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Brigham and Women's Medicine Residents Profile picture
@BrighamMedRes
Jan 31, 2019 • 1 tweets • 2 min read • Read on X
36M w/ 7d bilat LE purpura, no fevers, mild HTN. 1st: Palp vs not. Vasculitis -> dependent areas. 2nd: Organ involvement -> CBC wnl, ↑Cr 1.5, UA w/ 2+ RBCs, 2+ prot -> Renal bx = mesangial thick +IgA. We have HSP. Tx ACE/Fish oil +/- steroids. Thanks discussant @MariaYialamas ImageImageImageImage

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More from @BrighamMedRes

Brigham and Women's Medicine Residents Profile picture
Dec 15, 2020
Thank you to our PD emeritus Dr. Marshall Wolf & @tmmeade1 for kicking off the week with a case of syncope yesterday!
The 💰 is in the 🗣️!
1. Is this true syncope? Transient LOC + spontaneous and rapid recovery
2. How worried 😱 are you for 💔 etiology? Any ❤️ disease, new chest pain/palpitations, exertional or supine syncope, FHx sudden cardiac death, abnormal VS or ECG should set off 🚨
...May be reassured by syncope stable x years, with clear prodrome & trigger, in a younger individual (<40 y/o)
🤔 In thinking about worrisome etiologies, recurrent syncope less likely to be tamponade, dissection, ACS, PE but arrhythmia🔌💓 still on the table!
Read 6 tweets
Brigham and Women's Medicine Residents Profile picture
Oct 28, 2020
Can't miss noon conference with Dr. Loscalzo! Yesterday we tackled a case of cardiac arrest 💔 in a ♀️ with a history of heart transplant.
Our patient had been transplanted for LMNA mutation
🩺 Most common genetic cause of familial DCM
Can present with or without 💪 muscular dystrophy
💟 Conduction disease typically precedes DCM, and pts often need PPM or ICD Image
Timing from transplant, host and donor factors can help to shape your ddx 🤔 ImageImage
Read 6 tweets
Brigham and Women's Medicine Residents Profile picture
Oct 26, 2020
What comes to mind when a patient with recurrent UTIs presents with 2 weeks of progressive pruritus and jaundice?

More from @LHortonGI and @sanjiv_chopra from today's morning report below... 🧐

#livertwitter
💫Jaundice and pruritus presenting together = *cholestatic* jaundice!

✖️Can typically rule out hemolytic jaundice - unless invoking Hickam's dictum and multiple problems🙂
🔎Start with RUQUS - computed tomography is not so good for biliary system!
Read 10 tweets
Brigham and Women's Medicine Residents Profile picture
Oct 20, 2020
So many great ID 💎💎💎 with @dsolsMD at morning report today, discussing a case of preseptal cellulitis + parotitis!
🦠Staph aureus, Strep sp, and anaerobes 🦠 implicated!
Preseptal cellulitis - infection anterior to orbital septum - can be differentiated from orbital cellulitis by pain with EOM 👀🙄 due to inflammation of extra ocular muscles and fatty tissue. ImageImage
When contemplating 💊:
1. who is the host? Not as simple as immunocompromised 😷 or not. Consider "area under curve" - total lifetime exposure to immune suppressing medications or conditions.
Read 6 tweets
Brigham and Women's Medicine Residents Profile picture
Oct 19, 2020
Make sure to carbo-load 🍭🍝🍬 before diving into this morning report, with @LHortonGI and the one and only Dr. Marshall Wolf!

We learned about a dramatic presentation with severe hypoglycemia causing a fender-bender...
Dr. Allen O. Whipple's "triad" of pathologic hypoglycemia originated from observing unnecessary exploratory surgeries for suspected insulinoma.

Reminder of his triad...
📉Hypoglycemia
😢Neuroglycopenic symptoms
☺️🍭Prompt resolution of symptoms with glucose administration Image
When evaluating suspected pathologic hypoglycemia, check labs concurrent with low glucose!
🩸beta-hydroxybutyrate / serum ketones
🩸insulin
🩸C-peptide
🩸proinsulin
🩸sulfonylurea screen

Check out this framework for interpretation, borrowed from 2016-2017 CMRs MCDreAmy! Image
Read 9 tweets
Brigham and Women's Medicine Residents Profile picture
Oct 1, 2020
Can't beat starting the day with morning report with APD Dr. @MariaYialamas! Today we delved into the world of ♀️ health with a case of amenorrhea!
In generating your ddx, common causes along the HPO axis include functional amenorrhea (due to any physical or emotional stress 😬), elevated prolactin, and PCOS.
Don't forget to include structural causes - mainly adhesions due to prior D&C Image
Exam pearl alert 🚨: rapid onset hirsutism, hair growth on back or upper abdomen, clitoromegaly ➡️ androgen secreting malignancy > PCOS.
Read 6 tweets

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