MD General Medicine
DM Neurology resident
Medical College Kolkata
Jun 10 • 10 tweets • 3 min read
An important teaching case
A 45 year old lady with significant vascular risk factors presented with hyperacute onset dimness in the L side of her field of vision, specially in the bottom half.
There is no other significant neurological or systemic hx.
Clinical examination revealed only a BP - 150/90, R arm, sitting position with confrontation perimetry showing an incongruent, incomplete L sided homonymous hemianopia.
Jun 10 • 6 tweets • 2 min read
A lot of referrals to neurology are basically what I like to call 'lazy' referrals.
For example, you get a patient with paraparesis and instead of performing a detailed clinical evaluation, you shotgun some MRI and NCS and send a quick referral to neurology.
Since these investigations are poorly chosen and poorly aimed, the end result is mass confusion where localization goes for a toss.
General medicine has been particularly egregious in this regard.
Mar 30 • 11 tweets • 4 min read
Interesting case in the ward today!
37y male first presented 10 yrs back, with insidious onset, progessively worsening R loss of vision --> complete blindness by 6 months.
He now presents with similar involvement of the L eye.
No other neurological/systemic hx.
Gen survey - NAD
CN 2 - R sided only perception of light, L finger count at 4 feet with colour desat, fundoscopy - B/L optic disc pale, L eye temporal hemianopia
CN 3,4,6 - EOM full in all directions, both pupils mid dilated and sluggishly R to light
Feb 5 • 9 tweets • 2 min read
I have not shown any demonstration of muscle power here but this patient had grossly weak (1/5) shoulder girdle muscles, including the biceps brachii.
Feb 3 • 4 tweets • 2 min read
I am no nephrologist but I deal with the aftermath of inappropriate treatment with tolvaptan all the time.
This information is obtained from the FDA access data from 2009.
Look at the indications.
Many people forget that many patients who are being treated with tolvaptan are either on fluid restriction or are dehydrated.
This can be exacerbated by ADH antagonism --> severe aquaresis --> serum Na shoots up --> VERY HIGH RISK of osmotic demyelination syndrome aka CPM!
Dec 13, 2022 • 12 tweets • 3 min read
1) I have been on social media continuously since class 8 --> that was back in 2008.
I began with Orkut and I have tried everything from the usual suspects like Meta (FB), Twitter and Ig to Reddit, Snapchat, Twitch and recently Mastodon.
These are some observations I have made.
2) The man or woman who follows everyone and everything is not worth following.
Not everything/everybody is worth your time.
Dec 12, 2022 • 5 tweets • 2 min read
1) The simplest thing that you can do to improve your/your family's health?
Use Google Tasks or a similar service to schedule periodic health checkups like blood pressure/weight check or blood sugar testing (if you don't do SMBG).
2) All habits require a cue.
These regular reminders will be the cue --> without a proper timely cue --> you don't have a concrete plan --> you don't have a plan --> you don't check --> you don't check --> you don't assess your health.
1) There are many books on clinical medicine and most of them are horrible.
Here is my curated list.
The first and most important book has to be Dr. Boloor's text.
Well written and compiled, it has all the little snippets that Indian examiners love.
Best Indian book imo. 2) The book for the discerning internist.
You will love this if you are into medical history.
This is not for beginners since it often delves deep into stuff that have little knowledge of, YET!
Nov 30, 2022 • 4 tweets • 2 min read
What is the best physiology book for 1st year?
It this one in my humble opinion.
Crisp, sufficiently detailed with good diagrams and explanations for various phenomena --> this is my Grade A recommendation.
I have gone through Ganong, Guyton, Taylor and Boron & Boulpaep ---> those are NOT for beginners.
The Indian textbooks are okayish but the diagrams are pretty terrible.
That is where Lippincott wins hands down.
Nov 30, 2022 • 7 tweets • 5 min read
Middle aged patient presents with insidous onset, progressively worsening SOB.
I normally don't push brands on social media but @SkechersIndia has to be an exception.
I have suffered from plantar fasciitis for years and it has been gruelling.
I have tried every brand --> homegrown to foreign and most of those don't work.
I bought this pair of running shoes a few days back and put them through the paces.
They are amazing. No doubt about it.
Single best pair of shoes I have ever worn.
Nov 23, 2022 • 7 tweets • 2 min read
1) The most important aspect of a medical residency and one that I always pay great heed to --> how well you are able to follow up your patients.
I cannot overstate how vital this is.
2) A lot of residents love talking about how they have seen this case and that --> but they have no case details and have no longitudinal data on the patient.
It means nothing.
Nov 22, 2022 • 6 tweets • 2 min read
1) This was an interesting case that I heard on a podcast yesterday.
A young patient with a diagnosis of Friedrich's ataxia EXCEPT it wasn't.
2) Dr Bertoni from @NeurologyUNMC who was a young neurologist at that time, goes against popular knowledge and makes a different diagnosis and starts treatment.
The patient improves drastically and manages to go home!