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Toxicologists are often consulted about 🍄foraging misadventures (wild mushroom ingestion).

Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.

So what to do?

A 🍄🧵
#FOAMed #FoamCC #MedEd
If you do have a good sample or photo you can work with a mycologist (your posion center knows one) to identify the shroom. But this is not frequent.
Since we almost never have that we usually rely on history and symptoms
Key to differentiating mushroom toxicity types: time to onset of GI issues. Most mushrooms upset the tummy. The 5hr “rule” helps identify bad ones.
Read 15 tweets
Heya #MedEd,

What do these 3 things have in common?

- Intern presentations (e.g. med student day off)
- Inverted SOAP – “APSO”
- Inheriting a pt w/ organ-based documentation

Answer: an opportunity to INVEST in your interns and here’s why...

@medrants @rabihmgeha

All 3 of the above scenarios encourage interns to leave their comfort zone to do more than simply “explain the data” or “propose a plan.”

This opportunity adds the DESIRABLE difficulty of letting them “say what they think is going on” & most importantly, explain “why?”

I find interns who inherit a pt & present in an inverted manner have ⬆️latitude to think out loud, particularly if not "performing" in front of med studs.

Best of all, when previous notes were organized by organ system, interns are also free from documentation inertia.

Read 9 tweets
Randomised clinical trials in cardiogenic shock in the PCI era Image
Treatment considerations for patients with AMI-cardiogenic shock Image
Enrolment data for major randomised cardiogenic shock trials (EuroIntervention 2021; 17: 451-65) ImageImage
Read 14 tweets
Flame Cells: These are plasma cells with vermillion-staining glycogen-rich overstuffed fibrils. Although these cytoplasmic features are suggestive of neoplastic plasma cells, can also be found in reactive cells.… #mmsm #myeloma #MedTwitter #USMIRC #MedEd ImageImage
Mott cell is a plasma cell characterized by an accumulation of multiple Russell bodies, globular cytoplasmic inclusions composed of immunoglobulin… #mmsm #myeloma #MedTwitter #MedEd #USMIRC ImageImage
Russell bodies are cytoplasmic inclusions filled with immunoglobulins… #mmsm #myeloma #MedTwitter #MedEd #USMIRC ImageImage
Read 7 tweets
Let’s take a minute to recap our latest blog post on a pretty daunting hematological emergency🩸

A thread 🧵 1/7 #MedEd #MedTwitter Image
An imbalance between ADAMTS-13 and von-willebrand factor can lead to catastrophic physiological damage 💔

🧵 2/7 Image
The classic FATRN presentation actually only occurs in less than 7% of cases 😳

Instead, look for:
🧠 CNS symptoms - 60% of cases
🤮 GI symptoms - 35% of cases
🫀 Cardiac symptoms - 25% of cases

🧵 3/7 Image
Read 7 tweets
🫁How to interpret pulmonary function tests ??🫁

I'm not a pulmonologist but have to deal with a fair share ILDs,
here's a simple approach useful in the clinic especially for non pulmonary specialists


#MedTwitter #RheumTwitter #MedEd Image
1️⃣Is the test valid?

You need to check for three things

🌬️ Effort
✅The time volume curve forms a plateau in 1-2 seconds
✅ sustained expiration for 6 seconds!

(2/7) Image
➰Flow loops

✅ for artefacts/abnormalities 📷⤵️

(3/7) Image
Read 8 tweets
1a) Welcome to a 🆕#accredited #tweetorial on the importance of time in range #TIR in #diabetes . . . with additional emphases on #primarycare and on practice in 🇨🇦.
#FOAMed #endotwitter #MedEd @MedTweetorials #nephtwitter #cardiotwitter
1b) Hence we welcome2⃣ expert faculty from Canada: Ilana Halperin @ilanajhalperin, academic endocrinologist at @Sunnybrook and @uoftmedicine, and Noah Ivers @NoahIvers, #familydoc & researcher at Women's College Hospital @UofT ImageImage
2) Earn 0.75hr 🆓CE/#CME by following this🧵! This program is supported by an unrestricted educational grant from Sanofi Canada and is intended for #HCPs. Statement of accreditation & faculty disclosures at
And so we begin . . .
Read 43 tweets
1/16 See below for this #Tweetorial on guideline and management updates for COVID-19. It is contributed by @RishiDesaiMD.
#MedTwitter #MedEd Image
2/ In all outpatient settings in which patients with COVID-19 are seen, including long-term care facilities, testing and treatment must be done in a timely manner. It is also crucial to consider patient risk factors for progression to severe disease and death. ImageImage
3/Conditions such as metabolic syndrome and obesity confer an increased risk of ICU admission, mechanical ventilation, acute respiratory distress, and death. Image
Read 16 tweets
1/Does PTERYGOPALATINE FOSSA anatomy feel as confusing as its spelling? Does it seem to have as many openings as letters in its name?

Let this #tweetorial on PPF #anatomy help you out

#meded #medtwitter #FOAMed #FOAMrad #neurosurgery #neurology #neurorad #neurotwitter #radres Image
2/The PPF is a crossroads between the skullbase & the extracranial head and neck. There are 4 main regions that meet here. The skullbase itself posteriorly, the nasal cavity medially, the infratemporal fossa laterally, and the orbit anteriorly. Image
3/At its most basic, you can think of the PPF as a room with 4 doors opening to each of these regions: one posteriorly to the skullbase, one medially to the nasal cavity, one laterally to the infratemporal fossa, and one anteriorly to the orbit Image
Read 18 tweets
A patient living with HIV with undetectable viral loads for many years asks you if they can stop their antiretroviral therapy (ART). What is the right answer and what is the underlying reason?


#MedEd #MedTwitter #FOAMed #IDTwitter
The answer is straight-forward: DO NOT STOP!
HIV is notorious for establishing a latent infection in a wide range of cell populations inside body. The lymphoid tissue is the major reservoir. (2/n)
As a result, there is a rebound viremia following the discontinuation of the ART originating from these reservoirs. (3/n)
Read 6 tweets
ICU stories (common): Middle-aged pt w hx of COPD was brought to the ED by EMS after SOB x 2 days. No fever or chest pain. Very quickly after ED arrival, he was intubated. CXR showed hyperinflated, “COPD” lungs. Here depicted in two images: ImageImage
Post-intubation ABGs showed: Image
BP dropped post-intubation to 55/40; propofol was started & then discontinued due to hypotension. iv fluids (2L Lactate Ringer's) were started & patient was brought to the ICU w SBP in upper 80s. Re-institution of propofol led again to hypotension. What would be the next step?
Read 19 tweets
Tuberculous Meningitis in this child w/ fevers and lethargy

💡 COMMUNICATING HYDROCEPHALUS with DEEP INFARCTION is highly suggestive of granulomatous meningitis
#neurology #MedTwitter #neurotwitter @TheASNR #MedEd #futureradres ImageImageImageImage
▶️In children, primary TB infection is commonly associated w/ meningitis

▶️Exudative meningitis of the basal cisterns can obstruct the normal CSF flow resulting in hydrocephalus
▶️Infectious vasculitis or spasm can result in infarction (particularly of the basal ganglia)

▶️Cranial nerve palsy can also be seen due to infectious neuritis
Read 4 tweets
We're seeing more consult questions for this, and it's also garnering national attention, so let's take a brief moment in #tweetorial format to talk about:


#xylazine #MedEd #FOAMEd #dermtwitter #medtwitter

What is Xylazine? It was created in the 70s as a veterinary anesthetic. As an analog of clonidine, it has similar effects as an alpha-2 agonist, leading to sedation, anesthesia, and euphoria in the CNS.
2/ Image
Recently, Xylazine has entered the drug supply, moreso in certain cities, but increasingly everywhere. It is often mixed with fentanyl as a cutting agent, and can also be used on its own. It may be called Tranq, Zombie Drug, or anestesia de caballo (horse anesthetic).
Read 12 tweets
1/Remembering spinal fracture classifications is back breaking work!

A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!

#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery Image
2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury. Let's start w/morphology. TLICS scores severity like the steps to make & eat a pizza:

Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in) Image
3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.

This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin! Image
Read 13 tweets
What is the most likely diagnosis in this 30 y/o w/ history of discitis/osteomyelitis presenting w/ fevers, chills, and neck pain? 🧠
#ent #Neurosurgery #Neurology #medtwitter #MedEd @The_ASSR #NeuroTwitter ImageImageImageImage
Answer: Longus Colli Calcific Tendinitis

▶️Etiology: inflammatory reaction in response to deposition of calcium hydroxyapatite crystals (just like in the rotator cuff)

▶️This case is a bit tricky as the history is somewhat misleading (though it often is in radiology)

▶️Sagittal STIR shows marked retropharyngeal/prevertebral edema (yellow arrow) and focal hypointensity from the hydroxyapatite crystals (green arrow)

▶️Axial T2 again shows the marked edema ImageImage
Read 9 tweets
Interesting case, what is the most likely diagnosis in this 25 y/o F w/ 1 year history of migraine headaches, left hand numbness, and b/l retinal artery occlusions? 🧠 👁️
#Ophthalmology #neurology #neurosurgery #neurotwitter #MedEd @TheASNR #MedTwitter ImageImageImageImage
Answer: Susac syndrome 🧠

▶️Susac syndrome is a microangiopathy (likely autoimmune affecting the precapillary arterioles) with a strong female predilection, typically occurring in women age 20-40
Clinical presentation:

Classic triad
2️⃣Branch retinal artery occlusions
3️⃣Hearing loss

💡Though most patients do not present with the complete triad (it may develop over years)
Read 7 tweets
As an intern, chart checking new patients was intimidating and time-consuming.

Even as a cardiology fellow, I continue to refine my system.

Here are 7 tips and tricks to help you out!

#arjuncardiology #MedTwitter #MedEd #Cardiotwitter #IMG Image
Read 10 tweets
Doctor: Where is the pain?

Patient: Pain pain everywhere!

❔How do we approach a patient with multiple joint pains❔

#polyarthritis #MedTwitter #MedEd #RheumTwitter Image
1️⃣ Is it polyarthritis?

First, you want to make sure it's polyarthritis - multiple (>4 joints) pain WITH SWELLING

& NOT 🚫

🔹Polyarthralgia⏩ pain WITHOUT swelling
🔹Widespread pain
🔹Bone pain
🔹Neuropathic pain

Let's deal with polyarthritis ⏬

2️⃣ Is it acute or chronic??

Acute<6 weeks

🔹 Infections- gonococcal, infective endocarditis, rheumatic fever, lyme disease, viral

🔹Elderly RA, ANCA vasculitis, paraneoplastic


Read 12 tweets
A 67-year-old female presents with encephalopathy, ataxia, and this finding on physical exam 👇

What is the diagnosis and what is the pathophysiology of this condition?

A thread 🧵🧵🧵(1/11)

#MedTwitter #MedEd #FOAMed
Wernicke encephalopathy (WE) is a known complication of thiamine deficiency first described by Carl Wernicke in 1881 characterized by the classic triad of:
1⃣Acute encephalopathy
2⃣Oculomotor dysfunction
3⃣Gait ataxia

Thiamine (Vitamin B1) is an important cofactor for several enzymes involved in metabolism ➡️ It is more important in areas with high metabolic requirements such as the brain. (3/11) http://thiamine.dnr.cornell...
Read 11 tweets
Studying for the IM Boards and Step 2 CK can be challenging.

Here are some of my notes that can help you.

Part #24: Ophthalmology : 5 High-yield facts!
#arjuncardiology #medtwitter #MedEd #IMG Image
Read 7 tweets
Hey #MedTwitter !

1. What does the image show?
2. Possible etiologies?

#RheumTwitter Image
It's a purpuric rash. The two most important DDs are:

🔹Small vessel vasculitis (lupus, ANCA, cryoglobulinemia etc) ♨️

🔹Infective endocarditis (janeway lesions) ❣️

Bleeding disorders often affect areas where the skin is soft and loose rather than the soles
Other causes of palmoplantar rash

1️⃣Infections- maculopapular, blanching

🔹Viral eg parvovirus, coxsackie, measles
🔹Bacterial- menigococcimia (purpuric, non blanching), syphilis (2°)
🔹Rickettsia- RMSF

#MedTwitter #MedEd Image
Read 6 tweets
1a) Welcome to a live-tweeted, #accredited #tweetorial from @nationallipid #NLA23 in #Atlanta on advances in #hyperlipidemia management #LLT. Our expert returning faculty is Pam R. Taub, MD @PamTaubMD #cardiologist from @UCSDHealth ImageImageImage
1b) Dr. Taub is a clinician/scientist and is a frequent contributor to our #accredited programs. She is the founding director of the Step Family Foundation Cardiac Rehabilitation and Wellness Center at #UCSD.
#FOAMed #cardiotwitter @MedTweetorials #MedEd #lipids Image
2) This program is supported by an educational grant from Esperion Therapeutics & is intended for #HCPs. Statement of accreditation & faculty disclosures at Earn 0.75 hr 🆓CE/#CME by following this 🧵!
Read 48 tweets
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A #tweetorial to help you remember cervical radicular pain distributions

#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #meded #spine #Neurosurgery Image
2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5.

If you divide your arm in half, that's at the elbow, you'll also get 5--C5 that is! C5 radiates to the elbow. So if it radiates below this, it's > C5 & above is < C5 Image
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution Image
Read 9 tweets
During my Internal Medicine training, I wrote 100s of History and Physicals (H&Ps).

Now as a Cardiology fellow, I read every single H&P for a new consult.

Here are 7 tips and tricks for effective H&Ps. #arjuncardiology #MedTwitter #MedEd #Cardiotwitter #IMG Image
Read 10 tweets

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