules on his face, neck, arms & trunk with hoarseness, fever, weight loss for months
Laryngoscopy: nodules over the tonsils & posterior pharyngeal wall
1/4

#medicine #dermatology

Skin & laryngeal 🔬: histiocytes with intracellular & extracellular PAS+ yeast cells
Skin biopsy🧫: tuberculate macroconidia confirmed as H. capsulatum var. capsulatum
Ab against Histoplasma by ID:➕

DISSEMINATED HISTOPLASMOSIS
2/4

doi.org/10.3109/136937…
#mycology #IDtwitter

Disseminated histoplasmosis involving skin & larynx in an apparently immunocompetent individual

The infection appeared to be imported from Thailand.

The patient responded very well to intravenous amphotericin B followed by itraconazole.
3/4

#microbiology #MedTwitter #Doctor

Read 4 tweets

A 37-YO, farmer in India, #HIV+ immunecompromised ♂️, treatment for suspected pulmonary tuberculosis: papulonodular lesions of 3-month duration over the face, neck, trunk, limbs, palms & soles, & oropharynx; fever & generalized lymphadenopathy
🔬: ?
1/7

#IDTwitter #microbiology

🔬: Blastoconidias within the macrophages.
🧫: Histoplama capsulatum: characteristic colony, conversion to yeast form, characteristic🔬appearance.

PROGRESSIVE DISSEMINATED HISTOPLASMOSIS
2/7

doi: 10.4269/ajtmh.17-0432
#dermpath #mycology #internalmedicine

Diagnosis is usually suspected on visualization of characteristic intracellular yeast (blastoconidias), the pathogenic or tisular form, with a clear rim and garnulomatous cellular infiltrate in tissue specimen or lymph node aspirate
3/7

#MedTwitter #Doctor

A 31-YO ♂️, sex with men, HIV treatment, HCV: in 2022, fever, cervical lymph nodes & erythemato-squamous papules, with umbilications & ulcerations, vesicles & pustules, & honey-colored crusts on the face, trunk & limbs including his palms & soles
1/7

#IDtwitter #primarycare

PCR: ➕for MPXVirus.
#HIV viral load of < 40 copies/mL and a CD4 + count of 167 cells/mm3

#MPOX (MONKEYPOX)
2/7

#healthcare #internalmedicine #microbiology
doi.org/10.1016/j.idcr…

Supportive care of Mpox was provided, namely,
✔️beta-lactams due to bacterial superinfection of the lesions,
✔️in addition to analgesia, which was initially administered with NSAIDs and then escalated to opioids.
3/7

#MedTwitter #MedStudentTwitter #dermtwitter

A 32-YO ♂️ sex worker, sex with men unprotected, HIV under treatment: 20 lesions scattered throughout the body of umbilicated, erythematous, violaceous papules with central ulcerations & pustules, fevers, cervical & axillary lymph nodes
1/5

#IDtwitter #primarycare #healthcare

HIV viral load of 1577 copies/mL and a CD4 + count of 932 cells/mm3

PCR: ➕ for Mpox virus

MPOX (MONKEYPOX)
2/5

#internalmedicine #microbiology doi.org/10.1016/j.idcr…

Mpox had been a neglected disease until May, 2022, and since then, there has been a notorious increase in the number of human monkeypox cases in non-endemic areas
3/5

#MedTwitter #MedStudentTwitter #dermtwitter

An 86-YO ♂️, injury on his L leg 47 years prior, several debridements, skin grafts, & vein stripping procedures: chronic bilateral leg progressive ulcers.

Superficial🧫: multiple organisms including E. coli & coagulase➖Staphylococcus.
1/6

#internalmedicine #IDtwitter

Skin biopsy🔬: bilateral invasive squamous cell carcinomas.

BILATERAL INVASIVE SQUAMOUS CELL CARCINOMAS (MARJOLIN ULCERS)
2/6

#dermatology #dermpath
doi.org/10.1093/cid/ci…

The mean time period between development of a wound to malignancy is 30–35 years.

The most common malignancies seen in Marjolin ulcers are squamous cell carcinomas, but basal cell carcinomas and melanomas have been reported.
3/6

#Doctor #healthcare #MedStudentTwitter

Read 6 tweets

A 24-YO♀️: a 10-year of episodes of redness & photophobia in eyes, &⬇️visual acuity
SLE: conjunctival hyperemia & peripheral corneal opacification, inflammation & crystalline deposits on the corneal
⬇️
INTERSTITIAL KERATITIS
1/5

DOI: 10.1056/NEJMicm1709103
#eye #internalmedicine

Etiologies:
✔️Bacterial: SYPHILIS, Lyme borreliosis, tuberculosis, etc.
✔️Viral: Herpesviridae (HERPES SIMPLEX, H. zoster, E-B)...
✔️Parasitic: Onchocerciasis, Acanthamoeba...
✔️Immune: Cogan's syndrome, contact lens-associated keratitis, autoimmune disease…
2/5

#microbiology

ESR:⬆️& evaluation for infectious causes: unremarkable.
6 months after the diagnosis of interstitial keratitis: vertigo, tinnitus, & hearing loss.
Audiometry: sensorineural hearing loss in both ears.
Clinical findings consistent with COGAN´S SYNDROME
3/5

#Ophthalmology #MedEd

A 38-YO♂️, #HIV➕: asthenia, fever, & generalized & confluent maculopapular rash predominantly on the back, cervical & inguinal lymphadenopathies, & stippled petechial hemorrhages in the soft palate (Forchheimer’s spots)
Subsequently, pustules appeared

1/5
#emergency #IDtwitter

Classic Mpox pustules appeared
PCR:
✔️for measles & rubella➖
✔️for Mpox➕

HUMAN Mpox, although confluent maculopapular rash & Forchheimer’s spots have been reported as classic signs of rubella or measles infections
2/5

DOI: doi.org/10.4269/ajtmh.…
#microbiology #MedTwitter

Forchheimer spots, a type of enanthem:
📌sometimes precede the skin rash of rubella.
📌tiny red spots on the soft palate in rubella, measles and scarlet fever.
3/5

#dermatology #internalmedicine #primarycare

Arjun G. Shah

@neurogenicpoet

Resources to study #Neurology

Adams and Victor’s. By far my favourite textbook.
The book is more clinically oriented, coloured with anecdotes and mental models. Reading it feels like seeing a pt in the ward/OPD

#MedTwitter #neurotwitter

It has elements of philosophy, history and is written eloquently.
Whimsical, yet profound, it’s teachings stay with me. Added bonus, my Guru in Neurology finds mention in the text 🙃 I’d recommend this for #mbbs #md and #dm students

Bradley is the standard #textbook in #neurology. A great book, it’s more like #Harrison. Great for information, latest research and management. Essential for the DM #neurology candidate, but also useful for MD #internalmedicine

Read 11 tweets

White coat #hypertension (WCH) can not be left alone

1. Patient: My BP is high only in hospital, at home it is normal. So, I don't want to do anything about it.
Me: High BP (whether in hospital or at home) can lead to adverse outcomes, so, you should aim for a normal BP 24/7.

2. A study showed that in untreated cohorts, WCH was associated with a 38% and 20% increased risk of #Cardiovascular disease (CVD) and total #mortality (death) compared with normotension (normal BP), respectively.

3. However, in the treated patients (who received medications to keep BP normal at office as well as at home), neither the risk of CVD, nor total mortality was increased in WCH.

Cause of coma in a #woman surprised us!

1. 65-year old woman was brought in an #unconscious state to #emergency dept. She sounded normal over phone to her son about 24 hours earlier. She stayed alone, so, further details were not available.
#MedTwitter #internalmedicine

2. Clinical examination revealed an #unconscious patient. She was afebrile; pulse and BP were normal. Pupils were equal and reacting to light. Meningeal signs were absent. She was electively mechanically ventilated in view of her unconscious state.

3. Serum #calcium was high (13 mg/dL). MRI brain was normal. Lumbar puncture was normal. Investigations were done to determine the cause of high calcium. There was no evidence of #endocrine disorder, infection or #Cancer.
#VitaminD level was very high (160 ng/mL).

Can #drinking excess amount of #water lead to death?

1. Water is life-saving and is essential for survival. However, ingestion of excess amounts of water, especially over a short period of time can lead to serious health hazards, including #death.
#MedTwitter #internalmedicine

2. How much water is needed on daily basis?

The normal daily requirement of water is 2.5 to 3 liters.
The requirement may be higher in summer months. Requirement also increases during #exercise (due to sweating), during fever, diarrhea or vomiting.

3. Why do some people drink excess amounts of water?

There is a misconception that drinking more water is good for #health.
Some people can drink more water due to #psychiatric illnesses.
#athletes can overestimate fluid loss and drink an excess amount of water.

Read 9 tweets