Ravi Singh Profile picture
Hospitalist and APD @SinaiBmoreIMRes, @CPSolvers, #Medicalsimulation #BeKind, #Behumble, #IMG Originally from South East London. Views= mine
Sarah Owens Profile picture 1 added to My Authors
May 6 8 tweets 3 min read
You start SQ insulin on a patient and they develop peripheral edema ?
What is the mechanism of "Insulin edema" ?
#MedTwitter #MedStudentTwitter 2/8
This condition was initially reported by Aaron Leifer, M.D. in 1928 in a 41-year-old male patient started on an insulin regimen which was published in JAMA.

Leifer A. A CASE OF INSULIN EDEMA. JAMA. 1928;90(8):610–611. doi:10.1001/jama.1928.92690350001012
Apr 16 17 tweets 7 min read
“The skin truly can be a mirror of what’s going on inside the body “
During a #CPSbootcamp conversation we started discussing mosquito bites. How they can be a signal to internal disease ? Let's explore @deboracloureiro @KirtanPatolia @CPSolvers @seymss15
#MedTwitter 2/17
Mosquito saliva-induced type I hypersensitivity induces a strong itch sensation. This is a process of vasodilation + inflammation

First ➡️ immediate wheal and flare reaction develops within 15–30 min➡️ delayed pruritic induration arises within a day or 2 which resolves
May 20, 2021 10 tweets 4 min read
1/ 10 The most recognized form of Non-Cardiogenic pulmonary edema(NCPE) is ARDS, however the scope of NCPE is much broader with many causes. One particular cause of NCPE we encountered was due to opoid use which is explored in this #medtweetorial
#MedTwitter #MedStudentTwitter 2/10 The onset of noncardiogenic pulmonary edema after opioid overdose was first described by Osler
during an autopsy in 1880

Osler W. Oedema of the left lung — morphia poisoning: Montreal General Hospital Reports Clinical and Pathological. Montreal: Dawson Bros., 1880:291.
Feb 23, 2021 11 tweets 5 min read
1/ Is bandemia with a normal WBC count concerning for a lethal infection?
It's a very interesting concept which I've faced and will explore below :
#MedTwitter #MedStudentTwitter #FOAMed 2/“Left shift” means that a particular population of cells is “shifted” towards more immature precursors
Josef Arneth (1873-1955) described this left-shift term.

% neutrophils is commonly reported as a "left shift" in the Diff which is incorrect
Dec 17, 2020 11 tweets 5 min read
1/ "Don't forget to correct that phosphate so that the it can help the patient recover from acute respiratory failure !" This concept triggered a lot of questions on rounds.
It's worth taking a quick look at this association !
#medtwitter #MedStudentTwitter #FOAMed #phosphate 2/⬇️Phosphate leads to ⬇️red cell 2,3-DPG and a reduction in ATP.
⬇️Phosphate diverts glucose -> 1,3-DPG into the Rapoport-Leubering pathway away from ATP generation towards producing 2,3-DPG so that the oxygen affinity of RBC's does not increase and the tissues receive O2.
Sep 25, 2020 14 tweets 6 min read
1/Why does the Hg/Hct drop in the first two days during hospitalization ?
We'll explore this issue in this short #medtweetorial
#medtwitter #FOAMed #MedStudentTwitter 2/Interestingly , anemia of hospitalization is commonly thought to be due to
- phlebotomy
- invasive procedures/ bleeding etc

However, prolonged bed rest can contribute to a drop in your pts blood count !
Another reason to get our patient's out of bed if possible !
Sep 8, 2020 12 tweets 5 min read
1/ LR has been making the rounds on #MedTwitter recently so I decided to put all of the important points versus NS into an infographic with additional points
#MedTwitter #MedStudentTwitter #Medtweetorials Image 2/ NS can cause coagulopathy
- NS dilutes clotting factors ➡️ impairing coagulation and hemostasis.
-NS can cause a functional impairment of thrombin and fibrinogen
- ⬆️ disruption of existing clots.
- acidic milieu can also ⬇️ clot formation/stability

Sep 1, 2020 15 tweets 5 min read
1/ In medicine, we get to eat humble pie time and time again. The vast amount of knowledge necessary can be a daunting task and what we learn isn't necessarily what we may see in the clinical realm. You can almost say there is an atypical presentation for everything. Image 2/ This leads to our case, on consults we come across a elderly pt with confusion and psychosis.
Normal Temp and RR: 18 and Low normal BP
Clinically dry with labs:
Normal Albumin and Normal gap. Image
Aug 21, 2020 9 tweets 4 min read
1/ We recently had a patient on service with B/l lower extremity edema with inflammation which was considered to be cellulitis and received antibiotics. This definitely made for some great teaching points as well as a rethink of the Dx.
#medtwitter #MedStudentTwitter #FOAMed 2/This was a great opportunity for a deep dive into domain of pseudocellulitides and this approach made the team reconsider the diagnosis especially since this was a bilateral process.
Aug 12, 2020 7 tweets 4 min read
1/6 @k_vaishnani discussed Cement PE recently and it reminded me of a patient I had with N/V due to a procedural complication that I was also not familiar with. A great learning point is to try to associate the procedure to the complication whilst trying to entertain other #DDX Image 2/6 The patient presented with a past medical history of DM and paroxysmal AFib s/p Ablation two days prior to admission.
One day after the procedure, she developed generalized progressive abdominal discomfort (+) persistent n/v, exacerbated with food intake.
Aug 3, 2020 4 tweets 2 min read
Day 6 on the floors. The team is scratching their heads over a patient in her 20’s with chest pain and SOB. No fever nor hypoxemia. COVID negative
Reviewed some likely illness scripts with the team making up a possible differential Image Courtesy of @CPSolvers
Findings on CT are mass like densities ( peripherally located) and asymmetric lymphadenopathy
COP and eosinophilia PNA less likely especially with the epidemiology.
Surprisingly Sarcoidosis can present atypically with asymmetric lymphadenopathy. Image
Mar 29, 2020 4 tweets 1 min read
Hospital Universitario Fundación Alcorcón

EK ONKAR, todos somos uno. Es lo que todos nuestros compañeros estamos haciendo en nuestro trabajo diario en los hospitales. Somos uno con el que sufre, somos uno con el que ríe, con el que se enfada, con el que comparte… con el que se recupera… con el que es feliz…