iiinova — where your digital self keeps evolving

Ryan Elliott @ryanelliott.bsky.social · 26/12/2025

🫁 Just passing on what I thought was a very nice diagram from Med G for respiratory physical examination. Always nice to have some materials on-hand for learners. #medsky #IMsky

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Ryan Elliott @ryanelliott.bsky.social · 06/08/2025

Lesson from this past week: Isolated elevation of anticardiolipin IgM does not meet laboratory criteria for antiphospholipid syndrome! According to EULAR 2023 guidelines below. #medsky #IMsky #rheumsky #hemesky #antiphospholipid #thrombosis

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Ryan Elliott @ryanelliott.bsky.social · 05/05/2025

🔬🩸Hemoglobin development (some fundamentals!) Embryo Hb Gower I = ζ2ε2 Hb Gower II = α2ε2 Hb Portland = ζ2γ2 Fetus HbF = α2γ2 Adult HbA = α2β2 ~97% HbA2 = α2δ2 ~2–3% HbF <1% #hemesky #medsky #IMsky #benignheme #hemoglobin #pediatrics

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Ryan Elliott @ryanelliott.bsky.social · 06/02/2025

💊 Abatacept Humanized protein construct from recombinant DNA (CTLA4 + IgG1 Fc) grown in hamster ovary cells. Selectively binds to CD80/86 on APCs, inhibiting CD80/86-CD28 costimulatory signal essential for full T-cell activation. #medsky #IMsky #rheumsky #biologics (Herrero-Beaumont et al., 2012)

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Ryan Elliott @ryanelliott.bsky.social · 03/01/2025

🩸Large Granular Lymphocytic Leukemia Indolent clonal proliferation of mature cytotoxic T cells - Neutropenia/anemia - a/w autoimmunity - CD8+ T cells w/ NK cell markers - intrasinusoidal bone marrow/spleen/liver path ~50% STAT3 / STAT5b mutation #hemesky #pathsly #hemepath #IMsky #medsky #leukemia

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Ryan Elliott @ryanelliott.bsky.social · 23/12/2024

🩸CML Treatment #ASCO2024 1. Assess (🫀,🫁,GI,comorbs) 2. Risk strat (Sokal, Hasford, EUTOS) 3. Treatment - Low risk: Imatinib - Int/high risk: 2nd-gen TKIs 4. Monitor (bcr-abl PCR🧪) #hemesky #hemeonc #oncsky #CML #leukemia

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Ryan Elliott @ryanelliott.bsky.social · 22/12/2024

💊 Antiarrhythmics - Vaughan Williams Classification 🫀Class I (Ia, Ib, Ic) - Na+ Channel Blockers 🫀Class II - Beta Blockers 🫀Class III - K+ Channel Blockers 🫀Class IV - Ca2+ Channel Blockers 🫀Class V agents - Other #medsky #IMsky #internalmedicine #cardiosky

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Ryan Elliott @ryanelliott.bsky.social · 20/12/2024

🩸AML Treatment (simplified) Here’s a nice general framework to treatment in AML! #hemesky #hemeonc #oncsky #medsky #AML #leukemia #ASCO24

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Ryan Elliott @ryanelliott.bsky.social · 19/12/2024

🩸Anticoagulant Reversal Warfarin =🚫II,VII,IX,X Reverse = Vitamin K, 4-PCC (II,VII, IX, X) Heparin =🚫II,X Reverse = Protamine (binds heparin) Dabigatran =🚫II Reverse = Idacrucizumab (anti-dabigatran mAb) Xa inhibitors (Apixaban) Reverse = Andexanet alfa (Xa decoy & binds drug) #hemesky #medsky

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Ryan Elliott @ryanelliott.bsky.social · 18/12/2024

🩸 Febrile Non-Hemolytic (FNHTR): - Time: ≤ 4 hours - Cause: cytokines in donor blood - Prevention: H2 blockers, antipyretics, leukoreduction - Mgmt: stop infusion, antipyretrics, H2 blockers, meperidine (rigors), r/o other causes, notify blood bank #hemesky #medsky #IMsky #internalmedicine

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Ryan Elliott @ryanelliott.bsky.social · 15/12/2024

💊 Chemotherapy: disrupting cancer cell cell growth and survival at multiple levels. This handy diagram summarizes chemotherapy classes and where they fit according to their mechanism of action ⚙️ #oncsky #hemeonc #hemesky #pharmsky #medsky #IMsky #cancer #chemo (Falzone et al., 2023. Cell)

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Ryan Elliott @ryanelliott.bsky.social · 15/12/2024

💊 This diagram covers the ~broad spectrum~ of antibiotic activity. #medsky #IMsky #internalmedicine #IDsky #punsky #puns #emimcc

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Ryan Elliott @ryanelliott.bsky.social · 14/12/2024

🩸Neutrophilic myelocyte Cytoplasm slightly basophilic to cream-coloured prominent red-purple azurophilic (primary) granules and numerous specific (secondary) granules nucleoli absent usually slightly indented nucleus w/ red blue and slightly condensed chromatin #hemeky #hemepath #pathsky #IMsky

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Ryan Elliott @ryanelliott.bsky.social · 13/12/2024

🫀Cardiac tamponade vs constrictive pericarditis vs restrictive cardiomyopathy A big thanks to #IMR for this handy comparison table. Good for reference down the road or for someone like myself currently studying for the #InternalMedicine Royal College exam here in Canada. #cardiosky #medsky #IMsky

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Ryan Elliott @ryanelliott.bsky.social · 13/12/2024

🌡️ Fever of Unknown Origin (FUO) = temp >38.3C multiple times x 3 weeks without obvious cause Infections: 20-40%. Connective tissue disorders: 20% Malignancy: 10-20% Undiagnosed: 20% Drugs (e.g., phenytoin): rare #medsky #IMsky #internalmedicine #IDsky #hemeonc #hemesky #oncsky #rheumsky

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Ryan Elliott @ryanelliott.bsky.social · 13/12/2024

🫀 Mitral valve prolapse (MVP) ✨dynamic examination✨ ⬆️ preload (squatting) > murmur soft + click late ⬇️ preload (standing) > murmur loud + click early ⬆️ afterload (handgrips) > murmur loud + click late ⬇️ afterload (initial Valsalva) > murmur soft + click early #cardiosky #medsky #IMsky #emimcc

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Ryan Elliott @ryanelliott.bsky.social · 11/12/2024

👋 Harrison’s really lends a *hand* here on this diagram! Associated diseases with pain in the joints of the hand and wrist. #medsky #rheumsky #internalmedicine #medpuns #puns

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Ryan Elliott @ryanelliott.bsky.social · 09/12/2024

🩸 Flower cells - think ATL! Adult T-cell leukemia/lymphoma (ATL) A/w HTLV-1 infection, Japan, Caribbean (Jamaica, Trinidad) Sxs: LAD, HSM, cytopenias, ⬆️ Ca2+, lytic bone lesions, skin lesions. Severity ranges from asymptomatic to fulminant. #hemesky #hemeonc #hemepath #pathsky #medsky #IMsky

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Ryan Elliott @ryanelliott.bsky.social · 09/12/2024

🩸Acute Intermittent Porphyria Cause: PBG deaminase deficiency leading to accumulation of prophyrins. Sxs: abdominal pain, neurological disturbances, light sensitivity, skin lesions, red urine. Ix: peri-attack urine porphyrins Rx: hemin, pain ctrl, fluids, avoid provoking meds #hemesky #porphryia

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Ryan Elliott @ryanelliott.bsky.social · 08/12/2024

🩸Babesiosis Babesia microti Spread via deer tick (Ixodes scapularis) Hemolytic anemia,⬇️Platelets PB smear: classic Maltese cross in RBC Rx = Atovaquone+Azithromycin #hemesky #IDsky #medsky #ticksky #ticktalk

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Ryan Elliott @ryanelliott.bsky.social · 08/12/2024

🩸Erlichiosis Ehrlichia chaffeensis E. ewingii Lone star tick (A. americanum) Fevers, rash, myalgias ⬇️platelets+WBC PB smear: morulae (microcolonies of Ehrlichiae) in cytoplasm of WBCs E. chaffeensis infects monocytes E. ewingii infects granulocytes Rx: Doxycycline #hemesky #IDsky #medsky

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Ryan Elliott @ryanelliott.bsky.social · 08/12/2024

🩸Anaplasmosis Anaplasma phagocytophilum Deer tick Eastern (Ixodes scapularis) Western (Ixodes pacificus) Fevers, myalgias ⬇️platelets+WBC PB smear: morulae in granulocytes Rx: Doxycycline Hard to distinguish between erlichiosis, good thing doxy covers both! #hemesky #IDsky #medsky #IMsky

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Ryan Elliott @ryanelliott.bsky.social · 06/12/2024

🩸Myeloma medications with mechanism of action all in one table! (Rajkumar SV, 2024) Black font — Approved drugs Blue font — Clinical trials #hemesky #hemeonc #oncsky #myeloma

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Ryan Elliott @ryanelliott.bsky.social · 05/12/2024

🩸 Barr bodies Small blebs of X chromatin, sometimes seen in neutrophils of patients of female sex. #hemesky #pathsky #hemepath

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Ryan Elliott @ryanelliott.bsky.social · 05/12/2024

🩸Flame cells Plasma cells that have glycogen-rich, vermillion-staining fibrils. Strongly associated with IgA myeloma but can pop up in other plasma cell dyscrasias or inflammatory conditions with rapid immunoglobulin production. #hemesky #medsky #IMsky #myeloma #pathsky #hemepath #hemeonc #oncsky

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Ryan Elliott @ryanelliott.bsky.social · 04/12/2024

🧠 Sharing some helpful HINTS for bedside determination of central vs peripheral vertigo. #Medsky #IMsky #neurosky #internalmedicine #neurology #vertigo #medpuns

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Ryan Elliott @ryanelliott.bsky.social · 03/12/2024

💊 My humour might be ~watered down~ but I just wanted to LOOP you all into this summary of common diuretics with their mechanisms of action included. #MedSky #IMsky #internalmedicine #nephsky #nephrology #diuretics #lasix #medpuns #puns

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Ryan Elliott @ryanelliott.bsky.social · 03/12/2024

🩺 A quick reference for various insulin analogs #MedSky #IMsky #diabetes #insulin

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Ryan Elliott @ryanelliott.bsky.social · 02/12/2024

🩸Whole Blood Donation and the processing to life-saving blood products for patients #transfusionmedicine #hemesky #IMsky

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Ryan Elliott @ryanelliott.bsky.social · 01/12/2024

🩸Platelets! Lifespan 7-10 days 150-450 × 10⁹/L Stimulated by TPO 1/3 sequestered in spleen Receptors: GpIIbIIIa -> fibrinogen GPIb-IX-V -> vWF P2Y12 -> ADP Granules: Alpha = fibrinogen, vWF, V, VEGF, PF4, PDGF, P-selectin Dense = ADP, Ca, Serotonin #hemesky #MedSky van der Meijden et al, 2019

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Ryan Elliott @ryanelliott.bsky.social · 30/11/2024

🩸 Secondary AML therapeutic drug classes and their mode of action #hemesky #MedSky #IMsky #AML Review article by Auerbach et al. 2024 pubmed.ncbi.nlm.nih.gov/38541635/

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Ryan Elliott @ryanelliott.bsky.social · 30/11/2024

🩸 Secondary AML mutations #hemesky #MedSky #IMsky #AML Review article by Auerbach et al. 2024 pubmed.ncbi.nlm.nih.gov/38541635/

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Ryan Elliott @ryanelliott.bsky.social · 28/11/2024

🩸 Iron deficiency associations +esophageal webs+dysphagia ➡️ Plummer-Vinson +angiodysplasia+AS ➡️ Heyde +nocturnal leg pain ➡️ RLS +craving ice ➡️ pagophagia +curved nail ➡️ koilonychia +gluten intolerance ➡️ Celiac +olfactory cravings ➡️ Desiderosmia #hemesky #MedSky #IMsky #IDA #anemia

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Ryan Elliott @ryanelliott.bsky.social · 27/11/2024

👁️ Kayser-Fleischer ring - dark brown/greenish-brown ring around the cornea's periphery (copper deposits in Descemet's membrane) - crescent 12 o'clock ➡️ crescent at 6 o'clock ➡️ eventually encircling the entire cornea - 🚫 vision problems - pathognomonic for Wilson's disease #MedSky #IMsky #GIsky

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Ryan Elliott @ryanelliott.bsky.social · 27/11/2024

Yamaguchi Criteria for Adult-Onset Still's Disease #MedSky #IMsky #rheumsky #AOSD

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Ryan Elliott @ryanelliott.bsky.social · 27/11/2024

🩸 Hairy cell leukemia! - Indolent neoplasm of mature B cells—appear w/ cytoplasmic hair-like projections. - PB cytopenias - Splenomegaly - Immunohistophenotyping: CD11c, CD19, CD20 bright, CD22 bright, CD25, CD103, CD123 and CD305 (LAIR) - BRAF V600E > 95% of cases #hemesky #pathsky #hemepath

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Ryan Elliott @ryanelliott.bsky.social · 26/11/2024

🩸 Paroxysmal nocturnal hemoglobinuria (PNH): Lack of GPI anchors ➡️ lack of CD55 & CD59 ➡️ unregulated complement activity ➡️ Triad: hemolysis, thrombosis, bone marrow failure (cytopenias) #MedSky #IMsky #hemesky #PNH #thrombosis #theInternAtWork

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Ryan Elliott @ryanelliott.bsky.social · 25/11/2024

Sideroblastic anemia 🩸🔬 ↑ serum Fe, ↑ marrow Fe, ↑↑ tsat, ↑↑ ferritin, ↓ TIBC, ↓ STFR PB: - hypo/normo-chromic RBCs - basophilic stippling - Pappenheimer bodies BM bx: - erythroid hyperplasia - occasional dysplasia BM asp: - ringed sideroblasts Cytogen/molecular: - R/O MDS-RS #hemesky #MedSky

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Ryan Elliott @ryanelliott.bsky.social · 24/11/2024

This is probably most digestible Acid-Base Disorder algorithm I have come across. Great for providing teaching to learners and handy pocket reference. #MedSky #IMsky #internalmedicine #acidbase

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Ryan Elliott @ryanelliott.bsky.social · 24/11/2024

A pretty handy infographic here on lupus anticoagulant (LA) - By Jeanne Des Escotais (fellow in Internal Medicine, Paris, France) #lupusanticoagulant #MedSky #hemesky

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