Conrad Fischer
@SeeFisch
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The World's Most Prolific Teacher of Medicine Tweets only reflect personal opinions.
Everywhere!
Joined February 2009
Hemoglobin A1C becomes unreliable when there is alteration of the lifespan of the red cell. Sickle cell, G6PD, thalasemia and any chronic hemolysis gives a false LOW A1c because the cells have not lived long enough for glucose to stick to them.
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Ranitidine (Zantac) is off the market because of teratogenicity.
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the REAL wonder drug of the year is:.SGLT2 inhibitors.Canagliflozin.Dapagliflozin.Empagliflozin.Ertugliflozin.*Prevent progression of chronic kidney disease.*Mortality benefit in CHF with low Ejection fraction (EF).*Even if NOT diabetic, use in CHF with low EF.
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Dear Applicants.You will not be penalized for not “signaling” my program. Safe it for insecure program directors who need that. You had to pay ERAS to apply to my program. That is “special” enough.
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Malaria causes 200 MILLION cases/year with HALF A MILLION dead each year. Why is #covid different? .Because it makes people in rich countries know they are at risk, rich people can die, that power and position do not protect you. May we remember our common humanity when all over.
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As if the good things SGLT2 inhibitors could not get any better, SGLT2 inhibitors increase the urinary loss of uric acid and decrease gout flares too!.
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imagine you are going to do your Step 2 exam and some political fool decides to shut off the internet for the whole country? Yes, it happened.
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What is the second drug to use, after metformin?.•If Obesity → GLP agonist. •If CHF → SGLT2 inhibitor. •If Chronic kidney disease→ SGLT2 inhibitor. *If nothing. maybe DPPIV inhibitor such as sitagliptin. Sulfonylureas or Pioglitazone are never the second drug.
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Fluoroquinolones, a class of antibiotics, have been associated with an increased risk of aortic aneurysm or dissection. This connection has been highlighted by several studies and regulatory warnings:.
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The Nightmare is over. My first thought is the safety of our residents in our training program. They are safe and will not lose their visas.
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So I am walking down a street in Boston just happens to be the teaching hospital of Harvard, Mass general and I hear “Dr Fischer DrFischer is that you?”.And an IMG Oren, a cardiology fellow at Harvard Says hello. “I watched your videos”.Doubting your dreams is a disease. Persist
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Diuretics can falsely elevate the protein level in pleural effusion, making a transudate look like an exudate.
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Isn't it great that Polycystic kidney disease (PCKD) now finally have a treatment, the V2 inhibitor, Tolvaptan?.
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BCG has no effect on TB screening .BCG has no effect on TB screening.BCG has no effect on TB screening.BCG has no effect on TB screening.BCG has no effect on TB screening.BCG has no effect on TB screening.
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My coronavirus infection was much milder than others. 80-90% have few symptoms. I am ten days past diagnosis and not contagious. We think I am immune, but hard to be sure. I went back to work.
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SGLT2 inhibitors have to be the drug class of the year! (Empagliflozin, Dapagliflozin, Canagliflozin, Ertugliflozin).*They make glucose "Floz in" to your urine!.*Delay progression of kidney disease (Real!!).*Decrease mortality in CHF even if you don't have diabetes! (AMAZING).
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Methotrexate clearly gives marrow suppression and all should be on folic acid, BUT!! if you develop Macrocytic anemia you should use FOLINIC ACID, because folinic acid does NOT need activation by dihydrofolate reductase.
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Why does Azithromycin help cystic fibrosis if it has no activity against pseudomonas?. Because Azithromycin is an ANTI-INFLAMMATORY.
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The LOWER the SODIUM in the DIET, the LOWER the CALCIUM in the urine. This is why a low sodium diet treats kidney stones. (PS always love the collaboration with the renal division at Brookdale).
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Can someone tell me the MECHANISM of how glucagon reverses Beta blocker toxicity?.
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In gout, the best BP med by far is Losartan which seems to definitely lower uric acid levels.
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Yes, Metronidazole is associated with a risk of hypoglycemia.
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I am in love with every church and temple and mosque because it is there that the love of divinity is nourished,. #GazzaUnderAttack.
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Amazing effect of SGLT2 inhibitors on Congestive Failure. Amazing decrease in mortality even with NO history of diabetes.
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Acute gout with GFR <30?.Can't use colchicine (it will accumulate and kill your marrow).Can't use NSAIDs (will kill last lonely, sad glomeruli).Use the Interleukin-1 (IL-1) inhibitor ANAKINRA.
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Ivermectin does NOT help COVID. Zinc and vitamin C do NOT help COVID. Steroids if hypoxic yes. Monoclonal antibodies MAY decrease hospitalization. Maybe. Remdesivir shortens illness but not mortality.
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SGLT2 inhibitors are really "Routine Miracles".By accident this diabetes drug is found to:.*Decrease mortality in CHF.*Prevent progression of CKD.*Prevent worsening of kidney disease with proteinuria even if there is no diabetes.And!!!!!.First generic will be out in 2025.
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What BP medication is most DANGEROUS in renal artery stenosis?.
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Ukrainian fashionista.level three body armor with my stylish New York City hat!. Outside a Ukrainian hospital. Dead doctors can’t help people
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Apixaban can be safely used in chronic kidney disease. Even on dialysis, 2.5 mg twice a day is safe. Wow! .Amazing. DOAC on Dialysis.
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Tirzepatide.*The MOST amazing new drug of the year!.*Combined GIP/GLP agonist.*The ONLY drug with 2-2.5% decrease in HgA1C.*15-30 pound weight loss. GIP= Glucose INSULINOTROPIC peptide.In past was "Gastric Inhibitory Peptide".
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Breakthrough!!!!.Treatment of IgA nephropathy!!!.New. *SGLT2 inhibitors for all with IgA nephropathy. *Sparsentan is dual endothelin angiotensin receptor antagonists.
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Oh my.
@SeeFisch Egyption Drs get paid 5000 L.E which is ~ 100$.As IMGs we apply for about 150 program ~3000$.
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Please do NOT use brand names for drugs. Use the generic name.
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COVID treatment.the ONLY two things that really lower mortality, besides the vaccine, are Dexamethasone if hypoxic and TOCILIZUMAB if seriously hypoxic.
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Pneumonia Management: Enormous Guideline Change.NO MORE MACROLIDES ALONE! Wow!.*Amoxicillin or Amox-Clav WITH macrolide or doxycycline.*Cefpodoxime WITH macrolide or doxycycline.*With many comorbidities, pre-treatment: Respirtory Quinolone (Levofloxacin).
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Where my residents from.China.Russia.Nigeria.China.Venezuela.Cameroon.Ireland.Georgia.Armenia.Poland.Ukraine.Dominican Republic.Iran.Iraq.Syria.Taiwan.India.Pakistan.Serbia.Kazakhstan.Tajikistan.Nepal.Bahamas.Trinidad.Guyana.Grenada.Israel.Palestine Bangladesh.Jordan.Turkey.Ethio.
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All Glomerulonephritis has:.RBCs.RBC casts.Proteinuria.Can lead to nephrotic syndrome. What's DIFFERENT? much easier.Eye/Ear = Alports.Eo's/Asthma= ChurgStraus (EoGPA).UPPER resp= Wegners (GPA).NO LUNG=PAN.ASLO/Hyaluronidase=Post Strep GN.GI/Joint/Skin = HenochSchon.NOTHING=IgA.
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Subclinical hypothyroidoism means high TSH with normal T4. Replace thyroxine if either/or:.• TSH >10.• TSH <10 and thyroid peroxidase (TPO) antibodies are present.
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What medication will relieve the pain of a urinary tract infection the fastest? it does this to the urine?
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I had zero publications in medical school.
Med students who matched into Neurosurgery had THIRTY SEVEN pubs/presentations on average??. This research arms race to match into residency is getting wild. It rewards students with enough financial support to take a gap year during med school.
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Amazing diagnostic world!.CT scan is 96% sensitive and specific for appendicititis. No more operating on thousands of people a year without a diagnosis.
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Brain Death.*No pupillary, corneal, gag, oculocephalic reflexes.*No response to stimuli. APNEA TEST.1. Oxygenate for 20 minutes.2. Remove ventilator.3. pCO2 goes up by 20 points= apnea. No CT needed.No EEG needed.No neurologist needed.No neurologist needed.No neurologist needed.
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yes, best BP drug in gout is an ARB such as LOSARTAN. Angiotensin receptor blockers increase the urinary loss of uric acid.
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Heart Failure with REDUCED ejection fraction.*Metoprolol ONCE a day is just as good as Carvedilol TWICE a day.*Metoprolol ONCE a day is just as good as Carvedilol TWICE a day.*Metoprolol ONCE a day is just as good as Carvedilol TWICE a day.*Metoprolol ONCE a day .Please. 2x =HARD.
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APNEA TEST.1. Oxygenate for 20 minutes.2. Remove ventilator.3. pCO2 goes up by 20 points= apnea.*No scan needed. *No neurologist needed.
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So for chlamydia, I am sorry to say that treatment is, yes, doxycycline twice a day for a week. More efficacy. Goodbye single dose azithromycin!!.Sniff~!!! I will miss you.
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Anticoagulation with CKD. If GFR <30, what to use for DVT, PE?.Apixaban. If ESRD on dialysis, what to use for DVT, PE?.Apixaban.
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Metformin: .*Blocks gluconeogenesis.*Increases insulin sensitivity.*Decreases intestinal insulin absorption.No risk hypoglycemia . The mechanism of decreased glucose absorption in the bowel has always been fuzzy and not too clear.
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Osteomyelitis Management.1. Xray first.2. If abnormal, hold off antibiotics and biopsy.3. If Xray negative, get an MRI.4. If MRI shows osteo, hold off antibiotics and get a biopsy. you cannot treat osteomyelitis empirically. Wait. Biopsy. get a precise organism.
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Subclinical hypothyroidoism.*High TSH with normal T4.Replace thyroxine if:.*TSH >10.*TSH <10 and TPO antibodies positive.
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For Asthma, Aminophylline has no role. None. It is extinct.
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Saying to start insulin ONLY becauae of HgA1c of >9% is TOTALLY wrong. Not 99% wrong. it is 100% wrong.
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GERD managment.Hard to understand why anyone would want to use an H2 blocker. Only 60% control. If PPIs do not work, then confirm that you really have GERD. PPIs should work in 90% so if they fail, there is a 90% chance you do NOT have GERD. do not treat Helicobacter in GERD.
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In acute myocardial infarction, it has been REALLY hard to get people to realize that OXYGEN does NOT help. Morphine does not help either. I know people want "MONA" as an acronym, but how about CAT?.Clopidogrel.Aspirin.Thrombolytics.or ACAST.Aspirin.Clopidogrel.ACE.Statin.TPA.
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Anti-psychotic medication olanzapine is amazingly effective in severe nausea.
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Sacubitril (neprilysin inhibitor) falsely increases BNP level.Obesity falsely lowers BNP.
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Well, this is quite clear. Based on your feedback, we will change our policy and will send out rejection letters. We have 4,500 applicants for 400 interview spots. It will not be my intention to hurt your feelings.
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My deepest sympathies to the resident doctor Abhaya of RG Kar Medical College of Kolkata, India and I strongly support the protest against the devastating violence and abuse of doctors in India.
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COVID Treatment.*Asymptomatic or mild symptoms. Not hypoxic= Monoclonal antibodies. *Mildly hypoxic- Nasal Canula = Remdesivir and Dexamethasone. *Severely Hypoxic: High Flow canula, intubated, bipap= Dexamethasone + Tocilizumab. NO VITAMIN C, NO ZINC, NO VITAMIN D PLACEBO.
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Yes, for every POINT below normal of ALBUMIN the CALCIUM is down by 0.8 . Yes, an oldie, but a goodie!!.
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It is still hard for me to accept that AZITHROMYCIN in first line in infectious diarrhea.
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How to get the urine OSMOLARITY from the SPECIFIC GRAVITY?.Multiply the last two numbers by 30.1.010 = 300 osmolarity.1.020= 600.1.030= 900. Fun while waiting for urine osmolarity!!!!!.
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SGLT2 inhibitors (Dapagliflozin, Empagliflozin, Canagliflozin) for diabetes.*Game changers!!!!!! MUST KNOW!.*Never cause hypoglycemia.*Decrease rate of progression renal disease AND!!!.*Decrease mortality if CHF present.
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Osteomyelitis is a LONG TERM infection. It is not sepsis. Osteomyelitis does NOT need urgent antibiotics. Osteomyelitis needs a bone biopsy. A bone sample to get the right treatment. DELAY antibiotics until bone biopsy is done.
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Cirrhosis Ascites: Spironolactone is given in 5:2 ratio with furosemide .eg (MUCH higher than CHF dose) .Spiro 100: Furosemide 40 .Spiro 200: Furosemide 80.Spiro 400: Furosemide 160 . Cirrhosis with any Upper GI bleed=Use ceftriaxone prophylaxis.
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Mechanism of Bicarbonate increase in COPD. COPD gives CO2 retention.CO2 retention is resp acidosis.Chronic respiratory acidosis increases new bicarbonate generation at distal tubule of kidney. COPD = Bicarbonate increase.
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Hyperglycemia.For every 100 above normal of glucose, the Sodium level should drop by 1.6.
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Remember, the specific H2 blocker Ranitidine is actually off the market. Carcinogenic Concerns.
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For GERD, yes, H2 blockers CAN be used. Weaker. Faster. Less expensive. For ULCERS, only PPIs.
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Dementia and Parkinson Disease.When dementia happens 1–2 years after PD, it is called "PD-associated dementia.".When dementia and PD begin at the same time, it is called "Lewy body dementia.".
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Students are taught about CHLORAMPHENICOL and aplastic anemia. Ha, Ha, Ha!! Not made or used in USA for 30 years, and NOT taught about dalbavancin. Dalbavancin. One dose lasts 7-10 days. cures osteomyelitis with two doses a week apart.
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Miracle Drug Class of 2022.SGLT2 inhibitors.Empagliflozin, Dapagliflozin, Ertugliflozin, Canagliflozin.*Lowers mortality in CHF with systolic dysfunction.*Decreases progression of chronic kidney disease (CKD).*Use in CKD with proteinuria, even without diabetes.
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$300 more for USMLE is a whole month's salary for many doctors outside the United States.
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Events in Nepal are a disaster for International Medical Education. We detected a marked excess in extremely &high score from Nepal last year & watching. Of the scores above 270 a huge amount were from one country Nepal. This truly damaged qualified people with lowere scores.
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Yes, Fosfomycin and nitrofurantoin are safe in pregnancy.
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SGLT2 inhibitors. They do NOT cause hypoglycemia when used alone. They DO cause DKA with a NORMAL blood sugar.
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I look at ERAS later than anyone in the country and just started today. I absolutely HATE not having a step 1 to use. All the letters sound the same. All the personal statements sound the same.
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Polycystic Ovary Syndrome (PCOS). Diagnosis of PCOS. • Clinical findings:.hirsutism, oligomenorrhea. • Sonographic findings: ≥10 cysts or ovary >10 cm. • Lab findings: ↑ anti-Mullerian hormone.
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Valproic acid causes hyperammonemia (super high ammonia) which can present as encephalopathy.
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We have found 100+ errors in Step up to Medicine. Watch my statement on this. @wkhealth #weareheretohelp #medicine #medtwitter
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