Ryan O'Keefe
@rokeefemd.bsky.social
MD/MBA PennMedicine/Wharton | Hospitalist | Onc, Pall Care, MedEd | Creator Point of Care Medicine | Clinical threads and pearls
December 19, 2025 at 10:00 PM
A normal serum free light chain (SFLC) ratio does not rule out AL amyloidosis, as renal dysfunction can alter light chain clearance; the absolute values and presence of an M-spike are key.
Source: Case 30-2025: An 82-Year-Old Woman With Abdominal Distention, Edema, And Pleural Effusion (NEJM)
Source: Case 30-2025: An 82-Year-Old Woman With Abdominal Distention, Edema, And Pleural Effusion (NEJM)
December 19, 2025 at 10:00 PM
A normal serum free light chain (SFLC) ratio does not rule out AL amyloidosis, as renal dysfunction can alter light chain clearance; the absolute values and presence of an M-spike are key.
Source: Case 30-2025: An 82-Year-Old Woman With Abdominal Distention, Edema, And Pleural Effusion (NEJM)
Source: Case 30-2025: An 82-Year-Old Woman With Abdominal Distention, Edema, And Pleural Effusion (NEJM)
December 18, 2025 at 10:00 PM
Be wary of labeling something myocarditis if CK is elevated, but troponin is not.
Proximal muscle weakness is also a tip off that an elevated CK is due to muscle damage.
Source: A Shifting Frame (NEJM) 10/1/2025
Proximal muscle weakness is also a tip off that an elevated CK is due to muscle damage.
Source: A Shifting Frame (NEJM) 10/1/2025
December 18, 2025 at 10:00 PM
Be wary of labeling something myocarditis if CK is elevated, but troponin is not.
Proximal muscle weakness is also a tip off that an elevated CK is due to muscle damage.
Source: A Shifting Frame (NEJM) 10/1/2025
Proximal muscle weakness is also a tip off that an elevated CK is due to muscle damage.
Source: A Shifting Frame (NEJM) 10/1/2025
December 17, 2025 at 10:00 PM
December 16, 2025 at 10:00 PM
Genitourinary TB is a great mimicker, often presenting as a chronic, culture-negative UTI or “sterile pyuria.”
Source: CPS, October 30, 2025 VMR with Rabih & Maddy - lower abdominal pain
Source: CPS, October 30, 2025 VMR with Rabih & Maddy - lower abdominal pain
December 16, 2025 at 10:00 PM
Genitourinary TB is a great mimicker, often presenting as a chronic, culture-negative UTI or “sterile pyuria.”
Source: CPS, October 30, 2025 VMR with Rabih & Maddy - lower abdominal pain
Source: CPS, October 30, 2025 VMR with Rabih & Maddy - lower abdominal pain
December 15, 2025 at 10:00 PM
A “snap of the fingers” hyperacute onset suggests a vascular event, whereas an acute onset over hours to days is more typical for Bell’s palsy.
December 15, 2025 at 10:00 PM
A “snap of the fingers” hyperacute onset suggests a vascular event, whereas an acute onset over hours to days is more typical for Bell’s palsy.
A small pontine infarct can damage the fascicle of the facial motor nucleus, producing a clinical picture identical to a peripheral nerve lesion (weakness of the entire side of the face).
December 15, 2025 at 10:00 PM
A small pontine infarct can damage the fascicle of the facial motor nucleus, producing a clinical picture identical to a peripheral nerve lesion (weakness of the entire side of the face).
December 14, 2025 at 10:00 PM
Source: CPS, October 24, 2025 VMR with Rabih & Sawsan - loss of consciousness
December 14, 2025 at 10:00 PM
Source: CPS, October 24, 2025 VMR with Rabih & Sawsan - loss of consciousness
A normal baseline ECG does not rule out severe AS, though left ventricular hypertrophy is a common compensatory finding.
Once symptoms develop, the prognosis without intervention is grim, with an average survival of ~2-3 years.
Once symptoms develop, the prognosis without intervention is grim, with an average survival of ~2-3 years.
December 14, 2025 at 10:00 PM
A normal baseline ECG does not rule out severe AS, though left ventricular hypertrophy is a common compensatory finding.
Once symptoms develop, the prognosis without intervention is grim, with an average survival of ~2-3 years.
Once symptoms develop, the prognosis without intervention is grim, with an average survival of ~2-3 years.
December 13, 2025 at 10:00 PM
Severe hypoxemia can be the presenting complaint due to mass effect from the interposed bowel causing compressive atelectasis of the right lung.
Source: CPS, October 23, 2025 VMR with Rabih & Krithika - progressive SOB and right-sided chest pain for 3 days
Source: CPS, October 23, 2025 VMR with Rabih & Krithika - progressive SOB and right-sided chest pain for 3 days
December 13, 2025 at 10:00 PM
Severe hypoxemia can be the presenting complaint due to mass effect from the interposed bowel causing compressive atelectasis of the right lung.
Source: CPS, October 23, 2025 VMR with Rabih & Krithika - progressive SOB and right-sided chest pain for 3 days
Source: CPS, October 23, 2025 VMR with Rabih & Krithika - progressive SOB and right-sided chest pain for 3 days
Key risk factors include chronic constipation, cirrhosis (due to a shrunken liver creating more space), and chronic lung disease (due to flattened diaphragms).
Look for haustral folds within the subdiaphragmatic lucency on X-ray.
Look for haustral folds within the subdiaphragmatic lucency on X-ray.
December 13, 2025 at 10:00 PM
Key risk factors include chronic constipation, cirrhosis (due to a shrunken liver creating more space), and chronic lung disease (due to flattened diaphragms).
Look for haustral folds within the subdiaphragmatic lucency on X-ray.
Look for haustral folds within the subdiaphragmatic lucency on X-ray.
December 12, 2025 at 10:00 PM