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Satya Patel, MD

@SatyaPatelMD

9 Jul

1/7 Let’s go over the evidence-based physical exam for lower extremity deep vein thrombosis (LE DVT). In the spirit of quantifying clinical concern, here is a question - besides inspection (and #POCUS), which tool will help you the most?

#MedTwitter #FOAMed #MedEd

2/7 The answer is a ruler! Let’s look at the LRs.

Quick review of LRs:
- The (+) and (-) indicate the LR if a finding is present or absent, respectively
- The more the LR deviates from 1, the more useful it is

3/7 For this particular set of exam findings, it may be more helpful to see how much the LRs change your post-test probability (assuming a pre-test probability of 50%). The presence of absence of asymmetric calf swelling seems to be the most helpful.

Graphic from McGee

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Satya Patel, MD

@SatyaPatelMD

7 Jul

1/4
Let's review the evidence-based physical exam for Cushing syndrome!

Quick review of LRs:
- The (+) and (-) indicate the LR if a finding is present or absent, respectively
- The more the LR deviates from 1, the more useful it is

#MedTwitter #MedEd #EndoTwitter #FOAMed

2/4
Things that stand out to me
- "Buffalo hump" doesn't have a defined LRs despite being taught as a "classic" finding (occurs in 34-75% of patients)
- The presence of moon facies has a lower LR than I expected (1.6)

3/4
- The absence (or presence) of abdominal striae is not particularly helpful
- The presence of a thin skinfold (thickness on the back of the hand <1.8 mm in women of reproductive age) can be VERY telling

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Satya Patel, MD

@SatyaPatelMD

23 May

@MedTweetorials

1/ Had some fun today on rounds with these! The Rinne and Weber tests stress out a lot of folks, so let's tackle them today.

#MedTwitter #MedEd #EndNeurophobia @MedTweetorials

2/ What are the Weber and Rinne tests used to help identify?

3/ The answer is both! Remember that the most useful exams are hypothesis-driven so you need to do a history to begin suspecting if a patient has either type of hearing loss. This will help you generate a pre-test probability for disease (this will become relevant later).

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Satya Patel, MD

@SatyaPatelMD

14 May

@MedTweetorials

1/8 When might an FeUrea not be as useful as FeNa? Let's explore briefly!

#NephTwitter #MedEd #MedTwitter #Tweetorial #FOAMEd @MedTweetorials

2/8 First of all, a quick reminder that the utility of the FeNa and FeUrea in evaluation of AKI needs to be carefully considered before they are ordered (I'm a big fan of looking at UAs). journalofhospitalmedicine.com/jhospmed/artic…

3/8 You might see a table like the one below that can be used to (cautiously) interpret FENa and FEUrea.

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Satya Patel, MD

@SatyaPatelMD

22 Mar

1/11 Congrats to those who matched! I tweeted about an inpatient pocket card set in 2020 and got great feedback. Here is the result of a big overhaul: bit.ly/pocketcardset

Let's review what's inside!

#MatchDay2021 #MedStudentTwitter #MedTwitter #TipsForNewDocs #FOAMed

@kelleychuang

2/11 Many thanks to my colleagues @kelleychuang @FulchJen @SimonWuMD @TylerLarsenMD @MichaelAyoubMD @PamelaTsing for helping me create and refine this.

@dgsomucla @uclaimchiefs @UCLAAnes @michael_ong @DoctorNappyJ @LizzieAbyMD @ShreyaTrivediMD

@nickmmark

3/11 First up is a pre-rounding checklist. Be systematic and read all of the notes in your patient’s chart (interdisciplinary care is critical).

H/t @nickmmark for the idea to use a QR code to maintain an updated version! This QR code also has some additional resources.

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Satya Patel, MD

@SatyaPatelMD

23 Jun 20

1/14 I was always asked as a student if I wanted to give fluids to a patient, but no one ever told me how they think about. Here is my approach to giving IV fluids.

Disclaimer: Things are simplified for the sake of pragmatism.

#MedTwitter #MedEd

2/14 I call my approach an "IV fluid timeout." It involves asking yourself four questions before giving someone IV fluids.

3/14 I broke down the answer two question one into two major buckets. This is the most important question because if a patient does not need IV fluids, do not give IV fluids.

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