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A patient comes in with joint pain, fever, and the skin findings below. They recently finished a course of antibiotics.

Diagnosis? Name of the skin findings?

#dermtwitter #medtwitter #meded #FOAMed
Nice work everyone!

The skin findings are keratoderma blenorhagicum (KB) and erythema nodosum, both findings that support the diagnosis of reactive arthritis.

Remember this is a seronegative spondyloarthropathy, usually after a gu or gi infection. Think hla-b27.
As @ZachHopkinsMD points out, there are more skin findings, such as mucosal findings in the oropharynx and in the genital region, & dactylitis (📸 is from psoriasis).

Don’t forget the board exam mnemonic:

Can’t pee (urethritis)
Can’t see (uveitis)
Can’t climb a tree (arthritis)
Read 3 tweets
1/ Get ready for the second installment of my ICU #Flextorials 💪🏻 This thread focuses on ICU intubation. These #MedEd #Tweetorials are designed to help you get in procedure shape for fellowship and residency. Enjoy! #EmoryNCCTweetorials
2/ Warm up: Push ups
3/ Rush to the head of the bed to claim the intubation!
Read 12 tweets
It's overdue. Time for a #dermtwitter #tweetorial on...

SEZARY SYNDROME!

We're going to focus on presentation and work up!

#sezary #ctcl #medtwitter #onctwitter #meded #FOAMEd
1/
Just a few years ago, Sezary Syndrome (SS) was thought to be the leukemic variant of Mycosis Fungoides (MF). We basically thought people had MF, it would keep getting worse, and then it would turn into SS.

Check out my old #tweetorial on MF here👇
2/
But patients often present with either the classic SS exam (red all over, super itchy), or with MF. Some patients would progress from MF--> SS, but it's the minority. So it became clear these are two different processes.

For that reason, we've changed how we think about it...
3/
Read 17 tweets
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A 🧵to help you remember cervical radicular pain distributions #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5. Similarly, if you divide your arm in half at the elbow, you get 5--C5 that is! C5 radiates towards the elbow. So if it radiates below this, it is > C5 & above is < C5
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution
Read 9 tweets
📌How to design a brain 101🧠🏗️

A 🧵 on how I use @powerpoint to create illustrations

🎨Key tools and my 2 secret weapons:

-@gboulouis adding "advanced" stuff
-@MVarkanitsa reviewing every little detail

#MedTwitter #MedEd #NeuroTwitter #NeuroRad #Neurology #neuropath #FOAMed
This 🧵 is inspired by a great recent post from @teachplaygrub, since we are using similar methods and tools on #PowerPoint!

🛠️ The Basic Toolkit:
-curve function ➰
-edit points function✴️
-Layering 🃏
-Zooming (x300-400%) for details 🔍

🎨 colors, shadows, 3D effects etc., depends on individual's style

1/
Read 15 tweets
We all know that stress is bad for our hearts.⚠️❤️

But did you know there is actual evidence of this heart-brain connection on FDG PET/CT?

A #Tweetorial 🧵 #CardioTwitter #MedTwitter #MedEd
We know that the stress response begins in the 🧠 salience network - the AMYGDALA is a 🔑 component.

Activation of this network ⬆️ SNS output, which ⬆️ immune cell output from the bone marrow.

Amygdalar activity ⬆️ in chronic stress conditions e.g., PTSD, anxiety & depression.
In other words, chronic psychologic stress causes ⬆ activation of the amygdala which, in turn, activates systemic inflammation.
Read 18 tweets
1/ A new dx of cirrhosis…
Recurrence of cancer…
A Monday procedure is canceled & your pt waited since Friday…

We’re frequently the bearer of bad news in the hospital.

Today #MedEdTwagTeam shares tips on incorporating teaching when giving difficult news.

#MedTwitter #MedEd Image
2/ As a reminder, we are continuing our discussion inpatient teaching.

Last wk, we covered tips on teaching around family meetings:

This wk, we focus on teaching when delivering difficult news, which can also be done during rounds & routine patient care Image
3/ But 1st… what counts as “difficult news?” We often think of cancer or terminal illnesses.

But with the definition ⬇️ I think we can agree there are plenty of times when we may be delivering difficult news to patients without even identifying it as such. Image
Read 11 tweets
1/Like a bad piano player in a run down bar--I take requests! By popular demand, a🧵on how I make those illustrations for my #tweetorials--all in #PowerPoint!
This one shows how to create shadow & highlights to give a 3D effect
#medtwitter #MedEd #FOAMed #powerpointpresentation Image
2/Let's use this french fry illustration I used for my varices🧵
I use the curve function to create shapes. It has the most control for drawing--the freeform function causes uneven lines.
After drawing the shape, I use the shape fill function to fill it in it w/the color I need Image
3/ 3D effects begin w/the gradient fill. I use the gradient fill that powerpoint offers for my selected color--it knows how to chose them so that the gradient is smooth Image
Read 10 tweets
1/As my attending once said, “If I’ve seen it once, I’ve seen it…well once.”
A 🧵about an interesting case that I’ve seen once in 15 years and never again. #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #Neurosurgery #HNrad Image
2/Pt with history only of diabetes came in with altered mental status. There were these super bright round balls in their ventricles. It looked like a snowman massacre happened, with big round snowballs in the ventricles Image
3/On MRI, these had intrinsic T1 hyperintensity w/chemical shift artifact--they looked like boba tea pearls floating in the ventricles. Typically, we think of chemical shift w/fat--but these were not fat on the CT!! They did not enhance & otherwise, brain was unremarkable for age Image
Read 4 tweets
A 51-YO🧔‍♂️, in Turkey: dyspnea, cough & production of yellowish, foul-smelling, & salty sputum

XR & CT (A-D): cavitary lesion containing irregular, serpiginous intracavitary material
1/3

DOI: doi.org/10.4269/ajtmh.…
#IDTwitter #radiology
2nd day of hospitalization: fever, myalgia, & sore throat

CT: subpleural ground glass opacities (fig.)

PCR for #SARSCoV2:➕
Eosinophilia
IFA IgG against Echinococcus granulosus:➕at 1/5,120

RUPTURED PULMONARY HYDATIC CYST COMPLICATED BY COVID-19
2/3

#microbiology #MedEd
Gross examination showed removed cyst (fig.).

Surgery combined with medical therapy remains the standard form of treatment of large cysts with multiple daughter cysts, complicated cysts, etc.
3/3

#parasitology #surgery
Read 3 tweets
1/ Is the voice box a black box for you?! Let's open the pandora's box of the anatomy of the #larynx together

An introductory #tweetorial on laryngeal #anatomy and the supporting structures. #FOAMed #medtwitter #meded #neurorad #HNrad #FOAMrad #medstudenttwitter @MedTweetorials
2/Everyone needs some support. Just like the tongue is supported by the hyoid, the main laryngeal support is the cricoid cartilage. It's like your favorite chair, with all the remotes next to it--not only does the cricoid provide support, it also connects structures in the larynx
3/ Although not official, the cricoid is like the real first ring of the trachea. Except it has an odd signet ring shape. The bulbous back part that makes it look like a signet ring provides the important articulation with the arytenoids
Read 11 tweets
1/Mike Tyson once said, “Everyone has a plan until they get punched.”
In honor of all the great hooks and crosses—here is a #tweetorial about mandibular fxs! #FOAMed #medtwitter #Meded #neurorad #HNrad #FOAMrad #Medstudenttwitter @MedTweetorials Image
2/A key concept in these fxs is dental occlusion. The jaw is meant to chew. To crush food, teeth need to come as close together as possible—occlusion. Each tooth needs to meet up with its counterpart that fits with it, so no room is left for food—and food will be crushed. Image
3/Occlusion can be lost w/a fx. The importance of dental occlusion makes mandibular fxs different from other fxs. Usually, we want to fix a bone so that it lines up again. But for the mandible, we want to fix it so the TEETH line up again—so chewing will work. Image
Read 14 tweets
Acetaminophen Toxicity algorithm. Very helpful

#Meded #medtwitter #USMLE #MRCP #razausmlemnemonics
via @ibcc
Pathophysiology of acetaminophen toxicity
Rumack-Matthew Normogram used for acetaminophen toxicity
Read 3 tweets
A 26-YO👩‍🦰, sexually active: 1-month of right knee and metacarpal arthralgia, tenosynovitis & pustules on her hand, developed an enlarging chest wall mass.

CT: an abscess on her chest wall, requiring drainage.
1/4

DOI: doi.org/10.1503/cmaj.2…
#IDTwitter #MedEd Image
Urine gonococcal nucleic acid amplification test: ➕ was positive,
16S rRNA with gene sequencing of wall fluid:➕for Neisseria gonorrhoeae.

DISSEMINATED GONOCOCCAL INFECTION

Ceftriaxone IV stopped after the abscess had resolved
2/4

#MedicalStudents #microbiology
Neisseria gonorrhoeae is transmitted mainly through unprotected vaginal, anal and oral intercourse
3/4

#MedTwitter #MedStudentTwitter
Read 4 tweets
The emerging concept of fluid tolerance: A position paper
#MedEd #MedTwitter #AnestesioArmy #SMMCE @vm_aventho

1️⃣Respondedor a fluidos: pruebas para predecir dependencia cardiaca a precarga. Permite evaluar si esta intervención provoca ⬆️significativo en volumen sistólico.
2️⃣Sobrecarga de líquidos: ⬆️>10% de líquidos acumulados = dividiendo balance de líquidos acumulado / peso corporal inicial paciente x 100.

3️⃣Tolerancia a líquidos: grado en el que paciente puede tolerar la administración de líquidos sin causar disfunción orgánica.
⚠️Sistemas a evaluar para evaluar la sobrecarga de líquidos:

1️⃣Pulmonar: requerimientos de oxígeno, ultrasonido pulmonar (líneas B), derrames pleurales, presión de enclavamiento capilar pulmonar elevada o signos ecográficos de presión auricular izquierda elevada.
Read 6 tweets
Lactante 4 meses, dermatitis atópica, su hermana con laringitis aguda: erupción papulosa de evolución a costras en 1 día, predominando sobre placas de eccema preexistentes.

Se inician en el tronco, incluyen cabeza, área del pañal y vesículas en boca.
1/5

#pediatria #Pediatrics
PCR (para herpesvirus y enterovirus):➕para enterovirus Coxsackie A6

ECCEMA COXSAKIUM

El A6 produce también: erupción vesículo-bullosa erosiva, cuadro Gianotti-Crosti-like y rash purpúrico-petequial

✒️Martín A y col continuum.aeped.es/screens/play/5… @aepediatria #dermatology
2/5
@aepediatria El eccema coxsackium puede producir fiebre con pápulas, vesículas y costras confluyentes en región peribucal, cuello, tronco, antebrazos, pantorrillas y dorso de manos y pies.

Generalmente, una enfermedad autolimitada con buen pronóstico.
3/5

@ContinuumAEP #Pediatrics
Read 5 tweets
ICU/CCU/Pharmacy pearls: Adenosine is another one of my favorite drugs (again: no COI); who doesn’t want to walk into a patient’s ward room after a rapid response is called for a HR of 190/min, administer 6 mg of adenosine and head back to the ICU 10 min later leaving the patient
on SR 80/min and the ICU charge nurse relieved that she will not have to find a creative way to “open up” another ICU room. Adenosine push is one of the VERY FEW intensivists’ triumphant moves, so I will take it. Nevertheless, there are a few things about adenosine use
that I think are fun or good to know (there are probably more than few, I just don't know them!):
1. Adenosine is a natural substance formed by the degradation of adenosine triphosphate (ATP); yes, that ATP! So, in theory
Read 14 tweets
No one asked, but here’s a short 🧵about how I like to stay on top of “the literature” as an IM resident without getting overwhelmed. Geared mostly at rising interns -#MedTwitter #MedEd
The biggest challenge for a millennial like me is get all the abstracts into a format that’s at least almost as convenient and attention-grabbing as Reddit. The solution is an RSS feed reader app
There are many options and most are free. I spent a good amount of time using Feedly but have since switched to InoReader (inoreader.com) because I like the simplicity of the layout and features. Use whatever you like
Read 10 tweets
ATTENTION FACULTY:

If you collect student feedback on your course, please think hard about what you ask and how you ask it.

Otherwise, you’re wasting everyone’s time… or worse.

Some suggestions:

(a🧵)

#MedEd
ONLY SURVEY STUDENTS WHO PARTICIPATED.

These days, many students don’t go to class or use institutional resources. Like, at all.

Requiring these students to complete your course evaluation will only generate meaningless feedback for you - and waste their time. Let them opt out.
BE SURE STUDENTS CAN ANSWER THE QUESTIONS YOU’RE ASKING.

Students are well-positioned to comment upon, say, the instructor’s enthusiasm.

But they don’t know whether the concepts that were taught were the ones that *should* be taught.

You need to evaluate that another way.
Read 11 tweets
With Memorial Day behind us, we're getting into the summer months, so time for a #tweetorial on:

SUNSCREEN!

While #dermatologists are the usual ones who are making these recommendations, I hope this #dermtwitter/#medtwitter 🧵can help everyone!

#MedEd #FOAMEd #sunscreen
1/
First of all, I have no COIs with any makers of sunscreen! Even so, I'm going to avoid talking about any brands. Instead, we'll focus on the different factors you should consider when picking your favorite.

What is your current preference for sun protection (if any)?
2/
There's debate in the field right now about whether everyone even needs sunscreen. For this #tweetorial, I'm going to focus on those who've decided they need sun protection.

So 1st rec: The best sunscreen is one you'll actually put on. Doesn't matter if you won't use it!
3/
Read 18 tweets
1/14🧵 ⭐️ It’s a little late on a Monday but still time for a public service announcement about MAST CELL ACTIVATION SYNDROME (MCAS) ⭐️ If someone tells you it’s not real it’s because they lack knowledge…
2/ MCAS is when mast cells Ⓜ️ inappropriately release histamine and other chemicals resulting in multi-system symptoms. 🔥sometimes they release too much, sometimes at the wrong time. They get a little confused 😐
3/ we need mast cells- they are our first line of defence (innate immune system) and located in most systems in the body. If you are stung by a bee and it’s red and itchy- that’s histamine release from mast cells Ⓜ️
Read 16 tweets
Niña de 5 años, araña entre las sábanas (1): fiebre de 2 días y placa eritematosa indurada en muslo con crecimiento centrífugo y una escara necrótica central (2)
¼

✏️M. Sendín-Martín y col. @HospitalUVRocio
DOI: 10.1016/j.anpedi.2020.12.005
#pediatria #Pediatrics
@HospitalUVRocio PICADURA DE LA ARAÑA RECLUSA PARDA

Las arañas del género Loxosceles o arañas reclusas o arañas violinistas debido a la morfología dorsal de su cefalotórax tienen una distribución mundial

La lesión se resolvió los días siguientes, sin dejar cicatriz.
2/4

#MedEd #dermatology
@HospitalUVRocio Las arañas reclusas parda causan lesiones necróticas a través de una enzima denominada esfingomielinasa D1. Los síntomas sistémicos incluyen fiebre o náuseas.

De forma infrecuente, signos graves como coagulación vascular diseminada o la rabdomiólisis
3/4
#IDtwitter #MedTwitter
Read 5 tweets
1/10 We often talk about evaluation of AKI in the context of ⬆️ creatinine, but let’s take a step back and think about eGFRs. Here is an approach to interpreting ⬇️ in eGFR! #NephTwitter #MedTwitter #FOAMed #MedEd
2/ This differential focuses on the estimated GFR (eGFR), which is calculated using serum creatinine +/- serum cystatin C levels (we will take a look at the equations in a bit). Biomarkers that actually measure GFR (such as inulin) are not clinically practical to obtain.
3/ Thanks to @ZacNephron for explaining GFR vs eGFR, referring me to Chapter 2 of @BookBurton, and sharing this thread to deepen my understanding of the utility of GFR:
Read 11 tweets
🧵 1/8 Myocardial bridging is present when part of coronary artery dips into & underneath heart muscle. Let’s dig deeper. 📖
Educational thread 🧵 1/8
#MedEd #CardioEd #CardioTwitter #MedTwitter #radialfirst @JACCJournals @YoungDgk @DGK_org @AGIKinterv @CardioNerds @escardio
📍2/8 Myocardial bridging is a congenital coronary artery anomaly, in which a segment of the artery (tunnel segment) dips into the myocardium (myocardial bridge). https://doi.org/10.1253/circj.cj-10-1278
📍3/8 Methods of detection vary greatly in sensitivity.
Myocardial bridging is seen in

🥇30% of pts in autopsy
🥈20% of pts in coronary CT-scan
🥉5% of pts in coronary angiography
#CardioTwitter #MedTwitter #RadialFirst https://doi.org/10.1253/circj.cj-10-1278
Read 9 tweets

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