LLL pneumonia with flank pain

WBC 33k —> 33k —> 25k

“I’m feeling better, but I still have this left flank pain”

Hmm. Not pleuritic. Incredibly sensitive CVA tenderness even to gentle touch.

CT with obstructing left UPJ stone 🤷🏼‍♂️

#medtwitter

Does the adage “The sun never sets on a parapneumonic effusion” still hold true?

Quote is from an OG pulmonologist at Georgetown Internal Medicine

If you want to change behavior, show the data. So proud of Anahita Rabiee adding to evidence behind safety of naltrexone in cirrhosis.

Among 2940 patients with cirrhosis started on naltrexone for AUD, zero cases of DILI was identified!
#livertwitter

sciencedirect.com/science/articl…

except when you are Krista Suojanen MD

Is your patient on the 'cusp' of benefiting from anticoagulation for their atrial fibrillation? Do they find the idea of apixaban sus?

Use the GARFIELD-AF risk calculator - af.garfieldregistry.org/garfield-af-ri…

It's in the 2023 ACC/AHA AFib guidelines and includes mortality and bleed risk.

The face of every primary team when they receive the morning page 'Please discharge your patients!'

If you live in the U.S. and treat 'CAP,' we're probably not thinking about Histo enough. Histo is endemic to the ENTIRE U.S. Nice graphic here re diagnostic considerations for the Big 3 fungal pneumonias.

academic.oup.com/cid/advance-ar…

“Whisper” dictating is creepy.

So while this doc could have gotten insured in training through the GSI they would now get denied.

This is one of the reasons it is absolutely paramount that you secure disability insurance while in medical training.

If you aren’t sure how here is the framework we use at MMM:

How much amphetamine and modafinil do we think was flowing through Biden last night?

The “diagnosis” of bronchiectasis is not the end of the road. At minimum, eval for:

· Associated comorbidities w/ H&P (RA, CTD, etc)
· CBC w/ diff
· Serum total IgE & specific IgE or skin prick test to Aspergillus
· Serum IgG, IgA, & IgM
· Sputum culture for bacteria & NTM

It’s ok to have “boring” days as a hospitalist. My med student & I:

-Decreased lab checks, stopped tele, pulled foleys
-Liberalized diets
-Picked up an eosinophilia
-Secured a few solid BMs
-Educated & reassured patients/families
-Coordinated with consultants

“Little” things

You don’t need a daily WBC.

You don’t need a daily CRP.

What you do need is vitals and a focused history and physical.

Treat the patient, and stop ordering the number.

Any tips for working on Zone 2 exercise (60-70% max HR)? Very hard to stay under that 70% when jogging!

I see a few referrals a year for eosinophilia. I always just follow this algorithm and think.

Always rule out secondary:
Parasite
Lymphoma
Collagen vascular dz
⬇️Adrenal
Meds
Allergy

If above negative then time for fun and do a marrow bx. tinyurl.com/2mu4mnk4

ED: “Surgery will admit the patient.”

Medicine:

Seems like it’s low hanging fruit for the EMR or Stewardship to put a stop to the dose of pre-op abx when the patient is already on broad spectrum coverage 🧐

Stop the madness that is daily labs.