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Time for another #morphology #Derm101 series #tweetorial on the skin exam. Today, we'll cover:


How the location a rash occupies on the body might help us with the differential diagnosis!

#FOAMEd #MedEd #medtwitter #dermtwitter #medstudenttwitter #dermatology
An important point to start:
Distribution is LEAST important in the skin exam. Primary & secondary lesions, configuration & scale are all better in informing our DDx.

I tell my learners that if confused about a rash, pretend it's elsewhere on the body & see if that helps.
Also - throughout this #tweetorial, I will try to display skin disease in lighter & darker skinned patients side by side. Remember in darker skin, erythema is harder to see, so I hope this highlights the point!

A question: In tweet 1, what distribution is shown in the photo:
Read 18 tweets
Anything I say to give hard-pressed doctors a well-deserved laugh, has a risk of making some of them angry.

But this will amuse not only to every doctor, but everyone who has a science degree, and indeed a many other people who have merely been to school…
At first I thought Twitter was being a wet blanket and opposing fun and frolics.

But then I noticed the yellow text, and Twitter is right - there are some people uneducated enough to fall for this nonsense.
So here is a short thread to rescue people who have been misled by the Koch Postulators.

#MedEd #FOAMed

In your opinion, infections are caused by what?
Read 32 tweets
1/ Antidote news! There has been promise recently regarding antidotes being developed for DOACs. Before we get onto that, a quick summary of what we have so far...
2/ In the case of bleeding while on warfarin, this should be stratified by severity. Usual rule is if life/limb/sight threatening bleeding, prothrombin complex concentrate + vit K is used. If not, vitamin K +- pause/cessation of warfarin is advised.
3/ Warfarin works by inhibiting vitamin K-dependent clotting factor production. These factors are II, VII, IX and X. The 'antidote' is prothrombin complex concentrate (e.g beriplex) which is a concentrated 'soup' of factors II, VII, IX and X (and some protein C and S)
Read 11 tweets
1/ Hey #MedEd #FOAMed, here's Week 2 of my @BostonChiefs #AMReportDxRx Morning Report:

Once again, we pulled out salient features, created a PR, brainstormed a schema, and reviewed illness scripts. Final Dx was Babesia! Here are the takeaways:
2/ Had a small white board, so needed one PPT slide with the case presentation, then used the white board to process the data. This time had residents work on a hemolytic anemia schema solo before brainstorming as group. Here's what it looked like:
What went well:
1. Giving residents time to work solo on framework, thanks @tony_breu!
2. Discussing importance of Bayesian reasoning

Ideas for improvement:
1. Include treatment pearls
2. Taylor content for medical students

#MedEd community, what has worked for you?
Read 3 tweets


THREAD about why race is in the @NICEComms hypertension (blood pressure) guidelines and why it should go:

@MedCrisis and I read #AngelaSaini's book "Superior" and were horrified at the inclusion of race without clear scientific basis:


The @NICEComms specifically implies that Black people are inherently different (assumption: biological/genetic) compared to White people.

Why? @DoctorMayJay

Suggestions: Black people are inherent salt retainers due to salt deficiency, etc:…

This article from @American_Heart is a long reach arguing that there are inherent genetic differences between Black people and White people citing small genetic studies:…
Read 14 tweets
Non-COVID teaching case: A middle aged woman with myelodysplastic syndrome presents with severe dyspnea and hypoxemia requiring intubation. She fails to improve with antibiotics. A chest CT is performed prompting a bronchoscopy. The results of BAL are shown:
What is going on here?
Pulmonary Alveolar Proteinosis (PAP) is a rare lung disease characterized by accumulation of surfactant-derived lipoproteins in the alveoli. This milky proteinaceous fluid impairs gas exchange and leads to hypoxemia and respiratory failure.
Read 9 tweets
Innocent looking chap, eh? Trustworthy?
Wouldn't con his poor doddery old boss?

"You know you said you would give me anything, if I could teach you Machine Learning?"

"Yes, and you did. What is your 1 wish?"

"22% pay increase."


--- and I certainly have been!

He didn't fully emphasise that this was 22%, per year, FOREVER.

If his salary is $1000 a year at present, what will it be in 1 year's time?
And after the 20th increment, what will his salary be?
Read 47 tweets
🔆Decision Algorithm for prescribing #SGLT2i #GLP1RA in #DKD

doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd ImageImage
🔆Strategies to ⬇️adverse events in #SGLT2i #GLP1RA

💡Keep genitals dry & clean
💡Prophylactic topical antifungal
💡⬇️Diuretic dose
💡Pt education-"STOP DKA" Protocol
💡Self foot examination
💡Monitor PTH/VitD

doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedEd Image
Read 20 tweets
We had out first virtual Radiology learning session today.

A monthly learning meeting between Emergency Medicine & Radiology.

Helping us learn from each other and from our cases

A thread to share our learning from the cases ⬇️

#FOAMed #FOAMrad #FOAMped #SoME #radiology
The types of brain herniations

A great summary by @docskalski…

A rare case of Tuberous sclerosis and the learning from that

A great summary by @BMUZIO…

@Radiopaedia @DrVikasShah
Read 8 tweets



I _had_ given up annoying people, forever.

But this one is such a facepalm. And there is now online evidence of me completely failing to debug a numbers thing.

#MedEd #Foamed #cardiotwitter

All blame goes to @mshunshin for my relapse.
I told Matt I had read this paper and I was gonna get some of this eicosapentanoic acid stuff for my TGs.

Then he said, "don't bother, just look at Table 2"
So I looked up the EVAPORATE paper again, and thought the master was merely swatting the grasshopper aside.

"Good try, Matt, but it will be OK - they have an 'out'"
Read 63 tweets
👋👋 A quick poll to start off this week's TIL
[❔]: Does your institution have droperidol on formulary?

#TwitteRx #MedTwitter #FOAMed #emergencymedicine #NurseTwitter
Droperidol ➡️ butyrophenone, D2 receptor antagonist, similar to haloperidol with
✅ faster onset (3-10m IV/IM)
✅ shorter-acting
✅ more sedating

Dosing = 0.625 - 10 mg
Indications: Agitation, N/V, HA/migraine, vertigo, adjunct analgesic

ADEs = EPS, hypoTN, QTp
Preg = C

[1961]: Developed
[1960s - 2000]: Frequently used in ED

[2001]: FDA ⬛️ Warning d/t QT prolongation & TdP + coincides w/ drug shortage of 💉 products ⏩ ultimately withdrawn from market 🪦

[2019]: American Regent™️ announces droperidol is back 👀... so is it worth the risk?

Read 9 tweets
OK team, #tweetorial #3 in our #Derm101 series on the #dermatology exam. Today, let's discuss:


How primary lesions are grouped or shaped. Read on to learn more!

#dermtwitter #medtwitter #medstudentwitter #meded #FOAMEd pc:@dermnetnz @BrwnSkinMatters
Since this is the 3rd installment in the #Derm101 series, remember that if you haven't already, you might want to check out the first two #tweetorials on skin morphology.

Primary Lesion:

Secondary Lesion:
I think of configuration as how the primary lesion might be shaped or grouped. So this would include rashes that are:

Target/Targetoid (kind of)

What configuration was the rash in tweet #1?
Read 20 tweets
A #tweetorial summing up some good resources for Paediatric Minor Injuries from the world of #FOAMed #FOAMped

First #tweetorial on some resources related to Upper Limb Injuries we see in children....
Perhaps one of the most favourite injuries we see?




#SupracondylarFractures part 1

A infographic summing this up from @EM3FOAMed and @drsarahedwards
Read 12 tweets
Thread tentang Hepatitis B serology untuk medical students & house officers.

#tweetorial #FOAMed #hepatitisB

Dr strange cakap,

okay jom
40 yo gentleman, came fever, malaise, arthralgia, yellowish discoloration eyes. He admits of multiple sexual partner. Liver enzymes elevated. U wanna screen for hepatitis, u took anti-Hcv for hep C, for Hep B what will u order?
being the excellent HO u are, u ordered serum HBsAg (hepatitis B surface antigen) for hepatitis B screening. tapi pernah tak tanya kenapa kita ambil HBsAg, bukan HBeAg ke, HBcAg ke?

"OoooOOoo, HBsAg tu maksud dia surface antigen ke boss?"
Read 24 tweets
As promised, here's the second installment of my #Derm101 series on the #dermatology physical exam and #morphology. A #tweetorial on:


#MedEd #FOAMEd #dermtwitter #medtwitter #medstudenttwitter pc:@dermnetnz
First off, if you haven't gone through the primary lesion #tweetorial yet, it's a good idea to start there. Here's the link:

As review, these are the different primary lesions👇
Secondary lesions are the changes that affect the primary lesion.

Say what? If a papule is scaly, the SCALE is the secondary lesion. If a plaque is crusty, the CRUST is the secondary lesion.

A question: What was the secondary lesion seen in the pic from the 1st tweet?
Read 16 tweets
Our August Newsletter is out, with important information on resources and educational opportunities that can enhance your #CTSurgery during the new academic year!

Full Newsletter:…
The @TSRA_official Clinical Scenarios in Cardiothoracic Surgery 2nd Edition has officially been published with lots of new content!

Editors include Drs. @clauden_louis, Watson, @AlexBresciaMD @JordanBloomMD @CoyanGarrett

Purchase your copy here today:…
Save the date for the upcoming @TSRA_official Webinar “Finding a Job in the COVID Era.”

Date: Tuesday September 8th 7-8PM EST

Panelists include Drs. Sundt, @medwards_md, Arnold, @AhmetKilicMD, @cllaucll2y, and @VinodThourani

#CTCareers #TSSMN #MedEd #FOAMEd #SoMe #Match2021
Read 21 tweets
1/ We recently had a patient on service with B/l lower extremity edema with inflammation which was considered to be cellulitis and received antibiotics. This definitely made for some great teaching points as well as a rethink of the Dx.
#medtwitter #MedStudentTwitter #FOAMed
2/This was a great opportunity for a deep dive into domain of pseudocellulitides and this approach made the team reconsider the diagnosis especially since this was a bilateral process.
3/Bilateral cellulitis is exceedingly rare and most likely Dx for this patient was gravitational eczema AKA Stasis dermatitis AKA varicose eczema especially with the Hx of decomp. CHF.
The legs did exhibit calor, dolor, rubor, and tumor. Does this help with a Dx of cellulits ?
Read 9 tweets
1/ Some reflections on remote and online classroom style medical education vs face to face (F2F)

#FOAMed #MedicalEducation

A thread...
2/ The growth in remote MedEd has occurred through necessity. Remote is different but not better than F2F. It has some clear advantages but also significant disadvantages. Where possible we need to mitigate these problems.
3/ Delivery is not learning. Remote MedEd is high risk for providing something which is not received in any meaningful way. His is especially true for education which is not the agenda of the learners.
Read 8 tweets
Let's get back to the basics. A #dermtwitter #tweetorial on:


My plan is to make a #Derm101 series on #morphology and the #skin exam, so this will be the first in that series of #medthreads.

#MedEd #FOAMEd #medtwitter #medstudenttwitter pc:@dermnetnz Image
Why are #dermatologists so obsessed with description?

Well, for us, morphology is everything. We start with the exam and take the history afterward based on the possible differential we've come up with!

So let's start simple. What was that lesion in the prior tweet?
That was a PATCH of vitiligo.

PATCHES are flat lesions >1 cm wide, whereas MACULES are flat lesions <1 cm wide! Check out photo #1 of perioral vitiligo where macules are coalescing into patches!

In #2, you can see both macules and patches in these Cafe au lait lesions. ImageImage
Read 12 tweets
Here’s a great #ECG of a man who presented to the ER with crushing chest pain.

[thread] Image
Here’s the ECG Computer Read:

"Non-specific ST abnormality, consider anterior subendocardial ischemia."

Take a good look at Leads V1-V3 and burn these morphologies and this pattern into your mind.

THIS is what Posterior #STEMI looks like on a Standard 12-Lead ECG!

[3/x] Image
Read 11 tweets
Ready for a #tweetorial? 68 yo man from Ecuador #COVID-19 positive, got tocilzumab and 3 courses of methylpred, HD12 became bacteremic with Strep constellatus and Citrorbacter freundii, HD 18 grew some Pseudomonas and MSSA in the sputum but the chocolate agar also showed this: Image
What other organism is in the sputum?
You all got it :) The answer is Strongyloides stercoralis and the patient has Stronge hyperinfection syndrome. They later had a gram stain of the sputum that showed a first-stage rhabditiform larava (300 micrometer), check it out! Image
Read 11 tweets
🚨Code Blue🚨 = patient in cardiac arrest. You've got your ACLS algorithms ready to go.

But…what if that patient is PREGNANT? 😳

I’ll leave ACLS pearls to my Medicine and EM colleagues. They all still apply! Here are a few notable things about running a maternal code.
Start the timer immediately. Not only will you need this for the code, but 4min after cardiac arrest, it’s time to perform a resuscitative hysterotomy. More on that later. 2/
Remember to move the bed away from the wall to make room for obtaining an airway. Maternal airways are classified as difficult right off the bat due to physiologic edema. The most experienced person available should be the one to conduct intubation. 3/
Read 15 tweets
1/15: #MedTwitter: You are admitting a 50-year-old man with a hx GI bleed for a PE. You start a heparin drip. What do you titrate the drip to?
2/15: At my institution, heparin anti-Xa levels (HAL) are recommended, but we routinely draw both aPTT and HAL. I’ve always wondered WHY?

There’s also the page: “The aPTT is supra-therapeutic but the HAL is therapeutic, which should we use?”

Let’s de-mystify this!
3/15: First, let’s understand unfractionated heparin (UFH).

UFH is a negatively charged, heterogenous mix of oligosaccharides. Heparin MUST bind antithrombin (AT) to have an anticoagulant effect. AT then inhibits Xa, thrombin (II), and other proteases.
Read 16 tweets
50M comes to clinic with severe pain on his index finger. It progressed to violaceous lesion with raised borders. PIP/DIP/MCP jts without effusion. No fevers and otherwise feels well.

Works as fisherman on the Cape

What organism?

#IDTwitter #MedTwitter #IDMedEd #FOAMed
👍Correct answer = E.rhusiopathiae, a GP bacillus
🌳Widespread in nature, infecting domestic and marine animals
🦀Infections in humans often from occupational exposure: animal processing, butchers, fisherman, farmers, vets
🔽Break down clinical syndromes into 3 categories:
1) Localized cutaneous (erysipeloid) inf, most common
▪️Subacute cellulitis, often hands/fingers (site of exposure), abrasion/wound can be portal of entry
▪️Might hear: seafood packer handling contaminated 🐟/🦀or similar -- but also think about w/😼🐶bites
▪️Incubation: 2-7d
Read 10 tweets

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