Off legs

Trainee doc interested in general internal medicine. Perpetually in The Valley of Despair

[Off legs @Eonisophil]

@whitfieldlewis6 Hammer curls for brachioradialis. Musculocutaneous nerve. Physique looking solid Dr Lewis!

[Off legs @Eonisophil]

@whitfieldlewis6 I have a strong family history of early CV disease. Father, aunts and uncles and cousins. Strokes and MI. I go to the gym, walk a lot and run. I need to recheck my LDL (always normal) but even if it’s normal, I often wonder whether I should take a statin. I’m male in early 30s.

[Off legs @Eonisophil]

@tetecombiscoito @DocPriyamMD For sure, HIV positive with multiple strokes it’s definitely worth checking ASAP

[Off legs @Eonisophil]

@drokane My biggest pet peeve is diagnoses of COPD in people with a negligible smoking history. This progressive type of dyspnoea on exertion could be a manifestation of CAD or aortic stenosis but clinicians too often prematurely close cases like these as a primary respiratory issue

[Off legs @Eonisophil]

@Medzonetv Presence of anaemia and thrombocytopaenia with end organ damage is indicative of thrombotic microangiopathy. TTP, ETEC associated HUS, complement mediated HUS and DIC are all possibilities. Check blood film, LDH, hapto, clotting, troponin and ECG. Consider prompt plasma exchange

[Off legs @Eonisophil]

@drkeithsiau @whitfieldlewis6 Add to this RCVS, SIH and pituitary apoplexy. Although I wonder about ‘thunderclap’ headaches potentially being something that is hard to really nail down in the history

[Off legs @Eonisophil]

@drkeithsiau @betahistan3 What were their eosinophils out of interest?

[Off legs @Eonisophil]

@NephRodby Creatine kinase

[Off legs @Eonisophil]

@PulmCrit How many notes made by nurses ‘MD aware’ before someone caves and throws in amlodipine

[Jonathan @jabberwock951]

Anaesthetist doing an LP: Gown, drapes, theatre cap, full patient monitoring, assortment of needles sizes and styles.

Med Reg doing an LP: It took me two hours but I found a spinal needle that rolled under the sofa in the break room, let's go.

[Dr Helgi @doctorhelgi]

Did you know that mechanical thrombectomy for stroke is 7 times more effective than thrombolysis for MI? It saves lives, reduces disability. Much of the UK still doesn’t have 24hrs access to thrombectomy and only 4% of stroke patients get one. #anaesthesia2025

[Off legs @Eonisophil]

@dr_tomparrott Is this as a registrar?

[Cliff Reid @cliffreid]

Fabulous schematic of the RV failure spiral in pulmonary embolism explaining the generation of laboratory and #POCUS findings as things increasingly go to shit

Thanks @NephroP for finding this 👊

from https://t.co/pLDm9W8HlU

[Skyler Lentz @SkylerLentz]

What’s the highest IPAP you’ll use with NIV in a patient with COPD and respiratory failure?

Before this trial I’d stop at ~ 20 cmH20, and think about intubating if not improving

After this trial:

Now up to 30 cm H20 may safely avoid intubation

https://t.co/LTDyYWE2mf

[Eddy J. Gutierrez, MD @eddyjoemd]

There are numerous clinical scenarios where trending a lactate may been helpful. This paper attempts to cover them all. 🎩 tip to the authors.
https://t.co/Sfr6vCn6le

[Off legs @Eonisophil]

@Janetbirdope Tophaceous gout or rhuematoid nodule

[Off legs @Eonisophil]

@mendietaalex1 TTP

[Stefan Milutinovic @stefankmil]

📄 20 studies that Internal Medicine Residents should read in the first year 👇

1/ 🏃‍♀️ RACE II trial: Lenient resting HR < 110 was non-inferior to a strict HR < 80 in patients with atrial fibrillation.

🧵

[Off legs @Eonisophil]

@mendietaalex1 Fits in with elevated intracranial pressure type headache. IIH probably top. DDx SOL, migraine, sinusitis, OSA/OHS