1/ 34 y/o F with new AML dx on chemo (7+3) ANC 200. Counts are expected to continue to drop & not get better for at least another ~10d. Has been febrile 🌡️🔥 & on cefepime 2g q8 for the past 5 days💊💉. What do you do next?

#MedTwitter #OncTwitter #IDTwitter 2/ Former chief resident & leukemia doc @andrewbrunner from @MGHCancerCenter spoke about acute leukemias & #FebrileNeutropenia (F+N) ! Here are some #ConferenceTwearls

Definition:

Febrile: ≥ T 100.4 🌡️

➕

Neutropenia: ANC ≤ 500 or an expected 📉 to an ANC of ≤ 500 in 48h

1/36 y/o F hx of anxiety p/w a 2nd episode of transient chest pain w emotional stress & her admission EKG shows 4 mm ST elevations in leads V1-V3. Her 1st troponins check was high. She is currently chest-pain free & vitals are normal.

What do you do next?
#MedTwitter 2/ This is a picture of her EKG

1/ID docs are known for their smarts, amazing notes and for being.....NOSY! 👃🔍

Former chief resident & ID fellow @PierreAnkomah unravels the clinical reasoning behind

🕵️‍♀️Why ID docs ask so many Questions

Follow for #ConferenceTwearls!

#IDtwitter @mgh_id @MGHBWHIDFellows 2/ One of the core concepts of clinical reasoning in ID is to

🔍 name the syndrome (i.e acute febrile diarrheal illness)

while exploring the interaction between

🦠 Microbes

👤 Host

🌍 Environment

1/ If there's some joint pain
In your neighborhood
Who you gonna call? 📞

🤯GOUT BUSTERS 👩‍⚕️

PGY-1 @Jen_LS_Hanberg gave a talk on
💊Urate-Lowering Therapy (ULT)💊

Let's review some pearls!
@MeganLockwoodMD @MGH_MSUS #MedTwitter #RheumTwitter #Nephtwitter #Gout 2/ Who gets ULT?

The strongest indication is for patients with:

✅2 or more flares annually

✅Radiographic damage due to gout

✅TOPHI

1/ We have a special tweetorial by PGY-1 @kevincmillerMD !

We are here to talk about @DGlaucomflecken 's favorite organ: THE SPLEEN! ♥️Or rather, what happens in its absence!

Is having a splenectomy a risk factor for thrombosis ❓🤔

@MedTweetorials #MedTwitter 2/ First, the spleen is a complex, beautiful & underrated organ. There, we said it. 🤷

It’s so great that 15% of people have an extra accessory spleen

The spleen has 3 general components: A marginal zone & 2 pulps.

1/ Res report with our fellow Dr. Michelle Rengarajan this week featured a cool case with a lot of ✨pearls✨

28 year old man presents with acute quadriplegia.

What's on your ddx? 2/ BMP drawn and showed K of 1.3!

Your intern year prepared you for this aggressive K repletion moment.

His K improved quickly and weakness resolved! Pt's TSH of <0.01 makes the diagnosis of

*drum roll*

✴thyrotoxic period paralysis (TPP)!✴

1/ The fall weather is getting us into the halloween spirit, and things are about to get bloody 👻❗

Let's review former chief resident and GI master @NnekaUfereMD's high yield pearls on:

🔴⚫ GI Bleeding ⚫🔴

@MGH_GI #MedTwitter #livertwitter 2/ What's the source?
Upper GI ⬆️ Vs. Lower GI ⬇️

⚫ MELENA
Usually ⬆️
Only 10% of cases are lower GI

🔴💩 HEMATOCHEZIA
- Non-Cirrhotic: ⬇️
only 15% of cases are from upper GI

- Cirrhotic: ⬆️
50% of cases are from upper GI

🔴🤮 HEMATEMESIS:
Rectal exam for triage

Good morning! ☀️ We are up & excited for grand rounds with Dr. Fauci!

@NIAIDNews @mgh_id @katrinarmstrong @RWalensky @MGHMedicine #MedTwitter #IDTwitter 1/ A reminder that while the clinical presentation of COVID-19 varies, a large proportion of adults in the U.S are susceptible to severe disease, more than 40% ‼️
Obesity is a key risk factor.

READ: It's not just people in nursing homes!

Recap of noon conference today with Dr. Nancy Wei on every intern’s favorite call admission aka DKA!! Here’s a framework to think about the different types of ketosis-prone diabetes subgroups!

Remember to think about beta-cell function and auto-antibody status to beta-cells!

Lets kick it with Dr. Bill Kormos and try not to pass out with excitement as we talk syncope 4 questions to ask:
1) Did this person have a LOC
2) Was it from syncope or non-syncope (rule out mimics such as metabolic, seizure, pseudo-syncope etc.)
3) Is the etiology of syncope clear (consider meds)
4) What is the underlying risk of cardiac syncope

Welcome to VTE Pearls with Dr. Sasha Wong 🫁 Think Virchow's triad for risk factors for hypercoagulability: stasis, endothelial injury and hypercoagulable state

Plane rides are not high risk in a healthy patient ✈️

Take a DEEP breath for part 2 🫁 of gas exchange with the great @galbamd 1/ Recap from Yesterday:
The partial pressure of O2 has a sinusoidal relationship with
the oxygen content.

The partial pressure of CO2 on the other hand has a a much more linear relationship due its ability to dissolve better

get pumped 👊 for more pulm #twearls from @galbamd tomorrow, but here's what we learned after part 1 of gas exchange today... 1/ 72yoM with COPD (FEV1 0.5L ~25% predicted) is admitted with a COPD exacerbation with accessory muscle use, RR 33, SpO2 84% and ABG 7.3/80/55. He is placed on NRB with improvement in SpO2 to 100%. He becomes obtunded and repeat ABG is 7.1/110/50. Why?

1/
@HawraAllawati (senior resident) here! Current fellow/MGH res alum @the_tjroberts & I found ourselves checking off an infamous task at 2 AM

[x]swing special slide🔬🩸

This inspired the following 🧵! Follow along & we guarantee that you will have a BLAST 😉! #MedTwitter 2/
63 M presents w CC of SOB x3 weeks. ROS: easy bruising.

T 39.0, BP130/80, O2 99% on 2L NC.

WBC 23K (2% neutrophils, 60% blasts), Hgb 8, plt 20. K 4, Cr 1.2, INR 1.7, D-dimer >1K, fibrinogen 112.

You pause and astutely start worrying about... acute leukemia!

What now?!

#FirstTweet! We will be sharing hepatology #Twearls from this morning's res report led by GI fellow extraordinaire @JacquelineChuMD! 2/5💡"Not all cirrhotics are created equal"-> It's important to distinguish compensated from decompensated cirrhosis! The latter indicates a much worse prognosis.

Some hallmarks of decompensated cirrhosis:
▪️ascites
▪️hepatic encephalopathy
▪️variceal bleed.