MBBS | MD Internal Medicine Resident | Health literacy & education | ⚠️ Views are my own. Not a clinical consult
Joined March 2016
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May 24
Think snoring is just an annoying habit? Think again.🚨 It could be the sound of you slowly suffocating in your sleep.
Let’s talk about OSA (Obstructive Sleep Apnea): the silent killer affecting MILLIONS who have no idea they have it👇
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A medical student asked me yesterday: "Sir, if sweating is strictly for temperature control, why do my palms and armpits get drenched in a freezing AC room right before a viva exam?"
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Dr. Priyam Bordoloi retweeted
If a doctor feels a hard, painless lump hidden in that exact area, massive alarm bells start ringing!
It is one of the most terrifying physical exam findings in all of medicine. Can anyone explain what it may indicate and why?
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Dr. Priyam Bordoloi retweeted
That spot is the left supraclavicular fossa. A hard, painless lump here is called a Virchow’s Node (and finding it is known as Troisier's sign).
Now your next question would be why it is so terrifying?
• Your body's main lymphatic drain the thoracic duct carries fluid from your entire abdomen and empties into the venous system right under that collarbone.
• If a patient has a hidden abdominal malignancy (classically gastric cancer, but also pancreatic or ovarian), tumor cells hitch a ride up this duct and get trapped in the neck. It is often the first and only sign of a silent, advanced cancer. A 5-second check can save a life. Never skip the physical exam!
FOLLOW ME for more such posts!
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If a doctor feels a hard, painless lump hidden in that exact area, massive alarm bells start ringing!
It is one of the most terrifying physical exam findings in all of medicine. Can anyone explain what it may indicate and why?
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That spot is the left supraclavicular fossa. A hard, painless lump here is called a Virchow’s Node (and finding it is known as Troisier's sign).
Now your next question would be why it is so terrifying?
• Your body's main lymphatic drain the thoracic duct carries fluid from your entire abdomen and empties into the venous system right under that collarbone.
• If a patient has a hidden abdominal malignancy (classically gastric cancer, but also pancreatic or ovarian), tumor cells hitch a ride up this duct and get trapped in the neck. It is often the first and only sign of a silent, advanced cancer. A 5-second check can save a life. Never skip the physical exam!
FOLLOW ME for more such posts!
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Dr. Priyam Bordoloi retweeted
Jun 13
Out of all major cancers, one stands out as the absolute deadliest, with the lowest 5-year survival rate worldwide. Which one is it?
A) Lung
B) Pancreas
C) Brain
D) Liver
Bonus: WHY is it so incredibly hard to survive?
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A patient asked me: "Sir, I know I have very high diabetes, but why do I have so much urination and extreme thirst? How is high sugar related to it?"
The truth is, it has absolutely everything to do with it.
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Jun 13
A patient asked me in the OPD: "Sir, I have thyroid disease, so why am I getting so thin? I thought having a thyroid was supposed to make me fat."
I had to explain that thyroid disease isn't just one..
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Dr. Priyam Bordoloi retweeted
Jun 12
You are the resident on call in the casualty. A patient is rushed in with severe Diabetic Ketoacidosis (DKA). Their blood sugar is a massive 650.
Your intern immediately reaches for the IV insulin to bring the sugar down.
You stop them instantly!
Question for the timeline: Why? What is the exact pathophysiology that makes immediate IV insulin so dangerous in this scenario and what MUST you push first?
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Jun 12
• Profound exhaustion
• Waking up 5-6 times a night to urinate
• Extreme thirst, craving ice-cold water
• Urinating up to 10 liters a day
• Blood sugar levels are perfectly normal
What is the exact diagnosis?
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Jun 12
The Diagnosis: Diabetes Insipidus
Unlike the common Diabetes Mellitus, this has absolutely ZERO to do with blood sugar.
It is a rare disorder where your brain stops making the hormone (ADH) that tells your kidneys to hold onto fluid or your kidneys simply stop responding to it.
The Danger: Flushing up to 15L of water daily leads to rapid, life-threatening dehydration and dangerous sodium spikes.
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Dr. Priyam Bordoloi retweeted
Jun 12
A family member in the casualty was furious. "Doc, my father is unconscious from liver failure and you are just giving him a laxative to make him poop? He needs brain medicine!"
I had to explain that the laxative is the brain medicine.
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Jun 12
A family member in the casualty was furious. "Doc, my father is unconscious from liver failure and you are just giving him a laxative to make him poop? He needs brain medicine!"
I had to explain that the laxative is the brain medicine.
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Jun 12
The exact pathophysiology of why a laxative is the ultimate brain medicine in liver failure. 👇
• Your gut bacteria produce toxic ammonia when digesting protein.
A healthy liver filters this out. A failing, cirrhotic liver can't, so the ammonia travels straight to the brain, causing severe swelling and a hepatic coma.
• Lactulose is a sweet syrup that acts as a highly specific chemical trap. In the gut, it converts the toxic ammonia (NH3) into ammonium (NH4 ).
Because NH4 has a positive electrical charge, it is permanently trapped in the intestines and cannot re-enter the bloodstream.
• The laxative effect then rapidly flushes these trapped toxins out through the stool.
• Once the gut is cleared, the brain's ammonia levels plummet, the swelling stops and the comatose patient slowly wakes up. Medicine at its finest.
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Dr. Priyam Bordoloi retweeted
Jun 12
The correct answer is B) Brain.
It sounds impossible, right? The very organ that processes every single pain signal in your entire body cannot actually feel pain itself.
So if the brain has zero pain receptors, why do we get such terrible headaches?
The pain isn't coming from your brain tissue. It comes from the structures surrounding it. The protective layers covering the brain (the meninges), your scalp, neck muscles and the complex network of blood vessels are absolutely packed with pain receptors. When these structures get inflamed, stretched or stressed, they send frantic pain signals TO the brain, which you experience as a headache.
This unique lack of pain receptors inside the brain tissue is exactly why neurosurgeons can perform open brain surgeries while the patient is completely awake, talking or even playing a musical instrument!
Hi, I am an Internal Medicine resident breaking down complex medical science and dropping everyday clinical pearls. FOLLOW for more!
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Jun 12
There is one organ in the human body that has absolutely zero pain receptors. Which one is it?
A) Heart
B) Brain
C) Liver
D) Stomach
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Jun 12
The correct answer is B) Brain.
It sounds impossible, right? The very organ that processes every single pain signal in your entire body cannot actually feel pain itself.
So if the brain has zero pain receptors, why do we get such terrible headaches?
The pain isn't coming from your brain tissue. It comes from the structures surrounding it. The protective layers covering the brain (the meninges), your scalp, neck muscles and the complex network of blood vessels are absolutely packed with pain receptors. When these structures get inflamed, stretched or stressed, they send frantic pain signals TO the brain, which you experience as a headache.
This unique lack of pain receptors inside the brain tissue is exactly why neurosurgeons can perform open brain surgeries while the patient is completely awake, talking or even playing a musical instrument!
Hi, I am an Internal Medicine resident breaking down complex medical science and dropping everyday clinical pearls. FOLLOW for more!
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Dr. Priyam Bordoloi retweeted
Jun 11
The Fatty Liver Timeline & Stats
The Progression:
• Grade 1 (Simple Fat) ➡️ Grade 2 (Inflammation): 20–30% of cases
• Grade 2 ➡️ Grade 3 (Fibrosis): ~20%
• Grade 3 ➡️ Grade 4 (Cirrhosis): 10–20%
The Timeframe:
• Speed: Progresses 1 stage every 7 to 14 years.
• Total time to Cirrhosis: 10 to 30 years (accelerates with diabetes, obesity, or alcohol).
How to Stop It (100% reversible early on):
• Lose 7–10% of body weight
• Zero alcohol & sugary drinks
• 150 mins of exercise/week
#GlobalFattyLiverDay #MedTwitter #LiverHealth
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