Parth
@flozinatorMD
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PGY 4 | Internal Medicine (AIIMS, New Delhi) | Alma mater (GMC, Rajkot)
New Delhi, India
Joined February 2021
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Inflammatory demyelinating diseases of CNS
1- Multiple sclerosis
2- NMO spectrum disorder
3- MOG associated disorder
#NeuroTwitter
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Hypokalemia - etiology.
Mainly three causes for hypokalaemia:
1- decreased intake
2 - redistribution loss
3 - increased loss (most common cause)
#NephTwitter
#EndoTwitter
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Pathogenesis of metabolic alkalosis
1- generation
2- maintenance
* Generation can be due to various causes, but maintenance is always due to inability of kidneys to excrete excess bicarbonate.
* Mineralocorticoid excess is common to both phases.
#NephTwitter
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Hyperkalemia - etiology.
Main causes:
1- decreased excretion (most common)
2- redistribution out of the cells
3 - excess intake (very rare - mainly in patients with underlying excretion defect)
Note - stop calculating TTKG for evaluation!
#NephTwitter
#EndoTwitter
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Post streptococcal glomerulonephritis vs Infection relation glomerulonephritis.
#NephTwitter
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Chilaiditi’s sign in a case of elderly male with idiopathic interstitial pneumonia (NSIP).
#MedTwitter
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Case of MEN 1 syndrome, post operative developed following finding.
Signs of latent tetany:
1-Chvostek sign
2-Trousseau sign
#EndoTwitter
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Clinical subtypes of myasthenia gravis - summary.
Imp points:
1- pyridostigmine may worsen MuSK-MG.
2-MuSK-MG is a part of IgG4 diseases - refractory to IVIG - responsive to RTX**
3- MuSK-MG has predominant bulbar features
4- M:F - 1:3 in EOMG
#NeuroTwitter
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Myotonic dystrophy - more than a simple muscle dystrophy (multi-system disorder)
#NeuroTwitter
#EndoTwitter
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IV loop diuretic titration in patients admitted for acute decompensated heart failure.
#NephTwitter
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Cold agglutinin disease vs warm AIHA - important points.
Drug induced CAD - Lenalidomide**
Immune checkpoint inhibitors can lead to warm AIHA.
Chronic lymphocytic leukemia can have warm AIHA.
#HemeTwitter
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37
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IBD arthropathy - types.
Following are few clinical features that denote relapse of IBD (may help to answer the ever lasting ques of relapse vs infection)
1- episcleritis >>uveitis
2- erythema nodosum>>pyoderma gangrenosum
3- “type-1” peripheral arthritis.
#RheumTwitter
4
33
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B cell lymphoma - summary.
1 - low grade lymphoma
2- intermediate grade
3- high grade lymphoma
#HemeTwitter
5
43
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Von Willebrand Disease types - covering most points.
Imp points:
1- thrombocytopenia in type 2B
2- cautious use of DDAVP in type 2B
3- type 2N aka “autosomal hemophilia”
4- type2N & 3 have clinical picture similar to hemophilia A.
#HemeTwitter
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Trigeminal autonomic cephalalgias (TAC) - summary.
1- cluster headache
2- paroxysmal hemicrania
3- SUNCT/SUNA
4- hemicrania continua
#NeuroTwitter
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21
95
Dose of NOACs in atrial fibrillation and pulmonary embolism - differences.
1- loading dose for apixa/rivaroxaban in pulmonary embolism.
2- UFH/LMWH/fonda overlap for 5 days for dabigatran/edoxaban in pulmonary embolism.
Following image summaries the difference.
#CardioTwitter
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@PanktiMehta24
@nihardesai7
@NicoGagelmann
@BhattArshad
@sakir_rheum
@Janetbirdope
@debaditya_roy
@SandhyaRheumat
Sjogren syndrome
Schirmer test
Dry tongue
Distal RTA - nephrocalcinosis
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4
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21 y/M
2018 - headache, LOW, low grade fever.Imaging had seller mass lesion for which referred to higher centre (didn't follow up).
2020 - Additionally, he developed polyuria/polydipsia, ED & intermittent episodes of hypoglycemia.
#Endotwitter
#Neurotwitter
#Hemetwitter
1/n
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Hypoaldosteronism - etiology.
Mainly due to:
1 - reduced aldosterone production
2 - aldosterone resistance
#EndoTwitter
#NephTwitter
1
23
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Glomerulonephritis with fibrillary deposits:
1- amyloid fibrils
2- non amyloid fibrillar deposits
a- fibrillary GN
b- immunotactoid GN
c- fibronectin glomerulopathy
d- collagenofibrotic glomerulopathy
#NephTwitter
3
20
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26/F presented with multiple small joint pain, fever, facial rash (can’t upload the pic) & difficulty in walking. CTD w/u was unremarkable. Basic infective workup was negative.
O/e she had ulcerative lesions over MCP & objective weakness in LL.
CK mildly elevated.
#RheumTwitter
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Antigens implicated in human membranous nephropathy.
Recently HSCT associated MN was shown to be associated with FAT1 antigen.
#NephTwitter
3
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60/M, uncontrolled T2DM, chronic alcohol & tobacco use (smoking).
Presentation
1- cough with expectoration *2months
2- hemoptysis *2months
3- loss of weight
IgG asp +ve
beta D glucan +ve
CT - Right upper lobe cavitation with surrounding consolidation- likely CCPA.
#PulmTwitter
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@nihardesai7
@MedTweetorials
@BrownHospMed
@Torsadepointles
@KailashKolhe
@NicoGagelmann
@rabihmgeha
@CPSolvers
@Rafameed
@pankti4299
@PanktiMehta24
DIC
Small vessel vasculitis - ?cocaine induced (levamisole contamination)
Tropical infections - scrub, lepto, hemorrhagic fever, etc.
Other infections- V. vulnificus (saltwater exposure?)
HLH/AOSD?
IE - murmur, vegetations?
Autoimmune - IgAV/IgAN, etc
Skin biopsy - HPE/DIF
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Ventilator asynchronies
1- trigger asynchrony
2- flow asynchrony
3- cycling asynchrony
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@AkankshaNag6
@nihar_nayak2
@DrAntariksh
Great :)
Pleasant coincidence. I had this for a while but didn’t post just for the reason that most cases that we see here are “post-TB” & ABPA and TB can literally by the first d/d for each of these :)
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Risk factors for hungry bone syndrome:
1-Higher volume of resected
2-preop BUN levels
3-preop ALP levels
4-Older age at time of sx
5-higher preop PTH & Ca
6-Radiological OFC
7- Vit D deficiency (25 OHD)
#EndoTwitter
0
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If twitter ends tonight, please stop giving oral iron BD for iron deficiency anemia.
If twitter ends tonight, please stop using estimated GFR in acute kidney injury.
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@nihardesai7
@MedTweetorials
@BrownHospMed
@Torsadepointles
@HemOncFellows
@doctorboletoh
@PanktiMehta24
@pankti4299
@NicoGagelmann
@Sthanu5
Infiltrative/malignant - lymphoma, leukemia, TB, histiocytosis.
Autoimmune - SLE, AOSD, cryoglobulinemic vasculitis (underlying LPD or HCV)
Infection - HIV, histoplasma, TB, cryptococcus, EBV, parvo?
Secondary HLH
Complementary alternative medications?
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Important 🧵
A man comes to the ICU after uncomplicated cardiac surgery. He is hypertensive and a nicardipine infusion is started. 10 minutes later he becomes hypoxemic. A chest radiograph is obtained.
What happened?
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@nihar_nayak2
I beg to differ when you say ARB have class effect for HFrEF.
Following ARBs have been shown to lower mortality in HFrEF beyond doubt
1- candesartan
2- losartan
3- valsartan.
#CardioTwitter
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Ischemic optic neuropathy - summary.
Most common optic neuropathy in adults above 50years.
Most common cause of unilateral optic nerve edema in adults above 50 years - NAION**
#NeuroTwitter
2
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Types of cryoglobulinemia.
Imp points:
1-Mixed cryoglobulinemia - type 2 & 3.
2-Low C4 in mixed cryoglobulinemia.
3- Meltzer’s triad in mixed cryoglobulinemia - purpura, arthralgia & weakness.
#HemeTwitter
#NephTwitter
1
10
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CLL vs monoclonal B cell lymphocytisis (MBL) vs small lymphocytic lymphoma (SLL)
#HemeTwitter
1
10
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Acute eosinophilic pneumonia vs Chronic eosinophilic pneumonia.
AEP can be mistaken for ARDS***
#PulmTwitter
1
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Periodic paralysis and non-dystrophic myotonia - summary.
Fournier*** electrodiagnostic patterns use short & long exercise test to differentiate among these entities given the clinical background.
#NeuroTwitter
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