BOWEL OBSTRUCTION:

👉A bowel obstruction can either be a mechanical or functional obstruction of the intestines.
👉Obstruction frequently causes abdominal pain, nausea, vomiting, constipation, obstipation, and distention.
👉LBOs are less common and compromise only 10% to 15% of all intestinal obstructions.
👉Most common cause of all LBOs is adenocarcinoma, followed by diverticulitis and volvulus.
👉Colonic obstruction is most commonly seen in the sigmoid colon.

1/n Gastric outlet obstruction (GOO).

Anatomically, mechanical obstruction can be at distal stomach, pyloric channel, or duodenum and can be intrinsic or extrinsic to the stomach.

👉Benign: Early satiety (53%) and bloating (50%).
Example: Peptic ulcer disease (resulting in a stricture of stomach/duodenum),
👉Malignant: Pain, vomiting, weight loss, and malnutrition.
Distal gastric cancer, common, 35 %.
👉20% of patients with pancreatic cancer develop GOO.

Labs:
Electrolyte abnormalities, and dehydration, including hypochloremic metabolic alkalosis & hypokalemia.

Credit:
National Center for Biotechnology Information
Radiopaedia
RSNA.org/Journals.

2/n

Sensitivity and Specificity:

The question is:👇

In a study, 200 of the 300 people with the disease had a positive test & 500 of the 700 people without the disease had a negative test

HOW TO DO CALCULATIONS: 👇

The first & important step is to prepare:

🙋‍♂️2 x 2 TABLE

1/n From the 👇table we gather that:

True Positive (TP) = 200
False Positive (FP) = 200
False Negative (FN) = 100
True Negative (TN) = 500

2/n

Sensitivity and Specificity ??

what is sensitivity?
what is specificity?

👇👇

Well, both are measures of a test’s 👉validity.

👉Remember:

🙋‍♂️SNOUT
SeNsitive test with a Negative result rules OUTthe disease

🙋‍♂️SPIN
Specific test with a Positive result rules INthe disease.

1/n 👉Sensitivity

✔️Ability to detect people who do have the disease.
✔️Used for screening or ruling out disease.
✔️TP/TP+FN (%)

👉Specificity

✔️Ability to detect people who do not have the disease.
✔️Used to confirm or Rule in the existence of a disease.
✔️TN/FP+TN (%)
2/n

Nail Findings &Associated Conditions

Change in color, texture, or shape can be harmless, but may suggest an underlying systemic disease. /1

#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
#medschool #MedStudentTwitter #medstudent #TwitterRx
👇
See 👇👇 Common Nail pathologies 👇👇👇👇 part -I
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Duration of Antibiotic Therapy
Deciding on the duration of antimicrobial therapy for an infection is neither straightforward nor simple. 👇
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
#medschool #MedStudentTwitter #medstudent #TwitterRx
🔽👇🔽🔽👇

/1 Most ID guidelines are based- either expert opinions or evidence-based medicine. Historically, duration of ABX Rx were based on arbitrary extension of days(magic numbers like 7, 10 & 14 days) rather than on reliable evidence with the main aim to ⬇️ failures & avoid underRx.

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LASIX and HF
👇👇👇👇
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor

👇👇👇

/1 4-chloro-N-(2-furyl-methyl)-5-sulfamoyl-anthranilic acid, member of the sulfa’s. Potent natriuretic drug, inhibits Na+-K+-2Cl− cotransporter in the ascending limb of the loop of Henle.
Direct Vd effects results in its therapeutic effectiveness in the Rx of acute pulm edema.

/2

Angioedema:

Edema of the deep dermis & subcutaneous tissues.

Etiology, types and treatments👇👇👇👇⬇️⬇️⬇️⬇️👇👇👇👇

/1

#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
👇⬇️⬇️⬇️⬇️👇👇👇👇 Mast cell–derived mediators tend to affect layers superficial to subcutaneous tissue, including the dermal-epidermal junction. These mediators cause urticaria & pruritus.

In bradykinin-mediated angioedema, the dermis is usually spared, so urticaria & pruritus are absent.
 
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Pseudomonas aeruginosa (PA):

Gram-negative bacillus found widely in nature, in soil and water.
/1

#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor @ImproveDX The genus Pseudomonas >140 species,> saprophytic & >25 species are associated with humans. Most known to cause disease in humans are associated with opportunistic infections.

⬆️ MR : ⬇️ host defenses, resistance to ABX & production of extracellular enzymes & toxins.
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Ischemic penumbra:
The part of an Ac ischemic stroke that is at risk of progressing to infarction but is still salvageable if reperfused. Located around an infarct core which represents the tissue which has already infarcted or is going to infarct regardless of reperfusion.
/1 In this small cohort, the penumbra system was able to revascularize the site of primary occlusion in all of the treated subjects enrolled into the study, resulting in a revascularization rate of 100%.
/2

ajnr.org/content/29/7/1…

Q: 50 y M, lung ca diagnosed 2 months ago, work up in process fit possible resection, presents with pain and swelling in LLE. Of note- Covid in Jan. Duplex: Ac DVT popliteal and tibial. Is IVC filter indicated? @SocietyHospMed @SatyaPatelMD @tony_breu @grepmeded @drmiketodorovic An IVC filter is a small device that is placed in your inferior vena cava to prevent blood clots from moving through your blood into your lungs .

Dementia
Acute cognition change with altered consciousness & impaired attention that fluctuates over time. Often unrecognized & unRx. May be preventable & early detec/ facilitates urgent assessment &Rx 1/16
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor The criteria for delirium listed in the Diagnostic and Statistical Manual of Mental Disorders vs Confusion Assessment Method (CAM) 👇👇. CAM has a sensitivity of 94% to 100% and a specificity of 90% to 95%.
2/16

The HPA Axis and Adrenal Fxn.
Typical excretion of cortisol ➡️diurnal pattern with peaking in the a.m, ⬇️toward the afternoon, & ⬆️ in the early p.m. The basal adrenal production of cortisol is 10-15 mg daily. #MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor Physiologic & psychological stress can boost daily production of cortisol to 3 or more times typical levels.
Adrenal insufficiency: caused by a disease involving the adrenal gland itself (primary AI) or one altering its regulation by the hypothalamus and pituitary (secondary AI)