Discover and read the best of Twitter Threads about #MRPearls
Most recents (8)
1/#MRPearls Pulmonary hypertension (PH) is a wide ranging disease that is associated with ⬆️ morbidity and mortality. How comfortable are you with right heart catherizations and the changing diagnostic criteria in PH? #tweetorial @AvrahamCooperMD 
2/#MRPearls Right heart catherizations in the supine position remain the gold standard for the diagnosis of PH. This is typically done using a fluid-filled balloon-tipped thermodilution catheter. Check out this image to see the various wave forms within each heart chamber.
3/#MRPearls This video does a fantastic job of demonstrating the pressure waveform changes that are seen in each chamber. @MichaeLheureux @AndreaMytinger @michellebr00ks @VCU_IMRes @GoodishIntent @JJRyanMD
1/ #MRPearls Have you ever had the clinical situation arise where you had to choose between vitamin K, prothrombin complex concentrate (PCC) & fresh frozen plasma to reverse warfarin in a clinically significant bleed? #tweetorial
@VCU_IMRes @rabihmgeha @DxRxEdu @michellebr00ks
@VCU_IMRes @rabihmgeha @DxRxEdu @michellebr00ks
2/ #MRPearls The first question you need to ask yourself is does this patient have a clinically relevant bleed? Do you know the definition as defined by the International Society on Thrombosis and Hemostasis (ISTH)? @marinanaz @MarkZieglerMD @nchadha3 @pchawla8 @murtipatel_
3/ #MRPearls Clinically relevant bleeding as defined by the ISTH:
1⃣ Fatal Bleeding
2⃣ Symptomatic Bleeding in a Critical Area or Organ
3⃣ Bleeding causing a drop in hemoglobin by > 2g/dL or bleed leading to transfusion of two or more units of blood.
1⃣ Fatal Bleeding
2⃣ Symptomatic Bleeding in a Critical Area or Organ
3⃣ Bleeding causing a drop in hemoglobin by > 2g/dL or bleed leading to transfusion of two or more units of blood.
1/ #MRPearls Epistaxis is a common complaint seen in both the inpatient and outpatient settings with approximately 60% of the general population having an episode of epistaxis in their lifetime with a pretty clear bimodal distribution (<10yo and >50yo). #Tweetorial @VCU_IMRes
2/ #MRPearls Most epistaxis actually occurs in the anterior nose at Kisselbach's plexus; however, cannot forget about posterior bleeds because they can lead to significant hemorrhage. @marinanaz @MarkZieglerMD @nchadha3 @pchawla8 @murtipatel_ @DrKisselFace @EmilyKRoseMD
3/ #MRPearls The etiology of most epistaxis cases can be readily identified through a focused history and physical exam. Important to ask about prior bleeding episodes, medications, OTCs including herbals, and other co-morbidities. @nehahipp @LauraLee714 @ETKirtonDavis
#MRPearls Can consider fecal immunochemical test (FIT) for blood for colorectal cancer (CRC) screening. It directly measures hemoglobin in the stool and should be repeated annually. The sensitivity for CRC is 73.8% and 23.8% for adenomas >10mm. @VCU_IMRes @AudreyBJernigan (1/4)
#MRPearls Fecal occult blood test (gFOBT) identifies hemoglobin by turning guaiac reagent paper blue. It should be done annually. Requires dietary and med restrictions. Not an ideal option given sens. 70% for CRC. Sens. 23.9% for adenomas >10mm. (2/4)
#MRPearls Multitarget stool DNA testing (FIT-DNA) is a composite of tests that assesses for DNA mutations along with FIT testing. No dietary or medication restrictions. Studied to be done every 3 years. Sens. for CRC 92.3%. Sens. 42.4% for adenomas >10mm. (3/4)
1/ #MRPearls How comfortable are you in diagnosing and managing peripheral artery disease? #Tweetorial @VCU_IMRes @AudreyBJernigan @michellebr00ks @abouzaki_md @AbbateAntonio @VCUHealthHeart @rabihmgeha @cjchiu @AdamRodmanMD @jackpenner @tony_breu
2/ #MRPearls It is estimated that atherosclerotic peripheral artery disease affects more than 200 million persons worldwide, including at least 8.5 million persons in the United States. @JeremyTurling @CVC_Coalition @padadvocate @CardiacRisk @VascProtection @American_Heart
3/ #MRPearls Diabetes and smoking are the strongest risk factors associated with peripheral artery disease. Check out these charts from @CircAHA demonstrating the odds-ratio for PAD in smokers. @GuruKowlgi @kalahasty @SamPowellMD @sammyd56702583 @SampathGundaEP @mitchbk1
1/#MRPearls Hope you got your calipers ready today because we are going to briefly discuss prolonged QT intervals. @VCU_IMRes @AudreyBJernigan @chrisLyoungmd @ktwaybill @JCHillyard @CoryRTrankle @AjayPMD @jaideeppatelmd @VCUHealthHeart #tweetorials
2/#MRPearls The QT interval refers to the time duration between the onset of the QRS complex and the end of the T wave as it returns to the baseline. QT interval represents the time taken for ventricular depolarization and repolarization. @kalahasty @abouzaki_md
3/#MRPearls The proper way to measure the QT interval requires one to use the maximum slope intercept method to define the end of the T wave as pictured below. Also, the QT interval is inversely proportional to heart rate. @SamPowellMD @totocarbone @JeremyTurling
#MRPearls The bronchial artery circulation is a relatively high pressured system and is responsible for 90% of life threatening hemoptysis cases. (1/7) @VCU_IMRes #Tweetorial
#MRPearls In contrast, the pulmonary artery circulation is a low pressured system with most episodes of non-life threatening hemoptysis occurring from this circulation. (2/7) @mkashiouris
#MRPearls The initial management of massive hemoptysis should include protecting the non-bleeding lung by turning the patient to the bleeding side. Time is lung in this situation. (3/7)
#MRPearls Have you ever gotten a chest x-ray that showed a pleural effusion and you questioned what further evaluation that you should proceed with? (1/18) @VCU_IMRes #tweetorial
#MRPearls What are the most common causes of pleural effusions? (2/18)
#MRPearls This chart from @NEJM demonstrates that pleural effusions remain a common occurrence in daily practice with the most common causes in the US being CHF, pneumonia, and cancer. (3/18) @mkashiouris
