WuidQ: Washington University ID Questions Profile picture
Nov 24, 2019 β€’ 5 tweets β€’ 2 min read β€’ Read on X
ID Miscellany|Exams|Signs|Humanities #idmesh

1/5
π™ƒπ™žπ™©π™―π™žπ™œ π™―π™€π™£π™šπ™¨
Unusual pattern of sensory loss in neurosyphilis (tabes dorsalis):

β–ͺ️ central face (tip of nose)
β–ͺ️ band on the trunk (nipple area)
β–ͺ️ medial forearms (when ulnar nerve pressed at elbow)
β–ͺ️ lateral leg Image
2/5
It is a physical exam finding lost in antiquity.

Tabes dorsalis was the most common form of neurosyphilis in the pre-antibiotic era but today, it is extremely rare (longest latency period between primary infection & SSx).

karger.com/Article/FullTe…
3/5
Tabes dorsalis involves posterior columns/dorsal roots.

β–ͺ️ wide-based gait, foot slap (worse in the dark)
β–ͺ️ +Rombergs, absent knee/ankle DTRs
β–ͺ️ vibration/proprio loss
β–ͺ️ lancinating paints
β–ͺ️ Charcot joint/ulcer
β–ͺ️ Argyll-Robterson pupil (another #idmesh topic)
4/5
Named after Eduard Hitzig (6 February 1838 – 20 August 1907), a German neurologist & neuropsychiatrist who was one of the first people to map out the motor and sensory areas of the brain. Image
5/5
The archived section of our medial libraries probably has the best resources on tabes dorsalis. But here is one from Google, published in 1936:

google.com/url?sa=t&rct=j…

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More from @WuidQ

Jan 6, 2021
38/M w/ progressive loss of scalp, axilla, and chest hairs. Recently dx w/ HIV 6 mos ago when he developed dissem cryptococcosis. He has now been taking TDF/FTC, raltegravir, TMP/SMX, azithromycin, & fluconazole x 6 mos. Drug-induced alopecia is suspected. Most likely culprit?
1/8 Nice job! 52% got the right answer, fluconazole.

In animals/humans, fluconazole has been shown to induce telogen effluvium bit.ly/2MMnF9j, one of the most common causes of nonscarring hair loss (see Table πŸ‘‡ bit.ly/38rTXyN).

@LParraRod @NNolanMD Image
2/8
Normal hair cycle: anagen (growth) πŸ‘‰catagen (transformation) πŸ‘‰telogen (resting) πŸ‘‰ shedding. Cycle is asynchronous (no mass hair shedding). At any given time, 90% of hair are in anagen, 1% in catagen, 10% in telogen.

@ID_fellows @PBMazi @LeMiguelChavez @gayathri25788
Read 9 tweets
Sep 24, 2020
32/M, h/o HSV encep 1 mo ago (s/p 21 d ACV), on ceftri/metronidazole for sacral OM, p/t ER +delusion, fever, seizure. CSF: WBC 25 (L>N), ⬆️TP, n/l gluc,(-)HSV. Septic w/u all(-). MRI:
b/l temporal lobe enhancement ⬆️ from prior. Whch of the ff is the best Tx for this condition?
1/11
The group is split b/n steroids & d/c metronidazole. The answer here is Tx w/ steroids. Indeed, this is a case of autoimmune post-HSV encephalitis (anti-NMDA receptor encephalitis post-HSV). Good job @LemuelNonMD
@LeMiguelChavez @adilrashid83 @Orchid10Tree @KhalafSuha
2/11
Metronidazole-induced encephalopathy is predominated by cerebellar Sx w/ a distinct involvement of the dentato-rubro-olivary pathway on imaging. We’ve talked about it here before. ReferπŸ‘‡for further discussion
Read 12 tweets
Sep 19, 2020
67/M w/ poor control DM, BPH, +10 d dysuria. T38.1, BP 120/80, +tender R CVA. WBC 14. U/A: 21 WBC, UCx: (-)bacteria, +Candida glabrata (fluc-R) x 2 samples. BCx(-), CT: +prostate hypertrophy. Has had no response to ceftriaxone. Has no Foley cath. Which of the ff is indicated?
1/15
The vote is split b/n micafungin and ampho deoxycholate! Thank you for all your responses!

Although micafungin may be a reasonable option, the correct answer here is ampho deoxycholate.

In this tweetorial, we will talk about Candida UTI and its treatment.
@ID_fellows
2/15
Candiduria can be challenging as it can potentially indicate: colonization, UTI, or candidemia/disseminated infxn.

Candiduria from a clean-voided urine sample is uncommon (<1%); more commonly seen in hospitalized patients w/ an indwelling bladder cath.
Read 16 tweets
Sep 16, 2020
ID Miscellany|physical Exam|Signs|Humanities #idmesh
1/20
𝙁𝙀𝙑𝙀𝙍 π™‹π˜Όπ™π™π™€π™π™‰π™Ž: 𝘼 π™‡π™Šπ™Žπ™ π˜Όπ™π™?

Great! Three quarters find inquiring about fever patterns still useful. We will review some of the most important fever patterns.

@ID_fellows

2/20
For centuries, physicians have relied upon meticulous observations to dx infections. For many years, observation of the fever pattern provided physicians w/ important diagnostic clues. However, the advent of abx & advanced dx & imaging has changed this landscape. #idmesh
3/20
Swift initiation of abx & antipyretics make it impossible to verify historical descriptions of certain fever patterns. Hence, inquiry into fever patterns loses its clinical significance bit.ly/33iXCLs.
Read 21 tweets
Sep 11, 2020
29M w severe persistent asthma p/w recurrent exacerbations despite optimal LABA/intranasal steroids. Abs eos 1250, total Ig E 1500, CT +mucus plugging, central bronchiectasis upper-middle lobes. Originally from Mexico, now in Texas. Which of the ff tests is indicated?
1/10
Great job! The majority got the right answer, allergic bronchopulmonary aspergillosis (ABPA).

Recurrent asthma exacerbations despite optimal asthma therapy & eosinophilia a/w mucus plugging and multilobar central bronchiectasis should raise suspicion for ABPA.
2/10
Aspergillosis, classified as saprophytic (aspergilloma), allergic (ABPA, hypersensitivity pneumonitis, allergic sinusitis), or invasive (pulmonary, other organs).

ABPA: hypersensitivity to A. fumigatus; can also occur from other fungi (referred as ABPM, M for mycosis).
Read 11 tweets
Jul 31, 2020
48M +cirrhosis, underwent routine large volume paracentesis. +Abd fullness, (-)fever, abd pain/tenderness, confusion. Ascitic fluid: light yellow, 100 PMNs, SAAG 1.5, Cx +pan-susc E. coli. WBC 8, Crea 0.8, bili 1.8. Which of the ff is best management for this patient?
1/5
Only 21% got this right: no abx, repeat para in 48H.

The dx of spontaneous bacterial peritonitis (SBP) rests on finding >/= 250 PMNs/mm3 in the ascitic fluid. Most patients with SBP are symptomatic (only 13% with no symptoms bit.ly/3gp5nEU)
2/5
The patient in our case is asymptomatic (no fever, abdominal pain, mental status change πŸ‘‰most common SBP symptoms) and the ascitic fluid is <250. This is a variant of SBP known as:

β–ͺ️Monomicrobial nonneutrocytic bacterascites (MNB)
Read 6 tweets

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