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[@esanum](/creator/twitter/esanum)
"💊🧬 Low-dose aspirin halves 3-year CRC recurrence in PI3K-altered tumors Design: Double-blind RCT after curative surgery for stage IIII CRC; tumor PI3K-pathway alterations required. XXX mg daily for X years vs placebo. Of 2980 genotyped XX% had PI3K alterations; XXX randomized (hotspot PIK3CA exon 9/20 = group A; other PIK3CA/PIK3R1/PTEN = group B). Results: 3-year recurrence XXX% vs XXXX% (HR 0.49; XX% CI 0.240.98) in group A; XXX% vs XXXX% (HR 0.42; 0.210.83) in group B. Disease-free survival favored aspirin in both groups. Severe AEs: XXXX% aspirin vs XXXX% placebo. Clinical read: First"  
[X Link](https://x.com/esanum/status/1977992774579523908) [@esanum](/creator/x/esanum) 2025-10-14T07:00Z 5714 followers, XXX engagements


"🔴 Diagnosis: Dermatographism (dermatographic urticaria) 📍 Immediate linear wheals/erythema after scratching or pressure skin writing 🔷 Physical urticaria from mast-cell degranulation histamine-mediated edema; often idiopathic/atopic 💡 Confirm by gentle stroke test; treat with non-sedating H1 antihistamines and avoid tight friction/pressure"  
[X Link](https://x.com/esanum/status/1979541959153684556) [@esanum](/creator/x/esanum) 2025-10-18T13:35Z 5712 followers, 2077 engagements


"✅ Answer: Dose-dependent COX inhibition 📍 Low dose (75100 mg): first-pass selective irreversible platelet COX-1 block TXA antiplatelet cardioprotection 📍 Higher dose: systemic COX-1/COX-2 inhibition in tissues PGE/PGI analgesic/anti-inflammatory 💡 Platelets cant resynthesize COX once-daily low dose works; higher doses bleeding/GI risk"  
[X Link](https://x.com/esanum/status/1980028069780828192) [@esanum](/creator/x/esanum) 2025-10-19T21:47Z 5715 followers, 1532 engagements


"@Doctors_GUILD ✅ Answer: C) Hypocalcemia 📍 Post-thyroidectomy paresthesias/tetany; Chvostek/Trousseau signs 🔷 Transient hypoparathyroidism from devascularized/removed parathyroids PTH Ca 💡 Monitor Ca/PTH; treat with calcium calcitriol (IV if symptomatic)"  
[X Link](https://x.com/esanum/status/1973795874141843730) [@esanum](/creator/x/esanum) 2025-10-02T17:03Z 5715 followers, 2015 engagements


"@TrackYourHeart ✅ Answer: c) 1530% 📍 Variant third branch from the left main between LAD and LCx (ramus). 🔷 Supplies the high lateral LV wallischemia can give ST elevation in I/aVL. 💡 Recognition matters for PCI/CABG planning; terminology varies (ramus/intermediate/median artery)"  
[X Link](https://x.com/esanum/status/1978963401960202703) [@esanum](/creator/x/esanum) 2025-10-16T23:16Z 5715 followers, XXX engagements


"✅ Answer: A) Endocardium 📍 Chordae tendineae (and AV valve leaflets) develop from endocardial cushions/subendocardial mesenchyme 🔷 Papillary muscles arise from myocardium; epicardium contributes to coronary vessels; mesocardium is transient 💡 Valve remodeling leaves thin fibrous cords anchoring leaflets to papillary muscles"  
[X Link](https://x.com/esanum/status/1979536967806144930) [@esanum](/creator/x/esanum) 2025-10-18T13:16Z 5715 followers, 3406 engagements


"🔴 Organ: Adrenal (suprarenal) gland 📍 Capsule cortex (zona glomerulosa fasciculata reticularis) central medulla 🧠 GFR: salt (aldosterone) sugar (cortisol) sex (androgens); medulla = epinephrine/norepinephrine (chromaffin) 💡 Regulation: ZG by RAAS; ZF/ZR by ACTH; venous outflow via a large central vein"  
[X Link](https://x.com/esanum/status/1979901993595314427) [@esanum](/creator/x/esanum) 2025-10-19T13:26Z 5715 followers, 2279 engagements


"😴🦴 Morning aches Clinician-backed sleepposture fixes (NPR Life Kit) "Sleep the way you stand." Aim for a neutral line ear shoulder hip; avoid chin-tuck or hyperextension and keep arms symmetric. Poor overnight alignment drives muscle tension and AM soreness. Position & pillows: Back: medium-loft pillow; fill gaps (e.g. small pillow under knees) to unload lumbar spine. Side: choose loft by neck-to-shoulder distance; consider a pillow between knees or a body pillow to align hips. Stomach: generally avoid; if you must use low/no head pillow and consider a thin support under hips. Systems"  
[X Link](https://x.com/esanum/status/1980197307649061317) [@esanum](/creator/x/esanum) 2025-10-20T09:00Z 5715 followers, XXX engagements


"🔴 Diagnosis: Pyogenic granuloma (lobular capillary hemangioma) 📍 Rapidly growing friable red papule on the lip that ulcerates/bleeds easily 🔷 Benign capillary proliferationoften triggered by minor trauma + hormonal surges (e.g. pregnancy precocious puberty) 🧠 VEGF-driven angiogenesis in the dermis 💡 Tx: shave/excision with cautery or laser; address triggers to prevent recurrence"  
[X Link](https://x.com/esanum/status/1979265038440632782) [@esanum](/creator/x/esanum) 2025-10-17T19:15Z 5715 followers, XXX engagements


"@Doctors__squad ✅ Answer: C) Factor VII 📍 Serum = plasma after clotting lacks fibrinogen ⚡ Factor VII is stable (vitamin Kdependent) and not consumed so present in both 💡 Labile factors V & VIII and prothrombin (II) are depleted in serum"  
[X Link](https://x.com/esanum/status/1980356741499089194) [@esanum](/creator/x/esanum) 2025-10-20T19:33Z 5715 followers, XXX engagements


"🔴 Diagnosis: Loa loa subconjunctival migration (African eye worm) 📍 Visible migrating worm foreign-body sensation tearing; Calabar swellings West/Central Africa exposure 🔷 Deerfly (Chrysops) transmission; diurnal microfilaremia 💊 Remove the worm + diethylcarbamazine (DEC); check microfilarial load & rule out onchocerciasis (risk of encephalopathy with DEC/ivermectin if high)"  
[X Link](https://x.com/esanum/status/1973109812931207451) [@esanum](/creator/x/esanum) 2025-09-30T19:36Z 5684 followers, XXX engagements


"✅ Answer: Reversal of benzodiazepine effects (procedural sedation or overdose) 📍 Competitive antagonist at the benzodiazepine site on GABA_A receptors ⚠ Avoid in chronic BZD users or mixed overdoses (esp. TCAs) due to seizure/withdrawal risk 💡 Short half-lifemonitor for re-sedation; supportive care remains first-line in overdose"  
[X Link](https://x.com/esanum/status/1975890949487116486) [@esanum](/creator/x/esanum) 2025-10-08T11:48Z 5613 followers, XXX engagements


"✅ Answer: Paroxysmal supraventricular tachycardia (PSVT) 📍 Purpose: Modified Valsalva maneuver to terminate the tachycardia 🔷 Vagal tone transient AV-nodal block (15 s strain at XX mmHg then supine + leg raise) 💡 If unsuccessful/unstable adenosine; avoid if hypotension or VT suspected"  
[X Link](https://x.com/esanum/status/1978925355453821018) [@esanum](/creator/x/esanum) 2025-10-16T20:45Z 5612 followers, 2465 engagements


"🔴 Diagnosis: Gastric phytobezoar (endoscopically fragmented and retrieved) 📍 Multiple irregular brown vegetative lumps consistent with plant-fiber concretions 🔷 Risks: prior gastric surgery or diabetic gastroparesis poor dentition high-fiber diet (e.g. persimmon) 💡 Tx: endoscopic fragmentation/extraction Coca-Cola/cellulase; consider prokinetics and diet changes to prevent recurrence"  
[X Link](https://x.com/esanum/status/1978963506809507874) [@esanum](/creator/x/esanum) 2025-10-16T23:17Z 5612 followers, XX engagements


"@medcrux ✅ Answer: A) Orbicularis oris 📍 Unilateral cleft lip = failed fusion of maxillary + medial nasal processes 🧠 Repair re-approximates the orbicularis oris to restore lip sphincter/philtral contour 💡 Timing often XX mo (Rule of 10s)"  
[X Link](https://x.com/esanum/status/1979169127299195160) [@esanum](/creator/x/esanum) 2025-10-17T12:54Z 5680 followers, XXX engagements


"@nervemed ✅ Answer: B) Scleroderma (systemic sclerosis) 📍 Perioral skin tightening with radial furrows microstomia; mask-like facies 🔷 Autoimmune fibroblast activation excess collagen ( anti-centromere/Scl-70) 💡 Screen for Raynauds sclerodactyly telangiectasia and reflux"  
[X Link](https://x.com/esanum/status/1979169143598252436) [@esanum](/creator/x/esanum) 2025-10-17T12:54Z 5695 followers, XXX engagements


"🔴 Diagnosis: Cutaneous anthrax (black eschar malignant pustule) 📍 Painless necrotic ulcer with central black eschar and marked surrounding edema on the lower lip 🔷 Bacillus anthracis spores edema/lethal toxins tissue necrosis 💡 Start ciprofloxacin/doxycycline; evaluate for systemic spread; no incision/drainage"  
[X Link](https://x.com/esanum/status/1979264927572394362) [@esanum](/creator/x/esanum) 2025-10-17T19:15Z 5635 followers, XXX engagements


"@Doctors_GUILD ✅ Answer: C) Coffee machine 📍 24/7 availability precise dosing zero drama 🧠 Caffeine blocks adenosine (A1/A2A)  alertness fatigue 💡 Use PRN; avoid late evening to protect sleep"  
[X Link](https://x.com/esanum/status/1979326664007127241) [@esanum](/creator/x/esanum) 2025-10-17T23:20Z 5676 followers, XXX engagements


"@DrAkhilX ✅ Answer: Alcoholic hepatitis 📍 AST 50400 with AST/ALT XXXX (classically 2) = hallmark pattern 🔷 Alcohol mitochondrial injury AST + B6 (pyridoxine) deficiency relatively ALT 🧠 Memory hook: Alcohol ST higher than LT (S for Scotch)"  
[X Link](https://x.com/esanum/status/1979264985478889688) [@esanum](/creator/x/esanum) 2025-10-17T19:15Z 5706 followers, 2940 engagements


"@MoarSahitoPTI ✅ Answer: It acutely expands intravascular volume 📍 Osmotic shift pulls water into plasma transient preload/PCWP 🧠 Higher capillary hydrostatic pressure worsens alveolar flooding (esp. LV failure/anuria) 💡 Avoid in pulmonary edema/CHF; use loop diuretics instead"  
[X Link](https://x.com/esanum/status/1979536952400793811) [@esanum](/creator/x/esanum) 2025-10-18T13:16Z 5706 followers, 4207 engagements


"@MoarSahitoPTI 🧠 Why avoid NSAIDs with antihypertensives 📍 COX inhibition renal prostaglandins afferent vasoconstriction & GFR ⚡ Na/HO retention BP; blunts the effect of ACEi/ARBs and diuretics 💡 Triple whammy: ACEi/ARB + diuretic + NSAID high AKI risk"  
[X Link](https://x.com/esanum/status/1976660976146792706) [@esanum](/creator/x/esanum) 2025-10-10T14:47Z 5714 followers, 2094 engagements


"✅ Answer: Methemoglobinemia 📍 Central cyanosis with low SpO despite normal lungs/airway; PaO normal; chocolate-brown blood 🧠 Fe Fe (metHb) cant carry/release O; triggers: dapsone nitrates benzocaine aniline dyes 💡 Antidote: Methylene blue XX mg/kg IV (avoid in G6PD deficiency use high-dose vitamin C)"  
[X Link](https://x.com/esanum/status/1979901978617528350) [@esanum](/creator/x/esanum) 2025-10-19T13:26Z 5715 followers, 3368 engagements


"✅ Answer: C) Lipid profile 📍 Yellow soft peri-palpebral plaques xanthelasma palpebrarum 🔷 Cholesterol-laden foam cells often linked to LDL/TG (familial or secondary) 💡 If abnormal also screen for secondary causes (hypothyroidism diabetes cholestasis) and manage CV risk"  
[X Link](https://x.com/esanum/status/1980028054228566476) [@esanum](/creator/x/esanum) 2025-10-19T21:47Z 5715 followers, 5440 engagements


"@drsthanus 🔴 Diagnosis: Large hiatal hernia 📍 Elderly patient with dyspnea/cough ⚡ CXR: big retrocardiac airfluid level forming a rounded opacity behind the heart 💡 Predisposes to reflux/aspiration; confirm with barium swallow/CT and manage medically or repair if symptomatic"  
[X Link](https://x.com/esanum/status/1980364148895846666) [@esanum](/creator/x/esanum) 2025-10-20T20:03Z 5715 followers, XXX engagements


"🫀 CABG graft map (SVG) 📍 Saphenous vein grafts typically to PDA (RCA) OM (LCx) and diagonal/LAD branches ⚡ LIMA LAD is the usual workhorse for best long-term patency; SVGs have higher occlusion risk 💡 Post-CABG: aggressive secondary prevention (antiplatelet statin BP/DM control)"  
[X Link](https://x.com/esanum/status/1980365302861885909) [@esanum](/creator/x/esanum) 2025-10-20T20:07Z 5715 followers, XX engagements


"🔴 Diagnosis: Trichostasis spinulosa 📍 Numerous pinpoint black follicular plugs over the nose (black dots) ⚡ Each plug is a tuft of retained vellus hairs in a dilated follicle (comedone-like) 💡 Manage with extraction + topical retinoids/keratolytics; consider depilation/laser for recurrence"  
[X Link](https://x.com/esanum/status/1980365708220379377) [@esanum](/creator/x/esanum) 2025-10-20T20:09Z 5715 followers, XXX engagements