Pulmonary Metastases from Chondroblastic Osteosarcoma🧵
#MedTwitter #MedEd A 21-year-old woman presented to the emergency department with an 8-month history of progressive swelling and pain in the right thigh.

Easy bruising:🧵
Ask how long and how frequently has easy bruising occurred? Is it ecchymoses or purpura? How extensive are bruises? Are they located in areas subject to trauma (e.g. limbs) or pressure (e.g.waist band)? Do petechiae occur? Are bruises painful?
#MedTwitter Has there been gum bleeding? Has the patient experienced prolonged bleeding after skin trauma, dental extraction, childbirth, or surgery?

Leprosy🧵
#MedTwitter 40 year old man presented with a 1 year hx of painless swelling of his earlobes. He also reported having nasal congestion and intermittent nosebleeds. On examination, painless, indurated, contiguous nodules along the helixes of both ears were observed.

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#FOAMed #MedTwitter

https://twitter.com/caffeinatedmd/status/1621306974267637762

This gingival enlargement is concerning for AML, we take a biopsy for histopathological evaluation and a myeloblastoma is present.

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#FOAMed #MedTwitter #MedEd

https://twitter.com/caffeinatedmd/status/1621224852286840834

A 65-year-old woman with stage IV breast cancer presented after being denied authorization to perform a banking transaction because her fingerprints were unrecognizable

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#MedEd #CardioTwitter

https://twitter.com/caffeinatedmd/status/1620307457494093825

This ECG is concerning for rapidly evolving inferior OMI that requires urgent reperfusion
➡️There is 1st degree AV block, PR interval ~200ms
➡️Q waves in lead III are pathological and extend into adjacent inferior leads, predominantly aVF

Let me explain 🧵

https://twitter.com/caffeinatedmd/status/1620002087718522880

Earlier that day, while gardening near a horse and sheep farm, he had felt something enter his right eye. At presentation, the visual acuity was 20/20 in each eye. Examination of his right eye showed conjunctival hyperemia without purulence, a normal anterior chamber and fundus—

Basilar skull fractures signs, 🧵
#MedTwitter #MedEd Anterior basilar skull fractures are associated with the “racoon eyes” sign, which refers to consequent bruising around the eyes.
Other signs of anterior basilar skull fractures include partial or total loss of vision and smell, eye movement defects due to cranial nerve damage.

What you are seeing in this video is paradoxical chest movement due to flail chest, let's explain this more extensively, 🧵:

https://twitter.com/TLHM_MD/status/1572752691335659521

Quick physiology revision:
This is the normal mechanism of breathing:

Very very good question, let's talk about the Mentzer index:🧵
#MedTwitter #MedEd

https://twitter.com/N0BEL2015/status/1570899257552699394

First let's do a quick revision:
Normally, the majority of adult hemoglobin (HbA) is composed of four protein chains, two α and two β-globin chains arranged into a heterotetramer. In thalassemia, patients have defects in either the α or β-globin chain -> abnormal RBC

#MedEd #MedTwitter
Let's talk about Levosimendan's interesting properties: 🧵
Levosimendan increases myofilament calcium sensitivity by binding to cardiac troponin C in a calcium-dependent manner which stabilizes the calcium-induced conformational change of troponin C, thus:

https://twitter.com/walinjom/status/1570986433770573824

1) Changes actin-myosin cross-bridge kinetics without increasing the cycling rate of the cross-bridges or myocardial ATP consumption
2) Increases the effects of calcium on cardiac myofilaments during systole
3) Improves contraction at low energy cost (inotropic effect)