Discover and read the best of Twitter Threads about #idmesh
Most recents (7)
32/M, h/o HSV encep 1 mo ago (s/p 21 d ACV), on ceftri/metronidazole for sacral OM, p/t ER +delusion, fever, seizure. CSF: WBC 25 (L>N), ⬆️TP, n/l gluc,(-)HSV. Septic w/u all(-). MRI:
b/l temporal lobe enhancement ⬆️ from prior. Whch of the ff is the best Tx for this condition?
b/l temporal lobe enhancement ⬆️ from prior. Whch of the ff is the best Tx for this condition?
1/11
The group is split b/n steroids & d/c metronidazole. The answer here is Tx w/ steroids. Indeed, this is a case of autoimmune post-HSV encephalitis (anti-NMDA receptor encephalitis post-HSV). Good job @LemuelNonMD
@LeMiguelChavez @adilrashid83 @Orchid10Tree @KhalafSuha
The group is split b/n steroids & d/c metronidazole. The answer here is Tx w/ steroids. Indeed, this is a case of autoimmune post-HSV encephalitis (anti-NMDA receptor encephalitis post-HSV). Good job @LemuelNonMD
@LeMiguelChavez @adilrashid83 @Orchid10Tree @KhalafSuha
2/11
Metronidazole-induced encephalopathy is predominated by cerebellar Sx w/ a distinct involvement of the dentato-rubro-olivary pathway on imaging. We’ve talked about it here before. Refer👇for further discussion
Metronidazole-induced encephalopathy is predominated by cerebellar Sx w/ a distinct involvement of the dentato-rubro-olivary pathway on imaging. We’ve talked about it here before. Refer👇for further discussion
ID Miscellany|physical Exam|Signs|Humanities #idmesh
1/20
𝙁𝙀𝙑𝙀𝙍 𝙋𝘼𝙏𝙏𝙀𝙍𝙉𝙎: 𝘼 𝙇𝙊𝙎𝙏 𝘼𝙍𝙏?
Great! Three quarters find inquiring about fever patterns still useful. We will review some of the most important fever patterns.
@ID_fellows
1/20
𝙁𝙀𝙑𝙀𝙍 𝙋𝘼𝙏𝙏𝙀𝙍𝙉𝙎: 𝘼 𝙇𝙊𝙎𝙏 𝘼𝙍𝙏?
Great! Three quarters find inquiring about fever patterns still useful. We will review some of the most important fever patterns.
@ID_fellows
2/20
For centuries, physicians have relied upon meticulous observations to dx infections. For many years, observation of the fever pattern provided physicians w/ important diagnostic clues. However, the advent of abx & advanced dx & imaging has changed this landscape. #idmesh
For centuries, physicians have relied upon meticulous observations to dx infections. For many years, observation of the fever pattern provided physicians w/ important diagnostic clues. However, the advent of abx & advanced dx & imaging has changed this landscape. #idmesh
3/20
Swift initiation of abx & antipyretics make it impossible to verify historical descriptions of certain fever patterns. Hence, inquiry into fever patterns loses its clinical significance bit.ly/33iXCLs.
Swift initiation of abx & antipyretics make it impossible to verify historical descriptions of certain fever patterns. Hence, inquiry into fever patterns loses its clinical significance bit.ly/33iXCLs.
#idgrandrounds
(Part 1 of 2)
31M carpenter from the Midwest, +3 wks b/l blurred vision/eye redness. No pain/discharge, floaters, (+)photophobia/hearing impairment. No headache, fever, N/V. Found to have new HIV dx (CD4 520 VL 120K). Exam: b/l red eyes, nonfocal neuro, no rash.
(Part 1 of 2)
31M carpenter from the Midwest, +3 wks b/l blurred vision/eye redness. No pain/discharge, floaters, (+)photophobia/hearing impairment. No headache, fever, N/V. Found to have new HIV dx (CD4 520 VL 120K). Exam: b/l red eyes, nonfocal neuro, no rash.
#idgrandrounds
(Part 2 of 2)
(-)RPR/TSPOT. N/l CBC/CMP. Optho: +uveitis.
(-)PMH/illicits. MSM. No h/o travel/pets. Brief h/o homelessness but no h/o incarceration.
Differential dx? @CPSolvers @TxID_Edu @jdcooperid @BradCutrellMD @Cortes_Penfield @MohitHarshMD @serotavirus
(Part 2 of 2)
(-)RPR/TSPOT. N/l CBC/CMP. Optho: +uveitis.
(-)PMH/illicits. MSM. No h/o travel/pets. Brief h/o homelessness but no h/o incarceration.
Differential dx? @CPSolvers @TxID_Edu @jdcooperid @BradCutrellMD @Cortes_Penfield @MohitHarshMD @serotavirus
@CPSolvers @TxID_Edu @jdcooperid @BradCutrellMD @Cortes_Penfield @MohitHarshMD @serotavirus #idgrandrounds
1/11
𝐏𝐑𝐎𝐙𝐎𝐍𝐄 was suspected. Diluted sample showed RPR to be 1:1024.
LP was performed and showed evidence of lymphocytic pleocytosis and with a +VDRL.
CASE RESOLUTION: Neuro-ocular syphilis, w/ prozone reaction
1/11
𝐏𝐑𝐎𝐙𝐎𝐍𝐄 was suspected. Diluted sample showed RPR to be 1:1024.
LP was performed and showed evidence of lymphocytic pleocytosis and with a +VDRL.
CASE RESOLUTION: Neuro-ocular syphilis, w/ prozone reaction
ID Miscellany|physical Exam|Signs|Humanities #idmesh
𝐂𝐨𝐧𝐣𝐮𝐧𝐜𝐭𝐢𝐯𝐚𝐥 𝐬𝐮𝐟𝐟𝐮𝐬𝐢𝐨𝐧
1/11
Is an important clue for leptospirosis that may often be overlooked on exam.
Pic from: link.springer.com/chapter/10.100…
𝐂𝐨𝐧𝐣𝐮𝐧𝐜𝐭𝐢𝐯𝐚𝐥 𝐬𝐮𝐟𝐟𝐮𝐬𝐢𝐨𝐧
1/11
Is an important clue for leptospirosis that may often be overlooked on exam.
Pic from: link.springer.com/chapter/10.100…
2/11
What is it?
Simply put, it is a form of non-exudative conjunctivitis
1⃣ Non-exudative:
▪️ No purulent discharge
▪️ No matting of eyes in the morning
What is it?
Simply put, it is a form of non-exudative conjunctivitis
1⃣ Non-exudative:
▪️ No purulent discharge
▪️ No matting of eyes in the morning
3/11
2⃣ Conjunctivitis: means that,
▪️ Pattern of eye redness 👉 red, dilated vessels maximal at the periphery (from the palpebral to the bulbar conjunctivae)
2⃣ Conjunctivitis: means that,
▪️ Pattern of eye redness 👉 red, dilated vessels maximal at the periphery (from the palpebral to the bulbar conjunctivae)
ID Miscellany|physical Exam|Signs|Humanities #idmesh
𝙏𝙚𝙢𝙥𝙚𝙧𝙖𝙩𝙪𝙧𝙚-𝙥𝙪𝙡𝙨𝙚 𝙙𝙞𝙨𝙨𝙤𝙘𝙞𝙖𝙩𝙞𝙤𝙣 (𝙁𝙖𝙜𝙚𝙩'𝙨 𝙨𝙞𝙜𝙣)
1/11
For every 1 deg F rise in temp, HR incrementally increases by 8-10 bpm (𝓛𝓲𝓮𝓫𝓮𝓻𝓶𝓮𝓲𝓼𝓽𝓮𝓻’𝓼 𝓻𝓾𝓵𝓮)
academic.oup.com/qjmed/article/…
𝙏𝙚𝙢𝙥𝙚𝙧𝙖𝙩𝙪𝙧𝙚-𝙥𝙪𝙡𝙨𝙚 𝙙𝙞𝙨𝙨𝙤𝙘𝙞𝙖𝙩𝙞𝙤𝙣 (𝙁𝙖𝙜𝙚𝙩'𝙨 𝙨𝙞𝙜𝙣)
1/11
For every 1 deg F rise in temp, HR incrementally increases by 8-10 bpm (𝓛𝓲𝓮𝓫𝓮𝓻𝓶𝓮𝓲𝓼𝓽𝓮𝓻’𝓼 𝓻𝓾𝓵𝓮)
academic.oup.com/qjmed/article/…
2/11
This is a physical sign that may have become less popular now because of more sophisticated methods of diagnosing infections.
But knowing its application can expand our clinical reasoning toolkit and enhance bedside diagnosis and teaching.
This is a physical sign that may have become less popular now because of more sophisticated methods of diagnosing infections.
But knowing its application can expand our clinical reasoning toolkit and enhance bedside diagnosis and teaching.
3/11
There are a couple of ways to determine whether 𝙏𝙚𝙢𝙥𝙚𝙧𝙖𝙩𝙪𝙧𝙚-𝙥𝙪𝙡𝙨𝙚 𝙙𝙞𝙨𝙨𝙤𝙘𝙞𝙖𝙩𝙞𝙤𝙣 is present.
▪️ using a math equation to derive a cut-off HR below which, a diagnosis of "relative bradycardia" can be made
▪️ applying a set of criteria
There are a couple of ways to determine whether 𝙏𝙚𝙢𝙥𝙚𝙧𝙖𝙩𝙪𝙧𝙚-𝙥𝙪𝙡𝙨𝙚 𝙙𝙞𝙨𝙨𝙤𝙘𝙞𝙖𝙩𝙞𝙤𝙣 is present.
▪️ using a math equation to derive a cut-off HR below which, a diagnosis of "relative bradycardia" can be made
▪️ applying a set of criteria
ID Miscellany|physical Exam|Signs|Humanities #idmesh
1/7
𝐄𝐩𝐢𝐭𝐫𝐨𝐜𝐡𝐥𝐞𝐚𝐫 𝐍𝐨𝐝𝐞𝐬
Palpating for the epitrochlear nodes is an exam that I like to teach at bedside. When palpable, these nodes often indicate a condition characterized by generalized lymphadenopathy.
1/7
𝐄𝐩𝐢𝐭𝐫𝐨𝐜𝐡𝐥𝐞𝐚𝐫 𝐍𝐨𝐝𝐞𝐬
Palpating for the epitrochlear nodes is an exam that I like to teach at bedside. When palpable, these nodes often indicate a condition characterized by generalized lymphadenopathy.
2/7
Epitrochlear nodes (EN) are superficial nodes located 2-3 cm above and anterior to the medial condyle of the humerus.
Exam: shake patient's hand, on the side to be examined; examiner's free hand palpates for ENs 👇
Pics from:
aafp.org/afp/2016/1201/…
memorangapp.com/flashcards/802…
Epitrochlear nodes (EN) are superficial nodes located 2-3 cm above and anterior to the medial condyle of the humerus.
Exam: shake patient's hand, on the side to be examined; examiner's free hand palpates for ENs 👇
Pics from:
aafp.org/afp/2016/1201/…
memorangapp.com/flashcards/802…
3/7
ENs drain the ulnar forearm & the little/ring fingers.
Enlarged ENs are rare in healthy individuals (no more than few millimeters in size).
Unilateral enlargement can indicate localized cutaneous infection/malignancy/inflammation of the forearm/hands.
ENs drain the ulnar forearm & the little/ring fingers.
Enlarged ENs are rare in healthy individuals (no more than few millimeters in size).
Unilateral enlargement can indicate localized cutaneous infection/malignancy/inflammation of the forearm/hands.
ID Miscellany|Exams|Signs|Humanities #idmesh
1/5
𝙃𝙞𝙩𝙯𝙞𝙜 𝙯𝙤𝙣𝙚𝙨
Unusual pattern of sensory loss in neurosyphilis (tabes dorsalis):
▪️ central face (tip of nose)
▪️ band on the trunk (nipple area)
▪️ medial forearms (when ulnar nerve pressed at elbow)
▪️ lateral leg
1/5
𝙃𝙞𝙩𝙯𝙞𝙜 𝙯𝙤𝙣𝙚𝙨
Unusual pattern of sensory loss in neurosyphilis (tabes dorsalis):
▪️ central face (tip of nose)
▪️ band on the trunk (nipple area)
▪️ medial forearms (when ulnar nerve pressed at elbow)
▪️ lateral leg
2/5
It is a physical exam finding lost in antiquity.
Tabes dorsalis was the most common form of neurosyphilis in the pre-antibiotic era but today, it is extremely rare (longest latency period between primary infection & SSx).
karger.com/Article/FullTe…
It is a physical exam finding lost in antiquity.
Tabes dorsalis was the most common form of neurosyphilis in the pre-antibiotic era but today, it is extremely rare (longest latency period between primary infection & SSx).
karger.com/Article/FullTe…
3/5
Tabes dorsalis involves posterior columns/dorsal roots.
▪️ wide-based gait, foot slap (worse in the dark)
▪️ +Rombergs, absent knee/ankle DTRs
▪️ vibration/proprio loss
▪️ lancinating paints
▪️ Charcot joint/ulcer
▪️ Argyll-Robterson pupil (another #idmesh topic)
Tabes dorsalis involves posterior columns/dorsal roots.
▪️ wide-based gait, foot slap (worse in the dark)
▪️ +Rombergs, absent knee/ankle DTRs
▪️ vibration/proprio loss
▪️ lancinating paints
▪️ Charcot joint/ulcer
▪️ Argyll-Robterson pupil (another #idmesh topic)
