Discover and read the best of Twitter Threads about #Tweetorial

Most recents (24)

Never in the history of medicine has so much been done, by so many, so incompetently, with so little consequence as in the treatment of severe hyponatremia. #Tweetorial 1/10
You shouldn't correct hyponatremia too fast. The speed limit is 8 mmol/L per day. We are terrible at it. In George et al, 41% of 1,490 pts were corrected faster than 8 mEq/L. Look at the poor slobs at the left of the nomogram whose Na actually went down 🤪 2/10
Thankfully this incompetence is rarely punished. Of the 611 (41% of 1490) patients who over-corrected in the George trial, only 7 developed osmotic demyelination syndrome (ODS). Screw the sodium correction and you can get away with it 99% of the time. 3/10
Read 10 tweets
1/Feeling unarmed when it comes to evaluating cervical radiculopathy & foraminal narrowing on MR?

Here’s a #tweetorial that’ll take that weight off your shoulder & show you how to rate cervical foraminal stenosis!
#medtwitter #meded #FOAMed #radtwitter #neurorad #spine #radres
2/First, the anatomy. Nerve rootlets arise from the anterior & posterior horns, merging to form anterior (motor) & dorsal (sensory) nerves roots in the thecal sac.

These come together & the dorsal root has its dorsal root ganglion before the spinal nerve extends extravertebral
3/Think of it like a road system but carrying information/impulses instead of cars. Small roads (rootlets) merging to make larger roads (roots), before these finally merge together onto the big highway, which is the dorsal root ganglion and spinal nerve
Read 22 tweets
#MedTweetorial #Part2 on RV Failure based on @NEJM article by @RyanTedfordMD @Brian_Houston12 !

We will discuss RV-PA uncoupling today!

PV loops are a scary thing to many. Refer to this #Tweetorial by my friend @AHajduczok for a primer on PV loops.
#1 This image summarizes all the parts of the PV loop of the left ventricle .

Note the end-systolic pressure, end-diastolic volume and stroke volume specifically to understand the upcoming tweets.
Let’s begin with a poll

Do you understand what RV-PA uncoupling is?
Read 17 tweets
1) Welcome to a new #accredited #tweetorial in our series of educational programs on #hypertrophic #cardiomyopathy #HCM. Previous programs, still available for 🆓CE/#CME, are at cardiometabolic-ce.com/category/hcm/.
Now you can earn another 0.75hr credit by following this 🧵!
2) Our expert author is JA Linderbaum MS, ARNP, FACC, FPCNA @jlinderbaum, Associate Professor of Medicine, @MayoClinic, CV #NursePractitioner, Assoc. Medical Editor #AskMayoExpert.
#FOAMed #MedEd @MedTweetorials #CardioTwitter @transformingHC @TNPJ_Journal #cardiology
3) This program is supported by an unrestricted educational grant from Bristol Myers-Squibb. Statement of accreditation and faculty disclosures at cardiometabolic-ce.com/disclosures/. Credit for #physicians #nursepractitioners #physicianassociates #nurses #pharmacists from @academiccme.
Read 70 tweets
1/Does the work up for dizziness make your head spin?

Wondering what you should look for on an MRI for dizziness?

Here’s a #tweetorial on what you can (and can’t) see on MRI in #dizziness

#medtwitter #meded #neurotwitter #neurorad #radres #HNrad #neurotwitter #stroke #FOAMed Image
2/The etiology for dizziness depends both on how you define dizziness (i.e., vertigo, imbalance) & where you see the patient

For imaging, subtle distinctions in symptoms usually aren’t provided & many common diagnoses are without imaging findings (BPPV, vestibular migraine) Image
3/The most important finding on imaging for dizziness is a stroke from vertebrobasilar insufficiency (VBI)

It's a relatively uncommon etiology of dizziness, but its prevalence increases in emergent/acute dizziness populations

Missed VBI can have profound consequences/morbidity. Image
Read 24 tweets
1/ Had a great time writing this @EPLabDigest article with @DrCJBradley

tinyurl.com/mryk3cwe

2️⃣ different perspectives (IC And EP) using different devices (watchman/ amulet) for LAAC in the community center.

Let’s take a dive into two different LAAC programs #Tweetorial
2/ #LAAC has come a long way over the past few years and now we have two main players in the space

🔸 @bostonsci #watchman
🔸 @AbbottNews #Amulet

Both are very effective and each has pros/cons

My center focuses on Watchman FLX while @DrCJBradley center focuses on Amulet… twitter.com/i/web/status/1…
3/ Historically #EPeeps has taken the driver seat in this space (rightfully so) due to experience with the LA/transeptal. HOWEVER the new gen #IC/structuralist have become a vital part of the team.

#LAAC programs require:
📌Implanter
🔎Imager
🧑🏼‍⚕️Anesthesiologist/Cath lab team… twitter.com/i/web/status/1…
Read 24 tweets
(1/n) Pain management is far from easy, and having chronic kidney disease only complicates things. Let’s take a quick look at the effects pain has on the kidney population, and what we can do about it!

#tweetorial #NephTwitter #pallcare
(2/n) Pain has a prevalence of 60% in the CKD population, 2-3x that of the general population!
It leads to:
⬆️ Depression and Insomnia
⬆️ Withdrawal From Dialysis
⬆️ Hospital Visits
⬇️ Health Related QOL
⬇️ Social Support
⬇️ Life Satisfaction
(3/n) A H&P qualifies pain and chronicity, but every pain discussion should discuss expectations. To set expectations you need to
🔴 Determine a pain level that would be tolerable
🔴 Come up with a tentative duration of treatment
🔴 Discuss risk and benefits of treatment
Read 19 tweets
1/To call it or not to call it? That is the question!

Do you feel a bit wacky & wobbly when it comes to calling normal pressure hydrocephalus on imaging?

Here’s a #tweetorial about imaging NPH!

#medtwitter #meded #neurotwitter #neurorad #radres #dementia #neurosurgery #FOAMed
2/First, you must understand the pathophysiology of “idiopathic” or iNPH. It was first described in 1965—but, of the original six in the 1965 cohort, 4 were found to have underlying causes for hydrocephalus.

This begs the question—when do you stop looking & call it idiopathic?
3/Thus, some don’t believe true idiopathic NPH exists. After all, it’s a syndrome defined essentially only by response to a treatment w/o ever a placebo-controlled trial.

However, most believe iNPH does exist--but its underlying etiology is controversial. Several theories exist
Read 19 tweets
1/I always say you can tell a bad read on a spine MR if it doesn’t talk about the lateral recess

What will I think when I see your read? What do you say about lateral recesses?

Here’s a #tweetorial on lateral recess #anatomy & grading stenosis
#medtwitter #neurorad #spine
2/First anatomy.

Thecal sac is like a highway, carrying the nerve roots down the lumbar spine.

Lateral recess is part of the lateral lumbar canal, which is essentially the exit for spinal nerve roots to get off the thecal sac highway & head out into the rest of the body
3/Exits have 3 main parts.

First is the deceleration lane, where the car slows down as it starts the process of exiting.

Then there is the off ramp itself.

The off ramp leads into the service road, which takes the car to the roads that it needs to get to its destination
Read 21 tweets
1/THREAD
Ever wonder why fluoroquinolones increase the risk of tendon rupture?

It seems so random that a whole class of antibiotics could cause tendon injuries, but the risk is real.

#medtwitter #tweetorial
2/
Fluoroquinolones inhibit bacterial function by blocking topoisomerase activity.

They first emerged as an antibiotic class in the 1960s, as byproducts of antimalarial quinine development.

Nalidixic acid = the first quinolone discovered.

pubmed.ncbi.nlm.nih.gov/14056431/
3/
The first report of fluoroquinolone-associated tendinopathy occurred in 1983.

2 renal transplant patients received norfloxacin and subsequently developed achilles tenosynovisitis.

Their symptoms spontaneously resolved w/ cessation of the norfloxacin.

pubmed.ncbi.nlm.nih.gov/6223241/
Read 16 tweets
1/Does trying to remember inferior frontal gyrus anatomy leave you speechless?

Do you get a Broca’s aphasia trying to name the parts?

Here’s a #tweetorial to help you remember the #anatomy of this important region

#medtwitter #meded #neurotwitter #neurorad #radtwitter #radres
2/Anatomy of the inferior frontal gyrus (IFG) is best seen on the sagittal images, where it looks like the McDonald’s arches.

To find the IFG on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, "i’m lovin it."
3/Inferior frontal gyrus also looks like a sideways 3 on sagittal images, if you prefer.

This 3 is helpful bc the inferior frontal gyrus has 3 parts—or "pars"
Read 13 tweets
🚨⚡️🫀Herzrhythmusstörungen sind häufiger bei Menschen mit red. LVEF. Aber wie sieht es aus, wenn die Rhythmusstörung die Ursache des schlappen🫀ist?

Ein kurzes Spotlight💡auf das Thema Arrhythmieinduzierte Kardiomyopathie (AiCM).
🧵1/16

#Tweetorial #Cardiotwitter #FOAMed
Grundsätzlich gibt es 3 typ. Rhythmusphänomene die für den Großteil der AiCM verantwortlich sind:

1️⃣ Vorhofflimmern
2️⃣ Anhaltende supraventrikuläre Tachykardien mit HF >100min.
3️⃣ Häufige VES (> 10% Gesamtlast)
📝 In der Literatur sind Vorhofflimmern und typisches Vorhofflattern mit tachykarder ventrikulärer Überleitung als häufigste Ursachen beschrieben.
Read 17 tweets
Here’s a critical care puzzle & illustrates some important cardiopulmonary physiology:

These two pictures were taken just an hour apart. What intervention was done in between that changed the respiratory pattern? (Red box)

Multiple choice & answers in the 🧵.

1/ ImageImage
The intervention was:

2/
This is Cheyne-Stokes Respirations (CSR) in a person with heart failure.

The intervention was dobutamine (an inotrope).

Cheyne-Stokes is a characteristically regular crescendo-descresendo respiratory pattern with interspersed periods of apnea.
3/ ImageImageImage
Read 25 tweets
1/ My favourite gene has 15 transcripts, which one should I use for further analysis? To report the position of variants? To design primers for? 🤯

This #tweetorial will show you how to filter and prioritise transcripts… 🧵

#genomics #bioinformatics #Ensembltraining 🧬 Screenshot of the transcript table of the LAMA3 gene in the
2/ To start, look for the #canonical tag in the flags column of the transcript table. The canonical transcript is based on conservation, expression, concordance with @appris_cnio and @uniprot, length, clinically important variants and completeness. Screenshot of the transcript table of the LAMA3 gene in the
3/ Many Ensembl #canonical transcripts will also be the #MANESelect, which is our collaboration with @NCBI. These transcripts match perfectly with RefSeq transcripts, so are the best to report variant location. Screenshot of the transcript table of the LAMA3 gene in the
Read 8 tweets
1/Having trouble remembering how to differentiate dementias on imaging?

Here’s a #tweetorial to show you how to remember the imaging findings in dementia & never forget!

#medtwitter #meded #neurorad #radres #dementia #alzheimers #neurotwitter #neurology #FOAMed #FOAMrad #PET
2/The most common functional imaging used in dementia is FDG PET. And the most common dementia is Alzheimer’s disease (AD).

On PET, AD demonstrates a typical Nike swoosh pattern—with decreased metabolism in the parietal & temporal regions
3/The swoosh rapidly tapers anteriorly—& so does hypometabolism in AD in the temporal lobe. It usually spares the anterior temporal poles.

So in AD look for a rapidly tapering Nike swoosh, w/hypometabolism in the parietal/temporal regions—sparing the anterior temporal pole
Read 16 tweets
1) Welcome to a new #accredited #tweetorial, "Utilizing Immunohistochemistry Testing, Biomarkers, and Targeted Therapeutics to Optimize Outcomes in Patients with NSCLC," featuring the highlights of a symposium presented at the #ESMOIO22 congress.
@myESMO #LCSM #FOAMed Image
2) The faculty for this outstanding program were @peters_solange (Chair) 🇨🇭, @HosseinBorghaei 🇺🇸, Natasha Leighl MD 🇨🇦, and @dplanchard 🇫🇷. A truly international roster of experts in #oncology!
Don't miss prior accredited courses in this space at oncologytweetorials-ce.com/category/lung-….
3) This program is supported by an educational grant from Sanofi. Statement of accreditation and author disclosures are at oncologytweetorials-ce.com/disclosures/.
Read 24 tweets
1) Welcome to this #accredited #tweetorial on genetic testing in the evaluation of patients with cystic kidney disease. #Kidney #cysts are a frequent finding, ranging from simple cysts to suspected or confirmed #ADPKD.
Expert author @dguerrot of @CHURouen 🇫🇷 leads us!
2) This program is supported by an educational grant from Otsuka Pharmaceuticals & is intended for #HCPs. #Physicians #Physicianassociates #nurses #nursepractioners #pharmacists 🇺🇸🇨🇦🇪🇺🇬🇧 earn CE/#CME credit. Statement of accreditation & faculty disclosures ckd-ce.com/disclosures
3a) Fortuitous discovery of non-malignant kidney cysts is increasingly frequent with age, and often leads to #nephrology referral.
Read 52 tweets
1/Your baby’s all grown up! Cerebellum may mean “little cerebrum” but its jobs are anything but little

Do you know cerebellar anatomy beyond vermis & hemispheres?

Here’s a #tweetorial about the functional #anatomy of the cerebellum!
#medtwitter #neurotwitter #neurorad #meded
2/Cerebellum means “little cerebrum” or “little brain” bc it looks like a mini brain--a mini me to the cerebrum one might say.

However, it does not play a mini role. In fact, despite being significantly smaller than the cerebrum, it contains as many neurons as the cerebrum
3/When most people think of cerebellar function, they think of balance. And the first thing that comes to mind with cerebellar dysfunction is imbalance & dizziness.

However, the cerebellum is involved in much more, including cognitive functions
Read 17 tweets
1/ You're finally settled in as an attending and you get a new patient.

They sound brain brain dead.
They clinically look brain dead.
Your team asks if they're brain dead.

Well this turned serious… a quick #tweetorial about 🧠 death
#NeuroTwitter #Neurocrit #MedTwitter
2/ The transfer 📞 you got was a 28 yo with no other history. They were concerned about her being in status epilepticus.

You turn off all sedation. They're still unresponsive.
3/ Clinically, they're intubated and have fixed and dilated 👀. No corneal or cough and not breathing over the vent. No motor response w/ painful stimuli 🤕

You scan their labs - ✅ no significant abnormalities You check their vitals - ✅ looks all good

What should we do next?
Read 20 tweets
1/Do you know all the aspects of, well, ASPECTS?

Many know the anterior circulation #stroke scoring system—but posterior circulation (pc) ASPECTS is often unknown

Here’s a #tweetorial to help you remember pc-ASPECTS
#medtwitter #neurotwitter #meded #neurorad #neurology #FOAMed Image
2/Many know anterior circulation ASPECTS. It uses a 10 point scoring system to semi-quantitate the amount of the MCA territory infarcted on non-contrast head CT.

If you need a review: here’s my tweetorial on ASPECTS: Image
3/But it’s only useful for the anterior circulation. Posterior circulation accounts for ~25% of infarcts. Even w/recanalization, many of these pts do poorly bc of the extent of already infarcted tissue. So there’s a need to quantitate the amount of infarcted tissue in these pts Image
Read 12 tweets
1/To be or not 2b?? That is the question!

Do you have questions about how to remember cervical lymph node anatomy & levels?

Here’s a #tweetorial to show you how--#Superbowl weekend edition!
#medtwitter #meded #neurorad #HNrad #FOAMed #FOAMrad #radres #radtwitter #ENT #radiology
2/Google cervical lymph node anatomy & you always get this anatomic picture w/the head flung back like a model posing.

But unless you live in LA, your patients don’t look like this & understanding anatomy from this image is difficult
3/First, you need to know how lymph node drainage works in the neck.

Nodes drain like rivers—smaller streams drain into larger rivers.

In the neck, there are outer circle nodes (peripheral) & inner circle nodes—both drain into the large river of the deep cervical nodes
Read 17 tweets
1/I always tell my fellows, “Anyone can see the bright spot on diffusion—what sets you apart is if you can tell them why it’s there!”

Can you tell a stroke’s etiology from its appearance on MRI?

Here’s a #tweetorial to show you how!

#medtwitter #neurotwitter #stroke #neurorad
2/First a review of the vascular territories.

I think the vascular territories look a butterfly—w/the ACA as the head/body, PCA as the butt/tail, and MCA territories spreading out like a butterfly wings.
3/Of course, it’s more complicated than that.

Medially, there are also small vessel territories—the lenticulostriates & anterior choroidal.

I think they look like little legs, coming out from between the ACA body & PCA tail.
Read 25 tweets
1/Can you ACE this #MedEd & #TwitteRx #Tweetorial on non-allergic drug-induced angioedema? 57yof w/ swelling of face, lips, and tongue w/ no urticarial rash. Meds: valsartan, sacubitril, metformin, simvastatin, sitagliptin, & risperidone. How many meds may be contributing? Image of patient with swelling of lips and face
2/Drug-induced angioedema (DIA) can be divided into 2 categories
1⃣ Allergic DIA: IgE-mediated release of histamine from mast cells
2⃣ Non-allergic DIA: Increased vascular permeability mostly from disruption of the kallikrein-kinin system (KKS) Drugs that cause angioedema.  IgE-Mediated include beta-lact
3/For non-allergic mediated DIA, easiest to think about changes in bradykinin (BK) activity
🥇- 👇metabolism of BK (and substance P)
🥈- 👆BK production
🥉- 👆BK receptor activity Drugs that decrease BK metabolism are ACE-Is, ARBs, Neprilys
Read 10 tweets
1/If all you know is: To Zanzibar By Motor Car—then you don’t even know half of facial nerve anatomy—literally!

Here’s a #tweetorial on the facial nerve anatomy you don’t know!

#medtwitter #neurotwitter #neurorad #radres #meded #FOAMed #neurosurgery #neurology #radtwitter
2/On coronal MRI sequences, the brainstem in the region of the facial nerve looks like a bodybuilder.

But it looks like one of those body builders who concentrates only on upper body workouts, so they are huge up top (the pons) & but have chicken legs (the medulla)
3/Facial nerve comes out in this region from between the pons & medulla.

It looks like a weightlifting belt, coming out from the waist between the giant pons upper body & the medulla chicken legs
Read 15 tweets

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