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Feb 9, 2021 • 4 tweets • 3 min read
1/ID docs are known for their smarts, amazing notes and for being.....NOSY! 👃🔍

Former chief resident & ID fellow @PierreAnkomah unravels the clinical reasoning behind

🕵️‍♀️Why ID docs ask so many Questions

Follow for #ConferenceTwearls!

#IDtwitter @mgh_id @MGHBWHIDFellows
2/ One of the core concepts of clinical reasoning in ID is to

🔍 name the syndrome (i.e acute febrile diarrheal illness)

while exploring the interaction between

🦠 Microbes

👤 Host

🌍 Environment Image
3/ see the example below that showcases the
🔍syndrome👤host 🌍environment

When it comes to 🦠 microbes, think of them in BUCKETS:
💥Viruses

💥Typical bacteria
💥Atypical bacteria
💥Mycobacteria

💥Fungi
💥Parasites

See an example w a ddx of ring enhancing brain lesions🧠 ImageImage
Don't forget non-infectious causes of a syndrome!

Take home points:
🔍use history as a diagnostic test
🔍practice using frameworks
🔍stay curious!

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More from @mghmedres

MGH IM Residents Profile picture
Apr 8, 2021
1/ 34 y/o F with new AML dx on chemo (7+3) ANC 200. Counts are expected to continue to drop & not get better for at least another ~10d. Has been febrile 🌡️🔥 & on cefepime 2g q8 for the past 5 days💊💉. What do you do next?

#MedTwitter #OncTwitter #IDTwitter
2/ Former chief resident & leukemia doc @andrewbrunner from @MGHCancerCenter spoke about acute leukemias & #FebrileNeutropenia (F+N) ! Here are some #ConferenceTwearls

Definition:

Febrile: ≥ T 100.4 🌡️

➕

Neutropenia: ANC ≤ 500 or an expected 📉 to an ANC of ≤ 500 in 48h
3/ It's 🔑to look for a source of possible infection. BCx for all comers! Additional w/u depends on the clinical context.

📸Low threshold to image/scope these pts since they may not present classically---> e.g. pt w perforated abdomen can present w soft abdomen on PE.
Read 7 tweets
MGH IM Residents Profile picture
Oct 4, 2020
1/ We have a special tweetorial by PGY-1 @kevincmillerMD !

We are here to talk about @DGlaucomflecken 's favorite organ: THE SPLEEN! ♥️Or rather, what happens in its absence!

Is having a splenectomy a risk factor for thrombosis ❓🤔

@MedTweetorials #MedTwitter
2/ First, the spleen is a complex, beautiful & underrated organ. There, we said it. 🤷

It’s so great that 15% of people have an extra accessory spleen

The spleen has 3 general components: A marginal zone & 2 pulps.
3/ ↔️Marginal Zone: Free-flowing transit space for immune cells, where antigens are captured by dendritic cells and B cells (i.e. as APCs) prior to migration to white pulp.

⚪️White Pulp: Physically exclusive lymphoid tissue where T and B cells mature 👶👧👩👵
Read 15 tweets
MGH IM Residents Profile picture
Sep 18, 2020
1/ Res report with our fellow Dr. Michelle Rengarajan this week featured a cool case with a lot of ✨pearls✨

28 year old man presents with acute quadriplegia.

What's on your ddx?
2/ BMP drawn and showed K of 1.3!

Your intern year prepared you for this aggressive K repletion moment.

His K improved quickly and weakness resolved! Pt's TSH of <0.01 makes the diagnosis of

*drum roll*

✴thyrotoxic period paralysis (TPP)!✴
3/ We are not done! What's causing the hyperthyroidism?

Review the axis to find 4 mechanisms:

1️⃣Autonomous hormone production by the thyroid (Graves vs. Toxic Nodule)

2️⃣Exogenous

3️⃣Release of preformed hormone

4️⃣Hypothalamic/pituitary stimulation of production Image
Read 8 tweets
MGH IM Residents Profile picture
Sep 15, 2020
1/ The fall weather is getting us into the halloween spirit, and things are about to get bloody 👻❗

Let's review former chief resident and GI master @NnekaUfereMD's high yield pearls on:

🔴⚫ GI Bleeding ⚫🔴

@MGH_GI #MedTwitter #livertwitter
2/ What's the source?
Upper GI ⬆️ Vs. Lower GI ⬇️

⚫ MELENA
Usually ⬆️
Only 10% of cases are lower GI

🔴💩 HEMATOCHEZIA
- Non-Cirrhotic: ⬇️
only 15% of cases are from upper GI

- Cirrhotic: ⬆️
50% of cases are from upper GI

🔴🤮 HEMATEMESIS:
Rectal exam for triage
3/ For hematemesis 🔴🤮,

The color of 💩 on a rectal exam guides triage. See the slide below in terms of urgency!

🚨Red stool suggests a brisk bleed that will need urgent attention🚨 Image
Read 4 tweets
MGH IM Residents Profile picture
Sep 10, 2020
Good morning! ☀️ We are up & excited for grand rounds with Dr. Fauci!

@NIAIDNews @mgh_id @katrinarmstrong @RWalensky @MGHMedicine #MedTwitter #IDTwitter
1/ A reminder that while the clinical presentation of COVID-19 varies, a large proportion of adults in the U.S are susceptible to severe disease, more than 40% ‼️
Obesity is a key risk factor.

READ: It's not just people in nursing homes! Image
2/ Dr. Fauci discusses COVID-19 vaccines💉

He is optimistic that we might get one by the end of the year. He also highlights the disturbing racial inequities with the pandemic and how vaccine trials should include underrepresented minorities! Image
Read 5 tweets
MGH IM Residents Profile picture
Aug 28, 2020
Recap of noon conference today with Dr. Nancy Wei on every intern’s favorite call admission aka DKA!!
Here’s a framework to think about the different types of ketosis-prone diabetes subgroups!

Remember to think about beta-cell function and auto-antibody status to beta-cells! Image
How does DKA happen?

Not via hyperglycemia.

It is from high glucagon and NO insulin. This leads to a release of glucose from glycogen stores, then subsequently a release of fatty acids from fat cells leading to ketone production, and ultimately, ketoacidosis.
Read 7 tweets

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