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Join me for a #dermtwitter #tweetorial on:


#MedEd #FOAMEd #medstudenttwitter #MedTwitter

Let's start ourselves off with a question: Which one of the following conditions will lead to scarring?
The correct answer is Pyoderma Gangrenosum! This illustrates a quick first point - scarring only occurs if you damage the skin into dermis and beyond. Epidermal damage heals without scarring, which is why the first 3 don't lead to scarring!
So what exactly is a scar?

Scarring is a normal part of healing that at its root, is extra collagen laid down to repair skin injury.

However, sometimes the process gets out of hand and exuberant which leads to hypertrophic scars (pic 1) keloids (pic 2)!
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The Medicare DIS-Advantage Plans...
Many seniors are being lured into Medicare Advantage Plans due to the added benefits of hearing, dental, and gym membership coverage. Image
These plans are actually run by private insurers and actually quite profitable for insurance companies with profit margins of 5% or greater (industry average is 4%)…
Further these plans have the added problems of:
1) Narrow Networks - in fact, many of the most prestigious cancer centers in the country are excluded from these plans. Oddly enough 60% of Cancer diagnoses are in Medicare aged individuals...…
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Hi #dermtwitter/#medtwitter! Our last (for now!) #tweetorial/#medthread on nails! This time it’s...


Education from @naildisorders and the @jmervak team!

@societypedsderm @PeDRAResearch #medstudenttwitter #medtwitter #meded #FOAMed
Beau’s lines (transverse ridge) and onychomadesis (nail shedding) common in kids! Often seen in a post-viral setting.

Common culprit = hand foot mouth disease!
Congenital malalignment of the great toenails – lateral deviation of the first toenails. More common than you think. Start looking at more toes and you’ll see it! Can improve with time or persist. Risk for nail thickening or ingrown nails.

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Join me for a quick #tweetorial/#medthread on:

Pearls for the #Dermatology Exam!

#MedEd #dermtwitter #medtwitter #medstudenttwitter #FOAMed

First a question - What do you think when someone asks for your help with a rash?
Regardless how you answered, I hope to teach you something today! Let's start!

"In #dermatology, we don't do an H+P, we do a P+H."

The exam is perhaps most important. You can use it to narrow down your ddx! Then, you use your history to further work toward the right dx.
"If there's scale, there probably is epidermal involvement."

Scale usually implies action in the epidermis. This doesn't rule out anything in the dermis or subcutis, but just that the pathology includes action up top.

Check out my #tweetorial on scale
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Hi #dermtwitter! Back for another #tweetorial/#medthread on nails! Today we’re learning about:

ONYCHOMYCOSIS- nail fungus!
This is THE most common nail condition- so follow along!
Education from @naildisorders
#medstudenttwitter #medtwitter #meded #FOAMed
Onychomycosis is more common in adults than kids.
Trauma, diabetes, immunosuppression, tinea pedis, psoriasis, and family history are some risk factors

Pro tip- check the feet for tinea pedis if you suspect onychomycosis!

Patients with onychomycosis present with nail discoloration (yellow to brown), onycholysis (nail separation), nail brittleness, or nail thickening.

The big toenail is most frequently affected.

Fingernail involvement without also have toenail involvement is uncommon.
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1/ “Let’s hear about this patient at the bedside.”

As an educator or learner, does this sentence make you tachycardic??

It’s another #TweetorialTuesday from the @MedEdTwagTeam! #MedTwitter #MedEd #MedStudentTwitter #Tweetorial #FacDev
2/ We are still covering the foundations of inpatient teaching.

This week, we will focus on general strategies to incorporate bedside teaching effectively into your inpatient teaching tool box!
3/ First, there are many benefits to teaching @ the bedside for learners, educators, & patients alike.

See articles:
⚡️@DanielRicottaMD TWDFNR @JHospMedicine:

⚡️@OlleTenCate Review on Bedside Teaching /
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Tip #1: Be thoughtful of your background.

Plain backgrounds are a fairly common choice. Pick a color that allows you to stand out (and not blend into the wall). I don’t recommend virtual backgrounds because of the associated lag and cutting out parts of your body with motion.
You can also have things in the background, but be prepared to talk about them. I had artwork with a favorite quote and a medal from my first half marathon behind me, and both came up in conversation. The rest of the wall behind me was light-colored and blank.
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Hi #dermtwitter! I'm working with @jmervak et al, who put together this amazing #tweetorial on


Specifically, findings in the setting of systemic diseases: let nails help your diagnosis!

Coordinated with @naildisorders

#medstudenttwitter #medtwitter #meded #FOAMed
First things first, do you mind telling us who you are?
3/Let's begin: Beau’s lines! Transverse depression across the nail. Means the nail briefly stopped growing and started again.

Seen weeks after nail injury! Or, if it's seen on multiple nails, ask about febrile illness (like post #covid19) or stressors like SJS or chemotherapy.
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The pupils can constrict (miosis) and dilate (mydriasis)
Mydriasis = bigger word = bigger pupil.

Constriction is a PARASYMPATHETIC function (tiny relaxed happy pupils)

Dilation is a SYMPATHETIC function (eyes wide with fear)
Pupils constrict in response to LIGHT and NEAR

Pupils dilate in response to DARKNESS and ADRENERGIC TONE

Drugs can also affect the pupils as can prior trauma/surgery
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How to answer one of the most common interview openers: “tell me about yourself” @Inside_TheMatch @futureradres #futureradres #MedStudentTwitter #MedTwitter - a thread 1/
1. Start wherever you want that resonates with you. Want to start with your upbringing? Your medical career? Where you were born? Whatever will help you tell YOUR story. There is no right or wrong as long as everything you say has a purpose. 2/
2. Make sure you tie in your passions. Tell us how you started becoming interested them along the way. Where did you pick up x,y,x skills or projects? Make sure you discuss the things that are exemplified on your app. 3/
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Dear Student Doctors and Unmatched grads, DO NOT allow yourselves to be used as free labor by any medical institution or facility. You are not indentured servants who are required to put your lives at risk for the business of medicine. If they want you to work as
2)medical or nursing assistants, they should pay you as such. Do not agree to work as RNs because you are not. RNs are a specialized discipline and trained accordingly. They are in demand and being paid their worth...finally. They deserve it. However, the powers that be don't
3)want to pay. If you work for free, they can attempt to use nurses less just to get by and save money. Don't do it. It harms you, it harms the patients and it disrespects the nurses who deserve every f***ing cent they get paid. If the facility is short-staffed, that is an
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Today we are featuring ✨University of Florida Neurology✨

Program: University of Florida (@UFNeuroRes)
Location: Gainesville, Florida

Check out this 🧵 to learn more!
#NeuroTwitter #Match2022 #NeuroMatch
2/ 📍What we look for (1/2):
📍We conduct a holistic review to find candidates with inherent curiosity for learning and a passion to serve neurological patients. As our chair Dr. Okun says - “the patient is the sun and we orbit around them”.
2/ 📍What we look for (2/2):
A team-focused attitude is also key, as we have a great group of residents and faculty who all support one another.
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Today we are featuring ✨ University of Chicago Neurology✨ @NeuroUcmc

Location: Chicago, Illinois

Check out this 🧵 to learn more!
#NeuroTwitter #Match2022 #NeuroMatch
2/ What we look for: (1/2)
📍 We look for applicants from diverse backgrounds that are passionate, motivated, and kind-hearted. One of our goals is to mold all of our residents into leaders in the field.
2/ What we look for: (2/3)
📍In addition, we take great pride in the fact that our residents work with an underserved population. Our residency stresses the importance of understanding our patients, their circumstances…
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Program: University of Wisconsin
Location: Madison, WI
Twitter: @UW_Neurology Image
2/ What we look for (1/2):
📍Attitude is more important than test scores!
📍We want to recruit good people who are going to bring a positive attitude and work to enhance our patients' care, engage in learning, and support their colleagues.
3/ What we look for (2/2):
...In return, we'll treat you with respect and help you become the best neurologist you can be! Image
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Today we are featuring ✨UT Houston Neurology✨

Program: UT Houston Neurology
Location: Houston, TX
Twitter: @UthoustonR
Instagram: @uth.neuro.residents

#NeuroTwitter #Match2022 #NeuroMatch Image
2/ What we look for (1/2):
📍Our residents thrive because they love spending time with each other and our faculty, are great team players, and enjoy a good work life balance. Image
2/ What we look for (2/2):
📍If you are passionate about neurology, hardworking, and envision yourself contributing to the field, either locally in Houston, nationally, or globally, consider training with us! Image
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📢📢 The supplemental @ERASinfo application is open!

I shared details about the application in a prior thread. A few other points & tips for #Match2022 #medstudenttwitter whether you're applying in #dermatology #internalmedicine or #GenSurgMatch2022.

Applicants will be invited to complete the supplemental application once they save a participating program in any of the 3 specialties in MyERAS.

‼️ There is a 24 hour delay between saving a program and receiving the invite. So, get saving if you haven't yet!
The supplemental app is now optional for ALL participating programs in the 3 specialties. All ?? are also optional.

I recommend you complete it. Why? I (& many others) feel this can only help applicants by allowing you to highlight unique qualities & prefs. 3/
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1/9 #Morningreport recently @SinaiBmoreIMRes
by M. Thomas featured a middle aged pt presenting with sudden collapse whilst getting ready in the morning.
No prodromal episodes
#DDx ?
#MedTwitter #MedStudentTwitter #FOAMed
For acute collapse, this would need to be defined along the spectrum of:
Pre-syncope-> Syncope-> Near SCD-> SCD.
A quick review of medications show multiple medications that can present with this condition:
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Hi #medtwitter #neurotwitter #medstudenttwitter #meded #FOAMed

It's been too long since my last #EndNeurophobia #tweetorial. As requested by @sukritibanthiya here is a tweetorial on MUSCLE DISEASE (MYOPATHY)

Let me know what you think and what I should cover next!
Classic pattern of weakness in myopathy is PROXIMAL symmetric weakness of the limbs, though there are exceptions.

There should be NO sensory findings (unless there is concurrent neuropathy) and reflexes are often spared until the patient is extremely weak.
Difficulty rising from a chair (hip girdle musculature), washing hair (shoulder girdle musculature)

CK is often elevated but not always

EMG can demonstrate myopathic pattern (though can be normal eg statin myopathy)

Definitive Dx may require muscle biopsy and/or genetic test
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"Unfortunately, current numbers & trends indicate that “long-haul Covid” is our next public health disaster in the making. To understand the landscape, we can... apply the lessons of past failures in approaching postinfection chronic disease syndromes."…
#MedTwitter if you want to understand the landscape & better understand the next public health disaster, we can help you.

Want to learn more about ME/CFS mentioned in the @NEJM?

We have curated info for healthcare providers here:…

We know this is a rough time to be a healthcare provider with so much being asked of you. How about learning through a Sundance award winning documentary? @unrestfilm is on @netflix & medical education credits are available here:

#MedEd #MedTwitter
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1/3-BACK by request for NEW ICU TRAINEES!

💥 12 KEY TRIALS I teach on #ICU Rounds each week they must know!

Do you agree?
Any you would add?

1. ARDSNET @NEJM -PMID 10793162

2. LEUVEN Glucose 1 @NEJM-PMID 11794168

3. SAFE Trial @NEJM PMID: 15163774
#FOAMcc #medtwitter #MedEd
2/3 12 Key ICU TRIALS I teach each week continued…

4. TRICC Trial @NEJM PMID: 9971864

5. SOAP Vasopressor trial @NEJM PMID: 20200382


7. Rivers EGDT @NEJM PMID 11794169

8. VAAST Trial @NEJM PMID 18305265

9. SMART Fluids @NEJM PMID 29485925
💥 3/3 12 KEY ICU TRIALS I teach each week continued…


11. Schweickert Early Mobility @Lancet PMID19446324

12. ABC Trial @TheLancet PMID 18191684

What others would you add?

#FOAMcc #FOAMed #SCCMSoMe #medtwitter #MedEd #MedStudentTwitter
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Here we go! I'm excited to share a #tweetorial on how to prep for the upcoming virtual interview season.

#Match2022 #MedStudentTwitter #MedEd #dermtwitter

Your #tweetorial road map:
1. Set Up (to ring light or not to ring light)
2. Question Prep (!!)
3. General Advice (there will always be surprises, here's how to handle them)

Set Up pt 1: Background.

There are typically three main approaches to interview backgrounds. First, let's do a poll, what's the #MedTwitter favorite?

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1/9 Let’s say you are about to do a thyroid exam. Before the exam you do not suspect goiter (pre-test prob of 50%). How does the exam influence your probability? Let’s review some LRs from McGee!
#MedEd #FOAMed #MedTwitter #MedStudentTwitter #EndoTwitter @MedTweetorials
2/9 You may think “well that’s nice, but my thyroid exam technique is not the best.” Don’t worry, the Stanford 25 has got your back (including this clinical pearl)!…
3/9 Now that you’ve identified a goiter, you will probably end up ordering some lab and imaging studies. But don’t leave the bedside just yet! Let’s first break down the differential for an enlarged thyroid (thanks again to the Stanford 25).
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#MedTwitter, thanks for the feedback on . Here is an ADH/RAAS-oriented modified algorithm for hyponatremia!

I still enjoy teaching using volume status, but this method is fantastic!

#MedStudentTwitter #FOAMed #MedEd #NeuroTwitter #NephTwitter Image
Thanks to @ArisSikolas for catching an error. At the bottom, it should say "Urine Na <30 suggests RAAS is on. Urine Na >30 suggests RAAS is off."
Corrected version! Image
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1/7 Spacers confused me, so I wanted to sort them out. Let’s start with a question - what type of inhalers can benefit from a spacer?

#MedTwitter #FOAMed #MedEd #MedStudentTwitter #PulmTwitter
2/7 Metered dose inhaler (MDIs) are best used with a spacer! Pressurized devices were invented far earlier, but the technology was adapted to treat asthma in the form of an MDI in 1957 by Riker Labs.…
3/7 MDIs have various advantages and disadvantages, some of which can be mitigated by spacers.…
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