Assoc Dean of Clinical Ed & Assoc Prof of Emergency Medicine @1LECOM. FSU & UF grad. Aging & Longevity. God. Golf @medtweetorials @hdx @EMBoardBombs @CPSolvers
May 30, 2021 • 5 tweets • 2 min read
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”
May 29, 2021 • 14 tweets • 3 min read
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.
Oct 1, 2020 • 14 tweets • 4 min read
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.
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
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.
Sep 6, 2020 • 7 tweets • 1 min read
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?
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
Aug 29, 2020 • 9 tweets • 2 min read
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
Aug 25, 2020 • 10 tweets • 4 min read
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.....
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
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
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