Discover and read the best of Twitter Threads about #internalmedicine

Most recents (24)

A 58-YO♂️, DM, fever & L lower quadrant abdominal pain 2 months prior: acute R-sided back pain, & 3/6 diastolic murmur at R upper sternal border.

CT: a R renal infarction & splenic embolism

MR: multiple infarctions
#Cardiology #medicine #cardiologia Enhanced abdominal computed tomography showing right renal i
Transesophageal echocardiography: a vegetation and severe aortic regurgitation.

Blood 🧫: Cardiobacterium hominis


#IDtwitter #microbiology Transesophageal echocardiogram revealing a large vegetation
The patient received antibiotic therapy and surgical aortic valve replacement, and he was doing well without major complications.

#infecciosas #MedTwitter #Doctor
Read 7 tweets
Beating Clinical MCQs in #USMLE or #boards2023 when you don’t know the answer! 🩺📝

🧵👇Check out 10 strategies to approach this challenge

#MedTwitter #MedEd #IMG #ECFMG #foamed #medicalstudent #internalmedicine #BoardExams #medicaleducation
Don't panic! 😱

Try to work through the question, use strategies below to narrow down the choices and make an educated guess. 💪🤔💡

General approach to MCQs: Reverse reading 📖🔙💭

a) read the MCQ starting at the last sentence in the stem (the actual question)
b) glance over the answer options
c) then work your way back to the stem

🧠I find this an effective technique to prompt & orient the brain.

Read 11 tweets
A 50-YO ♀️ bitten by her pet rat: fever, myalgia, sore throat, headaches a nonpruritic rash on extremities including palms & soles, arthralgias, knees arthritis.

A punctate wound with central necrosis on L palm, & her R thumb.

#rheumatology #internalmedicine #dermatology
Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
✔️Gram stain: scant pleomorphic gram-negative bacilli in chains with lateral bulbar swellings
#microbiology #rheumatologist
Synovial fluid 🧫culture: Streptobacillus moniliformis identified by biochemical testing & confirmed by MALDI-TOF.


#bacteriology #IDtwitter #microbiología
Read 9 tweets
A 29-YO♂️, 6 months before, HIV + & non–drug-resistant pulmonary tuberculosis, antiretroviral & 4-drug antituberculous therapy initiated but soon reduced to rifampin & isoniazid only: abdominal pain on the L side
CT: ?

DOI: 10.1056/NEJMicm2206174
#radiologist #GITwitter
CT: an enlarged spleen with numerous hypodense lesions (A).
CD4 cell count: 119/mm3
VIH viral load: 1778 copies/mm3

A splenectomy was performed to evaluate for cancer:
numerous necrotic nodules with purulent discharge (B).

#microbiology #gastroenterology #IDtwitter
🔬granulomatous inflammation with caseous necrosis (C) and acid-fast bacilli (D, arrowheads).
A tissue🧫: ➖

PCR: ➕for Mycobacterium tuberculosis


#bacteriology #MedTwitter #GIPath
Read 5 tweets
A 50-YO♂️of North India, visited bat caves & a bird sanctuary in Thailand: multiple plaques & nodules on his face, neck, arms & trunk with hoarseness, fever, weight loss for months
Laryngoscopy: nodules over the tonsils & posterior pharyngeal wall

#medicine #dermatology
Skin & laryngeal 🔬: histiocytes with intracellular & extracellular PAS+ yeast cells
Skin biopsy🧫: tuberculate macroconidia confirmed as H. capsulatum var. capsulatum
Ab against Histoplasma by ID:➕

#mycology #IDtwitter
Disseminated histoplasmosis involving skin & larynx in an apparently immunocompetent individual

The infection appeared to be imported from Thailand.

The patient responded very well to intravenous amphotericin B followed by itraconazole.

#microbiology #MedTwitter #Doctor
Read 4 tweets
A 37-YO, farmer in India, #HIV+ immunecompromised ♂️, treatment for suspected pulmonary tuberculosis: papulonodular lesions of 3-month duration over the face, neck, trunk, limbs, palms & soles, & oropharynx; fever & generalized lymphadenopathy
🔬: ?

#IDTwitter #microbiology Wide spread papules and nodules over face. Similar lesions w
🔬: Blastoconidias within the macrophages.
🧫: Histoplama capsulatum: characteristic colony, conversion to yeast form, characteristic🔬appearance.


doi: 10.4269/ajtmh.17-0432
#dermpath #mycology #internalmedicine 1.- Histologic section of skin lesion showing sheets of macr
Diagnosis is usually suspected on visualization of characteristic intracellular yeast (blastoconidias), the pathogenic or tisular form, with a clear rim and garnulomatous cellular infiltrate in tissue specimen or lymph node aspirate

#MedTwitter #Doctor
Read 7 tweets
A 31-YO ♂️, sex with men, HIV treatment, HCV: in 2022, fever, cervical lymph nodes & erythemato-squamous papules, with umbilications & ulcerations, vesicles & pustules, & honey-colored crusts on the face, trunk & limbs including his palms & soles

#IDtwitter #primarycare ImageImageImage
PCR: ➕for MPXVirus.
#HIV viral load of < 40 copies/mL and a CD4 + count of 167 cells/mm3


#healthcare #internalmedicine #microbiology…
Supportive care of Mpox was provided, namely,
✔️beta-lactams due to bacterial superinfection of the lesions,
✔️in addition to analgesia, which was initially administered with NSAIDs and then escalated to opioids.

#MedTwitter #MedStudentTwitter #dermtwitter
Read 7 tweets
A 32-YO ♂️ sex worker, sex with men unprotected, HIV under treatment: 20 lesions scattered throughout the body of umbilicated, erythematous, violaceous papules with central ulcerations & pustules, fevers, cervical & axillary lymph nodes

#IDtwitter #primarycare #healthcare
HIV viral load of 1577 copies/mL and a CD4 + count of 932 cells/mm3

PCR: ➕ for Mpox virus


#internalmedicine #microbiology…
Mpox had been a neglected disease until May, 2022, and since then, there has been a notorious increase in the number of human monkeypox cases in non-endemic areas

#MedTwitter #MedStudentTwitter #dermtwitter
Read 5 tweets
An 86-YO ♂️, injury on his L leg 47 years prior, several debridements, skin grafts, & vein stripping procedures: chronic bilateral leg progressive ulcers.

Superficial🧫: multiple organisms including E. coli & coagulase➖Staphylococcus.

#internalmedicine #IDtwitter Image
Skin biopsy🔬: bilateral invasive squamous cell carcinomas.


#dermatology #dermpath… Image
The mean time period between development of a wound to malignancy is 30–35 years.

The most common malignancies seen in Marjolin ulcers are squamous cell carcinomas, but basal cell carcinomas and melanomas have been reported.

#Doctor #healthcare #MedStudentTwitter
Read 6 tweets
A 24-YO♀️: a 10-year of episodes of redness & photophobia in eyes, &⬇️visual acuity
SLE: conjunctival hyperemia & peripheral corneal opacification, inflammation & crystalline deposits on the corneal

DOI: 10.1056/NEJMicm1709103
#eye #internalmedicine
✔️Bacterial: SYPHILIS, Lyme borreliosis, tuberculosis, etc.
✔️Viral: Herpesviridae (HERPES SIMPLEX, H. zoster, E-B)...
✔️Parasitic: Onchocerciasis, Acanthamoeba...
✔️Immune: Cogan's syndrome, contact lens-associated keratitis, autoimmune disease…

ESR:⬆️& evaluation for infectious causes: unremarkable.
6 months after the diagnosis of interstitial keratitis: vertigo, tinnitus, & hearing loss.
Audiometry: sensorineural hearing loss in both ears.
Clinical findings consistent with COGAN´S SYNDROME

#Ophthalmology #MedEd
Read 5 tweets
A 38-YO♂️, #HIV➕: asthenia, fever, & generalized & confluent maculopapular rash predominantly on the back, cervical & inguinal lymphadenopathies, & stippled petechial hemorrhages in the soft palate (Forchheimer’s spots)
Subsequently, pustules appeared

#emergency #IDtwitter
Classic Mpox pustules appeared
✔️for measles & rubella➖
✔️for Mpox➕

HUMAN Mpox, although confluent maculopapular rash & Forchheimer’s spots have been reported as classic signs of rubella or measles infections

#microbiology #MedTwitter
Forchheimer spots, a type of enanthem:
📌sometimes precede the skin rash of rubella.
📌tiny red spots on the soft palate in rubella, measles and scarlet fever.

#dermatology #internalmedicine #primarycare
Read 5 tweets
Resources to study #Neurology

Adams and Victor’s. By far my favourite textbook.
The book is more clinically oriented, coloured with anecdotes and mental models. Reading it feels like seeing a pt in the ward/OPD

#MedTwitter #neurotwitter
It has elements of philosophy, history and is written eloquently.
Whimsical, yet profound, it’s teachings stay with me. Added bonus, my Guru in Neurology finds mention in the text 🙃 I’d recommend this for #mbbs #md and #dm students
Bradley is the standard #textbook in #neurology. A great book, it’s more like #Harrison. Great for information, latest research and management. Essential for the DM #neurology candidate, but also useful for MD #internalmedicine
Read 11 tweets
White coat #hypertension (WCH) can not be left alone

1. Patient: My BP is high only in hospital, at home it is normal. So, I don't want to do anything about it.
Me: High BP (whether in hospital or at home) can lead to adverse outcomes, so, you should aim for a normal BP 24/7.
2. A study showed that in untreated cohorts, WCH was associated with a 38% and 20% increased risk of #Cardiovascular disease (CVD) and total #mortality (death) compared with normotension (normal BP), respectively.
3. However, in the treated patients (who received medications to keep BP normal at office as well as at home), neither the risk of CVD, nor total mortality was increased in WCH.
Read 5 tweets
Cause of coma in a #woman surprised us!

1. 65-year old woman was brought in an #unconscious state to #emergency dept. She sounded normal over phone to her son about 24 hours earlier. She stayed alone, so, further details were not available.
#MedTwitter #internalmedicine
2. Clinical examination revealed an #unconscious patient. She was afebrile; pulse and BP were normal. Pupils were equal and reacting to light. Meningeal signs were absent. She was electively mechanically ventilated in view of her unconscious state.
3. Serum #calcium was high (13 mg/dL). MRI brain was normal. Lumbar puncture was normal. Investigations were done to determine the cause of high calcium. There was no evidence of #endocrine disorder, infection or #Cancer.
#VitaminD level was very high (160 ng/mL).
Read 7 tweets
Can #drinking excess amount of #water lead to death?

1. Water is life-saving and is essential for survival. However, ingestion of excess amounts of water, especially over a short period of time can lead to serious health hazards, including #death.
#MedTwitter #internalmedicine
2. How much water is needed on daily basis?

The normal daily requirement of water is 2.5 to 3 liters.
The requirement may be higher in summer months. Requirement also increases during #exercise (due to sweating), during fever, diarrhea or vomiting.
3. Why do some people drink excess amounts of water?

There is a misconception that drinking more water is good for #health.
Some people can drink more water due to #psychiatric illnesses.
#athletes can overestimate fluid loss and drink an excess amount of water.
Read 9 tweets
Brain #stroke caused during cold water bath in a 68-year old person with High BP

1. Winters are here and many people need to take bath in cold water. #Cold water #bathing can also be a part of cultural ritual. It is safe; however, in some cases; it can lead to serious diseases.
2. Here, I am sharing my experience of treating a person with stroke (which he suffered during cold water bath). 68-year old man was brought with a history of right-sided weakness and inability to speak for 26 hours.
#MedTwitter #neurotwitter #internalmedicine
3. Symptoms started within minutes of him taking dip in a holy river as part of cultural ritual. He was previously well except for #hypertension, for which he was taking medicines. He was initially treated at a local hospital and referred one day later as he did not improve.
Read 10 tweets
Repeated abdominal pain and vomiting could be a sign of "Abdominal Epilepsy"

Abdominal pain & vomiting are common symptoms of many gastrointestinal disorders. However, in some patients, no obvious cause can be found despite extensive investigations.
Case report
22-year old woman presented with repeated episodes of epigastric #abdominal #pain associated with #vomiting of three months duration. Symptoms occurred almost on daily basis, more in evenings, post which she felt tired and lethargic. She was evaluated by gastroenterologist.
Extensive investigations- upper GI endoscopy, CT and ultrasound of abdomen, LFT, serum amylase, etc were normal. Symptomatic treatment also did not help. At this point she was referred for my opinion.
#gastroenterology #internalmedicine
Read 5 tweets
Iron-deficiency anemia: 5 interesting facts

1. The richest source of iron is meat.
For vegans and vegetarians, the best source of iron is blackstrap molasses. Other good sources of iron are lentils, tofu, spinach and soybeans.

#MedTwitter #InternalMedicine #MedEd
2. What is pagophagia?
Half of patients with moderate iron-deficiency #Anemia develop pagophagia. Usually, they crave ice to suck or chew. Occasionally, patients prefer cold celery or other cold vegetables in lieu of ice.
3. Severe anemia may cause myocardial ischemia and coronary insufficiency. Patients can present with heart failure. General examination reveals koilonychia, angular stomatitis and gingivitis (fissures at the corners of mouth).
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
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
On Acute General Medicine service (#internalmedicine) at the moment, and realise I repeat myself a lot when telling the junior doctors (interns, residents, fellows/registrars) how we should do things. Also applies to #IDTwitter I think. Here are a few of them (in a thread) 🧵
1. Don't look at the radiology reports before you've looked at the X-rays/scans yourself, and decided what you think they show. Otherwise you'll never get good at interpreting them. (exception: ultrasounds!)
2. Check every medication on every patient every day. Often they are no longer needed, or were not needed in the first place. With electronic prescribing software, this actually takes longer than in the paper days, but it's important and worth the time!
Read 10 tweets
This is the first year I have not applied for #Match2023

It’s the first time I’m not worrying if I did “enough” to finally get in.

And I have to say, I haven’t felt HAPPIER or more fulfilled in years.

I had been running the #Match marathon for 4 years, kept pushing through, amping my experience, rewriting my PS, getting new LORs, working during a pandemic.

Kept ending up #unmatched, sometimes more heartbroken than the previous year, with no time to process what happened.

I had made every sacrifice to get into residency because that was the only way I saw my future as a physician

But that’s where I was wrong - I was stuck with tunnel vision of what it meant to succeed as a doctor

After #Match2022 I decided I was ending the toxic cycle

Read 15 tweets
Educational 🧵 on autoimmune hemolytic anemias (AIHA). Not medical advice. Always open to feedback and corrections.
#medtwitter #hematology #internalmedicine #classicalhematology
1/Immune hemolytic anemia
Broadly divided into three groups:
Autoimmune hemolytic anemia (AIHA)
Alloimmune hemolytic anemia
Drug induced immune hemolytic anemia
We will discuss AIHA in this 🧵
2/AIHA - Major categories
Warm autoimmune hemolytic anemia (WAIHA)
Cold agglutinin disease (CAD)
Paroxysmal cold hemoglobinuria (PCH)
Mixed-type AIHA
Read 26 tweets
📢📢 The supplemental @ERASinfo application is open!

I shared details about the application in a prior thread. A few other points & tips for #Match2022 #medstudenttwitter whether you're applying in #dermatology #internalmedicine or #GenSurgMatch2022.

Applicants will be invited to complete the supplemental application once they save a participating program in any of the 3 specialties in MyERAS.

‼️ There is a 24 hour delay between saving a program and receiving the invite. So, get saving if you haven't yet!
The supplemental app is now optional for ALL participating programs in the 3 specialties. All ?? are also optional.

I recommend you complete it. Why? I (& many others) feel this can only help applicants by allowing you to highlight unique qualities & prefs. 3/
Read 17 tweets

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