Discover and read the best of Twitter Threads about #medstudenttwitter

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Everyone loves those pretty colored fMRI pictures with the blobs. But what do they mean? How do they make them?
A #tweetorial called “F— that: Understanding fMRI”. #FOAMed #medtwitter #Medstudenttwitter #neurotwitter #FOAMrad #neuroradiology #radiology
fMRI is based on a principle called “neurovascular coupling.” This is the principle if there is increased neuronal activity in a region, there will be increased blood flow to that region to meet the increased demand
Think of it like a baby crying because it is hungry—parents immediately rush to feed it. The increased oxygen demand of the neurons immediately brings increased fuel to feed it.
Read 17 tweets
Why is cranial nerve 6 uniquely affected by⬆️ intracranial pressure? Why is it special? A common question after the CN6 tweetorial.
Here is a maybe #tweetorial, but maybe a🧵about why CN6 is alone affected by ⬆️ pressure. #FOAMed #medtwitter #Medstudenttwitter #neurotwitter Image
Think of the intracranial CSF space like a balloon, distended by CSF instead of air. Cranial nerves begin inside the balloon, and then they exit as they begin their extradural portion Image
Most cranial nerves move immediately away from the CSF space after they exit—usually going out through their respective foramina. However, CN6 uniquely runs along the outside of the “balloon” in Dorello canal Image
Read 7 tweets
It is rare a patient tells you where their pathology is—but they do when they tell you they have a cranial nerve palsy—you just have to know where to look!
A #tweetorial about the Six Syndromes of the Sixth Cranial Nerve. #FOAMed #medtwitter #Medstudenttwitter @medtweetorials
To understand the six syndromes, you have to know the anatomy of the 6th nerve. It starts in the brainstem, at the facial colliculus—what looks like the butt of the brainstem. It then travels anteriorly through the brainstem to exit out the ventral surface of the pons.
It exits the brainstem at the inferior aspect of the pons—under what looks like pot belly of the pons and then travels anteriorly in the subarachnoid space towards the clivus
Read 17 tweets
My fellows complained they hate memorizing classifications, like LeFort. I thought, “There must be a better way—maybe understanding instead of memorizing.”

A #tweetorial about understanding the LeFort classification. #FOAMed #medtwitter #Medstudenttwitter @medtweetorials
To understand LeFort, you need to understand facial buttresses.
These are not true anatomic structures but a way of understanding facial structure.
Facial bones support facial structures like a table supports food, with legs (vertical buttresses) and table top (horizontal)
In the face, the two main structures the buttresses are supporting are the orbits and the alveolar ridges of the maxilla and mandible supporting the teeth
Read 12 tweets
You start SQ insulin on a patient and they develop peripheral edema ?
What is the mechanism of "Insulin edema" ?
#MedTwitter #MedStudentTwitter
This condition was initially reported by Aaron Leifer, M.D. in 1928 in a 41-year-old male patient started on an insulin regimen which was published in JAMA.

Leifer A. A CASE OF INSULIN EDEMA. JAMA. 1928;90(8):610–611. doi:10.1001/jama.1928.92690350001012
The severity of edema is usually mild, involving the limbs, sparing the torso and face.
Resolution is usually seen after one to two weeks of conservative treatment with fluid and salt restriction and may or may not involve the use of diuretics…
Read 8 tweets
Hi #MedTwitter #MedStudentTwitter #neurotwitter #MedEd #FOAMed! It's been too long since my last #EndNeurophobia #tweetorial so here's an introduction to brain imaging–thanks @sarrovasta for the request!🧠❤️
cc:@CPSolvers @rabihmgeha @DxRxEdu @AvrahamCooperMD @caseyalbin
Let's start w/CT. I'll focus on brain (and not bone or soft tissue). First:

* Identify normal structures and any abnormalities in:
- Size
- Shape
- Symmetry
(note *symmetric* abnormalities such as ventriculomegaly or diffuse cerebral edema may not be obvious w/o experience)


* Identify abnormalities
- Hypodensity
- Hyperdensity


• Hypodensity:
- Ischemia
- Inflammation
- Infection
- Neoplasm

• Hyperdensity:
- Blood
- Calcification
- Hyperdense tumors (e.g. lymphoma)
- Thrombus in vessel
- Contrast enhancement

Read 19 tweets
I want to talk about guilt.
A 🧵

As doctors, we strive to do our best for patients. We often make sacrifices to ensure patient care is as good as possible in what, let's face it, is a system that is breaking at the seams.
Many decisions made by doctors are layered with emotional & moral dilemmas.
Weighing up the different elements of scenarios, the pros & cons, the potential consequences & risks.

Generally we can reconcile the outcome of these decisions with the fact that we've done our best
But during the pandemic, doctors faced decisions that left them feeling that they hadn't done their best.

Patients dying without their relatives, decisions to determine who gets the last ICU bed, delays in cancer surgery, deciding who gets a chance at life & who doesn't.
Read 8 tweets
Residents/fellows often ask if ✍️ a review paper is worthwhile.

👇a short🧵with pros/cons/tips on writing review articles.

#MedTwitter #AcademicChatter #MedStudentTwitter #MedEd
Is ✍️ a review a good idea?

Short answer: yes

1. No resources/funding required
2. Gain in-depth knowledge in a specific area
3. SOA reviews are highly cited
4. Excellent venue to hone✍️skills

1. Time consuming
2. Not a substitute 4 original🔬
3. Unpredictable fate
How do I select a topic?

1. ✍️ on broad topics if no good 📝 exist (eg, SCAD, aneurysms, TV interventions), or if u find a novel angle (eg, stakeholder perspectives on stroke prevention in AF)

2. ✍️ on niche areas (eg, electrosurgery, ICE for LAAO, TAVR leaflet thrombosis)
Read 10 tweets
🧵 The Developmental Milestones of a Medical Student: A Sarcastic Thread

Ever wonder if medical students are meeting their age-appropriate milestones?! Well now you can know!

Starting with: Developmental Milestones – 2 Months

#MedTwitter #MedStudentTwitter #PedsTwitter

Developmental Milestones – 4 Months

Developmental Milestones – 6 Months

Read 20 tweets
Duration of Antibiotic Therapy
Deciding on the duration of antimicrobial therapy for an infection is neither straightforward nor simple. 👇
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
#medschool #MedStudentTwitter #medstudent #TwitterRx

Most ID guidelines are based- either expert opinions or evidence-based medicine. Historically, duration of ABX Rx were based on arbitrary extension of days(magic numbers like 7, 10 & 14 days) rather than on reliable evidence with the main aim to ⬇️ failures & avoid underRx.

There is growing evidence to support for shorter courses. It is important for prescribers to be up to date with best practices. Duration of therapy plays a pivotal role in antimicrobial stewardship programme within the global effort to optimize antibiotic use &⬇️resistance.

Read 26 tweets
Tweetorial on updated pneumonia vaccine guidelines 💉

Let’s start with some terminology ➡️

The ones from the old guidelines:
PCV13 = Prevnar 13
PPSV23 = Pneumovax 23

And the new:
PCV15 = Vaxneuvance
PCV20 = Prevnar 20

#MedTwitter 🧵
PCV = Pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20)

PPSV = Pneumococcal polysaccharide vaccine (PPSV23)

It’s important to note that ALL of these protect against the bacteria Streptococcus Pneumoniae and not other types of pneumonia
PCV13 (Prevnar 13) is still recommended for childhood vaccine series, no changes there. But it is no longer found in the adult recommendations

PPSV23 (Pneumovax) is also no longer sufficient on its own
Read 8 tweets
"Difficult Patient"
"Poor Historian"
"Low Health Literacy"
Or the indefensibly still in use, "Poor Protoplasm"

So many of the labels Medicine uses for patients are just a way of saying, "Not one of Our People."

2/ Medical Students and Residents, don't accept this terminology; don't allow it to dehumanize your patient, remove their agency, and undermine their care. Phrases like these can and do kill people. Fight back against this; both subtly and explicitly. #MedStudentTwitter
3/ When someone on your team says the patient is non-compliant, ask whether the plan they 'didn't comply' with was guided by shared decision making and realistic considering their healthcare barriers; ask whether the plan was discussed with them, and if they consented to it.
Read 10 tweets
🧵As a scientist & physician, when our #pandemic predictions are off, I think it's important to circle back & analyze why. In late Dec 2021, I tweeted a🧵predicting widespread disruption of everything from health care & pharmacies to grocery stores & schools in Jan/Feb '22. 1/x
The reason for my prediction was the pattern of a huge spike in #COVID19 cases the prior winter (driven in part by holiday travel) & the fact that #omicron was considerably more contagious than prior #COVIDvariants & more able to evade immunity from vaccines or prior infxn. 2/x
The pace in growth of cases in Dec '21 in countries w/ early #Omicron outbreaks was stunning. The graphs were vertical. In the US, we appeared on target to have >500K cases/d in the US. We had no idea yet how long the surge would last. 3/x
Read 18 tweets
🧵on basic #inhaler technique b/c we can all do better educating our #copd #asthma patients 🫁

Studies show inhaler error is common & many pts aren’t taught how to use their inhalers properly

↑💊 ≠ always the answer

#MedTwitter #MedStudentTwitter #Tweetorial
Step 1: Actually ask how they use their inhaler😅

With so many types, it’s not surprising pts & providers get confused 😵‍💫

Esp in clinic, ⏰ is tight. But only takes a min to explain

Also pharmacists/RTs are amazing! I <3 using them when able

Let’s first discuss the common inhaler devices. Which one was used in the clip above?

Read 23 tweets
1/10 As someone who struggles with test-taking, I made a framework for tackling some common test-taking hurdles. I had the opportunity to go over this with all our @uclaimchiefs housestaff and decided to make it into a 🧵 #MedTwitter #MedStudentTwitter #FOAMed
2/ Test scores are important because they are what you need to become board-certified. Scores are often conflated with competency - that is quite a fallacy as so many other factors go into competency.
3/ Here is a non-comprehensive set of examples of test-taking hurdles. Let’s go through each of them systematically in a way that resonates with internists - problem listing! FYI, all of these end of overlapping a lot
Read 11 tweets
1/12 Looking to stand out on your residency application? Letters of recommendation (LoR) are crucial! This thread is geared towards MS3/4s & will include some strategies & tips for finding letter writers and helping them (help you)!
#MedTwitter #MedStudentTwitter #Match2023
2/12 Do not underestimate the power of a strong LoR! Residency programs that conduct a holistic review of course look at multiple aspects of an applicant’s file. However, letters of recommendation consistently rank as one of the most important factors.
3/12 So, say you’ve identified an attending who you worked well with and who has agreed to write you a LoR. What can you do to help them?
For starters, check out this thread by @DavidBassilyDO
Read 12 tweets
An in-depth review of metacarpal fractures.

If you're interested in orthopedics you'll definitely want to check this review out!

What is an eponym for this fracture? Image
This patient is presenting with an intraarticular fx of the 5th metacarpal base.

This fracture is similar to a Bennett's fx (an intraarticular fx of the 1st metacarpal base).

This fracture goes by a few eponyms: a reverse bennett, baby bennett, or mirrored bennett. Image
A Ronaldo fracture is a comminuted fracture of the 1st metacarpal base. (shown above)

Displacement of a Reverse Bennett fracture is due to which of the following muscles?
Read 14 tweets
I don't know who on #MedStudentTwitter needs to hear this, but Step 1 is not the High Jump. A high score doesn't win, and a low score doesn't eliminate you from contention; it doesn't determine how good of a doctor you will be, and it certainly doesn't determine your worth.
It's not really a competition at all, but if you need a track and field analogy it's more like that weird water obstacle in the Steeplechase.

You might leap right over it. You might stumble. You might fall face first with an embarrassing splash and get trampled a bit like I did.
But all that matters is that you get over it somehow; and then you can keep running. If you really stumble it might mean you have some catching up to do, but the nice thing about this- compared to the real Steeplechase- is that finishing is the goal, not beating anybody else.
Read 6 tweets
As the #residency interview for #Match2022 wraps up, applicants often ask, how do I let programs know I really like them? how do I increase my match chances?
Not required and not sure makes a difference but if it makes you feel better do it. Most important, be honest! #MedEd(1/4)
Be honest! Do not tell a program they are your first choice if they are not, and a program canNOT ask you where you are ranking them. See here for Match Communication Code of Conduct. (2/4) #Match2022 #MedTwitter #MedStudentTwitter @Inside_TheMatch…
Do NOT rank a program higher just because u think they ranked u high & u more likely to match there. Rank programs in order of YOUR TRUE PREFERENCE. The Match algorithm works to ur advantage so rank higher those u liked more even if reach. More tips… (3/4)
Read 4 tweets
A #dermtwitter #tweetorial on...


Join me for a quick #thread on this autoimmune blistering disorder!

#MedEd #FOAMEd #medtwitter #MedStudentTwitter
Pemphigus vulgaris is where the patient's own antibodies target a Desmosomal protein, which leads to the keratinocytes coming apart.

I describe this to patients as a brick wall, where the mortar holding things together is getting dissolved.

Remember this?👇
This is contrast to the Pemphigoid group of diseases, that target the hemidesmosome. In other words, remember that:

pemphiguS = Superficial (in the epidermis) (1)
pemphigoiD = Deep (below epidermis) (2)

pemphigus = FLACCID blisters
pemphigoid = TENSE blisters
Read 17 tweets
It's Martin Luther King Jr. day
In the essence of Dr. King, I'm going to keep it extra real with Twitter this evening. This is particularly aimed at the medical training programs in the Midwest and South. The performative mission statements really have to end. We're sick of it.
Soooooo many programs have these amazing mission statements of supporting diversity, fostering a community of diverse backgrounds, etc...then you look deeper and they've graduated one resident of color in the past decade. They have a homogeneous faculty but their patients aren't.
Another thing that needs to end is the courtesy interview. If you're not actually interested in ranking candidates of color, then don't invite them for an interview (or ask them to rotate at your hospital). It's a trend in medicine and applicants are aware; it's quite insulting.
Read 17 tweets
🧵 Part 14 of my #Tweetorial Series for #Match2022: Rank Order List 🧵

Let's talk about what to consider when making your ROL!

@FuturePedsRes @Inside_TheMatch @InternalMed_Res @FutureGenSurg @futureradres @NMatch2022 @IMG_Advocate @FutureAnesRes @futureENTres @FamilyMed_app

In this thread, I’ll be sharing what I feel are the Top 15 most important things to consider when formulating your rank order list (ROL) of residency programs.

So without further ado, let’s get started!

In no particular order:

Resident Vibe

Virtual meet-and-greets are different than in-person socials, but you should have been able to get a general sense of the vibe of the residents from each program. What are the kind of people you want to be around? How did the residents make you feel?

Read 30 tweets

I'm channeling my "Curious Clinician" today for this different type of #dermtwitter #tweetorial.

Let's start with a question. What does acral mean?

#MedEd #FOAMEd #medtwitter #medstudenttwitter
If you answered, "hands, feet, and ears," you're correct! This is tricky, and it wasn’t until dermatology residency that I learned it’s not palms and soles!

If you haven't yet, take a look at my old #tweetorial on acral rashes as a primer.

Let’s first cover the easy stuff. We use our hands for so many different things that by virtue of that fact, certain things happen more frequently.

✔️Contact dermatitis from hand washing
✔️Herpetic whitlow (especially in dentists)
✔️Actinic skin damage (UV on dorsal hands)
Read 17 tweets
#MedStudents, #Residents, #Fellows, and #Research Trainees - I recently had both a resident and fellow ask me how I got involved in research and published when I was a #trainee. I thought I would share my tips and advice in this thread. #MedTwitter #ACGME #MedStudentTwitter
1. Ask yourself👉what you want from this? To pursue research as career? To boost application for #residency #fellowship #employment? To get a recommendation letter? Regardless, aim for #publication (most value). Conference talks are cool, but publications stay on CV forever!
2. Basic science research=⬆️time+lab training vs clinical research. Study designs: RCTs, prospective, retrospective, case reports, review papers. Publishing case reports+review papers are most feasible endeavors during training! Best way to boost #publication numbers.
Read 22 tweets

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