@medics_AbuSaif

@medics_AbuSaif

Lea Alhilali, MD

@teachplaygrub

1/Do radiologists sound like they are speaking a different language when they talk about MRI? T1 shortening what? T2 prolongation who?

Here’s a translation w/a #tweetorial introduction to MRI.

#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #ASNR23 #neurosurgery

2/When it comes to bread and butter neuroimaging—MRI is definitely the butter. Butter makes everything taste better and packs a lot of calories. MRI can add so much information to a case

3/In fact, if CT is a looking glass into the brain—MRI is a microscope. It can tell us so much more about the brain and pathology that affects the brain.

So let’s talk about the basic sequences that make up an MRI and what they can show us.

Read 22 tweets

Christopher Carrubba, MD

@cjcarrubbaMD

Thoughts on #endometriosis from the perspective of medical education 🧵

USMLE and shelf examinations make endo seem super easy. It’s a young woman with pelvic pain & some combo of infertility, dyspareunia, and dyschezia

Throw some OCPs at the problem and boom, case closed

Students don’t talk about endo as a cause of urinary symptoms. Many have it on their list as a cause of heavy abnormal bleeding.

Most have no idea that MRI is useful for diagnosis and few know when to refer for surgery or how to manage patients after surgery

Read 7 tweets

Top Biomedical Science

@imedverse

What is the Diagnosis?

#TipsForNewDocs #MedEd #MedTwitter #medicine #medical #medicare #health #healthcare #FOAMed #ClinicalPearl #clinicaltips #MedStudents

19yo woman who was 34 weeks pregnant presented to the emergency department with a 3-day history of abdominal pain. Physical examination revealed hyperpigmented macules on her lips and CT scan showed intussusception.

The diagnosis was Peutz–Jeghers syndrome

Read 5 tweets

Top Biomedical Science

@imedverse

Beautiful anatomy graphics from @medics_AbuSaif

#TipsForNewDocs #MedEd #MedTwitter #medicine #medical #medicare #health #healthcare #FOAMed #ClinicalPearl #clinicaltips #MedStudents #anatomy

Read 24 tweets

Dr Ram's Dermatology

@manojramMD

QuizTime 10

35 yr F
Slight itchy/mostly asymptomatic lesions
Scaling+/-
Present on face back chest
Sun exposed areas
>1yr duration

Dx ?
#MedTwitter #dermatology #dermtwitter #MedEd #usmle #NEET #FOAMed #Medstudent #health #education

Chronic Cutaneous Lupus Erythematosus/Classic DLE

Begin as red-purple macules, papules, or small plaques Rapidly develop a hyperkeratotic surface
Early classic DLE- sharply demarcated, coin-shaped (i.e., discoid) erythematous plaques covered by a prominent, adherent scale+

Typically expand with erythema and hyperpigmentation at the periphery
Leaving hallmark atrophic central scarring/telangiectasia/hypopigmentation

Read 4 tweets

Osler

@oslertech

Are you a #juniordoctor or #medstudent?

Here's 10 great FREE modules to help get you started on the wards!

#meded #medschool #tipsfornewdocs #juniordocs #FOAMed #medtwitter #medstudenttwitter #juniordoctors #medstudents

Occasionally you'll need to perform sterile procedures. Make sure you prepare the best you can

osler.app.link/CztXIRjyntb

Providing basic life support is a core skill for all healthcare staff

osler.app.link/u4fe8uqyntb

#basiclifesupport #bls #FOAMresus #resuscitation

Read 13 tweets

EKGDX

@ekgdx

1/ Let’s talk about the ST segment #CardioTwitter.

ST segment normally represents the interval between ventricular depolarization and repolarization.

Normal ST

✅ Usually isolectric or may vary from 0.5 mm below to 1 mm above isolectric line in L leads.

#ekgdx #Medicine

2/ ST elevation (STE)

ST changes suggesting myocardial injury:

✅ New STE ≥1 mm in all leads other than V2 or V3.
✅ New STE in V2-V3 ≥2 mm in men older than 40 years old and ≥2.5 mm in men younger than 40 years old or ≥1.5 mm in women.

#ekgdx #Medstudent #MedTwitter

3/ Types of ST segment elevation include:

✅ Convex Upward (previous pic)
✅ Horizontal (this one)
✅ Concave Upward (see next)
✅ Obliquely Straight (see next)

#ekgdx #st #MedTwitter #ecg #ekg #CardioTwitter #Medstudent

Read 9 tweets

Lea Alhilali, MD

@teachplaygrub

1/They say form follows function! Brain #MRI anatomy is best understood in terms of both form & function

A #tweetorial on how to remember important functional #brain #anatomy

#meded #medtwitter #neurosurgery #neurology #neurorad #FOAMed #FOAMrad #radiology #medstudent #radres

2/Let’s start at the top. At the vertex is the superior frontal gyrus. This is easy to remember, bc it’s at the top—and being at the top is superior. It’s like the superior king at the top of the vertex.

3/It is also easy to recognize on imaging. It looks like a big thumb pointing straight up out of the brain. I always look for that thumbs up when I am looking for the superior frontal gyrus (SFG)

Read 12 tweets

Lea Alhilali, MD

@teachplaygrub

1/One important aspect to stroke care is well... ASPECTS.😂

Here’s a #tweetorial to help you remember this basic #STROKE scoring system

#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radiology #radres #neurology #Neurosurgery #CT #meded #neurotwitter

2/ASPECTS stands for “Alberta Stroke Program Early CT Score.” It is meant to replace gestalt-ing what percent of the MCA territory is infarcted. Instead, it uses a 10-pt score to semi-quantitate the amount of infarcted tissue in the MCA territory on non-contrast head CT

3/You can think of it as a scorecard for the MCA.

For each region of MCA territory NOT infarcted, the pt gets one point

So the highest score possible is 10, and lowest score possible is 0

Read 18 tweets

Lea Alhilali, MD

@teachplaygrub

1/Does PTERYGOPALATINE FOSSA anatomy feel as confusing as its spelling?Does it seem to have as many openings as letters in its name?

Let this #tweetorial on PPF #anatomy help you out

#meded #medtwitter #FOAMed #FOAMrad #medstudent #neurosurgery #neurology #neurorad #headandneck

2/The PPF is a crossroads between the skullbase & the extracranial head and neck. There are 4 main regions that meet here. The skullbase itself posteriorly, the nasal cavity medially, the infratemporal fossa laterally, and the orbit anteriorly.

3/At its most basic, you can think of the PPF as a room with 4 doors opening to each of these regions: one posteriorly to the skullbase, one medially to the nasal cavity, one laterally to the infratemporal fossa, and one anteriorly to the orbit

Read 18 tweets

Lea Alhilali, MD

@teachplaygrub

1/Frontal sinus fractures are a headache! Knowing what's important about these fractures is important to any trauma CT report

Here’s a #tweetorial to help you remember & understand these critical fractures

#meded #medstudent #radres #neurorad #HNrad #FOAMed #FOAMrad #medtwitter

2/Calvarium & sinuses act as important protectors of your intracranial contents, most importantly, your brain. They are like a built in helmet to protect you from linebackers of life

3/The sinuses are actually even better than a helmet. They are like the crumple zone of a car, but for your brain. They can be crushed inwards, absorbing energy and keeping it from impacting your brain

Read 14 tweets

Lea Alhilali, MD

@teachplaygrub

1/When it comes to brachial plexus pathology, you shouldn’t have to wing it! A #tweetorial to help you figure out #brachialplexus injuries
#medtwitter #meded #neurosurgery #orthotwitter #orthopedics #neurorad #radres #medstudent #FOAMed #FOAMrad #spine #radiology #neurotwitter

2/When it comes to brachial plexus injuries, the most important distinction to make is whether it is a pre or post ganglionic injury. Pre ganglionic injuries are nerve root avulsions from the spinal cord and cannot be repaired, while most post ganglionic injuries can be repaired

3/It’s like repairing a house. If there’s a structural flaw at the beginning, before you’ve even built it, you won’t even try to build it, you’ll just scrap the design (preganglionic). But if there’s damage after the house is built, you can salvage it w/repair (postganglionic)

Read 16 tweets

Lea Alhilali, MD

@teachplaygrub

1/Ready for some heavy lifting? My second #tweetorial on the BRACHIAL PLEXUS! This time we cover how the #brachialplexus looks on #MRI.

#medtwitter #meded #neurosurgery #orthotwitter #orthopedics #neurorad #radres #medstudent #FOAMed #FOAMrad #spine #radiology #neurotwitter

2/Brachial plexus is how the cervical nerves reach the arm. In the coronal plane, it looks like a slide, guiding nerves downward. Bc nerves are traveling laterally, sagittal MRI plane is our plane of choice to cut the nerves in cross section & see down the barrel of the nerves

https://twitter.com/teachplaygrub/status/1575941184278581250

3/But it’s more than a slide, it’s a complex highway, w/nerves joining & dividing—like highway off ramps & on ramps. If you want to know more about this intrinsic anatomy, see my first brachial plexus tweetorial here:

https://twitter.com/teachplaygrub/status/1575941184278581250

Read 18 tweets

Lea Alhilali, MD

@teachplaygrub

1/Raise your hand if you’re confused by the BRACHIAL PLEXUS! I could never quite remember or understand it—but now I do & I’ll show you how
A #tweetorial on #brachialplexus #anatomy!
#medtwitter #meded #neurosurgery #orthotwitter #orthopedics #neurorad #radres #medstudent #FOAMed

2/Everyone has a mnemonic to remember brachial plexus anatomy. I’m a radiologist, so I remember one about Rad Techs. But just remembering the names & their order isn’t enough. That is just the starting point--let’s really understand it

3/From the mnemonic, we start with the roots—the cervical nerve roots. I remember which roots make up the brachial plexus by remembering that it supplies the hand. You have 5 fingers on your hand so we start with C5 & we take 5 nerve roots (C5-T1).

Read 21 tweets

Lea Alhilali, MD

@teachplaygrub

1/Need help reading spine imaging? I’ve got your back!
A #tweetorial about the ABCs of reading spine MRs & CTs.
#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radres #neurosurgery #spine #orthopedics @medtweetorials @stefantigges

2/A is for alignment. Normal spinal alignment is perfectly in balance, resulting in the minimal energy needed for erect posture. Even subtle changes in alignment need compensatory changes to maintain posture, resulting in more work/energy expenditure & pain.

3/The goals for alignment on imaging: (1) look for unstable injuries & (2) look for malalignment that causes early degenerative change. Abnormal motion causes spinal elements to abnormally move against each other, like grinding teeth wears down teeth—this wears down the spine

Read 19 tweets

Lea Alhilali, MD

@teachplaygrub

1/Don't fall for the siren song of calling all bright round objects at foramen of Monro colloid cysts. Like a true siren song, this may be a trap!
A🧵about lesions in this region that can trap you
#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #meded #Neurosurgery

2/Here are 3 lesions, all round and bright and in the region of the foramen of Monro. Can you tell from the images which is a colloid cyst and which may be something else? Choose which one or ones you think are a colloid cyst

Choose which one you think is a colloid cyst

Read 13 tweets

Lea Alhilali, MD

@teachplaygrub

1/Controversy in radiology gets tense! The Mt Fuji sign for tension pneumocephalus is under scrutiny.When should you call it?
A #tweetorial about #imaging this important #neurosurgery complication
#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #meded #neurotwitter

2/Some believe that the peaked, mountain like appearance of the frontal lobes is a critical sign of a life-threatening complication & should be called & reported. Others believe it is too non-specific, is commonly seen when there isn’t tension & should be retired. Who’s right?

3/First, let’s clarify about what the Mt Fuji sign actually is. Most are familiar with the fact that large collections of pneumocephalus can compress the frontal lobes—making them look like the slopes of a mountain. But this isn’t actually enough to call Mt Fuji.

Read 12 tweets

Lea Alhilali, MD

@teachplaygrub

1/Talk about going for the jugular! A 🧵 about a case I never thought I would never be lucky enough to see & the largest IJ I’ve ever come across!
#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #neurosurgery #meded #neurotwitter #radiology

2/A “syndromic appearing” young adult pt who was a poor historian & could not specify any prior diagnosis, p/w left neck swelling. On CTA, calling the IJ supersized would have been an understatement

3/Posterior to the IJ was a tangle of vessels, but no identifiable soft tissue mass, concerning for a vascular malformation. Catheter angiography showed a Jackson Pollack painting appearance of tangled vessels consistent with an AVM

Read 9 tweets

Lea Alhilali, MD

@teachplaygrub

@MedTweetorials

1/Does trying to figure out cochlear anatomy cause your head to spiral? Hungry for some help?
Here’s a #tweetorial to help you untwist cochlear CT anatomy w/food analogies!
#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radres
@MedTweetorials #HNrad

2/On axial temporal bone CT, you cannot see the whole cochlea at once. So let’s start at the bottom. The first thing you come to is the basal turn of the cochlea (makes sense, basal=bottom). On axial images, it looks like a banana. I remember both Basal and Banana start w/B.

3/As you move up to the next slice, you start to see the upper turns of the cochlea coming in above the basal turn. They look like a stack of pancakes. Pancakes are the heart of any breakfast, so they are at the heart or middle of the cochlea on imaging.

Read 9 tweets

EM Pearl

@PearloftheWeek

Today's pearl is about Salicylate☠️!

Toxicity is most often seen with acetylsalicylic acid (Aspirin), but also methyl salicylate (Oil of Wintergreen- 5 mL = 22 aspirin), bismuth subsalicylate (Pepto-Bismol), teething gels, & headache preparations (BC Powder) ingestion
🧵1/11

- Mechanism of Action:
Uncouples oxidative phosphorylation & ↑Renal NaHCO3 excretion➡️AG Metabolic Acidosis
Stimulates medullary 🫁 drive ➡️ 1° respiratory alkalosis

- Clinical: Tinnitus, N/V, Tachypnea/Hyperpnea, AMS & Hyperthermia (late)➡️⚠️RAPID DECOMPENSATION
🧵2/11

- Labs: Order at minimum BMP, HFP, VBG, Salicylate /APAP lvl, EOTH, UA,EKG
Salicylate Lvls:
Acute Tox:
15 - 30 mg/dl = therapeutic range
>30 mg/dl = symptoms begin
> 90-100 mg/dl = severe toxicity
Chronic Tox:
40-60 mg/dl = severe toxicity
🧵3/11

Read 12 tweets

Lea Alhilali, MD

@teachplaygrub

1/"You can put this diagnosis in the differential as many times as you want in your life, but you will only be right once," I told my fellow.
A🧵about a dx you hear about but are rarely lucky enough to see #medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres #neurosurgery

2/Pt had a calcified lesion in the posterior fossa found incidentally on a trauma CT, that was now enlarging. It had very coarse, stippled appearing calcifications, like grains of sand or dirt

3/It also had very jagged, irregular margins, almost as if the grains of calcium had just been piled up together haphazardly

Read 6 tweets

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