Discover and read the best of Twitter Threads about #medicine

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Some unpopular opinions for new medicine interns that I wish someone told me one year ago:

#Interns #MedStudentTwitter #Medicine #MedTwitter
1. When you get your schedule, you'll hear that you’re starting on the worst block/service/etc.

Ignore that. Like med school, intern experiences depend on unpredictable factors like who you work with, availability of resources, proximity to free food, etc. It's super variable.
2. People will tell you to separate work and home.

Instead, do whatever you want. If you pre-chart better at home or want to note-prep before going in, if it helps you know what's ahead, do it. Check on your patients on your day off if you want. It's okay to worry about them.
Read 11 tweets
Transgender health: Comparing model bills to real proposals; Many bills have preambles asserting that the risks of #gender-affirming care outweigh its benefits, which has been rebutted by major #medical organizations.…
1) The AP obtained the texts of more than 130 bills in 40 state legislatures from Plural, a public policy software company, and analyzed them for similarities to model bills touted by the conservative groups Do No Harm and the Family Research Council.
2) The model bills have similar preambles, including the assertion — rebutted by major #medical organizations — that the risks of gender-affirming care outweigh its benefits.…
Read 10 tweets
Hey #medicine residents !!

Time to talk about EOSINOPHILS today. Not as common a consult as thrombocytopenia and anemia but important nonetheless.

A short 🧵 to touch upon all things eosinophilia 👇🏻

#MedTwitter Image
Before we go any further, it's important to know this

🩸Eosinophil ≥ 500 is ABNORMAL

Eosinophil is a predominantly tissue dwelling cell so 🩸 eosinophil DON'T correlate with tissue damage 🤷‍♂️

We see a few patients with ⤴️⤴️Eos and no 🫀🫁 injury !!
Where do eosinophils come from?

Short answer: Bone Marrow

They are cells of the granulocytic lineage, siblings of neutrophils and basophils, children of the myeloblast (image👇🏻)

IL5 is the cytokine responsible for it's production, important to know because we have anti IL5 mAb Image
Read 24 tweets
#HeartFailure (HF) is classified on the basis of ejection fraction (EF) and then into classes and stages. Let's have a look at what each of these mean to a physician in a clinical setting . A 🧵 (1/13)

#MedTwitter #MedEd #medicine
#CardioTwitter #Cardiology
#Heartfailure 💔 is a clinical syndrome that results from a structural or functional impairment of one or both ventricles. Ventricular filling and ejection are thus, hampered.
On the basis of EF, HF is classified into
1️⃣Heart failure with reduced ejection fraction(HFrEF)
2️⃣Heart failure with improved ejection fraction(HFimpEF)
3️⃣Heart failure with mildly reduced ejection fraction(HFmrEF)
4️⃣Heart failure with preserved ejection fraction(HFpEF)
Read 13 tweets
Classically placed in the arm
May be placed in the leg (eg in #pediatrics /neonates – which may then terminate in the infrarenal IVC/iliacs)
#criticalcare #cardiovascular
- Lower infection rate then central lines
- Used in the outpatient setting
- Can be used for several weeks to months
- Duration of PICC lines may be from 4 weeks to 6 months
(although they have been known to be functional for more than 300 days)
Read 20 tweets
INTRAVENOUS THROMBOLYSIS (fibrinolytic therapy) can be successfull if given

A. Within 30minutes to 12 hrs in STEMI

B. Within 3-4.5 hrs in Acute ischemic stroke

C. Within 14 days in Pulmonary embolism

Choose the ✅️correct statement/s among the above.

#Medtwitter #MedEd Image
✅️TRUE statement/s among the above three
Fibrinolytic agents are plasminogen activators(PA) that act by converting plasminogen to plasmin. Plasmin then degrades the fibrin matrix of thrombi and produces soluble fibrin degradation products resulting in clot lysis. Image
Read 15 tweets
Drug of choice for ANAPHYLAXIS in a patient with no response to Epinephrine?
Patient is on Propranolol 60 mg BD for essential tremors.
#MedTwitter #emergencymedicine #CriticalCare Image
Anaphylaxis is a severe, life threatening systemic hypersensitivity reaction characterized by being rapid in onset with potentially life threatening airway, breathing, or circulatory problems and is usually, although not always, associated with skin and mucosal changes.( ICD-11)
Read 9 tweets
Hey #medicine residents !!


Not every patient with anemia needs blood and not is blood transfusion free of complications.

I'll list out a few TRANSFUSION REACTIONS in case you'll have forgotten about them 👇🏻


Let's start w/ TACO🌮

This isn't the good Mexican 🌮 we love🤣

This is pulmonary oedema resulting from overzealous transfusion🤷‍♂️

Risk factors: patients who can't handle fluids we'll, i.e. patients w/ kidney,heart disease etc

Totally avoidable complication🙏🏻


2/10 ImageImage
A close differential of TACO is TRALI. The symptoms are the same but this is non-cardiogenic pulmonary oedema.

So BNP will be normal here, neck veins won't be dilated

TACO needs diuretics and some restraint on your part🤣

TRALI=supportive care


Read 10 tweets
Snake venoms are complex mixtures of proteins, peptides, and other molecules that have evolved for various purposes, such as prey immobilization and digestion. This video demonstrates how procoagulants in some snake venom promote blood clotting. How does this work? See Next⬇️1/3
These procoagulants directly interact with proteins involved in the blood clotting process. Often these are proteases (cleave proteins) which ultimately lead to the rapid formation of fibrin, the protein mesh that stabilizes blood clots. ⬇️2/3 Image
Understanding venom is important in medicine, as there are many medical applications such as anti-clotting agents and blood pressure medication. 3/3
#Science #Biology #medicine
Read 4 tweets
You are a young #medicine resident !!

35/♀️/ wheeled in with 1 e/o seizure f/b loss of consciousness😮

Urgent CT👇🏻

Husband reveals she was on blood thinners after her ♥️ surgery, 5 yrs ago 😱

How do you manage this patient?

Read this thread to know more 👇🏻


1/12 Image
Yes, the CT shows a large hematoma

The patient was most likely on a vitamin K antagonist (VKA) post her prosthetic valve surgery!

The labs are back, she has also started to 🩸 through Foley's catheter😭

•CBC: 8/5600/201k
•INR: 8.8
•aPTT: 32s (control 29s)


This is a classic example of warfarin toxicity & unfortunately quite commonly seen here in 🇮🇳

Why ?

The therapeutic window is 👇🏻


Read 13 tweets
🧵1/12: Writing your first case report can be a rewarding experience as it allows you to contribute to medical literature and showcase your clinical expertise. Here's a step-by-step guide to get you started! #CaseReport #MedEd #MedTwitter
🧵2/12: Start by selecting an interesting or unique case that adds value to the presentation, diagnosis, or treatment of a condition. The case should provide new insights or challenge existing knowledge. #MedicalWriting #CaseSelection
🧵3/12: Look at existing literature for similar cases. If there are less than 20 cases reported on PubMed, it's a good indication that your case might be worth sharing. A thorough literature review is essential for a successful case report. #PubMed #LiteratureReview
Read 13 tweets
You are a young #medicine resident in a busy emergency when a 26/♂️ walks in with 👇🏻

C/o cough and respiratory distress + facial swelling x 7days. He is unable to sleep as the symptoms ⤴️ on lying down 😮

What do you do next?

You read this thread👇🏻


1/18 Image
You immediately know what's going on, you ask for an urgent chest imaging. Only a chest Xray is available and shows 👇🏻

Damnnnnn 😮😮😮

What's that ??


2/18 Image
That is a massive mass in the neck and the mediastinum, also B/L CP angles are blunted 😮😮

This looks like a malignancy l/t superior vena cava (SVC) syndrome!

This is a medical emergency and you must know what next to do before the oncologist gets there!


Read 19 tweets
Hiccups are a common and usually harmless phenomenon that can occur in people of all ages. For hospitalized patients, the etiology may be more sinister. To approach and manage such a case we need to know the etiology. Here's a 🧵 on the same. (1/17)
#hiccups #MedTwitter #MedEd
Hiccups (aka 'singultus')are involuntary contractions of the diaphragm muscle. When this happens, it causes a sudden intake of air, which results in the sound we know as a #hiccup.(2/17)
🔵Acute attack of hiccups last less than 48 hours
🔵 Persistent hiccups last more than 2 days
🔵 Intractable hiccups last more than 1 month
Read 17 tweets
An 85-YO in rural Mississippi: months of tender, erythematous plaques & edema on bilateral hands extending to the elbows & on feet extending below the knees with significant pain

🔬skin granulomatous inflammation & numerous AFB

#IDtwitter #dermatology ImageImage
A repeat skin extensive granulomatous inflammation (A), with Ziehl-Neelsen stain clusters of acid-fast bacilli throughout the dermis (B).
Kinyoun stain >9 AFB/high-power field (C & D).

#dermpath #microbiology (A) Skin biopsy specimen, h...
Molecular identification: 100% identity to multiple Mycobacterium leprae


#MedTwitter #MolBiol
Read 19 tweets
Hospitalisation can burn a hole in your pocket and derail your finances. It will become even tough, if the person who brings in the money, is now in a hospital bed. All this can be avoided by just paying a small annual premium towards health insurance

#healthinsurance #hospital
There are some loop holes in these insurance policies which may again end up leaving a hole in your pocket. So let's shed light on a few things you should be aware of before purchasing insurance.

#HealthForAll #healthinsurance #hospitalised #hospitals
1) What type of health plan it is?

There are various types of health insurance plans -
Individual Health Insurance
Senior Citizen
Surgery & Critical Illness,etc
Go thoroughly through the benefits of each plan and then choose the one that best caters to your requirement.
Read 37 tweets
Does a #preop #medicine consult lead to better outcomes?
Probably not in most cases
New in @JAMAInternalMed from @OttawaHospital @OttAnesthesia @aims_periop @OttawaIM @ICESOntario
Among those who had a consult, baseline risk was higher (not surprising)

But, even with clustered adjustment and PS matching…

No signs of benefit:
-OR 1.19 (1.11-1.29) mortality
-LoS, costs and adverse events also significantly⬆️ with consult
-Consistent in sens analyses
Testing ⬆️
Interventions ⬆️
New B-blocker Rx ⬆️

Were consult pts just less healthy and our data couldn’t adequately adjust? Maybe…

But rates of cancer screening no different btw groups
Read 7 tweets
A snapshot in time confounded by @TheNRMP match “algorithm”. The truth is #medicine is we have work to do in #genderequity - US physician workforce only 37% women. Rads 27%, Gen Surg 22%, #EM 👋🏼29%…@acepnow @WomenSurgeons @AmCollSurgeons @radiologyacr @EmergencyDocs…
@AAMCtoday stats on 2021 US physicians by % female. #pediatrics 65%, #orthopedics 5.9%. Note surgical sub speciality ($$$) higher male dominance, medical/primary care higher female…#orthotwitter @aap_peds @aaos1
New generation of US #doctors show progress, by @aamc study on residents and fellows, 47% total female, #gensurg 46%, #radiology still only 27%, #emed 39%…
Based on the @StanfordMed graphic, we can assume why progress for gensurg but why not for Rads…
Read 9 tweets
How I secured AIR 814 in NEET PG 2023.
A 🧵

1. My previous ranks
NEET PG 2021 - 22244
NEET PG 2022 - 8474

I was working till July 2022 under compulsory rural service post MBBS till June of 2022. Could not get MD Gen MED, so decided to drop and prepare for the next 6-7 months.
Until July of 2022, I only solved Marrow Q banks and did pearls. Did not study any notes.
Then I came across @DrAditya2935 sirs videos of how a person cracked the exam using revision notes and his suggestion of Kam Pado Baar Baar Pado.
It was really difficult to start off with notes because I had never used them. But slowly I got the hang of it. Solved PYQs and annotated them to my Marrow Revision notes. I also subscribed to Reflex app by @DrAditya2935 sir and solved as much as I could.
Read 9 tweets
The establishment creates this problem by first denying the disease, creating a vacuum that quickly fills up with untested treatments & questionable cures. Then they go about trashing their victims who desperately need relief, and the doctors who are willing to treat.
#BTDT #Lyme
It is both infuriating & heart wrenching to watch this scene play out again, with some of the same establishment players engaging in narrative control. Go to ~48:00 for IDSA creep Paul Auwaerter’s word salad tossed at Congress, thx to my friend @PowerOfNeo…
That they have denied, conflated & confused for DECADES #LymeDisease #ME #mecfs #cfs #fibromyalgia and passed them off as psychiatric, and now are doing the same with #LongCovid, should tell you all you need to know about #PublicHealth’s intentions.
Read 4 tweets
A 44-YO♂️, stayed in a rural cottage of France 2 weeks previously: cramping upper abdominal pain with watery diarrhea.
He had passed what he thought were worms in his feces
#GITwitter #IDtwitter #microbiology “Worm” specimen brought to clinic by patient (petri dish
The specimens: identified as the larvae of the drone fly, Eristalis tenax
These larvae are 2.5–3 cm in length; the posterior tube gives them the name of “rat-tailed maggots”

#parasites #GIPath #Doctor “Worm” specimen brought to clinic by patient (petri dish
Myiasis caused by E. tenax:
✔️rare but have been
✔️reported from various countries including Europe
✔️most often intestinal myiasis, but cases of infestation of the nasal cavity, urinary tract, and vagina have been described.

#Doctor #MedStudentTwitter
Read 6 tweets
3 años ♀️, padre con lesiones cutáneas similares: lesiones cutáneas polimorfas localizadas en los glúteos, con elementos papulares, vesiculares y pustulosos umbilicados

🖊️M Roguera y col. @hgermanstrias @aepediatria
DOI: 10.1016/j.anpedi.2022.09.006
#pediatria #infecciosas Lesiones cutáneas en glúteo izquierdo. Detalle de las lesi
@hgermanstrias @aepediatria Se confirmó en el padre la infección por virus de la viruela del mono (MPXV).

PCR de líquido vesicular de las lesiones:➕para MPXV.


#MolBiol #virology #virología
@hgermanstrias @aepediatria Se realizó aislamiento de contacto y secreciones respiratorias (aérea y gotas) en el domicilio hasta la curación completa de las lesiones cutáneas (a los 10 días de evolución).
No hubo complicaciones ni nuevas lesiones en el seguimiento.

#IDtwitter #microbiología
Read 12 tweets
2 meses ♂️, madre VIH+, toxicómana, y chancro perineal indoloro en 2º trimestre del embarazo:
Un mes de rinorrea serosanguinolenta, lesiones dérmicas, FC 180lpm, FR 50rpm, Tª 38,8°C, crepitantes finos en tórax, hepatoesplenomegalia,

#dermatología #pediatria #infecciosas Queilitis y exantema generalizado macular con hiperqueratosi
🧪CMIA anti-Treponema pallidum :➕
⬇️: glucosa, hemoglobina, plaquetas, albúmina
⬆️:transaminas, bilirrubinemia directa
RX: periostitis en huesos largos
PL: hipoglucorraquia, hiperproteinorraquia, sin pleocitosis y VDRL➕
VDRL materno:➕

#microbiologia #urgencias Periostitis en huesos largos.

Penicilina G sódica cristalina durante 14 días, con adecuada evolución y alta por mejoría clínica.

🖊️@_jicastillo @samanthap78 @Mascarejazzy col.
DOI: 10.1016/j.anpedi.2022.06.019
Read 5 tweets
A 26-YO♂️ no #sexual contacts other than with his male partner: 6-day of fever, malaise, a swollen parotid gland, & ulcerative lesion on the ipsilateral lower lip.

Mild lymphopenia

#IDtwitter #dermatology #EarNoseThroat Swelling of left parotid gland (A)  The ulcerative lesion on
PCRs on the throat & ulcer swabs:➕for human #monkeypox (hMPX)
Genomic sequencing: clade IIb variant clustering within the current international mpox virus outbreak


#sexually #maxillofacial #microbiology
7 days after initial presentation, his clinical condition had improved together with a decrease in the parotid swelling and the size of the ulcer.

#MedTwitter #Doctor #MedStudentTwitter
Read 6 tweets

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