Some cool #Syphilis Pearls from an article that @k_vaishnani shared ncbi.nlm.nih.gov/pmc/articles/P… Primary syphilis first manifests into a painless chancre at the site of inoculation 1 to 6 weeks later… Hematogenous dissemination then can occur typically 4 to 10 weeks later, giving rise to secondary syphilis. <40% of pts w/ syphilis have primary syphilis diagnosed. These “Secondary” lesions last for several weeks before spontaneously resolving. Coined “early, latent infection”

Some optics neuritis pearls in a short #Medtweetorial 🧵…. We all know that optic neuritis is frequently associated with multiple sclerosis (MS). But optic nerve inflammation can exist from autoimmunity, infection, granulomatous disease, paraneoplastic disorders, & demyelination Classical ON from MS is unilateral, moderate, painful color vision loss with an afferent pupillary defect & normal fundus examination.

If you have not listened to the @CuriousClinPod most recent podcast (Episode 10: Why does metronidazole treat both bacterial and parasitic infections?) then I suggest you tune in.

curiousclinicians.com/2020/09/30/why…

I'll summarize their show notes here in short #medtweetorial First a question:

Was metronidazole first used as an antibiotic or as an antiparasitic?

When you order a serum alcohol level, what does the lab measure? An answer and a quick #Medtweetorial on false elevations in #ETOH If you guessed NADH, you would be correct.

A Teal pain in the neck:

Follow along for a short #medtweetorial on #CervicalArteryDissection

or see the full handout here emboardbombs.com/s/Cervical-Art…

from @EMBoardBombs @blakebriggsMD @IltifatMD This review will focus on spontaneous dissections, not traumatic, as well as the pathophys, risk factors, presentation, diagnosis, and management.

Cervical artery dissections are a common cause of stroke in young(<50 years )w/ some reports of up to 20% being from dissections

Time for some #SpacedRepetition from @CPSolvers @DxRxEdu @rabihmgeha

Some chat recap #ClinicalPearls and bonus pearls from #VirtualMorningReport on Friday Sept 25th clinicalproblemsolving.com/morning-report…

Case by the brilliant @Rafameed A 31-year-old M born and raised in Brazil w/ no PMH presented with a 3 mon history of worsening DOE, orthopnea, 7kg weight loss, abdominal distention, dry cough, and syncope

Base rate of disease for an ID case with @k_vaishnani and @Rafameed is very high

We didn't have a #Neuro case today on @CPSolvers #VMR with @AaronLBerkowitz but don't worry! Let's recap a prior episode for some #SpacedLearning @DxRxEdu @rabihmgeha

With @ddeng_22 @KannuBansalMD

clinicalproblemsolving.com/morning-report… A 26 yo M w/ a PMH of nodular sclerosing hodgkins lymphoma p/w left-sided facial droop, L arm weakness, and dysarthria.

He presented 12 hours after onset and his symptoms had resolved.

3 months prior he had an autologous stem cell transplant and is currently on Brentuximab.

While on the topic on #Angioedema with @EMBoardBombs

It was mentioned about tPA causing angioedema. It is scary and happened to me. I didn't know about it until it happened to me.

Follow along for a short #medtweetorial case report with some tips. ncbi.nlm.nih.gov/pmc/articles/P… The most dreaded adverse effect of tPA, hemorrhagic conversion of an ischemic stroke.

But there is another scary, unusual & potentially life-threatening adverse effect of tPA. ANGIOEDEMA

It usually affects the side of the tongue ipsilateral to the stroke.

Check out this great review on BRUE's or “brief resolved unexplained event” @EMBoardBombs by @blakebriggsMD and @Lmellick here, emboardbombs.com/papers/2020/9/…

Or follow along for a short #medtweetorial review on the highlights. #EM #EMPeds #EmergencyMedicine #MedTwitter

https://twitter.com/EMBoardBombs/status/1306548537950339072

What is a BRUE? It reflects a general “catch-all” CC

The old term was ALTE (apparent life-threatening event), but this term was too broad and incorrectly assoc symptoms and SIDS.

It peaks in incidence at <2 months of age but can occur anytime within the first year

Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha @dminter89
Chat recap of the #ClinicalPearls #VirtualMorningReport

Episode 140 - Virtual Morning Report - September 11, 2020 clinicalproblemsolving.com/morning-report… Let's start with an initial PR:

A 27 y/o male with no PMH from Mexico presents with 10 days of generalized abd pain, vomiting, diarrhea, fever, & yellowing of his eyes

Deploy our Jaundice Schema; clinicalproblemsolving.com/dx-schema-jaun…

Some nice learning tips from a case report on #AdrenalInsufficiency

I wish all articles had them!

1. It is important to include primary adrenal insufficiency in the differential diagnosis for significant hyponatraemia even with the absence of hyperkalaemia. 2. Hypo-osmolar hyponatraemia with urine osmolality greater than serum osmolality and urinary sodium excretion >20 mmol/L, typically seen in syndrome of inappropriate antidiuretic hormone (SIADH), can also be seen in adrenal insufficiency, due to increased vasopressin secretion.

Contaminated blood cultures have been recognized as a troublesome issue for decades. This comes at a big cost, with additional costs associated with this unnecessary treatment were approximately $1,000 per patient. While target rates for contamination have been set at 2 to 3% (30, 131), actual rates seem to vary widely between institutions, from as little as 0.6% to over 6%. What organisms, when isolated from blood cultures, usually represents contamination?

Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

September 1st Ep. 132: clinicalproblemsolving.com/morning-report…
w/@AaronLBerkowitz @medrants @G_Khafaji @MariaMjaleman

Teaching points illustration by @sukritibanthiya First, let's start w/ an initial PR:

A 49 y/o F w/ a PMH of HTN, ETOH/THC abuse p/w bilateral leg weakness that started a week ago following during an admission for CAP that has since gotten worse along with urinary and fecal incontinence

There has been some interesting discussion about Relative vs Absolute Risk Reduction as some don't really understand it.

I don't blame those who don't, but it is important if you want to inform others about the findings, you must not be misleading...👇👇 You can read the document here if you like reading documents, meddent.uwa.edu.au/__data/assets/…

Or you can follow along tweetorial style

If you haven't signed up with the @CPSolvers yet, I highly recommend it! They send great recaps of episodes w/ spaced repetition teaching pearls! See tweetorial below

Episode 116: Dr. Dardia presents a case to Arsy, Dr. Maus, and Dr. Brooks, clinicalproblemsolving.com/2020/08/17/epi… A 67-year-old man presented with subacute respiratory symptoms w/ night sweats & was found to have multifocal pulmonary infiltrates, anemia, & a protein gap.

He completed antibiotic tx w/ clinical resolution of his respiratory symptoms, but on repeat labs.....

Lazarus rises: #NarcoticOverdose and reversal

emboardbombs.com/papers/2020/8/…

Check out this great short board-style review on #Opioid overdose and reversal agents #Narcan @EMBoardBombs

or follow along this short thread below 👇👇 Opioid abuse is an epidemic that has its roots in poor prescribing practices by physicians.

In the US alone, ~5 million people were estimated in 2015 to have used heroin at least once in their lives.

329,000 reported use within the past month.

Need a refresher about what ABnormal saline is? First listen to this episode on the @CuriousClinPod curiousclinicians.libsyn.com/episode-7-abno…

Then review their great episode show notes here,
curiousclinicians.com/2020/08/19/epi…

Or follow this short thread for some cool facts from the shownotes Saline was originally used in the 1830s by a Scottish physician named Thomas Latta to treat cholera patients during an epidemic that affected most of Europe.

His solution contained the following:
•Sodium 134 mmol/l
•Chloride 118 mmol/l)
•Bicarbonate 16 mmol/l

Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

August 17th Episode 119: clinicalproblemsolving.com/morning-report…
W / @MohitHarshMD @KromerHaylie & Ninand Bhat Let's start with an initial problem representation:

A 75 y/o M w/ a PMH of COPD, CAD, & aortic valve replacement p/w 2 weeks of dyspnea on exertion, 1 month of LE edema, 20 lb weight loss & recent onset PND and Orthopnea

Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

August 12th Episode 115: clinicalproblemsolving.com/morning-report…
w / Sonia Silinsky Krupnikova @Flower_freeland @pri_athavale
Teaching points @sukritibanthiya Let’s start with an initial problem representation:

A 50 y/o F w/ a PMH of remote gastric bypass, anemia, MGUS & hereditary elliptocytosis p/w worsening fatigue, dyspnea on exertion, chronic chest discomfort and trouble sleeping at night

Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

August 11th Episode 114: clinicalproblemsolving.com/morning-report…
W / @Anu08877649 Joshua Morris & @Rafameed
Teaching points illustration by @sukritibanthiya Let’s start with an initial problem representation:

A 55 y/o M w/ no known PMH except a 30 pack-year history of tobacco abuse presents with recurrent syncope (lightheaded prodrome) over last 2 mon along w/ R shoulder pain, 15 lb weight loss for 3 months, and an occasional cough

Time for some #SpacedRepetition: @CPSolvers @DxRxEdu @rabihmgeha
Chat recap of the #ClinicalPearls #VirtualMorningReport

August 10th Episode 113: clinicalproblemsolving.com/morning-report…
w/ @kiaracamacho96 @RizwanDania & Maria Jose Vides
Teaching points illustration by Sukriti Banthiya Let's start with an initial problem representation:

A 73 y/o M w/ a pmh of DM2, depression, hypoTh, BPH presents w/ a few days of nocturia & LE pain & brought in bc he was found lying on the floor of his bathroom disoriented after experiencing dizziness, blurry vision & falling