A fab 🧵 to help you get out of bed!
1/
6/21 - bit.ly/2TbybKM #cpsvmrpearls The Ddx for lymphocytic pleocytosis is divided into Infectious causes (bacterial, viral, parasitic, fungi) and Non-Infectious causes (Autoimmune and Malignancy)
2/
6/22- bit.ly/35Vi32L #cpsvmrpearls We usually think of neurocysticercosis -> seizure or HA w a circle & a dot/few dots on imaging, but there is a rare form called cysticercal encephalitis that is
1. more common in young girls
2. p/w miliary cysticercosis & AMS (1/2)
In these pts., remember to avoid anti-parasitic drugs which can cause fatal cerebral edema
Tx = steroids & AEDs (2/2)
3/
6/23 - bit.ly/3x0OCbF #cpsvmrpearls Thrombocytopenia can be interpreted as an acute phase reactant, whereas thrombocytosis suggests chronic inflammation.
4/
6/24 - bit.ly/2Sw2rj7 #cpsvmrpearls Acute pericalcific arthritis mimics Septic arthritis and Crystalline arthropathies.
5/
6/25 - bit.ly/3hdbEVL #cpsvmrpearls Isolated aPTT elevation and thrombocytopenia points to APLA.
6/
6/27 - #cpsvmrpearls Amyloidosis can affect the GI tract causing protein losing enteropathy and therefore anasarca.
& don't forget to join us!!
More information about Virtual Morning Report here: bit.ly/3dmBFB7

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More from @CPSolvers

21 Jun
a brilliant🧵 for your Monday morning:

6/14 - bit.ly/3gR3UbQ #cpsvmrpearls Both TTP and HUS can p/w kidney injury + neurological Sx. To differentiate b/w them based on clinical Sx, remember that in TTP, the neuro Sx > renal Sx and in HUS, the renal Sx > neuro Sx
6/15 - bit.ly/3ql5IOU #cpsvmrpearls Consider CV & neuro causes when evaluating unwitnessed LOC. Presence & location of tongue bites can help differentiate b/w them: Bites on the a) lateral aspect of the tongue - seizure b) tip of the tongue - syncope c) lips/cheek - PNES
6/16 - bit.ly/35CthJt #cpsvmrpearls CNS involvement is infrequent in small & medium vessel vasculitis which commonly p/w << systemic manifestations, but when present, CNS involvement is a predictor of poor prognosis & indication for aggressive immunosuppressive Tx. (1/2)
Read 8 tweets
4 Mar
1/#MedTwitter, want to learn more about antiracism in medicine?

We encourage you to check out our Antiracism in Medicine series for deep dives on racism in medicine, structural inequities, police violence and health, and more.

The first 6 episodes are available here:
2/ Episode 1: Racism, Police Violence, and Health

Join us for a deep dive on police violence and health with special guests @RheaBoydMD and @RRHDr.

Listen here: bit.ly/2D0jqT3
3/ Episode 2: Dismantling Race-Based Medicine Part 1: Historical and Ethical Perspectives

Join us for a deep dive w/ @EdwinLindo,
@LashNolen, @rohankhaz & @dereckwpaul: bit.ly/ARCP_Ep2
Read 7 tweets
16 Mar 20
1/ #MedTwitter, we have another lactic acidosis case!

Find the last two here:
(1) bit.ly/33gz9pu
(2) bit.ly/2U95Ktm

You just placed a pt on precaution for COVID & get a page about your next admission...

56M p/w R leg pain 1 hr after injuring his shin at home.
2/ T 99F, BP 127/78, HR 84, R 13, 98%
The R leg is bruised, swollen, and tender.

X-ray was w/o fracture, but U/S showed a large hematoma in the anterior R lower leg.

Patient reports frequent nosebleeds & bruising during the past year. Denies a FHx of bleeding conditions.
3/ Labs:
Hgb 11
PLT 220
Blood smear - normal
BMP - normal

aPTT 99 (25-36)
PT 12 (10-13)
Fibrinogen 300
Plasma vWF antigen - normal

Need a bit of a refresher on coagulation studies? Luckily, @CPSolvers is working on a schema for you! #MedTwitter, we’d appreciate your feedback!
Read 11 tweets
16 Mar 20
#MedTwitter we wanted to share some of the pearls that came from our first virtual morning report yesterday.

We have another TODAY @ 12pm PST/3pm EST

Zoom link coming soon.

Here are yesterday's teaching points:
Hyperkalemia can lead to fatal arrhythmias.

Treatment includes 3 stages:
1. cardiac membrane stabilization (e.g., IV calcium gluconate)
2. shifting potassium (e.g., B2-agonists, insulin, bicarb)
3. eliminating excess potassium (e.g., loop diuretics, K-binding resins, dialysis)
Spontaneous tumor lysis syndrome (TLS) is rare, but can occur with aggressive tumors (e.g., leukemia, lymphoma, small cell cancer).

Electrolyte derangements in TLS include hyperphosphatemia, hyperkalemia, hyperuricemia, and hypocalcemia.
Read 7 tweets
13 Mar 20
1/ #Medtwitter, a new case is here! Check out the last one here: bit.ly/33gz9pu

68M w/ fatigue, 20lb weight loss & dry cough x6 mo. No fevers but has frequent drenching night sweats.

How do you approach unintentional weight loss? Check out our schema below!
2/ No issues chewing or swallowing food, post-prandial pain, vomiting, or diarrhea.

VS T 37C BP 135/60 HR 82 RR 14 98% RA
On exam, he had a non-tender left 3x3 cm supraclavicular mass.

CBC and CMP were normal.
Lactate 5.3 mmol/L
3/ Elevated lactate is surprising given the patient’s story.

Take a minute to reflect on less uncommon causes of elevated lactate.

Looking at this schema through the lens of knowing the patient has a supraclavicular mass, does it filter the diagnoses in this schema?
Read 9 tweets
12 Mar 20
1/ #Medtwitter, we have a case for you, including a new #IllnessScript from @jackpenner & @EmmaHLevine!

32F presents with fevers, chills, & malaise x 5 days. Pt is somnolent and accompanied by her husband who denies localizing symptoms.

VS T 39C BP 120/60 HR 100 RR 14 100% RA
2/ While the RN is out of the room, the telemetry alarms for V-tach. When the RN returns, the monitor shows sinus rhythm.

Husband reports that the patient appeared to yell out and then was shivering violently for ~2 minutes.

What in this telemetry strip suggests artifact?
3/ You notice that although at quick first glance, the morphology in lead I and II might resemble a wide complex rhythm, lead III shows sinus tachycardia.

Therefore the limb leads I and II are capturing artifact (probably from movement of the patient).
Read 7 tweets

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