Discover and read the best of Twitter Threads about #SpacedLearning

Most recents (10)

We didn't have a #Neuro case today on @CPSolvers #VMR with @AaronLBerkowitz but don't worry! Let's recap a prior episode for some #SpacedLearning @DxRxEdu @rabihmgeha

With @ddeng_22 @KannuBansalMD

clinicalproblemsolving.com/morning-reportโ€ฆ
A 26 yo M w/ a PMH of nodular sclerosing hodgkins lymphoma p/w left-sided facial droop, L arm weakness, and dysarthria.

He presented 12 hours after onset and his symptoms had resolved.

3 months prior he had an autologous stem cell transplant and is currently on Brentuximab.
First of remembering that E=MC2

Time of onset and localization

Sudden Onset: Think stroke, seizure, Todd's paralysis, toxic metabolic, migraine with aura

Localization: Brainstem ipsilateral face and contralateral body
Read 24 tweets
29M w severe persistent asthma p/w recurrent exacerbations despite optimal LABA/intranasal steroids. Abs eos 1250, total Ig E 1500, CT +mucus plugging, central bronchiectasis upper-middle lobes. Originally from Mexico, now in Texas. Which of the ff tests is indicated?
1/10
Great job! The majority got the right answer, allergic bronchopulmonary aspergillosis (ABPA).

Recurrent asthma exacerbations despite optimal asthma therapy & eosinophilia a/w mucus plugging and multilobar central bronchiectasis should raise suspicion for ABPA.
2/10
Aspergillosis, classified as saprophytic (aspergilloma), allergic (ABPA, hypersensitivity pneumonitis, allergic sinusitis), or invasive (pulmonary, other organs).

ABPA: hypersensitivity to A. fumigatus; can also occur from other fungi (referred as ABPM, M for mycosis).
Read 11 tweets
1/
OMG! I had an awesome #MedEd breakthrough this week.

SOOOO PUMPED!

And guess what? Consider this #spacedlearning because it all loops back to my Monday meeting with one of my #mentors @dan_p_hunt_MD.

Wanna hear about it? You do? Good! ๐Ÿ˜ Image
2/
Okay, so one of the agenda items was about my struggles with clinical teaching during #COVID19.

Specifically:

When I canโ€™t bedside round or have the students or whole team go in due to a patient being a #PUI or #COVID19+, itโ€™s limiting my teachable moments.

Waaah.๐Ÿ˜ข
3/
Dan suggested I try this:

1. Bring my mini-whiteboard
2. Assign a question to the students while I go into isolation room with resident or intern.
3. Leave them with the board/marker and allow them to rapid fire search on whatever devices or computers.

Cool right?
Read 6 tweets
Part 1/2 ๐Ÿ“Œ
32/M w/ 6 wks fever, abd pain, weight loss. Exam: tender RUQ, hepatomegaly. ๐Ÿงช: WBC 3.1, Hgb 8, Plt 110; AST 62, ALT 70, Alk Phos 450, bili 0.8; RPR(-). HIV came back +, CD4 89. CT: scattered tiny heterogenous liver lesions. Path shown๐Ÿ‘‡[Go to next tweet] ImageImage
Part 2/2 ๐Ÿ“Œ [case continued]
Path shown๐Ÿ‘†: multiple dilated blood-filled spaces surrounded by clumps of Warthin-Starry+ rods, AFB stain (-). Lives in Florida, no travel, previously healthy, worked as a cashier, no pets. What is the most likely opportunistic infection?
1/12
The majority got this one right - Bartonella. As @k_vaishnani @JosGilbertoMon1 @NateWarnerMD @Elennaro @ArmelleID correctly pointed, this is indeed a case of โšก๏ธbacillary peliosis (BP).

@MedTweetorials

Pictures taken from: bit.ly/3joTS2m
Read 14 tweets
28/F fom Bolivia, no PMH, referred to you for a +Trypanosoma cruzi serology. No SSx, has normal EKG (w/ 30 sec strip), CXR & echo. Which of the following complications of Chagasโ€™ disease has the most evidence to support treating her with benznidazole to reduce risk?
1/14
Only 1/3 got the correct answer: vertical transmission.

Although most patients with indeterminate Chagas are treated w/ benznidazole, there is limited data on the effect of Rx to progression to cardiomyopathy/GI involvement (partly because it requires decades of ffup).
2/14
There is also limited data (& no broad consensus) in treating indeterminate Chagas in patients who are at risk for reactivation (e.g. HIV, those undergoing transplant). bit.ly/2z3p5Fs bit.ly/2z00jpM
Read 15 tweets
#idgrandrounds
1/2
68/M +progressive L facial/arm numbness & weakness, R hip pain x 6 wks. +malaise/wt loss but no fever. Exam: no rashes, +dysarthria. Labs: U/R.

Brain MRI: 2x2 cm R thalamic mass w/ vaso edema
CT: speculated RUL mass, sclerotic R iliac crest/SI joint

๐Ÿ‘‡
2/2
Lives in rural IL near a creek. Stays at home w/ a dog. Loves to garden. No travel, incarceration.

Neurosurgery performed burr hole/biopsy of mass (c/f glioblastoma). ID was consulted when biopsy came out.

What is your ddx/dx? @TxID_Edu @jdcooperid @GermHunterMD
1/11 Biopsy of brain mass: broad-based budding yeast, Cx: Blastomyces dermatitidis. Urine Histo Ag: low positive

CASE RESOLUTION: Disseminated blastomycosis

@LemuelNonMD @TxID_Edu @Cortes_Penfield @KartikAcharyaID @IDdoc_Vetri @jdcooperid got the correct Dx/Ddx! Thank you.
Read 13 tweets
Teaching Rounds Day 3

Anemia - Part 1

Neighbors and Time Zones...

Join us #medtwitter & #medstudenttwitter
Claim:
It's nearly impossible to have an approach to anemia.

Yup, impossible.

It's as tough as having an approach to altered mental status?

Wait, what?

Wasn't that the VERY first @cpsovlers episode?
And...what about this schema??
Well, we lied.
Sort of.

That's an approach to ACUTE altered mental status.

Not just any old altered mental status....
Read 22 tweets
21/M w/ 2 days abrupt fever, sore throat. No cough/rhinorrhea, rigors, hoarseness. Exam: b/l tonsil exudates, +tender cervical LAD, no neck swelling. No PMH, allergies. Sexually active w/ female partners, no prior STI. 4th gen HIV(-), rapid Strep(-). W/c of the ff is correct?
1/16
Strictly based on guidelines, 31% got the correct answer -- observe/counsel. At some point in our practice, we might have done any of the above choices, which might seem reasonable.

The goal of the Tweetorial is to discuss evidence behind Abx prescription for pharyngitis.
2/16
Respiratory viruses cause the majority of acute pharyngitis (up to 45%). Group A Strep (GAS) is the major bacterial cause & the main indication for Abx. But, it comprises only 10% of acute pharyngitis (higher in other areas).
Read 17 tweets
February Teaching Rounds - Recap

Part 1 of 2.

Because #spacedlearning is an endless journey...

Join us #medtwitter & #medstudenttwitter
Day 2 - Upper GI bleed

1. 4 common pathways to a working Dx of an overt upper GI bleed

2. 3 common diagnosis...

3. 2 KEY questions!

More here -
bit.ly/2V9pboc
Day 3 - H20 toxicity

1. Hyponatremia = excess H20 = H20 toxicity.
The is true is most, but not all cases

2. Why do we care?
When neurons swell they don't work well...

3. @jackpenner's @CPSolvers video & schema bit.ly/3b64K0T

More here - bit.ly/3bUWUri
Read 5 tweets
#idgrandrounds
48F, bitten by a monkey at a zoo. She calls her primary who then calls you for advice.

What Qs should you ask? What infections should you be worried about? @TxID_Edu @Cortes_Penfield @BradCutrellMD @jdcooperid

Have you had a consult on monkey bite before?
@TxID_Edu @Cortes_Penfield @BradCutrellMD @jdcooperid 1/15
Great! Thank you for ALL your responses. Speical thanks to @TxID_Edu @vivax74 @VarunPhadke2 @10minus6cosm for referencing additional resources.

Hope this tweetorial helps, especially those who may get consulted on monkey bite/exposure in the future.

Follow the thread ๐Ÿ‘‡
2/15
๐–๐ก๐š๐ญ ๐ข๐ง๐Ÿ๐ž๐œ๐ญ๐ข๐จ๐ง๐ฌ ๐ฌ๐ก๐จ๐ฎ๐ฅ๐ ๐ฒ๐จ๐ฎ ๐›๐ž ๐ฐ๐จ๐ซ๐ซ๐ข๐ž๐ ๐š๐›๐จ๐ฎ๐ญ?
A LOT, but the most important ones are:

1โƒฃ Herpes B
2โƒฃ Rabies
3โƒฃ Tetanus

Let's talk a little bit more about Herpes B and rabies ๐Ÿ‘‡
Read 16 tweets

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