Top Tweets for #PEARL1
USAF
Boeing KC-135 Stratotanker
#PEARL1 59-1520 (KC-135T)
#PEARL2 58-0086 (KC-135T)
#PEARL3 63-8022 (KC-135R)
#PEARL4 58-0095 (KC-135T)
Spotted over Northern #Australia supporting 3× B-2's.

#Pearl1: Chronic heart failure is a hypermetabolic state, and may present as cardiac cachexia, associated with significant muscle and weight loss.
#Pearl1: For workup of fever, think "IMADE" -- Infection, Malignancy, Autoimmune, Drugs/Toxins & Endocrinopathy; with a focus on excluding infection first, as this will preclude further management of malignancy/autoimmune processes.
3/
Hx: Born in Philippines (+bCG, negative PPD)
#PEARL1: Consider w/ travel history
• TB
• melioidosis
• food-transmitted bacterial: (V parahaemolyticus)
• parasitic: (ancylostomiasis, amebiasis, fasciolopsiasis, & schistosomiasis)
https://t.co/4hzon9swzc
3/ #PEARL1: how does pregnancy change the DDx?
❤️ consider preeclampsia, severe asymptomatic HTN or HTN emergency, valvular disease, & cardiomyopathy
🩸 Hyper-coagulable state, PE
chorioamnionitis-induced ARDS is rare in the absence of premature labor or ruptured membranes
4/
Labs: lipase 114, ALT 112, AST 88
#PEARL1: elevated lipase classically a/w pancreatic inflammation, but can also be seen in
• cholecystitis
• bowel obstruction
• celiac disease
• drugs: opiates & cholinergic agents
DDx for elevated liver enzymes (from penn frameworks):

2/ My initial approach to fever is as follows, and is adapted from Penn frameworks: https://t.co/JM11FdmljA
#PEARL1: I always try to remember the importance of assessing:
1. Host: immunosuppressed?
2. Exposures: work, sexual, travel, animals, IVDU, food/water

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