Sonrips

221b Baker Street

[Keith Siau @drkeithsiau]

Alcohol related liver disease - new JAMA review July 2026 🚨

1️⃣ Pathophysiology ⚙️
2️⃣ Progression ➡️
3️⃣ Assessment 💡
4️⃣ Management 💊

📸: https://t.co/yfAzCbrx3P

[Nelson Mogaka @NelsonMogaka_]

The knowledge gap between orthopedic surgeons and internal medicine physicians is overwhelmingly huge.

[Sonrips @Erick_RM5]

@abdulhamid_199 Cluster headache

[Crazy Moments @Crazymoments01]

A man went to the doctor complaining of hoarseness after drinking water and they found this

[Felps 🧠🔪 @suricatodosus]

@Valtorewrites Rheumatology, Nephrology and Infectious Diseases

[Nelson Mogaka @NelsonMogaka_]

Why do Internal Medicine consultants ask 50 questions that seem unrelated to the chief complaint... then somehow end up with the correct diagnosis?

[Sonrips @Erick_RM5]

@DrNovinoTailor Loss of anti-clotting proteins in urine

[Sonrips @Erick_RM5]

@MicroClinicoVLC Daptomicina

[Sonrips @Erick_RM5]

@IhabFathiSulima Isotretinoin

[Dr. Hector Rossete @HectorRossete]

El salario (beca) del médico residente / El salario de jóvenes construyendo el futuro.

[𝙳𝚛. 𝙼𝚊𝚑𝚖𝚘𝚘𝚍 ☤ @Dr___MD]

Internal medicine is basically professional overthinking.

[Alejandro Macias @doctormacias]

Expira la patente de Semaglutida (Ozempic). La agencia reguladora de Canadá aprueba la versión genérica de semaglutida de ⁠Apotex. Se abre una ventana para el uso económico de la molécula en la diabetes.

[Sonrips @Erick_RM5]

@nervemed Digoxin

[MedicoNotes @MedicoNotes]

🧬 MEN Syndromes — Distinguish Them in 60 Seconds

⸻

1️⃣ MEN 1 — Wermer Syndrome

The “3 Ps”
🔸 Pituitary Tumour → e.g., Prolactinoma
🔸 Parathyroid Hyperplasia → most common initial presentation → hypercalcaemia
🔸 Pancreatic Islet Cell Tumours → Gastrinoma (Zollinger–Ellison) + Insulinoma
🧬 Gene: MEN1 (Chromosome 11) → Tumour suppressor mutation

⸻

2️⃣ MEN 2A — Sipple Syndrome

The “2 Ps + 1 M”
🔸 Parathyroid Hyperplasia → hypercalcaemia
🔸 Phaeochromocytoma → adrenal gland tumour
🔸 Medullary Thyroid Carcinoma (MTC)
🧬 Gene: RET proto-oncogene (Chromosome 10) → Activating mutation

⸻

3️⃣ MEN 2B — Mucosal & Marfanoid

The “1 P + 2 Ms”
🔸 Phaeochromocytoma
🔸 Medullary Thyroid Carcinoma → most aggressive form, early onset
🔸 Mucosal Neuromas + Marfanoid Habitus
⚠️ NO parathyroid disease — key distinguishing feature!
🧬 Gene: RET proto-oncogene (Chromosome 10) → Activating mutation

⸻

4️⃣ The Master Comparison

➊ MEN 1 → Pituitary + Parathyroid + Pancreas (MEN1 gene, Chr 11)
➋ MEN 2A → MTC + Pheo + Parathyroid (RET gene, Chr 10)
➌ MEN 2B → MTC + Pheo + Neuromas/Marfanoid — NO parathyroid (RET gene, Chr 10)

⸻

🧩 Exam Pearls
🔹 MEN 2B is the MOST aggressive — presents earliest with MTC
🔹 Phaeochromocytoma rule → ALWAYS give alpha-blocker BEFORE beta-blocker to prevent hypertensive crisis
🔹 MEN 1 vs MEN 2 genetics → Tumour suppressor (MEN1) vs Activating oncogene (RET)
🔹 Hypercalcaemia in MEN → think Parathyroid (MEN 1 and 2A only — NOT 2B)

⸻

📚 Master MEN syndromes and all of endocrinology in our high-yield endocrinology book:

🔗 https://t.co/2UQyCbb6in

⸻
#MENSyndrome #usmle #Endocrinology #MedicalEducation #doctor

[Oren Gottfried, MD @OGdukeneurosurg]

Brainstem anatomy

[Oliverio @LuisOliverio]

La última revisión de Enfermedad Celíaca, en NEJM (2026). Puntos clave:

🟢La prueba inicial de elección son los anticuerpos IgA antitransglutaminasa tisular (tTG-IgA). Peeero, siempre pide IgA total en conjunto (2% tienen deficiencia de IgA) y NO suspendas el gluten antes.
🟢 La biopsia sigue siendo el estándar en adultos: Aunque (tTG-IgA>10x el límite sperior + anticuerpos antiendomisio positivos) tienen VPP 99.9%
🟢 Casi 100% tienen haplotipo HLA-DQ2 o HLA-DQ8. Pero como 45% de la población general también: sirven solo para descartar.
🟢Presentación clásica de malabsorción: diarrea, pérdida de peso, esteatorrea, en realidad es rara. Más bien vemos síntomas inespecíficos, ferropenia, osteoporosis, hipertransaminasemia.
🟢 Si persisten con síntomas y atrofia a pesar de dieta sin gluten: cuidado; tienen mayor riesgo de desarrollar complicaciones malignas, en particular el linfoma de células T asociado a enteropatía.

Completo en (https://t.co/3O93s10Td0).

[Practicon @moy_qmac]

Paciente:
"Dr, vengo por que me duele la espalda baja".

El enfermo del NEJM:

[Sonrips @Erick_RM5]

@drabdulhameed07 D

[Sonrips @Erick_RM5]

@modernHealthMe D

[Sonrips @Erick_RM5]

@ZahoorAhmed1450 B