May 9th = Tip #9 #TipsForNewDocs #MedTwitter

One of the biggest lessons from intern year is getting a gestalt for sick vs not sick

This relies on recognizing signs and symptoms that should give you pause

A brief list and crowdsourcing to add to this list!
Tachycardia in a pt w/ HFrEF

Back pain in a pt w/ MRSA bacteremia

Nausea/vomiting in a pt w/ T1D

Syncope on exertion

Syncope while at rest

A non-healing wound in a pt w/ diabetes

Confusion in a pt w/ cirrhosis

Failure to thrive in an older pt

Recurrent falls
Weight loss in a patient w/ hx of cancer

Unintentional weight loss, period

Increased WOB in all pts

Sudden onset dizziness

When a pt says their chest pain is identical to their prior MI

Back pain + hypotension

RUQ pain + fever

Many more to include! Please add!

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More from @MohitHarshMD

May 4
May the 4th be with you! Tip #4 #TipsForNewDocs #MedTwitter

You’ve probably heard this one time and time again: “read more” or “read up on your patients”

Yet no one tells you HOW they read more and make that information stick!

A 🧵 on the system I developed in residency
I have a terrible memory so I have to brush up constantly

Being told to read more was daunting because the amount to read was overwhelming and I may only retain 10% of the UpToDate article, etc

There are 3 areas I focus on

Dx reasoning
Rx reasoning
Patient Centered EBM
Dx Reasoning:

As many on here describe well, it isn’t the reps. It’s the intentionality to those reps and active reflection on cases that improve your dx skills

If your dx is delayed or incorrect in real life, spend time reflecting on your illness script and cognitive biases
Read 16 tweets
Oct 23, 2020
Hey #MedTwitter fam!

Time for the inaugural #MedDermTwagTeam #tweetorial on #Scleroderma

This is a diffuse (get it?) topic so @RashDecisionz & I will try to keep it focused

I’ll tweet on illness script

S/O to @CPSolvers @MedEdTwagTeam and many others for the inspiration!
1/12
Who else gets confused with the terminology? I sure do

The confusion may arise because scleroderma is a spectrum of disorders. Also, people say Scleroderma interchangeably with #SystemicSclerosis

The subtype is based on extent of skin & organ involvement

2/12 Image
Let’s focus on Systemic Sclerosis (SSc)

SSc is a multi-organ, progressive vasculopathy and fibrosing condition with skin being main target

Earliest sign is Raynaud phenomenon, occurs in 95% of pts

Skin thickening w/o Raynauds makes SSc unlikely

nature.com/articles/s4158…

3/12
Read 13 tweets
May 1, 2020
As promised, pt 2 in Potassium #Tweetorial series. This time, Aldosterone and Potassium Homeostasis

Another large physiology topic, so I’ll be brief and stick to highlights from reading #BurtonRose textbook, which I highly recommend for all levels of learner

Thread ⬇️
Aldo is well known to provide Internal Balance of K after oral intake or fluctuation in [K]

Aldo works by augmenting K secretion in principal cells. After K load, Aldo is directly enhanced and contributes to kaliuresis via changes in Na and K channels and Na-K-ATPase activity
The initial step is ⬆️ luminal Na permeability which in turn ➡️ enhancing K secretion.

Poll: Why does increased distal Na delivery aid in Kaliuresis?
Read 11 tweets
Apr 28, 2020
Time for my first #medtwitter #Tweetorial on Insulin and Potassium regulation!

This is part 1 of a tweetorial series on K homeostasis/Hyperkalemia. This is a big topic, so I’ll stick to concepts.

Poll: What percent of total body Potassium is within extracellular fluid?
The answer is only 2%!

That means shifts of even small amounts of K either in or out of the ECF leads to huge changes in plasma K concentration.

A great way to think of K regulation is external and internal K balance.

This interplay was described in a 1978 NEJM review
External Balance revolves around Total Body Potassium (TBK) and is determined by K intake - K excretion.

Internal Balance revolves around the distribution of K w/in our intra- and extracellular fluid compartments

K excretion is primarily through kaliuresis, unless ⬆️diarrhea
Read 8 tweets

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