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A #stroke #tweetorial. Inferior division MCA infarct often gets mistaken for PCA territory. Sometimes it can be quite difficult to distinguish MCA vs PCA territory infarcts (especially near the borderzone). #neurotwitter #medtwitter #medstudenttwitter
1/ Reminder of topography: MCA (yellow) and PCA (green) territory. Inferior division MCA (near the borderzone of PCA) involves the occipital lobe
3/ This is an example of a patchy MCA territory infarct. Note that the inferior division MCA affects the partieto-occipital lobe (except for the very medial portion of the occipital lobe, which we already stated is PCA). Red line indicates the borderzone between MCA/PCA
Read 7 tweets
With in-person rotations back in full swing, it’s time for a thread about managing rough feedback. This is geared towards #MedStudentTwitter, but hopefully applicable to everyone whether you are giving or receiving feedback.

Here we go...
@HollandStanton @m3betch
Why I care: I got called “shy”, “unengaged”, a “passive learner”, & a “great pediatrician on my OB rotation”🙃. Critical feedback can hurt. I had to learn how to receive it and also how to change my actions so that the comments reflected my commitment. Thanks to mentors, I did.
First, I had to learn as a person who liked being liked and getting good grades to not take feedback personally, even when it sounds personal. Even though feedback is the basis of grading, people often get little training in it or uncomfortable giving/asking for it.
Read 14 tweets
Does it have to take a national movement against racism for the discrimination BIPOC women face in medicine to be taken seriously?
Does it have to take a national movement for “all these disparities women face in the workplace are worse for intersectional women” to move from a one-liner in #DEI work to the forefront and for #SystemicRacism to be relevant in the women in medicine movement?
When Black women spoke up about the discrimination we face and asked for allies to hold systems and institutions accountable, why is our go to answer “academia takes time?”
Read 8 tweets
What does a PATHOLOGIST do?

A quick primer for:
Med Students

Please read:

#medtwitter #MedStudentTwitter
#pathtwitter #pathology #pathRIOT

At the Hospital, Pathologists diagnose:

- Every Culture
- Every Blood smear
- Every CBC
- Every Bone marrow
- Every Chemistry
- Every Biopsy
- Every Surgical resection
- Every FNA
- Every Blood transfusion
- Every Flow cytometry
- Every Molecular test

- Every Cancer patient
- Every Cancer type
- Every Benign tumour
- Every Non-neoplastic tissue
- Every Cytogenetics test
- Every Pap smear
- Every Frozen section
- Every Toxicology
- Every Autopsy
- EVERY COVID19 test
- & MORE!

- All of Forensics

Read 5 tweets
Committed to ending racial health inequities?

You need to be talking to your patients about their civic health.

Voting and health inequities are closely linked.


Families separated at the border
Another school shooting
#COVID19’s racist impact
The ongoing fight for #Medicaid

All impact the health of our communities. Outcomes that are heavily influenced by participation in, or lack of, voting.
#VoteHealth #VoteKids (2/)
Although we know policies directly impact health we see gaps in opportunity not only for access to resources but to the ballot box where many of our communities’ decision makers are selected.
#VoteHealth #VoteKids…
Read 21 tweets
Hi #MedTwitter and #MedStudentTwitter! As #MS4's gear up for virtual interview season, I thought I create this #Tweetorial: Residency Interviews - Showing Your Best Zoom Self🕴️‍♀️🕴️‍♂️💻 (let me know your thoughts and suggestions!😄)
Tip #1 - Your eye level is appropriate
- If you can trace a straight line with your hand from your eyes directly to your webcam, it'll prevent you from looking a bit slanted on the screen.
- Better camera angle = better eye contact with your interviewers😄
Tip #2 - Make sure there is no light source behind you (or a bright light source above you).
- We want to read each other's expressions, so it is important to see each other clearly.
- Don't sit underneath an overhead light (this causes shadows on your face).
Read 12 tweets
1/ Mechanism: Lung + Brain Injury in #COVID19:
In the ICU w/ #COVID we are dealing w/ SEPSIS & ARDS…most of what goes wrong in the human body when it’s infected with SARS-CoV-2 virus is mediated by…

read on...
#medtwitter #medstudenttwitter #pulmcc #tipsfornewdocs #meded
2/ Injury from SARS-CoV-2 virus is mediated by how much swelling (inflammation) and blood flow abnormalities (clotting and bleeding) occur, it’s wise to review what we know about SEPSIS, ARDS, & the BRAIN.
3/ Lung pathology affect parallel disturbances in the brain (& liver) via endotoxin, TNF, hypoxemia, shock & coagulopathy, metabolic derangements, & medical therapy such as the mechanical ventilator itself & sedatives & analgesics.
Read 8 tweets
1/ What do #racism & #redlining have to do with inequities in #HIV outcomes?

Our new study just published in #ClinInfectDis examines neighborhood deprivation, race/ethnicity, and HIV viral suppression. Thread 👇🏾

#MedTwitter #MedStudentTwitter #IDTwitter… ACCEPTED MANUSCRIPT "Neighborhood Deprivation and Racia
2/ #Redlining in the 1930s involved racialized federal mapping of housing "desirability" (L) --> ⬆️💰 into White/affluent areas + systematic disinvestment in "undesirable" areas.

To this day, HOLC maps of urban areas like Omaha STILL align w/deprivation & racial segregation (R). An official U.S. Home Owners Loan Corporation (HOLC) map of Area Deprivation Index (ADI) map of the Greater Omaha Area, Racial Dot Map of Greater Omaha Area, demonstrating clear pr
3/ Omaha is among the most segregated U.S. cities. Our HIV clinic serves ~50% Black and Latinx pts, who disproportionately live in deprived neighborhoods.

We assessed neighborhood disadvantage using the ADI, outlined by @amyjhkind et al. in @NEJM.…
Read 8 tweets
As promised, here's the second installment of my #Derm101 series on the #dermatology physical exam and #morphology. A #tweetorial on:


#MedEd #FOAMEd #dermtwitter #medtwitter #medstudenttwitter pc:@dermnetnz
First off, if you haven't gone through the primary lesion #tweetorial yet, it's a good idea to start there. Here's the link:

As review, these are the different primary lesions👇
Secondary lesions are the changes that affect the primary lesion.

Say what? If a papule is scaly, the SCALE is the secondary lesion. If a plaque is crusty, the CRUST is the secondary lesion.

A question: What was the secondary lesion seen in the pic from the 1st tweet?
Read 16 tweets
Just how precious of a gift is the mentoring process for the mentor?


It's also:

In short, #mentoring is THE BEST.

#MedTwitter #MedStudentTwitter #MedEd
We hear about how mentoring is a bidirectional process.
This is not hyperbole. It’s very much been my experience.

#Mentoring students gives as much, if not more, to the mentor, as it gives the mentee.

The students I get to mentor inject me with life.

In a system that often can make you question your worth, contribution, ability, and unique talents, being able to have powerful and meaningful conversations with learners is such a precious gift.

Read 19 tweets
1/ We recently had a patient on service with B/l lower extremity edema with inflammation which was considered to be cellulitis and received antibiotics. This definitely made for some great teaching points as well as a rethink of the Dx.
#medtwitter #MedStudentTwitter #FOAMed
2/This was a great opportunity for a deep dive into domain of pseudocellulitides and this approach made the team reconsider the diagnosis especially since this was a bilateral process.
3/Bilateral cellulitis is exceedingly rare and most likely Dx for this patient was gravitational eczema AKA Stasis dermatitis AKA varicose eczema especially with the Hx of decomp. CHF.
The legs did exhibit calor, dolor, rubor, and tumor. Does this help with a Dx of cellulits ?
Read 9 tweets
#NeurologyMorningReport #NMR Case 65 #MedTwitter #NeuroTwitter Updates & Answers posted later today. Asking your help #MedEd #neurology #neurologyresident #neurologist #medstudent #NeurologyProud #MedStudentTwitter Join me in educating. Share your questions and knowledge.

1/ Image
Page - 25yo man, hx B cell ALL, ?seizure, now w/ AMS Please come to bedside
Admitted w/diarrhea & GI graft vs host disease
h/o ALL, multiple relapses including leptomeninges now in remission

What further information do you need? What are your 1st thoughts about what's going on?
See image for details of event and vital signs

Medications: tacrolimus, infliximab, remicade

3/ Image
Read 15 tweets
Medicine/Surgery/Academia have a race and gender problem. So what are we going to do about it? We're going to get comfortable with being uncomfortable. #MedTwitter #BlackMedTwitter #MedStudentTwitter #BlackintheIvory
Before we can even get into the issues within medicine, we need to address the idea that because we are medical professionals we are exempt from having to deal with the issues that often happen right outside our doors. i.e. injustice, discrimination, racism
My white coat does not protect me from being a Black woman in America. And my privilege to wear one has been accomplished in spite of a system that was built to stop me from wearing one. So for me the world outside my ivory tower and inside it are interchangeable.
Read 17 tweets
Hellooooo my friends throughout #MedTwitter and beyond!

My name is Harry (he/him) and I'll be your host for the next 24 hours as we take a journey through my experience with disability & activism in medicine and the FIRST DAY of our @NEJM Forum!

Endless thanks to Tricia 💞
Some norms/disclaimers:

💥 I am an M2 and these are my lived experiences. They do not represent the views of @HopkinsMedicine, @traependergrast, or @NUFeinbergMed.
💥 Abled or disabled, feel free to post questions/comments publicly or to DM me. I'll try to respond!!
I want to start out by saying that while some of this work can get heavy and I am certainly not immune to feeling frustrated, I derive SO much joy from talking and learning about this with all of you here on #MedTwitter and offline.

Let's have some fun!
Read 62 tweets
Let's get back to the basics. A #dermtwitter #tweetorial on:


My plan is to make a #Derm101 series on #morphology and the #skin exam, so this will be the first in that series of #medthreads.

#MedEd #FOAMEd #medtwitter #medstudenttwitter pc:@dermnetnz Image
Why are #dermatologists so obsessed with description?

Well, for us, morphology is everything. We start with the exam and take the history afterward based on the possible differential we've come up with!

So let's start simple. What was that lesion in the prior tweet?
That was a PATCH of vitiligo.

PATCHES are flat lesions >1 cm wide, whereas MACULES are flat lesions <1 cm wide! Check out photo #1 of perioral vitiligo where macules are coalescing into patches!

In #2, you can see both macules and patches in these Cafe au lait lesions. ImageImage
Read 12 tweets
1/ Patient-Physician Relationship: TEN POINTS
As a student & in training, I was told to keep a professional distance from patients, that getting to know them too well would backfire & cause stress if they should die.

#medtwitter #meded #medstudenttwitter #tipsfornewdocs #pulmcc Image
2/ Patient-Physician Relationship: Young Doc vs. Older Doc thoughts…

I heard these warnings & often people mistakenly, in my opinion, used Osler’s advice in his Aequanimitas address as a basis for this ‘sage’ counsel. This meant my patients were victims of my “standoffishness.”
3/ Patient-Physician Relationship: Young Doc vs. Older Doc thoughts…

Later, once I sensed something missing in my service to my patients as their physician, I went back to what I’d learned reading Martin Buber & his brilliant “I-thou” (think “I-you”) treatise on relationships.
Read 10 tweets
Questions to ask on your virtual #residency interview (a thread with anxious #medstudenttwitter) in mind. This recruitment season looks incredibly different and it's had to get a good sense of a place/people/program without that in person experience. These questions may help!
1) What would you describe the focus of this residency program to be? // I used this question on my interview cycle. It's helpful to hear the first word/concept brought up by people in the program. How does the PD's response compare to interns & residents? Ask: everyone.
2) What changes do you anticipate for the residency in the next few years? // I also used this question and it's helpful to get a sense of how the program (anticipates) it will change. Do they plan to grow? Are they revamping their educational curriculum? Ask: leadership.
Read 14 tweets
1/ of 13:
QOL & #Disability: NYTs Classic

PRO TIP: do NOT project onto a person her Quality of Life. Ask & learn instead!

@benmattlin w/ incurable spinal muscular atrophy writes beautifully:

“I never walked or stood on my own.” Read on...

#MedTwitter Image
2/ Mattlin: For people like us, simply enduring can feel like a tremendous victory. One bad cold, though, could spell our end. If our lungs fill with phlegm, we lack the muscle strength to cough them clear. Pneumonia is common.

#MedStudentTwitter #meded
3/ Mattlin: It’s not generally acceptable in my segment of disability community to harp on our defenselessness. Rather, the idea is to assert core competencies, to distance ourselves from the Jerry’s Kids’ model and anything else remotely pitiful.

#TipsForNewDocs #tipsforolddocs
Read 13 tweets
43yr chronic #alcohol user on Liv.52 #Herbal supplement for 1yr. Believes Liv52='hepatoprotective'. Consumes along with to cancel alcohol-toxicity. Diabetes uncontrolled on #Ayurveda. Comes with #jaundice, severe #headache, eyes 'bulged' 2 days, nasal discharge #livertwitter Image
At admission, #seizures, uncontrolled, put on #ventilator. Deep jaundice, comatose. Investigations=acute on #chronic liver failure #aclf
#MRI Brain Part 1👇
Extensive hemorrhagic infarcts, almost all of anterior and mid #brain.
#medicine #MedTwitter #radiology Image
MRI Brain Part 2👇
Both sides cortical venous thrombosis and anterior third of superior saggitsl sinus thrombus.
#imaging #stroke #NeuroTwitter #neurology #NeuroTwitterNetwork Image
Read 5 tweets
1/15: #MedTwitter: You are admitting a 50-year-old man with a hx GI bleed for a PE. You start a heparin drip. What do you titrate the drip to?
2/15: At my institution, heparin anti-Xa levels (HAL) are recommended, but we routinely draw both aPTT and HAL. I’ve always wondered WHY?

There’s also the page: “The aPTT is supra-therapeutic but the HAL is therapeutic, which should we use?”

Let’s de-mystify this!
3/15: First, let’s understand unfractionated heparin (UFH).

UFH is a negatively charged, heterogenous mix of oligosaccharides. Heparin MUST bind antithrombin (AT) to have an anticoagulant effect. AT then inhibits Xa, thrombin (II), and other proteases.
Read 16 tweets
Where do you pray at work?

I’ve been thinking about this FAQ a lot lately. I recently instinctively answered it with my call room/office of course. But then I realized that wasn’t always the case.
One of our interns this year is Muslim. I casually told him I was going upstairs to pray and his eyes lit up.

“How, where do you do that?”

This is when I realized that my prayers were one of the things I had to sacrifice in the past.
As a medical student, resident, fellow, we didn’t have a designated call room or office. We shared with everyone. There was no area to call our own or find some alone time, let alone perform our daily prayers as Muslims.

I never felt empowered enough to ask for space.
Read 7 tweets
1/ Today I was asked by #ATS forum: “Are antipsychotics ever indicated for #delirium in ICU patients?”

My reply: “YES, to control hyperactive delirium symptoms to avoid respiratory suppression...👀 example...

#MedTwitter #MedEd #MedStudentTwitter #pulmcc #TipsForNewDocs
2/ HYPERACTIVE DELIRIUM & antipsychotics

Answer cont: For example, in a patient with CHF or COPD who needs BIPAP to avoid intubation but has marginal BP and HR so perhaps can’t tolerate an alpha-2 agonist. In such patients, antipsychotics might be just the right medication...
3/ HYPERACTIVE DELIRIUM & antipsychotics

Answer help patient get over claustrophobia of CPAP mask. This approach is fine as long AS LONG AS we know we are NOT reducing delirium, rather converting positive sympt of anxiety/delirium into calm toleration of resp support.
Read 5 tweets
Sorry to burst your bubble but NOT #Ayurvedic contribution

- identified by Jesuit Priests - isolated by Pelletier & Caventou (French Pharmacologists)
- isolated by Hans Andersag (German Scientist)
#MedTwitter #MedStudentTwitter
📌Reserpine (old world blood pressure drug) - identified in Rauwolfia serpentina in South Asia by botanist Rumpf of Dutch East-India Company, isolation by Műller, Schlittler & Bein (Germany)

➡️ In India isolated earlier by Bose&Sen, modern scientists -for psychosis treatment
📌Artemisin -from Traditional Chinese Medicine - isolated by modern medicine trained Chinese Pharmacologist Tu-Youyu

📌Metformin(diabetes drug) -from Galega officinalis[French Lilac], from European Folklore, isolated and improved -Muller&Reinwein,Germany & Leclerc,France
Read 8 tweets
Hey #MedStudentTwitter, I am on inpatient nephrology consults for the next month and wanted to share some of the teaching pearls I learn each day. So, I decided to start this threat! I will add more every couple of days.

Hope y’all find it helpful!
Teaching point 1:

When documenting the dialysis plan, nephrologists like the following to be included:

(1) nephrologist managing their outpatient dialysis, (2) dialysis center, (3) dialysis schedule and duration of each session, (4) estimated dry weight and goal weight.
Teaching point 2:

In patients with AKI, FENa really only matters if they are oligiric (UOP < 400 mL), otherwise it’s essentially useless.

If a patient with oligiric AKI is on diuretics (loops or HCTZ) then FENa will be falsely elevated. FEUrea is preferred here.
Read 16 tweets

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