#MedTwitter, The spleen hasn't had much time in the spotlight. Need an approach to splenic lesions?

Listen to our most recent @CPSolvers episode for pearls on splenic infarcts and one particular pesky organism ➡️

Thread below by @SaklawiMD📷bit.ly/3JEVbsl When evaluating a splenic lesion, consider splenic infarct, abscess, and masses of various etiologies. As @sharminzi eloquently puts it, the spleen is like one big lymph node.

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)

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

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

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.

#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)

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

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?

1/ #MedTwitter, thanks for joining us last week for our case #tweetorial (bit.ly/38rGrZs)! We have more clinical reasoning practice for you today!

67F w/ HTN, HFpEF & RA (on chronic prednisone & PCP PPx) p/w 3 days of progressive dyspnea, malaise & productive cough. 2/ As you get more information, what clinical reasoning tool can you use to determine how the data you gather increases or decreases the probability of the diseases you’re considering?

1/ #MedTwitter, we have a new edition of the “Clinical Reasoning Corner” coming this week, which means it’s time for some more clinical reasoning practice!

Follow along and let us know how you’re thinking about the case!

Today’s chief complaint is fever & abdominal pain. 2/ You’re called to admit a 52F w/ cirrhosis 2/2 Hepatitis C who is p/w 3 wks of progressive abdominal distension, and 2 days of abdominal pain & fevers.

She has a fever to 38.6C, scleral icterus, a diffusely tender abdomen, and a positive fluid wave.

1/ #MedTwitter, we have a new blog post from @zoemarklyon and @StephenieLe11.

Before diving into the blog, let’s warm up with a case that spans the lungs, the skin, and maybe more!

Ready? 2/ A 43 yo woman presents with 9 months of worsening dyspnea on exertion, fatigue & a dry cough. She is hypoxemic to 87% on room air.

Pause and reflect on how you’d approach her dyspnea with the help of our dyspnea schema by @BBroderickMD

1/ #MedTwitter, it’s time for #ClinicalReasoning practice with Bayes’ Theorem!

Follow along and let us know what you’re thinking!

72-yo-woman with HTN, DM, & knee replacement (10 days ago) p/w pleuritic chest pain, dyspnea and cough. 2/ As you walk down to the ER, you have diagnoses in your mind that are somewhere between unlikely and very likely.

This likelihood is known as:

1/ A quick glance at the foot of the bed unravels a rare answer to a common complaint... another #tweetorial to sharpen our #clinicalreasoning skills, #medtwitter! Try to solve this mystery case and see if you can... nail it! 2/ A 58 year-old man presented with gradual, progressive dyspnea. Two months ago he had no trouble ambulating, now he is limited to several blocks.

1/12 #Medtwitter friends, time for another #tweetorial! Summer is coming and it’s time to break out the hiking boots and get ready to review our favorite zoonotic infections. We’ll circle back to the idea of a “Doxycycline Deficient State” 2/12 A 50M presents with fevers, sudden onset severe headache, myalgias and a maculopapular rash first in his wrists, ankles, and extending to his trunk after a week long summer hiking trip in Montana. What is the diagnosis?

1/#Medtwitter friends, we are thrilled to share a #tweetorial courtesy of @StephenieLe11 and inspired by @DrDanRestrepo's episode on intrarenal AKI #FOAMed
clinicalproblemsolving.com/2019/03/21/epi… 2/30M presented with MSSA native tricuspid valve endocarditis and lower extremity edema was found to have AKI. What are the renal manifestations of endocarditis?

14/Friends, it's time for part 2 of this case tweetorial.
Make sure to check out #1-14 before you move on. #medtwitter #foammed

https://twitter.com/CPSolvers/status/1110146319253823489

15/Based on the hypertension, proteinuria, and pathology demonstrating characteristic vascular changes on biopsy, coupled with sclerodactyly and raynaud’s, she was diagnosed with scleroderma renal crisis (SRC). Check out this illness script for scleroderma:clinicalproblemsolving.com/wp-content/upl…

1/Hey, #medtwitter, bust out your schemas - it's time for another CPSers tweetorial! #FOAMed #clinicalreasoning #medthread 2/A 46F presented with 2 weeks of diffuse abdominal pain, nausea and vomiting. Pause and reflect on how you’d approach her abdominal pain, and then check out this schema: clinicalproblemsolving.com/dx-schema-abdo…

1/Friends, it's time to break out those schemas with another case tweetorial! Thanks to @dminter89 for putting this together, and to @UCSFMedicine's @jakejmayfield for the case! #FOAMed #medtwitter #medthread 2/A 26-year-old man presented with 2 weeks of progressive shortness of breath and cough.

How would you approach his dyspnea?
Check out this schema from @JohnsHopkinsDOM's @BBroderickMD clinicalproblemsolving.com/%20dx-schema-d…

Friends, it’s time for another case, tweetorial style. #medtwitter #FOAMed #clinicalreasoning An 85M with ischemic cardiomyopathy (EF 20%) with an AICD for primary prevention presents with a syncopal episode. Pause and think of your schema for syncope, and then check out this approach by @StephVSherman from @BCM_InternalMed
clinicalproblemsolving.com/dx-schema-sync…

1/Break out your schemas! Let’s talk about a case tweetorial-style courtesy of @dminter89 . Thanks @tonybreu, @MedEdPGH , @BCM_InternalMed and @medrants and many others for the inspiration. :) 2/ A 30 yo man presented with 1 week of fevers, chills, & headache after travel to South America. Take a mental pause and think through your DDx.
Here is one approach to fever in a returning traveler
clinicalproblemsolving.com/%20dx-schema-f…