The best thing a neurologist can do for a patient with atherosclerotic stroke is refer to an internist/endocrinologist/nephrologist to adequately evaluate the manage the underlying diabetes and hypertension. I don't how it makes sense to talk about carotid stents and long term AF monitoring when the patient has a BMI of 40 or resistant HTN, possibly due to 1° hyperaldosteronism.

A very interesting experience by a senior physician I know.

He is an MD in Chest Medicine and recently admitted an 86 year old man with pneumonia causing an exacerbation of his COPD.

He tried his best - the whole team did. But the patient developed sepsis and had to be shifted to the CCU.

Things went downhill fast and soon an AKI developed.

The patient ultimately succumbed to his illness a few days back, at around 2 am in the night.

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.

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.

I have always been tremendously interested in the history of medicine and its quirky stories.

One of the most interesting is West syndrome.

This is one of the rare syndromes which is simultaneously named after a physician and a patient. In 1841, the general practitioner W.J. West from Turnbridge wrote a letter to the Lancet entitled 'on a peculiar form of infantile convulsions' describing symptomatology in his own son.

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. On exam,

Gen survey - NAD

Neuro exam

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

Spot diagnosis.

#MedTwitter
#neurotwitter 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.

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!

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.

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.

A piece of history.

Can you explain what this means?

#MedTwitter
#history
#bata
#shoes Everybody got it right.

The first word which @arshiet got partially correct is DHANUSHTANKAR ie ophisthotonus --> dhanu means bow and it refers to the person spasming into the shape of a bow.

The disease is tetanus as everybody has said!

Wear shoes and avoid pricks!

Celine Dion has developed stiff person syndrome.

Best wishes to her as she attempts to fight this condition.

#MedTwitter
#neurotwitter
#StiffPersonSyndrome
#CelineDion

washingtonpost.com/lifestyle/2022… In case, you don't know who she is --> this will remind you.

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!

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.

Middle aged patient presents with insidous onset, progressively worsening SOB.

Chest is full of wheezing and creps.

What is this?

#MedTwitter This is the HRCT thorax.

I am a big fan of @baxirahul sir and his Tweetorials.

Short, crisp and chockful of useful data --> highly recommended for physicians and patients --> for diabetes is all pervasive.

#MedTwitter
#endotwitter
#diabetes
#prediabetes

https://twitter.com/baxirahul/status/1379374504338718721

What is my personal regime?

1. Weekly BP and weight measurements.

2. Brisk walking to cover at least 7k steps/day. I also have my own exercise regimen.

1) Why is biochemistry so commonly disliked by medical students?

Because they are made to memorize metabolic pathways without rhyme or reason. 2) They spend hours memorizing the structures of amino acids and the Krebs cycle.

Its a classic case of missing the forest for the trees.

They never learn integrated metabolism as a whole and with proper clinical correlation.

1) I am presently working on curating the best free resources for medical professionals.

I will focus on the medical subspecialties.

I will also post some of my own work. 2) Why am I doing this?

Because FOAMed is the future.

Because we have some amazing work on Twitter and other SM that does not get the visibility it deserves.

I follow a lot of educational podcasts.

This is a recent addition to my list that I am finding extremely useful both as a refresher and for first time reading.

I would recomment it for gen med residents without hesitation. twitter.com/neurologywithkd

1) I have had the pleasure of listening to this podcast episode by @ebtapper and @ShreyaTrivediMD among others.

It is hands down the best review of alcohol-associated hepatitis I have had the pleasure of perusing in the past few years. @ebtapper @ShreyaTrivediMD 2) Here is the link.

https://twitter.com/COREIMpodcast/status/1590313911878025220?t=_KOOW-xsH9I8ZfFIDPjiSA&s=19

This is the most important tweet you will read today.

Vit D levels deficiency is a nebulous concept.

@hswapnil sir explains this mystery!

#MedTwitter
#Endotwitter
#NephTwitter
#VitaminD

https://twitter.com/hswapnil/status/1552678958457667586

@anujtiwari11 @vimlesh62283335 @ashwinrajenesh @DrSarahAlam @thehormoneD0C @Coffeehudigi @DrPyaricetamoI @nihar_nayak2