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What is meant my Pulsus Paradoxus ?
A one-stop pathophysiology thread youโ€™d ever need ๐Ÿงต

#MedTwitter #MedStudentTwitter #MedEd #FOAMed #CardioEd #USMLE #ICU #EMTwitter Image
To understand Pulsus Paradoxus in detail,

It is essential to realise for a fact that, 1. Pleural pressure, 2. Abdominal pressure, 3. Heart chamber pressures & 4. Lung pressures, are all interconnected, interact & react among each other.
As we inspire โ€”> the diaphragm moves down, creating a more negative intra-pleural pressure & a more positive abdominal pressure โ€”> this adds up to โฌ†๏ธ venous return to right atrium โ€”> excess blood enters RV & โฌ†๏ธ right ventricular end diastolic pressure (RVED)
Read 14 tweets
Time to go VIRAL!!
Cheatcodes/rules regarding general virology to get through NEET/INICET/USMLE
๐Ÿ’ ๐Ÿ’ questions to ask while learning
1)DNA vs RNA virus
2)ss vs ds virus(single vs double-stranded virus)
3)Symmetry of the virus? (icosahedral vs helical vs complex)
4)enveloped or non-enveloped?
5) site of replication- nucleus or cytoplasm?
6)genome- circular or linear(for MLE) or segmented?
7)RNA viruses- +ve sense ss or -ve sense ss
๐Ÿฆ RNA viruses are ss except for rotavirus(Reoviridae)
๐Ÿฆ DNA viruses are ds except for parvovirus

๐Ÿ’ symmetry
๐Ÿฆ all DNA viruses are icosahedral except poxvirus
(poxvirus is comPlOX)
Read 19 tweets
If you're headed into a dedicated study period for the #USMLE, here are some points to consider before you get started...
Dedicated study is a time of exponential intellectual growth - it can be physically, mentally, and emotionally taxing, however it is so rewarding! ๐Ÿ™‚
1. Embrace the 'practice as you perform' mindset! ๐ŸŽฏ

Beginning UW & NBME blocks in the morning (with consistent breaks) similar to Prometric exam day can optimize your performance on exam day.

Doing questions in the AM will become 'like brushing your teeth' on exam day!
Read 10 tweets
Thoughts on #endometriosis from the perspective of medical education ๐Ÿงต
USMLE and shelf examinations make endo seem super easy. Itโ€™s a young woman with pelvic pain & some combo of infertility, dyspareunia, and dyschezia

Throw some OCPs at the problem and boom, case closed
Students donโ€™t talk about endo as a cause of urinary symptoms. Many have it on their list as a cause of heavy abnormal bleeding.

Most have no idea that MRI is useful for diagnosis and few know when to refer for surgery or how to manage patients after surgery
Read 7 tweets
Congratulations for every one,

J1 visa process

Wanted to share this info with all the people who matched this year! Hope itโ€™s helpful.



j1 visa process:
Sequence of events after the match:
1. Sign the contract.
2. Obtain the Statement of need at the Ministry of Health, Delhi (Documents needed: Offer letter, Passport, Valid visa, Surety bond, Application).
3. TPL creates a profile for the applicant at EV net (Documents needed: Offer letter, Statement of need, Current CV, Copy of Passport pages, Medical school diploma, Passport size photograph)
4. ECFMG will notify the applicant that the application has been initiated.
Read 16 tweets
Very intelligent ๐Ÿง  and #brilliant doctors. Doctor vs #DoctorWho Quiz.
Which #cytokine stimulate the growth and differentiation of #eosinophils.
#medtwitter #meded #doctor #USMLE #medical
Very intelligent ๐Ÿง  and #brilliant doctors. #Doctor vs #Doctor Quiz.
Which #cytokine stimulate the growth and differentiation of #eosinophils.
#medtwitter #meded #doctor #USMLE #medical
On Targeting #Eosinophils which clinical condition will benefit most ?
Read 5 tweets
Beating Clinical MCQs in #USMLE or #boards2023 when you donโ€™t know the answer! ๐Ÿฉบ๐Ÿ“

๐Ÿงต๐Ÿ‘‡Check out 10 strategies to approach this challenge

#MedTwitter #MedEd #IMG #ECFMG #foamed #medicalstudent #internalmedicine #BoardExams #medicaleducation
Don't panic! ๐Ÿ˜ฑ

Try to work through the question, use strategies below to narrow down the choices and make an educated guess. ๐Ÿ’ช๐Ÿค”๐Ÿ’ก

General approach to MCQs: Reverse reading ๐Ÿ“–๐Ÿ”™๐Ÿ’ญ

a) read the MCQ starting at the last sentence in the stem (the actual question)
b) glance over the answer options
c) then work your way back to the stem

๐Ÿง I find this an effective technique to prompt & orient the brain.

Read 11 tweets
I see many MBBS students and young doctors in Twitter. I thought I will post some thoughts of mine about career choices here which may help a few people.
When I was in college from 2008-14, there was no provision of high speed internet till final year and internship. So there were no YouTube videos to help and guide me regarding career choices.

I was totally confused about what to do next and was not keen to take up busy specialities. I decided to do PG in PSM or Psychiatry and went for PG coaching in Kerala after a brief period of working.
Read 19 tweets
Juxta-articular (near joint articulations) punched out erosions on the metatarsals is indicative of GOUT | (Gout = mostly toes)


#MedTwitter #RheumTwitter #neurotwitter #usmle
Psuedogout presents with chondrocalcinosis (calcification of cartilages) | (psuedogout = mostly knees)

Chronic neuropathic (charcot) arthropathy presents in those with chronic diabetes and peripheral neuropathy.

Common signs on xray are :

1. Hour glass phalanges
2. Sucked candy apperance
3. Subluxation of several foot joints.

Read 6 tweets
QuizTime 13
Happy New Year 2023

40yr old M comes to us with the following lesions of few months duration.
Applying various ointments from different places

Dx ?
#dermtwitter #MedTwitter #dermatology #MedEd #FOAMed #NEET #USMLE Image
Local adverse effects of topical corticosteroid use

On detailed history taking and careful examination it was found out
The patient was using verities of topical ointments from shops and sources for prolonged duration
They mostly contained corticosteroids
Self medication +
Skin atrophy is the most prominent cutaneous adverse effect
Involves both the epidermis and dermis

The development/ exacerbation of dermatoses of the face
steroid rosacea, acne, and perioral dermatitis, is a well-known side effect of topical corticosteroids
Read 5 tweets
QuizTime 10

35 yr F
Slight itchy/mostly asymptomatic lesions
Present on face back chest
Sun exposed areas
>1yr duration

Dx ?
#MedTwitter #dermatology #dermtwitter #MedEd #usmle #NEET #FOAMed #Medstudent #health #education Image
Chronic Cutaneous Lupus Erythematosus/Classic DLE

Begin as red-purple macules, papules, or small plaques Rapidly develop a hyperkeratotic surface
Early classic DLE- sharply demarcated, coin-shaped (i.e., discoid) erythematous plaques covered by a prominent, adherent scale+
Typically expand with erythema and hyperpigmentation at the periphery
Leaving hallmark atrophic central scarring/telangiectasia/hypopigmentation
Read 4 tweets
Impressing ๐˜พ๐™ค๐™ฃ๐™จ๐™ช๐™ก๐™ฉ๐™–๐™ฃ๐™ฉ ๐™ค๐™ฃ ๐™๐™ค๐™ช๐™ฃ๐™™ โ“

Residents use the fancy diagnosis and terms like
๐‡๐‹๐‡ - Hemophagocytic lymphohistiocytosis

A ๐Ÿงต on what is ๐‡๐‹๐‡ and how to diagnose it
#usmle Hemophagocytosis
๐Ÿ“Hyperinflammatory syndrome caused by โฌ†๏ธcytokine release

๐Ÿ“ Either due to genetic or acquired overactivation of CD8 T cells and natural killer (NK) cells

โœด๏ธ Hemophagocytosis is neither sensitive nor specific for HLH

๐Ÿ…ฒ๐Ÿ…ป๐Ÿ…ฐ๐Ÿ†‚๐Ÿ†‚๐Ÿ…ธ๐Ÿ…ต๐Ÿ…ธ๐Ÿ…ฒ๐Ÿ…ฐ๐Ÿ†ƒ๐Ÿ…ธ๐Ÿ…พ๐Ÿ…ฝ ๐Ÿ‘‡
Lets discuss one of the ๐–ˆ๐–†๐–˜๐–Š ๐–˜๐–ˆ๐–Š๐–“๐–†๐–—๐–Ž๐–”๐–˜ that came to AIIMS:

24,๐Ÿ’ƒ, without any Co-morbidties

C/O Fever, Malaise, Sore throat, Headache

๐Ž๐ง ๐„๐ฑ๐š๐ฆ๐ข๐ง๐š๐ญ๐ข๐จ๐ง :
๐Ÿ”ธHR ~125/min ๐Ÿ”บ
๐Ÿ”ธSevere Pallor
๐Ÿ”ธCervical Lymphadenopathy
๐Ÿ”ธPetechial Rash

Read 12 tweets
1/Feeling lucky? Or feeling evidence based?
A #tweetorial about how to read a #pituitary #MRI using data and know if thereโ€™s cavernous sinus invasion w/the Knosp score.
#medtwitter #FOAMed #radres #neurorad #FOAMrad #neurosurgery #medicalstudent #meded #USMLE #endocrinology Image
2/The hardest part of a pituitary MRI is deciding if there is cavernous sinus invasion. It makes sense that the more lateral a tumor goes on MRI, the more likely it has invaded the sinusโ€”bc it is going the direction of the sinus. But how far is far enough? Image
3/This is important bc each time a radiologist makes a call on imaging, they make a bet & they are betting their credibility. And unlike other bets, there is only 1 wagerโ€”all in! So it is important to not call it when you might be wrong, bc overcalls destroy credibility. Image
Read 15 tweets
1/ Many folks have messaged me asking for guidance regarding #USMLE, so I figured I might create a thread on how I was able to take all exams (except step3) while still in #medicalschool.
The following ๐Ÿงต is what I found useful for me, obviously doesn't apply to everyone.
2/ Disclaimer, I was an average #medicalstudent, no genius or prodigy.
I put in the extra effort and it paid dividends.
I graduated in Nov 2012, as an #IMG and matched into surgery in Mar 2013. If I can do it, so can you, just remember no shortcuts in life.
3/ The first time I heard of #USMLE was in Dec 2010, when my buddy was studying for it.
It was around that time I looked into studying for this "international exam" as I would falsely assume.
Once I did some digging, I realized, everyone has to take it to practice in the US.
Read 22 tweets
1/Hello all,Good morning! Happy independence week๐Ÿ‡ฎ๐Ÿ‡ณ๐ŸŽ‰๐ŸŽŠ
Got a beautiful chest teaching case ๐Ÿ‘‡๐ŸปXray โ–ถ๏ธCT โ–ถ๏ธHPE

๐Ÿ›‘27 year old female came with h/o chest discomfort, breathing difficulty, cough x 1 week

Lets breakdown itโœ๏ธ๐Ÿ“ ๐Ÿ”ฅ
#radres #chestrad #Pulmonology #MedTwitter #FOAMrad Image
2/ Frontal CXR shows homogenous opacity in R.mid & lower zone in paravertebral region
โ‡๏ธIt has well defined superior,inferior&lateral borders, medial border is merged with mediastinum(incomplete border sign)
โ™‰๏ธOpacity has Broad base contact with mediastinum s/o mediastinal origin Image
โ‡๏ธLung lesion will be covered by lung margins all side(not always) & form an acute angle with meds
โ™‰๏ธNormal silhouette of right heart border is seen (neg silhouette sign) s/o lesion not in ant med
๐Ÿ‰‘Hilar vessels are seen coursing through the opacity (Hilum overlay sign +ve) ImageImage
Read 7 tweets
If youโ€™re an IMG who studied medicine in English and passed all #USMLE steps, you should NOT be required to sit for an English language exam.

Enough with the ripoff and making money out of the poor students.
If youโ€™re an IMG (or US graduate) who passed all #USMLE steps and interested in primary care in rural areas (where there is DIRE need for primary care physicians), you should be offered contracts with competitive salaries.
If youโ€™re an IMG (but a US citizen) who passed all #USMLE steps and interested in primary care, you should be offered a chance to do your residency training in the Indian Health System or Bureau of Prisons.
Read 7 tweets
Acetaminophen Toxicity algorithm. Very helpful

#Meded #medtwitter #USMLE #MRCP #razausmlemnemonics
via @ibcc
Pathophysiology of acetaminophen toxicity
Rumack-Matthew Normogram used for acetaminophen toxicity
Read 3 tweets
Pay attention to this thread:

Sodium/Glucose Cotransporter *2* (SGLT2) receptors are in the *1st* part of the proximal tubule, where 90% of glucose reabsorption occurs & also where SGLT2 inhibitors like empagliflozin work.

SGLT *1* receptors are in the *2nd* part of the tubule. Image
SGLT2i โ†“ systolic HF mortality in patients with OR without diabetes.

Drugs that โ†“ systolic HF mortality:
โ€ขรŸ-blockers (metoprolol, bisoprolol, carvedilol)
โ€ขHydralazine (with nitrates)
โ€ขNeprelysin inhibitor (sacubitril)
โ€ขSGLT2 inhibitors Image
Additionally, SGLT2 inhibitors โ†‘ sodium delivery to macula densa and SLOW the progression of GFR decline in kidney disease by restoring the tubuloglomerular feedback (TGF) and are associated with DECREASED mortality from kidney disease among patients with diabetes. ImageImage
Read 8 tweets
Preparing for Step 2CK:
1. UWorld: I can't stress enough how important this is!!! Give it as much time and dedication as possible. The more you're thorough with it, the better!
#medtwitter #USMLE #step2
I started UWorld with just Medicine, when I was halfway done, I added Surgery, and so on. So towards the end I was solving mixed blocks. Start timed mode as early as possible: Q. stems can be really long, and require a lot of practice to get through quickly.
2. Divine Intervention Podcasts: These are GOLD. (God bless Divine! ๐Ÿฅบโค) Must listen: No.s 37, 97, 184, 204, 231 (Risk Factors/Most Common/ Military)

3. Mock exams: UWSAs and NBMEs
Read 7 tweets
Duration of Antibiotic Therapy
Deciding on the duration of antimicrobial therapy for an infection is neither straightforward nor simple. ๐Ÿ‘‡
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
#medschool #MedStudentTwitter #medstudent #TwitterRx

Most ID guidelines are based- either expert opinions or evidence-based medicine. Historically, duration of ABX Rx were based on arbitrary extension of days(magic numbers like 7, 10 & 14 days) rather than on reliable evidence with the main aim to โฌ‡๏ธ failures & avoid underRx.

There is growing evidence to support for shorter courses. It is important for prescribers to be up to date with best practices. Duration of therapy plays a pivotal role in antimicrobial stewardship programme within the global effort to optimize antibiotic use &โฌ‡๏ธresistance.

Read 26 tweets
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor


4-chloro-N-(2-furyl-methyl)-5-sulfamoyl-anthranilic acid, member of the sulfaโ€™s. Potent natriuretic drug, inhibits Na+-K+-2Clโˆ’ cotransporter in the ascending limb of the loop of Henle.
Direct Vd effects results in its therapeutic effectiveness in the Rx of acute pulm edema.

Vasodilation leads to reduced responsiveness to vasoconstrictors, such as angiotensin II and noradrenaline, and decreased production of endogenous natriuretic hormones with vasoconstricting properties.

Read 15 tweets

Edema of the deep dermis & subcutaneous tissues.

Etiology, types and treatments๐Ÿ‘‡๐Ÿ‘‡๐Ÿ‘‡๐Ÿ‘‡โฌ‡๏ธโฌ‡๏ธโฌ‡๏ธโฌ‡๏ธ๐Ÿ‘‡๐Ÿ‘‡๐Ÿ‘‡๐Ÿ‘‡


#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
Mast cellโ€“derived mediators tend to affect layers superficial to subcutaneous tissue, including the dermal-epidermal junction. These mediators cause urticaria & pruritus.

In bradykinin-mediated angioedema, the dermis is usually spared, so urticaria & pruritus are absent.
Read 7 tweets
Pseudomonas aeruginosa (PA):

Gram-negative bacillus found widely in nature, in soil and water.

#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor @ImproveDX
The genus Pseudomonas >140 species,> saprophytic & >25 species are associated with humans. Most known to cause disease in humans are associated with opportunistic infections.

โฌ†๏ธ MR : โฌ‡๏ธ host defenses, resistance to ABX & production of extracellular enzymes & toxins.
Often found in water in sinks & can contaminate respiratory equipment, which can serve as an environmental reservoir, especially in ICUs. Is the most serious pathogen causing ventilator-associated pneumonia & remains the most important pathogen in patients with CF.
Read 15 tweets
Acute cognition change with altered consciousness & impaired attention that fluctuates over time. Often unrecognized & unRx. May be preventable & early detec/ facilitates urgent assessment &Rx 1/16
#MedTwitter #MedEd #USMLE #FOAMed #hospitalist #mbbs #medicine #doctor
The criteria for delirium listed in the Diagnostic and Statistical Manual of Mental Disorders vs Confusion Assessment Method (CAM) ๐Ÿ‘‡๐Ÿ‘‡. CAM has a sensitivity of 94% to 100% and a specificity of 90% to 95%.
2/16 Image
disturbances of sleep, altered psychomotor activity, and changes in emotion (eg, anxiety, apathy, lability, irritability, or anger). Subtypes of delirium are hyperactive, hypoactive & mixed. Hypoactive form >> hyperactive form. Inattention is hallmark. 3/16
Read 17 tweets

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