Srinivas

@PulmCrit What about those who cannot produce sputum

as a general rule, IGRA (interferon gamma release assay) should NOT be used as a test for active pulmonary TB if you're worried about active pulmonary TB --> isolate & get induced sputa yes, this is effort-intensive, but it's the correct way to do it

@Rheumat_Aravind Good information Sir

🧵 Clinical Pearl Paradoxical Mantoux = A previously negative Mantoux test becomes positive after initiation of anti-tubercular therapy. Mechanism: Active TB → anergy → effective ATT restores cell-mediated immunity → delayed hypersensitivity returns → Mantoux (+) Key point: ✅ Immune recovery ❌ Not treatment failure Seen in: • Miliary TB • TB meningitis • Malnutrition • Immunosuppression #Tuberculosis #MedTwitter @docakx @IhabFathiSulima #Rheumatology #ClinicalPearls

@DrMShujat Excellent info for the upcoming doctors!

6️⃣ Eyes Examine: Conjunctiva → pallor Sclera → jaundice Cornea → Kayser-Fleischer ring Pupils Nystagmus Fundoscopy if needed 7️⃣ Mouth & Tongue Look for: Central cyanosis Oral ulcers Angular stomatitis Glossitis Poor dentition Candidiasis Dehydration Fetor hepaticus Gum hypertrophy Tongue clues: Smooth → B12 deficiency Tremulous → thyrotoxicosis Dry → dehydration 8️⃣ Neck Examination Neck Veins JVP Lymph Nodes Always check: Cervical Axillary Inguinal Thyroid Examination Enlargement Nodules Tenderness Carotids Bruits if indicated 9️⃣ Chest & Skin Look for: Scars Rashes Pigmentation Spider nevi Petechiae Purpura Striae Edema Pressure sores 🔟 Lower Limbs Check: Pedal edema Cyanosis Varicose veins Ulcers Calf tenderness Peripheral pulses 1️⃣1️⃣ Anthropometry (When Relevant) BMI Waist circumference Mid-arm circumference

General Physical Examination (GPE) Scheme for Residents & House Officers [This Is the Scheme I Follow as a Resident] A structured GPE is not just a ritual, it often gives the diagnosis before investigations arrive. 1️⃣ Start From the End of Bed Before touching the patient, observe: Sick or comfortable? Conscious level Body build & nutritional status Posture & gait Respiratory distress? Pallor / jaundice visible? IV lines, catheters, oxygen, drains Abnormal movements Facial appearance (Cushingoid, acromegaly, Parkinsonian, myxedema etc.) This “end-of-bed impression” is highly underrated. 2️⃣ Vital Signs (Never Skip) Pulse Rate Rhythm Volume Character Radio-radial delay Radio-femoral delay Blood Pressure Both arms if indicated Postural BP if dizziness/syncope Respiratory Rate One of the most ignored yet most important vitals. Temperature Pattern matters. Oxygen Saturation 3️⃣ General Survey Build & Nutrition Cachexia Obesity Muscle wasting Dehydration Mental Status Orientation Agitation Confusion Drowsiness Hydration Status Look for: Dry mucosa Sunken eyes Poor skin turgor Hypotension 4️⃣ Hands Examination Look at: Pallor Cyanosis Clubbing Koilonychia Leukonychia Nicotine staining Tremors Flapping tremor (asterixis) Peripheral cyanosis Dupuytren contracture Osler nodes / Janeway lesions Capillary refill Palms may diagnose: Liver disease Endocarditis Thyrotoxicosis Chronic hypoxia 5️⃣ Face Examination Look for: Pallor Jaundice Cyanosis Facial puffiness Malar rash Butterfly rash Moon face Mask facies Ptosis Exophthalmos Xanthelasma Facial asymmetry

@DrAyubaD Sail sign. Pneumomediastinum

EASY ONE 🔥🔥EMERGENCY 🔥🔥 Newborn with respiratory distress and sudden deterioration. Chest X-ray done Spot the special sign. What is your diagnosis ? #MedX image courtesy ;

@HYDTP What class of fire extinguisher is advised? Thank you.

@TimesAlgebraIND Also the effect of CBN

BIG BREAKING NEWS 🚨 MASSIVE 50% Biharis have voted for BJP in Delhi 🔥🔥 Next Election is in Bihar !! Record 40% South Indians voted for BJP as per Axis My India. MASSIVE improvement after Annamalai campaigned here. 54% Haryanvis and 57% Pahadi voters of Uttarakhand and Himachal respectively backed BJP 🔥

@RShivshankar Another Pakistan in making! Can't say God save Canada , as HE too is fed up with their pruile antics

Shocking! Canada state broadcaster (CBC) mainstreams a Xenophobe, religious exclusivist like Pannu to incite hate attacks against Hindu-Canadians calling into question their loyalty to Canada and suggesting that they should be expelled. A state broadcaster can't be acting on its own. This is nothing but the Canadian state sponsoring hate and extremism!

@x_rahulraj Valid point.

India is a victim of excessive political discussions. The youth of this country who should be learning, creating, implementing, improving, and working on nation-building are getting lost in politics or entertainment.

@CYBTRAFFIC Sir, Was issued double challan for the same violation at the same time in Cyberabad jurisdiction. Called the numbers in website but getting re-directed to call multiple personal numbers without any solution. Please help in resolving the issue. Thank you.

@HYDTP Sir, Was issued double challan for the same violation at the same time in Cyberabad jurisdiction. Called the numbers in website but getting re-directed to call multiple personal numbers without any solution. Please help in resolving the issue. Thank you.

@orangebook Very true!

Life gets better once you realize that no one cares about your past struggles, people only care about what they can see, about who you are today, and whether you can bring any joy or value into their lives.

@balaji25_t Thank you Sir for your efforts to keep us updated. Appreciate your untiring dedication and concern towards the people of TS in general and Hyderabad in particular. You deserve all round applause for it. Have a wonderful day!

Widespread rains occured in North Telangana during overnight hours ALERT ⚠️ The depression impact to turn massive as widespread downpours ahead in North, East, Central Telangana during next 72hrs with FLOODS expected at few areas ⚠️ Hyderabad asusual we'll have moderate rains, gloomy ముసురు kind of weather these 72hrs

@TimesAlgebraIND We decide our foreign policy as per our needs and requirements. Can not be to the interest of a third party which never supported India in any international forms

🚨 Ukrainian President Zelensky criticises PM Modi. He said "Its a huge disappointment that leader of World's largest democracy hugs bl00dy criminaI in Moscow" Zelensky didn't like PM Narendra Modi meeting Russian President Vladimir Putin in Moscow. "This is a devastating blow to peace efforts" - He said