A Twittersphere of teaching points, clinical questions, challenging diagnoses, and all things Internal Medicine M4 Acting Intern
Joined April 2018
- Tweets 19
- Following 3
- Followers 55
- Likes 4
Photos and videos
15 Jul 2019
So our last block of AIs talked about gram bacteremia (great MRSA resource below). What about patients with gram neg bacteremia?
- duration of treatment?
- what modality of antibiotics (IV/PO)?
- do indwelling lines need to be removed?
- do we need surveillance cultures?
27 Jun 2019
Yes! TTE should be performed /- TEE. See this great review of Staph bacteremia specifically also with treatment recs. No linezolid, yes Dapto or Vanc. Management of Staphylococcus aureus Bacteremia ja.ma/2J5EHcY
1
20 Jun 2019
An old post but a good one that no one responeded to previously. Let's see what you all think!
1 May 2018
You are the intern who admits a patient with sepsis found to have gram-positive cocci bacteremia - what are the next steps in management that all pts with GPC bacteremia need? Also what antibiotic, duration & route to treat with?
4
2
24 Jun 2019
Good job! IV Vanc to start is perfect if we don't know the speciation. I can think of something else to order, especially if there are more than one set of positive cultures. Any thoughts? Since it was brought up, what bloodstream infections require indwelling line removal?
1
11 Jun 2019
Alright, let's resurrect this thing! You are the AI for an 80 yo female with dementia admitted with delirium from a UTI. On hospital day 2, you notice left calf swelling and ultrasound (US) confirms peroneal vein DVT. What do you do next? Select an answer and post your rationale
43%
Anticoagulate for 3 mos.
0%
Don't treat/defer to PCP
43%
Don't treat/order 1 wk US
14%
Anticoagulate for 6 mos.
7 votes • Final results
2
20 Jun 2019
Great studies @komal_safdar & @yunnerz! As you can see the evidence isn't convincing. CHEST guidelines give grade C evidence to support 2 week ultrasound surveillance of low-risk distal DVTs. It is a risk-benefit discussion with the patient and risk assessment of clot extension
1
2
20 Jun 2019
I am excited that not treating with anticoagulation is an option. This patient received a week of anticoagulation inpatient before I assumed care of her. Repeat US showed resolution of the thrombus & we stopped anticoagulation.
6 Jul 2018
Lets see if we can drum up some tweets (and learning!). Please post/tweet what you found x.com/VCUActingIntern/status…
24 May 2018
2 tweets today: What criteria supports the clinical diagnosis of acute diverticulitis? Who should be admitted vs managed as outpt? Do all these patients need antibiotics? What are some options for antibiotic regimens, including duration (PO and IV)? Share your resources
24 May 2018
2 tweets today: What criteria supports the clinical diagnosis of acute diverticulitis? Who should be admitted vs managed as outpt? Do all these patients need antibiotics? What are some options for antibiotic regimens, including duration (PO and IV)? Share your resources
24 May 2018
Alright block 2 AIs, this tweet was left unanswered from the last cohort. What are your thoughts? x.com/VCUActingIntern/status…
11 May 2018
Any thoughts? x.com/VCUActingIntern/status…
11 May 2018
Any thoughts? x.com/VCUActingIntern/status…
1 May 2018
You are the intern who admits a patient with sepsis found to have gram-positive cocci bacteremia - what are the next steps in management that all pts with GPC bacteremia need? Also what antibiotic, duration & route to treat with?
1 May 2018
You are the intern who admits a patient with sepsis found to have gram-positive cocci bacteremia - what are the next steps in management that all pts with GPC bacteremia need? Also what antibiotic, duration & route to treat with?
1
26 Apr 2018
Alright Acting Interns, here's your first question to ponder. A common problem we face are patients admitted to the hospital with altered mental status. How do we differentiate between meningitis and encephalitis? Let's list some differentials of each too.
2
1
27 Apr 2018
Good. So this patient likely has encephalitis. What's our differential? In addition, how does our differential vary by the time of the year?
1
26 Apr 2018
Here's another question hot off the wards --
My pt c/o dysuria. This is her UA:
UA -- Prot Neg, Leu Lar, Nit Pos, Ket Neg, Glu Neg, RBC 7, WBC 25, pH 8.0, triple phosphate crystals seen.
What is likely organism? Should I treat? With what?
2