MBBS MD General Medicine aka Wolf of College Street! Tweets = own!
Jul 18 • 4 tweets • 1 min read
1) I counselled a junior of mine today.
She was not happy with her PG subject and wanted to leave it and sit for NEET PG again.
I listened to her for nearly an hour and what did I realize?
2) She has very little idea of how tough the real world of medicine is.
Most of our viewpoints, prior to residency are derived from people who are in the same soup like us!
I love passion, but I love reality more.
Jul 18 • 6 tweets • 2 min read
1) Unpopular opinion
Many people think that a degree, especially one in the medical field owes you a cushy job with perks and benefits.
Frankly, those days are over.
Degrees in isolation are becoming redundant.
You need to be knowledgeable and skilled.
Performance will be your only asset.
Jul 17 • 4 tweets • 2 min read
1) Recently I was asked whether there is an alternative to Harrison? --> I really don't think there is.
Because the book does a really good job of encapsulating gen med within its volumes SUBJECT to certain limitations of course.
2) I am committing heresy here by saying that it may have alternatives --> but its actually a question of which style suits you best.
Some prefer POC resources like UTD, some like YT and some prefer a traditional textbook.
The info is more or less the same.
Jul 17 • 6 tweets • 3 min read
1) The TB issue is huge in India because
1. TB can invade every organ system with a bewildering array of manifestations --> requires great diagnostic skills.
2. Dx methods like microscopy and even PCR often fail in case of paucibacillary disease.
3. Serology = useless
4. The interaction between the TB bacillus and the immune system is complex.
Why some people can contain it within granuloma and why it spreads hematogenously in others --> this is not well known.
Research is less focused here since TB is not a First World problem.
Jul 16 • 4 tweets • 2 min read
1) Somebody just asked me about the management of scorpion bite --> something I have never dealt with before.
Apparently, they are divided by species and by presentation --> autonomic storm/neuromuscular toxicity or DIC!
India --> Mesobuthus spp --> autonomic storm!
2) How did I learn all this within 5 minutes?
The single most important resource for internists everywhere.
I love textbooks, but this is the digital age.
Jul 16 • 4 tweets • 2 min read
The best ECG resources for the budding internist
1. Goldberger 2. LITFL 3. Dr Amal Mattu's lectures PRN
I found Schamroth and Marriot pretty tedious unless you are planning on doing cardio.
Your opinions please.
Please don't practice 1 ECG a day --> The ECG without clinical context is like Top Gun without fighter jets --> useless!
Sinus tachy by itself --> meh.
Sinus tachy in a patient with ?PE --> get me the CTPA NOW!
Jul 15 • 9 tweets • 2 min read
1) True learning is not about reading a lot of books, checking out many Tweetorials or listening to a lot of podcasts.
If that was so, everybody would have been 'successful' and not creating content about 'success'.
2) True learning is based on something I called the retention percentage --> the percentage of your knowledge that you can actually use in your day to day life.
Jul 11 • 4 tweets • 1 min read
1) Unpopular opinion here --> but something you should check out.
If you are planning on doing MD gen med residency, it might be worthwhile to do it somewhere with a relatively smaller subspecialty/gen med ratio.
2) A large and very well equipped subspecialty dept will usually directly admit all the unusual/teaching cases. Gen med can't do much here.
A smaller dept usually does not have enough staff to cover 24×7 on call and is less enthusiastic about situations like this.
Jul 10 • 14 tweets • 4 min read
1) This is Kaiser Wilhelm II of Germany (1859-1941).
He strengthened the German Empire but his erratic personality and tactless behaviour antagonized the international community.
It is believed that his unstable foreign policy was one of the major reasons behind World War I. 2) He was born on the midnight of 26th Jan, 1859 and had an extremely traumatic birth.
You can read an extensive account through this link.
1) I was reading a bit of neurology today, for exams and general knowledge.
I have always maintained a lively interest in medical history and the development of this great profession of ours.
2) I was also influenced by the fact that we have a patient admitted at present, with generalized chorea under evaluation.
Common differentials have been ruled out but we haven't made the elusive diagnosis yet.
So a bit of reading was in order.
Jul 8 • 4 tweets • 2 min read
Since there are lots of MBBS students are asking me how to approach Harrison in UG,
1) It must be hard being an MBBS student nowadays with everybody criticizing you for not having enough clinical knowledge/not going to the wards etc etc.
I don't think we should blame them for circumstances beyond their control.
2) Medical science has expanded so rapidly that you must now run, just to stay in the same place. Basic knowledge has also changed with along with our ideas of complications. Its no longer 'a simple case of anything'.
Jul 3 • 9 tweets • 4 min read
1) A terrible crash at the Grand Prix today, but thankfully no lives were lost --> and it is all thanks to this man. 2) Who was he?
Dr Eric Sidney Watkins |(1928-2012) , commonly known in Formula 1 (F1) as Professor or Prof Watkins was an English neurosurgeon.
He was the FIA F1 Safety and Medical delegate, head of the F1 medical on track team and first responder for a period nearly 26 years.
Jul 3 • 12 tweets • 5 min read
1) Gen med residents are taught to think of secondary hypertension, especially primary hyperaldosteronism, if the following conditions are met.
- young onset HTN (age < 40)
- family history
- resistant HTN
2) First of all, young onset HTN is a controversial term nowadays --> with the rise of fast food and sedentary lifestyles with pediatric obesity and metabolic syndrome --> it is entirely possible that the age may need to be shifted even lower!
Jul 2 • 8 tweets • 1 min read
1) Another case of the silent killer.
A middle aged relative of mine has been forgetting things recently --> he doesn't remember where he put his keys, his assistant's name or what he had for lunch that day.
2) His daughter calls me up and schedules a meeting.
Its borderline Alzheimers --> she worries!
What will happen to him? Is there anything to be afraid of? Should we consult a neurologist?
Jun 30 • 5 tweets • 3 min read
Bilateral locomotor brachialis in a middle aged patient with severe hypertension and severe dizziness under eval ? post circulation stroke --> 280/170 mmg Hg (manually measured 4 times by 4 different people)
I saw two cases 5 years back and they have stayed with me since.
I do not fear any disease per se but I am not ashamed to say that I dread rabies --> it is a terrible affliction.
2) The first patient was a small child of around 7 years old --> he had been bitten by a street dog around 1 month back. But his family had opted for natural healers.
When he was brought in, he was crying uncontrollably with a terror stricken expression on his face.
Jun 18 • 10 tweets • 3 min read
1) As an intern, GP or a gen med resident, you are constantly exposed to MR imaging of the brain. This is a complicated imaging modality that requires a radiologist for optimum analysis and reporting. But you must know the basic sequences and how to identify them.
2) The five most common sequence that we use in internal medicine are the T1 (with or without contrast), T2, FLAIR, DWI and ADC sequences. SWI/GRE sequences are also used in certain cases.
Jun 17 • 12 tweets • 3 min read
1) Bell's palsy (BP) is typically defined as an IDIOPATHIC unilateral LMN type CN7 palsy.
It is named after the Scottish neurophysiologist, Charles Bell. (vide infra) 2) But an LMN type CN 7 palsy is NOT the same as Bell's palsy.
It is merely the idiopathic form, often thought to be due to herpes or varicella induced direct nerve damage or as post infectious demyelination.
Jun 10 • 4 tweets • 1 min read
1) I was recently contacted by a young man who was unsure of pursuing NEET since he had a tumor during his preparatory phase which had badly derailed his studies.
He was worried that he had lost 'a lot of time' and that his peers were far ahead of him!
2) I told him something I had learnt from one of my mentors long back --> No plan in life, as in war, survives first contact with the enemy!
Jun 8 • 10 tweets • 3 min read
1) Cephalosporins are a commonly used class of antibiotics --> what's not so commonly known is that some members of this drug class can cause major bleeding complications!
4 groups of cephalosporins have been implicated in this problem!
2) This is based on the different side chains attached to position 3 of the cephem nucleus!
The first and largest group is the NMTT (N-methylthiotetrazole) side chain containing group --> cefamandole, cefotetan, cefmatazole, moxalactam and cefoperazone!