🧵 Thread: Iron Deficiency Anemia (IDA)

A complete, high-impact clinical master thread for residents.
#MedTwitter #MedEd #Hematology #FOAMed #IDA

IDA begins long before hemoglobin falls

Iron deficiency has stages.
First ferritin drops, then TSAT falls, then erythropoiesis becomes restricted.
Anemia is the final stage.
Patients may have fatigue, pica, hair loss or RLS even with normal Hb.
Early detection prevents neurologic and functional decline. 2️⃣ Iron physiology that actually affects daily practice

Absorption occurs in the duodenum.

Heme uses HCP1.
Non heme requires reduction then enters via DMT1.

Ferroportin exports iron from enterocytes and macrophages.

Hepcidin, produced in the liver, blocks ferroportin when inflammation is present.

This is why chronic disease causes iron trapping and poor oral iron response.

🧵THREAD: ABPA MASTERCLASS 🫁🔥

The COMPLETE practical guide for residents

👇 Open this thread. Save it.

#MedTwitter #FOAMed #ABPA 1. What is ABPA and why should you care? 🚨

Allergic Bronchopulmonary Aspergillosis is a hyperimmune reaction to Aspergillus fumigatus sitting inside the bronchi.
The immune system reacts excessively and causes
• airway inflammation
• eosinophilia
• mucus impaction
• bronchiectasis
• recurrent lung injury

Think of it as “asthma with fungal-driven chaos”.

It affects
• Asthma
• Cystic Fibrosis
• Sometimes COPD / bronchiectasis patients with sensitisation

Delay in diagnosis leads to fibrosis and permanent lung disability.

🧵 Perioperative Anticoagulation

This is one of the hardest decisions in medicine.
Stopping too early increases clots.
Stopping too late increases bleeding.
This thread simplifies everything.
#MedTwitter #FOAMed 1️⃣ Start with the fundamental question

Perioperative AC is about preventing two dangers
• Surgical bleeding
• Thrombosis when AC is stopped
Every patient needs BOTH risks assessed before making any move.

🧵 Clostridium difficile: The Complete 2025 Clinician Thread

C. difficile is one of the few infections where a single antibiotic course can trigger a full-blown toxic colitis.

Here is the master thread covering risk factors, diagnosis, treatment, recurrence and new global updates 👇
#MedTwitter #FOAMed #InfectiousDisease 1️⃣ Why C. difficile is rising worldwide

Because modern healthcare unintentionally creates the perfect conditions:
• Broad-spectrum antibiotic use
• Widespread PPI use
• Longer hospital stays
• Ageing population
• ICU care, chemotherapy and immunosuppression
• Recurrent admissions
• Enteral tube feeding
• Disrupted microbiomes post infections and post COVID

🧵 THE ULTIMATE VASOPRESSOR + INOTROPE ICU MASTERCLASS

🚨 Shock kills fast. Choosing the wrong pressor kills faster.
Choosing the right one saves a life instantly.
This is the thread every resident, intern and ICU doctor should read today.
#MedTwitter #CriticalCare #FOAMed 1️⃣

🚨 First Rule of Shock : Tank → Pump → Pipes
Before starting ANY vasopressor, ask:
💧 Is the tank full?
🫀 Is the pump working?
🩸 Are the pipes too dilated?
Pressors = squeeze pipes
Inotropes = boost pump
Fluids = fill tank
Squeezing an empty tank → organ ischemia.

Adrenal Insufficiency is one of the few conditions that can mimic almost every chronic illness… until it suddenly becomes a life-threatening shock emergency.

Fatigue → dizziness → salt craving → abdominal pain → collapse.

Here is the most complete breakdown you’ll read today 🧵👇
#MedTwitter #Endocrinology
#FOAMed 2️⃣

🧠 What the adrenal gland normally does

It produces cortisol for stress response, immunity and glucose balance.

It produces aldosterone for sodium, potassium and volume.

It produces adrenal androgens for energy and libido.

Adrenal Insufficiency = collapse of one or all of these systems.

🧵Thread: Evidence Based Guide to Cold & Flu Care

🤧🦠
Cold and flu hit millions every year, but most people STILL self treat the wrong way.
Here is the most practical, no nonsense, evidence based guide for doctors, students and the public.

#MedTwitter #InternalMedicine #FOAMed 1️⃣ What actually causes the common cold?

It’s a viral upper respiratory infection.
Harmless. Self limiting. Miserable for a few days.
Main culprits: Rhinovirus, non COVID coronavirus, RSV, Influenza, Parainfluenza, Adenovirus, Enterovirus, Metapneumovirus.
Spread by droplets, touch and contaminated surfaces.
#FluSeason #MedTwitter

🧵 SARCOPENIA: The Ultimate Resident-Level Masterthread
If you understand this, you will never miss a case on rounds again.
Interactive, detailed, crisp, and complete.
#MedTwitter #InternalMedicine #Geriatrics #FOAMed 💪🧓🔥 1️⃣ What is Sarcopenia?
A progressive loss of muscle strength and muscle mass that worsens disability, falls, hospitalization, and mortality.
Not just aging. It is a syndrome.
Coined by Rosenberg in 1989.
Think of it as muscle failure like how we think of heart failure or renal failure.
💡 Strength declines faster than mass.

🧵 LACTATE & LACTIC ACIDOSIS: The Complete ICU Breakdown
If you truly understand this thread, you will stop reacting to lactate and start interpreting it like an intensivist.
#MedTwitter #CriticalCare #ICU #FOAMed 1️⃣ Lactate is a survival molecule, not a toxin ⚡
When cells are stressed, lactate rises to help generate ATP quickly.
So a high lactate is not “bad”. It’s the body saying:
“Either oxygen is low, mitochondria are blocked, or my clearance is impaired.”
Your job is to find which one.

🧵 CHRONIC DIARRHOEA: The Complete Clinical Breakdown
If you master this, chronic loose stools will never confuse you again 👇
#MedTwitter #FOAMed #InternalMedicine #Gastroenterology 1️⃣ What is Diarrhoea? Let’s begin at the roots 💧
Diarrhoea means passing loose or watery stools more than usual.
Objectively
● Stool weight more than 200 g in a day
● Or three or more loose stools per day
Chronic diarrhoea = more than 4 weeks
Remember: patients judge diarrhoea by consistency, not weight or frequency.

🧵 HYPOXEMIA: The ICU Masterclass

1️⃣ Start with the foundation
Hypoxemia = low PaO2 in arterial blood (mmHg).
Hypoxia = low oxygen at tissues.

A patient can have SpO2 99, Hb 5 and lactate 7. This is hypoxia despite normal saturation.

❓ SpO2 98 but lactate rising. What failed?
A Oxygenation
B Oxygen delivery

#MedTwitter #FOAMed #ICU #CriticalCare #InternalMedicine 2️⃣ DO2 is the real determinant of survival
DO2 = Cardiac Output × CaO2
CaO2 = 1.34 × Hb × SaO2 + 0.003 × PaO2

Most oxygen is carried on hemoglobin.
Cardiac output determines delivery speed.
SpO2 alone cannot tell you if tissues are suffocating.

🍺 ALCOHOL : The Most Socially Accepted Toxin

We celebrate with it, mourn with it, and cope with it.
Yet alcohol quietly kills nearly 3 million people every year, ranking among the top ten causes of preventable death worldwide.

Let us understand the full story from casual use to full blown dependence.
#MedTwitter #PublicHealth 🧵 🔹 1. The Language Has Changed

Stop saying “alcohol abuse” or “ETOH abuse”.
These are outdated and stigmatizing.

🩺 Use
• Unhealthy Alcohol Use : the broad term for all harmful drinking
• Risky Use : any amount that increases health or social risks
• Alcohol Use Disorder (AUD) : clinically significant impairment as defined by DSM 5

Language matters. We treat disease, not morality.
#AddictionMedicine

🧵 “ALL PEP at ONE PLACE” — The Ultimate Thread for Clinicians & Students

What to do after exposure to 👇
☣️ HIV
🦠 Hepatitis B
🧪 Hepatitis C
🐕 Rabies
🔩 Tetanus

#MedTwitter #USMLE #NEETPG #InfectiousDiseases

@DrAkhilX @prarit_v @doctors_squad @drkeithsiau @DoctorLFC ⚕️ HIV PEP (Post-Exposure Prophylaxis)

Every second counts! Start within 2 hours, never beyond 72 h.

Step 1: Wash wound with soap + water. No spirit, betadine, or bleach.
Step 2: Evaluate exposure (needle-stick, mucosal, skin contact).
Step 3: Baseline tests → HIV, HBsAg, HCV.
Step 4: Start PEP immediately (don’t wait for reports).

Preferred 4-week Regimen:
💊 TDF + 3TC + DTG (1 OD)

Counsel about adherence + safe sex until final test (3 months negative = clear).
#HIV #PEP #MedEd

@DrAkhilX @prarit_v

🧠 Orthostatic Hypotension (OH): The Forgotten Cause of Falls, Fatigue & “Coat Hanger Pain”

A complete clinical breakdown every resident should know 🩺
#MedTwitter #USMLE #neetpg 1️⃣ Case Starter
72-year-old man with diabetes & hypertension admitted for syncope.
BP normal lying down, but every time he stands, he feels dizzy.
Diagnosis: Orthostatic Hypotension (OH)

Let’s unpack this 👇

🧵 1️⃣ Inpatient Hyperglycemia

25% of hospitalized patients have diabetes.
But even non-diabetics with hyperglycemia face worse outcomes — higher infection rates, longer stays, more readmissions, and higher mortality.

Hyperglycemia isn’t just a number. It’s a prognostic marker and a modifiable target.

Let’s break it down 👇
#MedTwitter #Endocrinology

@DrAkhilX @prarit_v @Doctors__squad @DoctorLFC @drkeithsiau 2️⃣ Pathophysiology & Clinical Impact

🏥 Why hospital hyperglycemia is dangerous:
•Impairs neutrophil and T-cell function
•Increases cytokine release and oxidative stress
•Impairs wound healing
•Promotes thrombosis and endothelial dysfunction

📊 Outcomes:
•↑ Mortality in sepsis, MI, stroke
•↑ Post-op infections & AKI
•↑ ICU admissions & readmissions

Even stress hyperglycemia (no prior diabetes) predicts poor prognosis.

1️⃣
🚽💥 “Burning while peeing” isn’t always a simple infection.

UTIs can be anything from harmless cystitis to life-threatening sepsis.
The 2025 IDSA guidelines completely changed how we classify and manage UTIs.

Here’s the ultimate clinical breakdown — made simple, practical & evidence-based 🧵👇
#MedTwitter #UTI #InternalMedicine

@DrAkhilX @prarit_v 2️⃣ New 2025 Classification
⚡ IDSA 2025: A Paradigm Shift

Old rule: “All male UTIs = complicated.” ❌
New rule: Site-based classification ✅
•Uncomplicated UTI (uUTI): Infection confined to the bladder (no fever, no flank pain).
→ Can occur in both men & women.
•Complicated UTI (cUTI): Infection extending beyond bladder (fever, flank pain, bacteremia, sepsis).

#ClinicalUpdate #IDSA2025

1️⃣
🔴 Vitamin B12 Deficiency — The Great Pretender

It can present as anemia, neuropathy, depression, or even dementia.
A simple, treatable cause behind complex presentations.

Let’s decode B12 deficiency completely from molecule to management 🧵

#MedTwitter #FOAMed #InternalMedicine

@DrAkhilX @prarit_v 2️⃣
💊 What is Vitamin B12 (Cobalamin)?

A water-soluble vitamin containing cobalt at its core.
It exists in two active forms
• Methylcobalamin (cytosol)
• Adenosylcobalamin (mitochondria)

These are required for essential cellular reactions that sustain DNA synthesis and myelin formation.

🧵 GUILLAIN–BARRÉ SYNDROME (GBS): The immune storm that paralyzes

A 28-year-old walks in saying, “Doctor, my legs feel rubbery.”
3 days later, he can’t stand.
By day 7, he’s on a ventilator.

That’s GBS — a medical emergency that turns your immune system against your own nerves.

Let’s decode it fully 👇

#MedTwitter #NeuroTwitter

@DrAkhilX @prarit_v 1️⃣ Definition & Core Idea

GBS is an acute autoimmune polyradiculoneuropathy causing rapidly progressive, symmetrical, areflexic paralysis.

🌀 Monophasic course:
•Progresses to peak (nadir) in ≤4 weeks
•Plateau for 2–4 weeks
•Then slow recovery

Most common cause of acute flaccid paralysis worldwide (after polio).
Incidence: ~1.8 per 100,000/year.
M:F = 1.5:1

🧵1. FIBROMYALGIA: The Pain You Can’t See 💭

“Doctor, I feel pain everywhere. But my tests are normal.”

That’s the daily story of a Fibromyalgia patient — where the pain is real, but invisible to scans.
Let’s understand this misunderstood condition in depth 👇

#MedTwitter #Fibromyalgia #Rheumatology

@DrAkhilX @prarit_v 2. What exactly is Fibromyalgia?

Fibromyalgia (FM) is a chronic, widespread pain syndrome caused by central sensitization — a malfunction of the brain’s pain processing system.

It’s not an autoimmune, inflammatory, or muscular disease.
It’s a pain perception disorder — the brain’s “volume knob” for pain is turned up too high 🔊.

🧵 NAUSEA & VOMITING — The Complete Clinical Guide 🤢🤮

Every doctor sees it.
Every patient fears it.
But few understand how complex it really is.

Here’s a master thread covering everything from mechanism to management — simplified, evidence-based, and high yield.
#MedTwitter #FOAMed #Medicine

@DrAkhilX @prarit_v 1️⃣ Let’s start with basics 🩺

Not every “vomit” is the same:

🤢 Nausea — uneasy feeling of needing to vomit
😬 Retching — dry heaving, contractions but nothing out
🤮 Vomiting — forceful expulsion of gastric contents
😑 Regurgitation — effortless return of food, no nausea
😋 Rumination — re-chewing of food, behavioral

Knowing which one you’re seeing is the first diagnostic step.

1️⃣
🚺 Why do some women develop coarse facial or chest hair like men?
It’s not just “extra hair” — it’s a clinical sign that hormones are talking.

Let’s decode HIRSUTISM — causes, evaluation & treatment 👩‍⚕️
A detailed, evidence-based thread 🧵👇
#PCOS #Endocrinology #Dermatology

@DrAkhilX @prarit_v 2️⃣
🔹 Hirsutism = excessive terminal (coarse, pigmented) hair growth in male-pattern areas in women — face, chest, abdomen, back.

⚠️ Differentiate from hypertrichosis → generalized fine hair (vellus), not androgen-driven, often drug-induced (phenytoin, minoxidil, cyclosporine).
#MedicalEducation #WomenHealth