Anmolpreet Kaur Grewal
@anugrewal19
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ECFMG certified medical graduate (2023) - Punjab, India Match 2025 applicant for Internal Medicine @CPSolvers Academy member
Joined April 2022
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VEXAS Syndrome
An autoinflammatory ds associated with Relapsing Polychondritis
Interestingly,both ds present with non specific & apparently unrelated symptoms
I got a chance to discuss about them & UBA1 gene in my presentation
@CPSolvers
#medx
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A lot to reflect on.
It makes us think of an important cause of Intracerebral Haemorrhage (can be fatal) which needs to be considered aside from hypertension, AVMs, blood thinners:
@CPSolvers
Loved
@GlassHealthHQ
consult on Right sided Pronator Drift!
@GlassHealthHQ
Consult was so helpful in today’s
@CPSolvers
Virtual Morning Report!
Official release 2.19.24! Mark your 🗓️
@anugrewal19
brilliantly presented to
@huitingruan
&
@rabihmgeha
R-side pronater drift on exam. To refresh my memory, I asked Glass Consult
🔥 response!
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Glioblastoma multiforme (GBM) :- Grade 4 Astrocytoma
Most common primary malignant brain tumor in adults (although metastasis>primary)
Mostly diagnosed in ages 60-70 years
Symptoms:- non-specific neurologic symptoms-> headache, seizure, focal deficits
Highly infiltrative tumors
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@rabihmgeha
@DxRxEdu
From what I read:-
1. Long standing Hypothyroidism: causes elevated LDL & TG levels
2. Long standing Diabetes Mellitus(atherosclerosis)
3. Glucagonoma & associated MEN1
4. Cushing Syndrome by increasing procoagulant factors and decreased fibrinolysis(like many other endocrine ds)
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Thankful for the platform which has allowed me to sharpen my skills and improve my knowledge. Love to interact and learn from so many amazing people from all over the world.
How strong can your clinical reasoning skills be even before residency?
See if for yourself as these incredible
@CPSolvers
team members showcase in this outstanding VMR teaching recap
Breathtaking.
@maryanamribeiro
@drtansue
@JiazhangXing
@anugrewal19
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@drpraveenpsy
@theliverdr
Confrontational and disrespectful? Lol. Do you mean he speaks truth?
Should he start with Respected Sir and end with thank you? That is people just fall for words?
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@rabihmgeha
@DxRxEdu
Adding to what everyone mentioned, if it is accompanied by a petechial/purpuric rash, levels of Cryofibrinogen should be checked in case we are not able to diagnosed an isolated vasculitis; as cryofibrinogenemia is known to lead to the development of arterial/venous thrombi.
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ICU stories!!
#MedTwitter
Critically ill patients need FAST HUG BID
Feeding
Analgesia
Sedation
Thromboprophylaxis
Head End elevation
Ulcer(Stress) prophylaxis
Glycemic control
Bowel movements
Invasive lines
De-escalation of antibiotics
Reinforces the importance of HUGS ! :)
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A beautiful mnemonic which includes pretty much everything that needs to be assessed in a patient, and if followed dedicatedly and efficiently, can save many many lives.
And it serves as a reminder to all,
keep giving hugs to your loved ones! BID, TID, QID, however you want.
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Astrocytoma-Grading based on histology & indicates prognosis
Grade 1: Pilocytic astrocytoma-most common primary brain tumor in children, mostly affects cerebellum
Grade 2: Diffuse astrocytoma
Grade 3: Anaplastic astrocytoma
Grade 4: Glioblastoma multiforme(areas of necrosis seen)
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Mainstay of treatment: maximal surgical resection
For the surrounding infiltration: radiation and chemotherapy is done following immunohistochemistry results
Also, GBMs have a high rate of recurrence.
Spontaneous intracerebral haemorrhage is frequently associated with
#GBM
.
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The tumor cells invade the surrounding brain tissue by migrating or Infiltrating, therefore it is almost impossible to remove the tumour entirely by surgery.
“On imaging, areas of increased T2/FLAIR signal surrounding the main tumor mass contain invading tumor cells.”
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Diagnosis: CT Brain / Contrast enhanced Brain MRI
#medtwitter
“Patients with atypical ICH are evaluated over time through repeat CT or MR imaging even if no evidence of brain tumor on histological and radiological findings exists.”
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Risk factors: Older ages (60-70 years)
Mostly males
Prior history of radiation
Family history of gliomas
A comprehensive history taking is important, to rule a tumour out especially in case an elderly male presents with intracerebral haemorrhage.
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@rabihmgeha
@DxRxEdu
Mostly we see Normocytic Anaemia in End Stage Renal Disease as it is related to deficiency of Erythropoietin.
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I: The day of insertion of Invasive lines and indwelling catheters should be noted & tried to remove as soon as possible to prevent nosocomial infections
D: De-escalation of antibiotics from broad-spectrum to narrow-spectrum once the organism is identified to prevent resistance.
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@ML_Philosophy
Lol if by manners you mean : a facade on the face and lips and no respect or love from inside… I don’t think it matters!
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@TrainingMindful
Being a Doctor, I am qualified enough to say that the health of most of the people does not come from medicine but the things mentioned.
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@AfiyaWB
I heard it somewhere that we break our fasts everyday after a night of not eating. Hence the first meal of the day is called ‘breakfast’. Not talking about the fasts kept in the day.
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S: To ensure adequate sedation if required (esp in intubated patients). Care should be exercised not to over sedate the patient impacting his vital signs. GCS to be assessed every hour.
T: Thromboembolic prophylaxis is important in bedridden patients, immobile, post surgical.
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F: To ensure the patient's intake is good, is being fed properly which helps in healing. Enteral is preferred over Parenteral
A: To ensure adequate analgesia, not more; not less. Pain score to be assessed every hour, vocally if possible, or by visual scale.
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H: Head end should be elevated 30-45º which minimises the risk of gastric reflux, aspiration, ventilator associated pneumonia
U: Ill patients can develop mucosal damage which could possibly lead to GI Bleed, prophylaxis with PPIs, H2 receptor blockers.
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G: Both hypoglycemia and hyperglycemia need to be looked out for. Previous history of DM? Regular RBS checking should be done.
B: Monitoring if patient has passed stool/not, number of bowel movements, consistency of stools, bowel sounds, abdominal distension.
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