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Joined June 2024
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Daily Dose of Medicine retweeted
C-Biopsy of Artery
◦ Temporal artery biopsy (TAB) is currently the gold standard method for the diagnosis of giant cell arteritis (GCA), with a specificity of 98% to 100% when histopathology demonstrates active necrotizing arteritis, characterized by a predominance of mononuclear cell infiltrates or a granulomatous process with multinucleated giant cells. Other features include narrowing and occlusion of the arterial lumen, intimal proliferation, rupture of the internal elastic layer, and lumen thrombosis.
◦ However TAB has a sensitivity of 77% and its false-negative rate ranges from 9% to 61%.
◦ False negatives may be due to the timing of biopsy, the length of the specimen, or the presence of segmental “skipping lesions” (observed in 12%‒28% of cases).
◦ It is also estimated that 25% of TAB for GCA are reported as “healed arteritis”, defined as fibrosis, attenuation and/or neovascularization of the media, irregular intimal proliferation, multifocal to complete loss of internal elastic lamina, adventitial fibrosis, and absence of ongoing chronic medial inflammation. The presence of “healed arteritis” is more often associated with prior history of polymyalgia rheumatica and longer corticosteroid use before TAB.
📸 Histopathological findings in biopsy-proven giant cell arteritis:
(A) Temporal artery with narrowed lumen, atrophic media, interrupted elastic lamina, and granulomatous inflammation consistent with the diagnosis of giant cell arteritis (H&E, x50).
(B) Typical area of granulomatous inflammation with multiple giant cells (black arrows) in the interrupted elastic lamina (H&E, x400).
(C) Similar findings in another temporal artery biopsy with interrupted elastic lamina (black arrow), granulomatous inflammation, and giant cell formation (H&E, x200).
(D) A clearer area of interrupted elastic lamina (red arrowhead) after special staining (Elastin, x200).
*Source: Alkatan, Hind M et al. “Giant cell temporal arteritis: a clinicopathological study with emphasis on unnecessary biopsy.” Frontiers in Ophthalmology vol. 3 1327420. 2023
🔗doi.org/10.3389/fopht.2023.1…
Daily Dose of Medicine retweeted
Hypoxic –ischemic encephalopathy(HIE) is an important cause of permanent damage to CNS tissue that may result in neonatal death or manifest as cerebral palsy. Which of the following is the characteristic of stage 1.
a. Baby dull and lethargic
b. Weak primitive reflexes
c. Contricted pupils
d. Puplis unequal in size
e. Normal reactive pupils
Daily Dose of Medicine retweeted
A term baby weighing 3.6kg delivered by c-section has tachypnea and acrocyanosis. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Vitals and systemic examination are normal with the exception of a respiratory rate of 84b/m and slight subcostal retractions. What diagnosis you will consider in this baby.
a. Congental diaghpramatic hernia
b. Pneumothorax
c. Cyanotic congenital heart disease
d. Transient tachypnea of newborn
e. Sepsis
Daily Dose of Medicine retweeted
Newborn in ER with tachypnea & resp distress:
- HR 160 bpm - RR 70 bpm - O2 sat 85%
- Scaphoid abdomen, chest fullness
- Bowel sounds in chest
Which step would you avoid 🚫?
a. Start IV fluids
b. Keep child NPO
c. Improve oxygenation
d. Bag mask ventilation
e. Start antibiotics
Daily Dose of Medicine retweeted
A 25 yr old known case of hypertension comes with redness of face and sweating. She had toothache for which she took ibuprofen, she is found to be hypotensive with a swollen face.
Next step?
a. Epinephrine
b. Parental fluids
c. Broad spectrum antibiotic
d. Dopamine
e. Norepinephrine
Daily Dose of Medicine retweeted
A 19 year male developed sharp, left-sided chest pain while running up a flight of stairs, followed by slight breathlessness on exertion. On examination, he appeared relatively well. His heart rate was 94 beats/min, and the respiratory rate was 18/min. On auscultation there was a clicking sound synchronous with the heart sounds.
What is the most probable cause of his symptoms?
a. Aortic dissection
b. Acute Pericarditis
c. Hypertrophic obstructive cardiomyopathy
d. Left apical pneumothorax
e. Mitral valve prolapse
Daily Dose of Medicine retweeted
Right sided PE
This chest X-ray suggests pulmonary embolism, showing Westermark’s sign (reduced vascular markings due to oligemia) and Palla’s sign (enlargement of the right descending pulmonary artery).
Daily Dose of Medicine retweeted
Bronchiolitis obliterans (BO)
A fibrotic lung disease that can occur in some patients with SJS. BO can cause obstruction of the small airways, resulting in air trapping. Patients with BO after SJS tend to have severe and progressive lung disease. There is no effective treatment for BO after SJS.
Daily Dose of Medicine retweeted
7yo girl in ED with mom; 3-day rash, "slapped-cheek" appearance, temp at 37.2°C (99°F).
What's the likely culprit?
a. Adenovirus
b. Rotavirus
c. Parvovirus
d. Coxsackievirus
e. Echovirus
Daily Dose of Medicine retweeted
🩸 A 71-year-old woman presents with:
•Ecchymoses & peri-follicular hemorrhage (saddle distribution) on legs
•Bleeding gums
•Anaemia
•Lives alone
🫛 Diet: No fruits/vegetables.
Which vitamin deficiency is most likely?
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin D
e. Vitamin E
#MedEd #FOAMed #Scurvy #VitaminC #ClinicalPearls
Daily Dose of Medicine retweeted
A difficult one
👁 The eyes never lie… but can you decode their story?
🩺 What’s the diagnosis? Need a hint, it will be in comment section
Drop your answers below! ⬇️
#FOAMed #ClinicalSkills #DailyDoseOfMedicine
Daily Dose of Medicine retweeted
🚨 Clinical Case Alert 🚨
A 47-year-old male with HTN & HLD presents with transient right-sided weakness (10 mins, resolved). ED workup = normal, admitted for further eval.
👉 Q: Which is the most appropriate initial treatment in the ED?
A. Clopidogrel
B. Ticlopidine
C. Heparin
D. Aspirin
E. Warfarin
💡 Drop your answers below! ⬇️
❤️ Like to support if you love our work!
#MedicalEducation #StrokePrevention #InternalMedicine #MCQ #MedTwitter
Daily Dose of Medicine retweeted
In acute attack of gout
what is treatment of choice ?
A-steroids
B-NSAIDs
C-Allopurinol
D-Diuretics
E-Febuxostat
#MedTwitter #MedX #NEETPG #NEETPGcounselling2024 #FOAMed #NEET #DoctorX
Daily Dose of Medicine retweeted
Hutchinson’s teeth are most commonly caused by congenital syphilis, where the bacterium Treponema pallidum is transmitted from mother to fetus. However, they can also result from conditions like fetal alcohol syndrome or severe maternal malnutrition. These teeth are characterized by notched, widely spaced upper incisors and are part of the broader Hutchinson’s triad, which includes eye and ear abnormalities.
Daily Dose of Medicine retweeted
Cold sores (herpes labialis) are painful, fluid-filled blisters caused by reactivation of the herpes simplex virus type 1 (HSV-1). They typically occur on the lips or around the mouth, often triggered by stress, illness, sunlight, or weakened immunity. The condition is contagious, spreading through direct contact. Treatment includes antiviral creams or oral medications like acyclovir to reduce symptoms and duration.
Daily Dose of Medicine retweeted
I will write less so u read more
Take away points :
1) First thing to do in UGIB - Maintain 2 x Wide Bore Peripheral IV Cannula
2) Even though a history of IHD should be alarming enough, TVCAD and Angina were add to clarify that Terlipressin is contraindicated which can exacerbate myocardial ischemia and lead to worsening angina or even infarction. Always take history and even of no history do an ECG before giving it, u can opt for Sandostatin (Octeritide)
3) The priority in managing variceal bleeding is resuscitation with blood, crystalloids, and managing hemodynamic instability and URGENT ENDOSCOPY
4) Proton pump inhibitors (PPIs) are beneficial for bleeding Peptic Ulcer not variceal bleeding
5) You wont do CTA but Endoscopy
Answer is : C
🚨 58-year-old with Upper GI Bleed, Hep C-related Cirrhosis, and TVCAD with Angina 🚨
James, a 58-year-old male with a history of Hepatitis C, decompensated cirrhosis (DCLD), and known stable angina due to TVCAD (transient vascular coronary artery disease), presents with hematemesis and melena. His vital signs are:
•BP: 88/55 mmHg
•HR: 115 bpm
•Respiratory rate: 22 bpm
•O2 saturation: 93% on room air
He has IV access in his right arm. His past medical history includes ischemic heart disease (IHD), with long-standing stable angina managed with nitroglycerin and beta-blockers. On examination, he has ascites, splenomegaly, jaundice, and signs of portal hypertension. There is concern for esophageal varices.
❓ What is the most appropriate next step in management?
a) Start IV terlipressin, transfuse blood, and monitor closely
b) Administer IV proton pump inhibitors (PPIs) and administer blood transfusion
c) Insert a second IV line, continue fluid resuscitation with crystalloids, and prepare for blood products
d) Increase fluid resuscitation with crystalloids and prepare for urgent CT angiography
What should be prioritized in stabilizing this patient with suspected variceal bleeding? 💡
#DecompensatedCirrhosis #Match2025 #UpperGIBleed #EmergencyMedicine #TVCAD #Angina #NEETPG #MATCHDAY
Daily Dose of Medicine retweeted
🚨 Winter is here ❄️
A 47-year-old man presents with escalating fatigue, headaches, and chest discomfort over 3 days. His wife reports new-onset forgetfulness and irritability, with their dog also showing signs of lethargy.
- Mild hypertension managed with lisinopril
- No smoking or cardiac history
- Absence of fever, cough, or recent illness
- BP: 128/85 mmHg
- HR: 100 bpm
- SpO₂: 97% on room air
- Skin: Pink, no cyanosis or rash
Initial Labs:
- Hemoglobin: 14.5 g/dL
- BSR: 248
- Troponin: Negative
- ECG: Sinus tachycardia
- Arterial Blood Gas: pH 7.29, PaO₂ 92 mmHg, HCO₃⁻ 16 mEq/L, Lactate 5 mmol/L
What's the most likely culprit behind this puzzling presentation?
A. Myocardial Infarction
B. Viral Encephalitis
C. Carbon Monoxide Intoxication
D. Panic Attack with Hyperventilation
E. Migraine with Aura
F. Diabetic Ketoacidosis
👇 Diagnose and discuss your reasoning below! Let's tackle this winter medical enigma together! 🔍
#MedTwitter #EmergencyMedicine #MedicalMystery #Toxicology #Neurology #Cardiology #WinterHealth
Daily Dose of Medicine retweeted
🚨 58-year-old with Upper GI Bleed, Hep C-related Cirrhosis, and TVCAD with Angina 🚨
James, a 58-year-old male with a history of Hepatitis C, decompensated cirrhosis (DCLD), and known stable angina due to TVCAD (transient vascular coronary artery disease), presents with hematemesis and melena. His vital signs are:
•BP: 88/55 mmHg
•HR: 115 bpm
•Respiratory rate: 22 bpm
•O2 saturation: 93% on room air
He has IV access in his right arm. His past medical history includes ischemic heart disease (IHD), with long-standing stable angina managed with nitroglycerin and beta-blockers. On examination, he has ascites, splenomegaly, jaundice, and signs of portal hypertension. There is concern for esophageal varices.
❓ What is the most appropriate next step in management?
a) Start IV terlipressin, transfuse blood, and monitor closely
b) Administer IV proton pump inhibitors (PPIs) and administer blood transfusion
c) Insert a second IV line, continue fluid resuscitation with crystalloids, and prepare for blood products
d) Increase fluid resuscitation with crystalloids and prepare for urgent CT angiography
What should be prioritized in stabilizing this patient with suspected variceal bleeding? 💡
#DecompensatedCirrhosis #Match2025 #UpperGIBleed #EmergencyMedicine #TVCAD #Angina #NEETPG #MATCHDAY
Daily Dose of Medicine retweeted
A 32-year-old woman in her third trimester of pregnancy presents with worsening jaundice, confusion, and abnormal bleeding. Lab results reveal severe coagulopathy and markedly elevated liver enzymes. Cause? 💡
A. Acute fatty liver of pregnancy (AFLP)
B. Hepatitis E virus (HEV) infection
C. HELLP syndrome
D. Autoimmune hepatitis
⬇️ Pregnancy can complicate everything! Drop your answers below and explain your reasoning! Let’s see how sharp your diagnostic skills are.
#MedicalEducation #PregnancyComplications #Hepatology #MedTwitter #ClinicalCases
