Pankti Mehta Profile picture
Jun 15, 2023 8 tweets 4 min read Read on X
🫁How to interpret pulmonary function tests ??🫁

I'm not a pulmonologist but have to deal with a fair share ILDs,
here's a simple approach useful in the clinic especially for non pulmonary specialists

(1/7)

#MedTwitter #RheumTwitter #MedEd Image
1️⃣Is the test valid?

You need to check for three things

🌬️ Effort
✅The time volume curve forms a plateau in 1-2 seconds
✅ sustained expiration for 6 seconds!

(2/7) Image
➰Flow loops

✅ for artefacts/abnormalities 📷⤵️

(3/7) Image
🔁 two readings

✅The two FEV1 & FVC values within 0.2L of each other

✅✅✅Also, always check if the age, weight, height etc have been correctly entered!

(4/7)
2️⃣First see the FEV1/FVC ratio

If ⏬

3️⃣ Check FVC

⏬FEV1/FVC, Normal FVC

"obstructive"

⏬FEV1/FVC, ⏬ FVC

"mixed pattern"

⬇️

↩️Check reversibility (⏫ by 12% or 200ml)

(5/7) ImageImage
2️⃣Go back to FEV1/FVC ratio

If normal,

3️⃣ Look at FVC

Normal FEV1/FVC, ⏬FVC

"restrictive'

⬇️

Check DLCO

(6/7) Image
@DrPujaMehta1 correct me if I'm wrong!

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More from @PanktiMehta24

Jul 10
How to approach a patient with #angioedema? 🧐 🧵

#MedTwitter

(1/7) Image
♦️There are two broad mechanisms of angioedema

1️⃣ Histamine mediated or #allergy 🤧
2️⃣ Bradykinin mediated 🥵

The management depends on the underlying mechanism !

Also before anything, secure the AIRWAY if needed 🫁

(2/7)
Image
Image
✏️What are the possible etiologies ?
🔹Allergic 🤧
🔹Drugs 💊
🔹Hereditary 🧬
🔹Acquired
- lymphoproliferative disease➡️ excess C1
-autoimmune diseases ➡️ antibodies against C1inh

(3/7)
Read 7 tweets
Jul 4
Facial rashes that look like lupus but are not ! 🧵🦋

1. Rosacea 🥵
🔹Look for telangiectasia
🔹Involvement of the nasolabial folds 🔹Flushing with spicy foods, heat, & sun exposure

#MedTwitter #RheumTwitter
Image
Image
2. Seborrheic dermatitis

🔹Yellowish scales
🔹 Involvement of the nasolabial folds, eyebrows & scalp Image
3. Dermatomyositis

🔹Involvement of the nasolabial folds
🔹Other rashes like heliotrope, gottron's etc
🔹Systemic features Image
Read 5 tweets
Jun 13, 2023
🔹Relapsing Polychondritis🔹

Important takeaways from an excellent presentation by @Lupusreference @eular_org #EULAR2023

#MedTwitter #RheumTwitter
🔹Rare disease
🔹Middle aged adults
🔹No♀️ predominance

👂👂👂👂
It's typically characterized by:
🥵Red/swollen
👂Spares the lobule
🤕Painful
⏳lasts >48 hrs
❌ ear discharge (infection)
❌ necrosis/purpura (CAPS)

📷⤵️Prone to erroneous diagnosis!! ImageImage
Once 👂chondritis is confirmed, rule out mimics! Image
Read 11 tweets
Jun 6, 2023
Doctor: Where is the pain?

Patient: Pain pain everywhere!

❔How do we approach a patient with multiple joint pains❔

(1/12)
#polyarthritis #MedTwitter #MedEd #RheumTwitter Image
1️⃣ Is it polyarthritis?

First, you want to make sure it's polyarthritis - multiple (>4 joints) pain WITH SWELLING

& NOT 🚫

🔹Polyarthralgia⏩ pain WITHOUT swelling
🔹Widespread pain
🔹Myalgia
🔹Bone pain
🔹Neuropathic pain

Let's deal with polyarthritis ⏬

(2/12)
2️⃣ Is it acute or chronic??

Acute<6 weeks

🔹 Infections- gonococcal, infective endocarditis, rheumatic fever, lyme disease, viral

🔹Elderly RA, ANCA vasculitis, paraneoplastic

(3/12)

#MedTwitter
Read 12 tweets
Jun 5, 2023
It's #WorldEnvironmentDay2023 & I thought why not discuss the influence of air pollution🏭 on various rheumatic diseases

The association of 🏭 is obvious with lung diseases, malignancies & skin problems

But, we have to understand that the effects are deeper than that😦
Particulate matter (PM10) is inhaled & affects the upper bronchi ⏩ local inflammation

Fine & ultrafine PM reach the alveoli & circulation ⏩ systemic effects

Levels of inflammatory markers ∝ exposure to 🏭

pubmed.ncbi.nlm.nih.gov/19687019/

pubmed.ncbi.nlm.nih.gov/33470401/ ImageImage
Does it increase the risk of disease development?

Yes!

In a study from Italy, exposure to PM 10 increased the risk of RA & other immune mediated diseases

pubmed.ncbi.nlm.nih.gov/35292563/aa Image
Read 6 tweets
Jun 3, 2023
Hey #MedTwitter !

1. What does the image show?
2. Possible etiologies?

#RheumTwitter Image
It's a purpuric rash. The two most important DDs are:

🔹Small vessel vasculitis (lupus, ANCA, cryoglobulinemia etc) ♨️

🔹Infective endocarditis (janeway lesions) ❣️

Bleeding disorders often affect areas where the skin is soft and loose rather than the soles
Other causes of palmoplantar rash

1️⃣Infections- maculopapular, blanching

🔹Viral eg parvovirus, coxsackie, measles
🔹Bacterial- menigococcimia (purpuric, non blanching), syphilis (2°)
🔹Rickettsia- RMSF

#MedTwitter #MedEd Image
Read 6 tweets

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