Discover and read the best of Twitter Threads about #Resident

Most recents (24)

A 5-YO♂️ with a history of IgA vasculitis & a pustular nasal lesions had started scabbing after 2 days of systemic glucocorticoids: progressively painful skin ulcerations of L forearm (A), R calf (B) & R foot (C).
1/4

DOI: 10.1056/NEJMicm2204111
#Pediatrics #dermatology Image
Biopsy samples from all three lesions showed a dense neutrophilic infiltrate with negative tissue cultures.

PYODERMA GANGRENOSUM
2/4

#MedTwitter #Doctor #MedStudentTwitter
Laboratory & radiographic: no signs of underlying systemic disease, such as cancer, inflammatory bowel disease, or autoimmune conditions.

After 8 months of glucocorticoids: the lesions resolved completely.
¾

#resident #pediatric #MedicalStudents
Read 4 tweets
A 17-MO♀️, Morocco: fever, pallor, epistaxis, gingival petechiae, lower limbsedema, & hepatosplenomegaly.

Pancytopenia, hypoalbunemia.
Triglyceridemia, ferritinemia, LDH & fibrinogen:⬆️
PT⬇️
Direct Coombs test:➕

🔬myelogram: ?
1/9

#parasitology #haematology #Pediatrics
Myelogram revealed the presence of leishmania bodies and figures of hemophagocytosis.

VISCERAL LEISHMANIASIS ASSOCIATED WITH MACROPHAGE ACTIVATION SYNDROME
2/9

doi.org/10.1016/j.idcr…
#Pathologists #microbiology #IDtwitter
The patient was put on liposomal amphotericin B and corticosteroid therapy with good clinical and biological evolution.
3/9

#MedTwitter #Doctor
Read 9 tweets
A 63-year old man, kidney transplantation: fever and a painful ulcer on the lateral side of the tongue.

🔬: showed invasion of X?
1/8

doi.org/10.1016/j.idcr…
#OralPath #maxillofacial #nephrology
🔬 showed invasion of Cryptococcus neoformans.

A tongue swab:➕for HSV-1.

The cryptococcal antigen test on serum: ➕

CRYPTOCOCCOSIS TONGUE ULCER IN A RENAL TRANSPLANT PATIENT
2/8

#mycology #Pathologists #microbiology
A CT-scan of the lungs showed extensive ground glass lesions & a lesion of 4.7 cm in the left upper lobe.

Bronchoalveolar lavage:➕for Cryptococcus neoformans & Pneumocystis jirovecii.

LUNG COINFECTION OF C. NEOFOMANS & P. JIROVECII
3/8

#IDtwitter #MedTwitter
Read 8 tweets
46 años ♂️, consumo de #cocaína: dolor en ambos pabellones auriculares con color violáceo.

La prueba de tóxicos en orina:➕a cocaína y benzodiacepinas
1/

dx.doi.org/10.4321/s0376-…
#urgencias #AtencionPrimaria
Al cabo de unos días: NECROSIS AURICULAR BILATERAL
SECUNDARIA A #COCAÍNA ADULTERADA CON LEVAMISOL

2/6
dx.doi.org/10.4321/s0376-…
#dermatología #Cirugíaplástica
La #cocaína en #España:
📌 adulterada en el 82,5% de la dosis con otro tipo de sustancias como el levamisol, la fenacetina y la cafeína.
📌Desde 2009, un aumento de cocaína adulterada con levamisol
3/6

#MIR #EducaciónMédica
Read 6 tweets
An 81-YO👵, type 2 DM: malaise, fever & anorexia, with oral pain & odynophagia, yellowish-white, pseudomembranous lesions on the tongue (A)

#endoscopy showed multiple shallow ulcers with a white coating (B)
1/6

doi.org/10.1503/cmaj.2…
#emergency #gastroenterology #MedEd
Glossal & esophageal🔬: multinucleated cells with moulded, ground-glass nuclei

PCR & immunohistochemical staining of the specimens: ➕ for herpes simplex virus type 1 (HSV-1)

HERPETIC GLOSSITIS AND ESOPHAGITIS
2/6

#GIPath #IDtwitter #microbiology
Her hemoglobin A1c was 7.2%.

Doctors treated her with a 7-day course of acyclovir, intravenously because of her odynophagia, and the oral and esophageal lesions completely resolved.
3/6

#MedStudentTwitter #MedicalStudents
Read 6 tweets
A 26-yo👩‍🦰, #sexually active, with 1 partner: right knee and metacarpal arthralgia, tenosynovitis and pustules on her hand.

CT: an abscess on her chest wall
1/9

doi.org/10.1503/cmaj.2…
#IDtwitter #MedTwitter #emergency Image
✔️Urine gonococcal nucleic acid amplification test (NAAT):➕
✔️🧫from the patient’s chest wall fluid:➖but
✔️16S rRNA with gene sequencing confirmed presence of Neisseria gonorrhoeae.

CHEST WALL ABSCEST WITH DISSEMINATED GONOCOCAL INFECTION
2/9

#microbiology #MolBiol
Her doctors treated her with incision and drainage and intravenous ceftriaxone 2 g/d. for 17 days after resolution of the abscess

If chlamydia infection has not been ruled out, chlamydia treatment with doxycycline for 7 days should be added.
3/9

#surgery #MedStudentTwitter
Read 9 tweets
An 85-YO👨‍🦳, chronic kidney disease, gouty arthritis: fever, neck pain & stiffness.

WBC & CRP:⬆️
MRI suggested cervical meningitis (A): enhancement along the epidural space (arrows), & thin enhancement in a portion of the meninges (arrowheads).

1/5
#neurology #radiology
CSF: not meningitis, & CSF🧫& molecular tests ➖ for bacteria & mycobacteria

CT: calcifications of the transverse ligament of the atlas (B).

Diagnosed with crowned dens syndrome: 20 mg prednisolone, & his symptoms dramatically improved.
2/5

#rheumatology #radres #emergency
However, CSF examination under polarising microscopy revealed monosodium urate crystals (C).
Dual-energy CT confirmed the calcifications to be monosodium urate crystals (D).
Uric acid:⬆️
MONOSODIUM URATE CRYSTALS IN CSF THAT CAUSED MENINGITIS-LIKE SYMPTOMS
3/5
#neurology #MedEd
Read 5 tweets
Reasons I love #neurology
1. 2022 is my 25th year in Neurology. I enjoy this subject many times more than 1998, when I entered this branch as a #resident at @OffCMCVellore I was dissuaded by many of my teachers to take up DM in another specialty but I stuck to Neurology
THREAD
2. Neurology is vast: If you love reading, there are several topics you can read. There are about 600 common #diseases in Neurology to read about. Newer diseases are being discovered, so there is no dearth of new topics to learn about.
3. History & physical examination are still the most important to arrive at a diagnosis. Whether it is epilepsy, migraine, stroke, Parkinson's disease or Alzheimer's disease, history & physical are more valuable than any investigations. MRI, EEG & EMG contribute but are not final
Read 11 tweets
A 29-YO👨‍⚕️#physician, a needlestick injury with a needle used to collect a fluid sample from a man who had a pustular rash (later confirmed to be #monkeypox), the gloves appeared intact to him
Four days later, a vesicle appeared on the pricked finger (A)
1/7

#MedTwitter #Doctor
#Monkeypox virus was identified in its fluid by PCR

MONKEYPOX AFTER OCCUPATIONAL NEDDLESTICK INJURY FROM PUSTULE
2/7

doi.org/10.3201/eid281…
#IDtwitter #MedStudentTwitter
Progress of #monkeypox index lesion:
A) on the 4th day of illness
B) on the 6th day of illness
C) on the 18th day of illness
D) Necrotic scab underneath the devitalized tissue of the index lesion on the 24th day of illness
3/7

#resident #medicine
Read 8 tweets
A👨, HIV + (CD4 = 25 cells/mm3): rash on arms, hands, chest, & buttocks compatible with #monkeypox
Ocular: redness, pain, itching, swelling, discharge, photosensitivity, & vision changes

Unilateral conjunctivitis, ulcer, & keratitis (fig.)
1/8

#ophthalmology #IDtwitter
A PCR swab of the conjunctival lesion:➕for Orthopoxvirus

OCULAR #MONKEYPOX
2/8

DOI: dx.doi.org/10.15585/mmwr.…
#eye #ojo #oftalmologia
Patients with #monkeypox can experience serious ocular complications:
5 consecutive patients with ocular monkeypox, have experienced delays in treatment, prolonged illness, hospitalization, & vision impairment.
3/8

DOI: dx.doi.org/10.15585/mmwr.… #MedEd #MedTwitter
Read 8 tweets
Mujer 55 años, cáncer de mama, quimioterapia: fiebre, bulla purpúrica dolorosa rodeada de eritema en el cuero cabelludo.

El recuento de glóbulos blancos y absoluto de neutrófilos: ⬇️(neutropenia)
1/4

doi.org/10.1503/cmaj.2…
#dermatology #IDtwitter #MedTwitter Image
Hemocultivos: Pseudomonas aeruginosa

ECTIMA GRANGRENOSO en sepsis neutropénica por PSEUDOMONAS AERUGINOSA
2/4

#microbiology #dermatologia #emergency
Al principio, las lesiones de ectima gangrenoso toman la forma de máculas rodeadas de eritema que rápidamente se transforman en ampollas y escaras ulcerativas necróticas.
3/4

#criticalcare #MedStudentTwitter #resident
Read 4 tweets
A 19-YO👩‍🦰, taken care of an 11-YO👦with bronchitis: cough, fever, dyspnea & pneumonia (XR)
Levofloxacin➡️hypoxia resolved, but:
- Orolabial blisters & rash, day 8
- Conjunctivitis, day 9
- Hemorrhagic denuded labial lesions, day 17
1/7

doi.org/10.1093/cid/ci…#IDtwitter #MedEd
🔬skin lesion: interface dermatitis, consistent with erythema multiforme/Stevens-Johnson syndrome–type histological changes
ELISA for M. pneumoniae IgM, initially➖, &➕at day 10

MYCOPLASMA PNEUMONIAE-INDUCED RASH AND MUCOSITIS (MIRM)
2/7

doi.org/10.1093/cid/ci…
#dermatology
Extrapulmonary manifestations of M. pneumoniae infection:
✔️in 10% of patients
✔️mucocutaneous eruptions, central nervous system disease, carditis, hemolytic anemia, and Raynaud disease associated with cold agglutinins, renal disease, or arthritis.

3/7

#MedTwitter #Doctor
Read 7 tweets
A 25-yo woman, cirrhosis due to autoimmune hepatitis, not pneumococcal vaccination: rapidly progressive sepsis with purpura fulminans.

16 h after admission, violaceous non-blanching ecchymoses from proximal thighs to the calves, & flaccid bullae.
1/9

#dermatology #MedEd Image
36 hours after admission, the skin was dusky & violaceous with sharply demarcated borders, bullae filled with red to black-colored fluid

Blood🧫: pan-susceptible Streptococcus pneumoniae.

PNEUMOCOCCAL PURPURA FULMINANS
2/9

doi.org/10.1016/j.idcr…
#IDtwitter #MedTwitter Image
She had progressive hypoxia & shock despite maximal ventilator & vasopressor support, & the patient passed away within 48 h of admission.

Autopsy: a cirrhotic liver, diffuse alveolar damage, & five liters of serous fluid in the abdominal compartment.
3/9

#Doctor #resident
Read 9 tweets
A 58-YO, toothache: swelling in the neck, sore throat, chills, chest pain; oral cavity indurated & woody, neck adenopathy; erythema spreading from his neck down over his anterior chest wall (A & B)
¼

#MedEd #IDtwitter #dermatology #MedTwitter
DOI: 10.1056/NEJMicm065036
LUDWING´S ANGINA is an infectious process involving the submental, sublingual, and submandibular spaces.

It can rapidly progress to hemodynamic instability and airway obstruction; in rare cases, it spreads into the mediastinum.
2/4

#Doctor #MedStudentTwitter #resident
Compromise of the airway can progress rapidly, with lethal consequences; therefore, immediate consideration should be given to surgical débridement of the infected areas and antimicrobial therapy.
¾

#medicine #MedicalStudents #microbiology #surgery
Read 4 tweets
A 40-year-old woman from Brazil, AIDS, CD4 91 cells/μL: headache, diffuse cerebral edema, coma, respiratory distress, tracheal secretion with nematode
(1), alveolar hemorrhage, periumbilical purpuric rash (2), & death

🔬brain: 3
1/

doi.org/10.1093/cid/ci…
#MedEd #IDtwitter
🔬tracheal secretion: Strongyloides stercoralis (1)

Skin biopsy: S. stercoralis larvae at the dermis and hypodermis.

DISSEMINATED STRONGYLOISIASIS WITH EXTENSIVE CUTANEOUS AND CEREBRAL INVOLVEMENT
2/5

#microbiology #MedStudentTwitter
Strongyloidiasis occurs worldwide, but predominates in tropical and subtropical areas.

People acquire the disease from penetration of larvae through the skin.
3/5

#MedicalStudents #MedTwitter
Read 5 tweets
Clinical features and novel presentations of human #monkeypox of 197 patients in a #London centre during the 2022 #outbreak

Median age: 38 years
All 197: men, &
196 identified as gay, bisexual, or other men who have sex with men
1/

bmj.com/content/378/bm…
#IDtwitter #MedTwitter
Concomitant infection:
- 35.9%: HIV
- 31.5%: a concomitant sexually transmitted infection.

All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%).
2/

#Doctor #MedStudentTwitter
86.3% participants reported systemic illness:
✔️ fever 61.9%),
✔️ lymphadenopathy (57.9%), and
✔️ myalgia (31.5%).
3/

#monkeypox #resident
Read 14 tweets
👩‍🦳 in her 70s: on the L 🦶, initially appeared pruritic papules that evolved to fluid-filled blisters with tense and denuded bullae (Fig1).

Over the ensuing 6 weeks an expanding annular plaque with peripheral scale (Fig2).
¼

DOI:doi.org/10.1016/j.mayo…
#dermatology #mycology
🔬(KOH): hyphae
🧫: Trichophyton rubrum

BULLOUS TINEA PEDIS.

The patient responded well to terbinafine cream and dilute acetic acid soaks.
2/4

#microbiology #IDtwitter
Bullous tinea, seen in adults and children, and most often affecting the feet, presents with an erythematous scaly rash with serous fluid-filled bullae, as opposed to the pus-filled blisters of bullous impetigo.
3/4

#MedTwitter #Doctor #MedStudentTwitter #MedEd
Read 4 tweets
34-YO👨‍🦰congenital, idiopathic intestinal pseudo-obstruction, total parenteral nutrition & infusion of lipid emulsions: fever & cough (paroxysmal coughing with his port infusion)

CXR: interstitial infiltrates & areas of faint alveolar opacities
Portacath blood
1/
#microbiology
Smear: globose, oval, budding #yeast with a small collarette, suggesting Malassezia spp.
Olive oil–supplemented🧫: Malassezia sympodialis (identified by DNA sequencing)

FUNGEMIA INFECTION & LUNG EMBOLI BY MALASSEZIA SYMPODIALIS IN THE PORTACATH VENOUS ACCESS SYSTEM
2/

#MedEd
The portacath was removed, & the patient was given liposomal amphotericin B, for 4 weeks.

His symptoms were gone by week 2, and the interstitial infiltrates were nearly resolved by week 4.
3/

doi.org/10.1093/cid/ci…
#mycology #IDtwitter #MedTwitter
Read 7 tweets
18-YO👨‍🦱: painful tender, fluctuant mass mass over the R anterior sin, chronic right knee pain, weight loss.

Leukocytosis
⬆️inflammatory markers (ESR, CRP)

XR & MR: ?
1/

doi.org/10.1093/cid/ci…
#Orthopedics #radiology #MedEd
X-ray: areas of lucency & sclerosis in the proximal tibial metadiaphysis
MR: consistent with an chronic osteomyelitis & intraosseous abscess with myositis involving the adjacent musculature

A presumptive diagnosis of BRODIE ABSCESS
2/

#IDtwitter #MedTwitter
Debridement with sequestrectomy
3 deep bone: Aggregatibacter aphrophilus
🔬: bone remodeling, fibrosis, & mixed lymphoplasmacytic & histiocytic infiltrates

BRODIE ABSCESS OF THE TIBIA DUE TO AGGREGATIBACTER APHROPHILUS
3/

doi.org/10.1093/cid/ci…
#microbiology #Doctor
Read 9 tweets
A 28-YO👨‍🦰traveling through Africa & Asia: a pruritic, erythematous rash on his back, trunk, buttocks, genitals, & lower limbs; dry cough & wheeze

X-ray: bilateral reticulonodular infiltrates
Eosinophilia
1/

doi.org/10.1093/cid/ci…
#IDtwitter #MedTwitter #dermatology ImageImageImage
CUTANEOUS LARVA MIGRANS (CLM) & LOEFFLER SYNDROME

The “creeping” skin lesions are diagnostic of CLM

The pustular rash across the patient’s buttocks & back is likely secondary to CLM folliculitis—a rarer, but well-described skin manifestation of CLM
2/

#Doctor #MedEd ImageImage
The patient’s cough and chest radiograph findings are characteristic of Loeffler syndrome, a recognized but rare complication of CLM.

CLM is caused by the infective stage larvae of animal hookworms from the family Ancylostomidae.
3/

#MedStudentTwitter #resident Image
Read 7 tweets
42-YO African American man, AIDS, CD4 57 cells/ mm3: 18-mth of progressively multiple papules coalescing into large exophytic nodules & plaques on face, scalp, & neck (A & B); & several lesions in in the groin, penis, & RUE
🔬:?
1/

doi.org/10.1093/cid/ci…
#dermatology #idtwitter ImageImage
GIANT MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a benign skin tumor caused by molluscum contagiosum virus.

Lesions >1 cm diameter are known as giant molluscum
2/

#Virology #MedEd #MedTwitter
Well-circumscribed intraepidermal lobules containing molluscum bodies (arrow)
These structures, which are composed of viral particles & cellular debris, are pathognomonic for this condition
Molluscum bodies enlarge and rise to the surface as cells age
3/

#Doctor #dermatologia Image
Read 8 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
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
Recién nacida, bajo peso al nacer: lesiones cutáneas vesículoampollosas anulares, violáceo-grisáceas, de predominio en espalda y miembros, con descamación de🤲y plantas, aspecto séptico, irritabilidad y tremulaciones
½

DOI: 10.1016/j.anpedi.2020.05.012
#pediatria #Pediatrics
Serología para sífilis de madre y RN:
PCR de Treponema pallidum (lesiones y LCR):➕

SÍFILIS CONGÉNITA PRECOZ

2/2
✏️MV Ordoño y col.
analesdepediatria.org/es-sifilis-con…
#microbiology #dermatology #MedEd #IDtwitter
La recien nacida recibió 10 días con penicilina G sódica I.V., con cicatrización de las lesiones del pénfigo sifilítico al nacimiento, persistiendo alopecia residual

#MedTwitter #Doctor #MedStudentTwitter
#resident #medicine #MedicalStudents #pediatric
Read 3 tweets

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