SWIM
@SWIMedicine
Followers
7,492
Following
40
Media
167
Statuses
334
Study With Me Internal Medicine 🏊|| Main account @MD1TALK
Joined August 2020
Don't wanna be here?
Send us removal request.
Explore trending content on Musk Viewer
seokjin
• 1051459 Tweets
コロンブス
• 228125 Tweets
DAOUOFFROAD NEW SERIES
• 176041 Tweets
Super Tuna
• 135119 Tweets
THANK YOU JIN
• 90557 Tweets
WE LOVE YOU JIN
• 76227 Tweets
#LISAxTeaser1
• 72576 Tweets
ROCKSTAR X LISA
• 71390 Tweets
ジンくん
• 45738 Tweets
9Days Left Kabir Prakat Diwas
• 44309 Tweets
#ダンジョン飯
• 41839 Tweets
VLOG 1 WITH BUILD
• 40018 Tweets
Eat Jin
• 38759 Tweets
#素のまんま
• 37288 Tweets
STELL 1N THE ROOM
• 29373 Tweets
#THE夜会
• 28606 Tweets
Francesca
• 24945 Tweets
Marseille
• 23948 Tweets
Benedict
• 22018 Tweets
De Zerbi
• 22014 Tweets
Quatennens
• 20838 Tweets
SOUL'd OUT
• 20503 Tweets
Santo Antônio
• 17320 Tweets
Eloise
• 15387 Tweets
michaela
• 14099 Tweets
#حنا_خدام_الحرم
• 10310 Tweets
@md1talk
3W’s
Wet → urinary urgency
Wacky → cognitive impairment
Wobbly → magnetic gait with falls 🧲
Imaging → hydrocephalus
Lumbar puncture → normal pressure
The diagnosis:
Normal pressure hydrocephalus
0
4
77
@md1talk
One important Differential would be:
Nephrogenic diabetes insipidus induced by lithium
Clinically evident by polyuria
Laboratory evident by hypernatremia, ↑ osmolality and dilute urine
0
3
49
This question is from my morning recalls, who can guess the answer ?
🤔🤔
Heparin
Clopidogrel
PCI
12
6
48
@md1talk
acE-i → dilate “E”fferent arteriole (the action of angiotensin 2 is to vasoconstrict the efferent) → ↓ GFR
NSIADs → ↓ prostaglandins → afferent vasoconstriction → ↓ GFR
0
0
46
@md1talk
Hypophosphatemia, mediated by FGF-23 hormone
↓ phosphate can lead to muscle weakness and arrhythmias along with respiratory depression
0
6
48
@md1talk
Koilonychia + fatigue = iron deficiency
Koilonychia + fatigue + esophageal web = plummer-vinson syndrome
0
3
46
@md1talk
Resistant HTN + Hypokalemia = primary hyperaldosteronism
“At least this is very true for exams sake”
First step is aldosterone/renin ratio.
Then confirmation is done by adrenal imaging (CT/MR)
1
3
40
@drtimothyli
Disseminated gonococcal infection
Triad of arthritis, tenosynovitis, pustular skin lesion
0
3
40
@md1talk
Colon = 45y → colonoscopy
Breast = 50y “USPSTF” → mammogram
Lung = 50y → low dose chest CT
Cervical = 21y → PAP
1
4
35
@md1talk
Toxic megacolon
- Toxic = systemic inflammation (by labs and symptoms and signs)
-Megacolon = large colon
For antimicrobials = ciprofloxacin + metronidazole cocktail 🍹
Steroids is needed and a corner stone in therapy 🎖️
Evaluation for C .Diff and if + = oral vancomycin
0
5
33
@md1talk
Hypertensive crisis with ingestion of foods containing tyramine
- Examples: aged cheeses, smoked/cured meats, alcohol (beer & red wine)
- Tyramine stimulates sympathetic by releasing noradrenaline, from vesicles into the synaptic cleft →↑↑↑ BP
- seen with MAOi agents
0
5
31
📍All of these signs are seen in which valvular disease ⁉️
A)Aortic Regurgitation
B)Aortic stenosis
C)mitral regurgitation
✳️answer is bellow 👇🏻
1
5
27
@md1talk
Neonate = to close the PDA
Labor = as tocolytic (delay labor)
Heart = in pericarditis
0
1
25
@md1talk
If there are any serious complications:
- stop the infusion
- Cryoprecipitate (10 units) over (10min) and more as needed
- Antifibrinolytic: aminocaproic acid or tranexamic acid
0
2
25
@md1talk
Hyperkalemia with sine wave pattern
First & the most critical step in management is to give calcium gluconate to stabilize the cardiac membrane
@grepmeded
0
0
25
@md1talk
With repeated use, the effect will eventually ↓ ↓ rapidly
This is called:
Tachyphlyaxis ✅, a none dose dependent response
0
1
24
@md1talk
risk:
•Hyponatremia
•Cerebral edema
•Pulmonary edema
•Hyperglycemia
•Hypokalemia
Use in:
•Correction of free water deficit (hypernatremia)
•Maintenance fluid
•Solvent for IV drugs
0
1
22
This is a 7 year old child, his previous history reveal URTI 2 weeks ago, presenting now with a complain of symmetrical ascending paralysis started form his toes, the most appropriate management is ?
Steroids
Acyclovir
IVIG
Aspirin
9
2
20
@md1talk
In summary:
- if we halve the length→ flow will double
- if we halve the diameter→ flow will be reduced 16 times
Since central catheter length is longer than peripheral, peripheral will deliver more flow if we use the same gauge size
0
0
18
@md1talk
Acute angle closure glaucoma
Supine position may help to reduce IOP
IV/PO acetazolamide + parasympathomimetic eye drops and call ophthalmology
0
2
18
@md1talk
Low voltage ECG
Differential → DOPES
-Death (near death) = shock
-Obesity
-Pericardial effusion/Pleural effusion
-Emphysema (COPD)
-Situs inversus (dextrocardia)
1
1
17
@md1talk
Food + descending flaccid weakness = think food borne Botulism
Caused by c. botulinum
Patho: inhibition of acetylcholine release from the presynaptic axon terminals
Remember this disorder by 4 D's: Dysarthria, Diplopia, Dysphagia, Dyspnea.
Confirm Dx by: toxin detection
0
4
17
@md1talk
Torsade pointes
Causes think LONG QT:
- Lytes (↓ K, Ca+2, Mg+)
- Drugs
- Hypothermia
- Stroke, SAH
If they are stable, then Mg sulfate is the agent of choice (1-2g infused over 10min, then 1g/h infusion)
Unstable, need to be defibrillated
0
1
15
@md1talk
Weight loss → tirzepatide (mounjaro)
Weight gain → Pioglitazone
Linagliptin (DPP-4) → no effect on weight
0
1
16
Psychiatric MEDS and sodium disorders:
- Anti (depressant, psychotic) = hyponatremia “mainly due to SIADH”
- Lithium = hypernatremia (nephrogenic diabetes insipidus)
0
2
15
In exams:
Fever + anorexia + rebound →
RLQ pain = appendicitis
LLQ pain = Diverticulitis
0
3
15
After meningitis, the patient developed this rash, this is called ? 🤔
6
0
12
Smith-Modified Sgarbossa Criteria:
•Concordant STE ≥ 1 mm in ≥ 1 lead
•Concordant ST depression ≥ 1 mm in ≥ 1 lead of V1-V3
•Proportionally excessive discordant STE in ≥ 1 lead anywhere with ≥ 1 mm STE, as defined by ≥ 25% of the depth of the preceding S-wave
0
0
14
Gastroparesis occurs in patients with long-standing (eg, >5 years) diabetes mellitus and is most commonly seen in those with renal, ocular, or neurologic involvement.
0
3
13
@md1talk
Absence seizure
To induce it, make them hyperventilate !
EEG: 3 Hz spikes and waves
DOC: ethosuximide
0
0
13
FEV1 & DLCO are the best predictors of post-operative outcomes following lung resection surgeries
1
1
3
Although all of these measures should happen in a certain time frame, when you see “STEMI” you need to think re-perfusion therapy (time is muscle and the vessel must be opened), so PCI is the answer here
In MCQs, choose according to best benefit if all answers were correct
0
3
13
Hypothyroidism can precipitate statin myopathy, and conversely statins can aggravate hypothyroid myopathy.
Therefore, many experts suggest screening for hypothyroidism prior to initiating statin therapy,
0
2
13
Patients with PAD & intermittent claudication have an estimated 20% 5-year risk of nonfatal MI & stroke and a 15%-30% risk of death due to cardiovascular causes
0
2
13
Fluid challenge steps:
TROL:
Type of fluid, Rate, Objective, and Limits.
0
4
12
Halo sign → invasive pulmonary aspergillosis
Reversed halo sign → Cryptogenic organizing pneumonia (COP)
0
0
13
Qtc prolongation
c diff diarrhea/ colitis
Tendinopathy
AAA expansion
High yield side effects
0
3
12
Diagnosis: RV infarction
Fluids is the corner stone step in management
Avoid nitrates
0
1
12
Patients presenting with acute diarrhea associated with steatorrhea should first be evaluated for infectious etiologies.
#Giardia
lamblia is the most common infectious cause of malabsorption and is diagnosed with stool microscopy or stool immunoassay.
#MedEd
#MedTwitter
0
1
12
What is cardio-renal syndrome ?
How many types ?
Check out this incredible info-graph
0
3
12
Blood cultures revealing microbes (high yield):
S. aureus → ECHO (to rule out IE)
Bovis → colonoscopy (to rule out colon cancer)
Candidemia → eye exam (to rule out endophthalmitis
0
2
13
The Drug of choice in anaphylaxis is Epinephrine ✅
The vasopressor of choice in septic shock is Norepinephrine ✅
Why ? Go back to the adrenergic receptors action
0
1
11
Hemolytic uremic syndrome typically occurs in children who have recently recovered from a diarrheal illness and who have acute renal injury, thrombocytopenia, and microangiopathic hemolytic anemia with schistocytes on peripheral smear
0
1
10
@drtimothyli
Melioidosis
Pathogen: B. pseudomallei
•Antimicrobial therapy
◦Initial intensive therapy: IV ceftazidime, imipenem, or meropenem for 10–14 days
◦Followed by eradication therapy: oral TMP/SMX (plus doxycycline) for 3–6 months
•Adjunct therapy: abscess drainage
1
1
11
Differential of ptosis
Keep in mind all of this, but memorize 3:
Horner’s
Myasthenia gravis
CN 3 palsy
0
2
11
@md1talk
1) Severe pain out of proportion to physical Exam
2) Mesentric ischemia
3) CT angiography for abdomen
0
1
11
@md1talk
1 = Aortic stenosis
2 = murmur radiates to carotids
3 = age (most common cause), bicuspid aortic valve
4 = surgical therapy is indicated in severe aortic stenosis with:
- Symptoms or
- EF < 50%
0
0
11
An absolute indication to give TPA in pulmonary embolism is the presence of hemodynamic compromise
0
0
9
ARDS
During hospitalization, a conservative fluid strategy aimed at achieving a neutral or negative fluid balance accelerates recovery from ARDS, with a trend toward improved survival rate ("dry lungs = happy lungs").
0
2
10
Imagine that you are a medical student, and at the final exam you started to hyperventilate, then you felt a dizziness and tingling in your hands
What are the pathophysiologic mechanisms responsible for your dizziness and tingling ?
1
1
9
Bad combinations in medicine:
-Statins and fibrates
-Phenytoin and lamotrigine
Any addition to this list ?
1
0
10
Fever + headache + photophobia + neck stiffness are an overlapping clinical features between subarachnoid hemorrhage (SAH) & meningitis
In SAH, the fever is usually a low grade !
0
6
10
66y old man, smoker and alcoholic, present with recurrent vague abdominal pain for months, current labs shows diabetes, stool reveals elevated fecal fat
What is the diagnosis🤔⁉️
6
0
10
ACE induced angioedema can occur at ANYTIME, not just within weeks of starting the medication
0
0
9
Alcohol use disorder first line pharmacotherapy:
Naltrexone (use with caution in liver failure)
Acamprosate (use with caution in kidney failure)
0
0
10
Neonate with hypoxemia → give O2:
• Improves → lung condition is likely
• Don't improve → heart condition is likely
0
1
9
@md1talk
PCI + kidney = CIN or cholesterol embolism
Contrast induced nephropathy “CIN”
-Start to rise 1-2d post contrast
-Peaks 3-5 day
-Return to baseline 5-7d
Prevention by isotonic fluids pre/post contrast “if indicated”
Patho: renal VC + toxicity to tubules
0
1
10
@md1talk
PJP
TMP-SMX
Steroids if hypoxia/ hypoxemia (saturation <92% or PaO2 <70 or A-A gradient ≧ 35)
CD4 <200
0
0
9
These cells are associated with which of the following vaginitis ?
A-Trichomonas
B-Bacterial Vaginosis
C-Candida
2
2
8
The preferred fluid in resuscitation of burn patients is ?
A)Normal saline
B)Ringer’s lactate (LR)
C)Albumin
7
1
7
Cerebral Perfusion Pressure (CPP) = MAP - intracranial pressure (ICP)
↑ in ICP -> reduce the CPP, so the BP have to compensate and ↑↑
This explains the hypertension in ↑ ICP
0
2
9
60y male known case of DM and hypertension present with hemoptysis, fever and night sweats
“Next” step in management ?
A)Blood cultures
B)Isolation
C)Start Anti-TB
8
0
6
Headache + Fever + Neck stiffness
BP is low and temp is high
What is the most likely diagnosis ?
2
3
7
@drtimothyli
Nocardia should always be kept in mind with the presence of lung, CNS, skin involvement
0
0
8
From the following agents, which will likely improve mortality in cirrhotic presenting with active variceal bleeding 🩸?
A)Ceftriaxone
B)Nitroglycerin
C)Erythromycin
3
1
8
The 2 main pillars of treatment of acute pancreatitis is:
1)Fluids
2)Pain control
0
0
8
This the eye of an addict patient found to be comatose at home, he barely breaths, what anti-dot should he receive 🤔💭
5
1
8
Acanthosis nigricans
sudden appearance or rapid spread “can” signal the presence of malignancy within the GI tract or lungs 🚨🚨🚨
0
2
8
Sokolow-Lyon criteria
LVH is suspected if either of the following criteria are met:
The sum of the S wave in lead V1, and the R wave in either lead V5 or 6
Is 35 mm or more
The R wave in lead aVL is > (11 mm)
1
0
7
Female obese presented with nocturnal diarrhea, her colonoscopy finding is shown bellow….
What is the most likely diagnosis ?
2
0
6
LR is preferred in burn patients, as these patients often require large volumes of fluids, LR will help you to avoid hyperchloremic acidosis which may happen with large volumes of normal saline
0
2
8
Drug-induced type 1 hypersensitivity reactions:
- Immediate in onset
- Mediated by IgE and mast cells/basophils.
- In Mild manifestations (eg, urticaria + pruritus without systemic symptoms) = antihistamines & stop offending drug.
0
0
8
Morbilliform drug eruption 💊
-Type IV hypersensitivity reaction -Caused by drugs (anticonvulsants, antibiotics)
-Occur 5-21 days following drug initiation.
-Erythematous macules & papules, distributed symmetrically on the trunk and extremities
-Mucosal involvement is absent
1
1
8
Coronary circulation:
Right dominance (85%) → PDA arise from RCA
Left dominance (10%) → PDA arise from LCX
CO-dominant (5%) → PDA arise from LCX & RCA
0
1
7