*PROS & CONS of MD/DNB MEDICINE* Based on my little understanding. Hope it helps #NEETPG2023 candidates. Medicine as a subject demands a great deal of mental exercise and an analytical attitude to garner a decent clinical acumen. 1/n #MedTwitter #medicine #counselling

Medicine is full of paradoxes. But every paradox is just physiology you haven’t understood yet. Follow 👉 @AshutoshSinghMD for such scientific insights!

1️⃣2️⃣ Paradoxical Septal Motion Septum moves wrong way in RV overload LBBB & post-CABG (Normally IVS moves towards LV during systole) 💡 Physiology: increased blood volume/pressure in the right ventricle → septum displaced toward RV during systole. Eg: left to Rt shunt, PAH

1️⃣1️⃣ Paradoxical Hypertension Beta-blockers worsen BP in pheochromocytoma 💡 Physiology: Unopposed α-adrenergic vasoconstriction (pheo) Moral: Never fight a hormonal tumor with half a strategy. Give a drug that blocks both ie phenoxybenzamine

🔟 Paradoxical Aciduria Metabolic alkalosis but urine loses acid instead of removing excess alkali 💡 Physiology: Hypochloremic, hypokalemic states → kidneys excrete H⁺ to retain Na⁺ via H⁺/Na⁺ exchange. Volume > acid-base logic. kidney sacrifices acids to retain fluid.

9️⃣ Paradoxical Splitting of S2 P2 before A2, and inspiration narrows the split (Opposite of normal) 💡 Physiology: Delayed LV emptying (LBBB, AS) → A2 delayed beyond P2; inspiration increases venous return → A2–P2 gap reduces.

8️⃣ Paradoxical Reaction (TB) in HIV Start ATT → lesions worsen. 💡 Physiology: As bacillary load drops, immune system rebounds → exaggerated inflammatory response (IRIS). Moral: Sometimes healing looks like harm.

7️⃣ Paradoxical Breathing Inspiration pulls chest inward instead of moving up. 💡 Physiology: Negative intrathoracic pressure + flail segment in multiple rib # → chest wall sucked in; diaphragm palsy → abdomen moves opposite. Loose muscles are sucked in.

6️⃣ Paradoxical Embolism Venous thrombus → arterial stroke. 💡 Physiology: Through a PFO or ASD, a venous clot bypasses lungs → goes straight to arterial circulation. Irony: a DVT arterial thrombi (stroke)

5️⃣ Warfarin Paradox Start warfarin → patient clots. 💡 Physiology: Protein C & S (natural anticoagulants) fall faster than procoagulant factors → transient hypercoagulability. Lesson: Bridge it, or it bridges you to catastrophe.

4️⃣ Obesity Paradox In HF, CKD, post-MI — mild obesity = better survival. 💡 Physiology: Adipose stores anti-inflammatory cytokines, gives metabolic reserve, buffers catabolism. In some diseases, BMI lies and outcomes surprise!

3️⃣ French Paradox High-fat diet, low CAD rates. 💡 Physiology: Moderate wine = ↑ HDL, ↓ platelet aggregation, polyphenols ↓ oxidation. Lifestyle > lipid profile. 👉🏻It wasn’t wine. It was walking to lunch instead of driving that created paradox

2️⃣ Oxygen Paradox Reoxygenation after hypoxia worsens injury. 💡 Physiology: Sudden O₂ influx → mitochondrial ROS → lipid peroxidation → cell death. Reperfusion saves tissue… but kills cells. 👉🏻Even oxygen can overdose you.

1️⃣ Pulsus Paradoxus Actually exaggeration of normal physiology BP drops >10 mmHg during inspiration (tamponade, asthma). 💡mech: Inspiration ↓ intrathoracic pressure → ↑ RV filling → septum bulges left → ↓ LV stroke volume → ↓ systolic BP. No pulse felt in inspiration

🧵 Paradoxes in Medicine — where physiology laughs at logic Life saving oxygen kills Anticoagulant induces clots ! A fat patient who lives longer ! Here are 12 such paradoxes you scratch your head at, with underlying physiology 1/12 #MedTwitter #Medicine #FOAMed @DrAkhilX

Folks stay away from NNN ! NNN= N-Nitrosonornicotine, a potent tobacco-specific carcinogen found in various tobacco products including cigarettes & smokeless tobacco.

You either retire a hero or rule long enough to see yourself become a villain

Describe the JVP ! It is the most misunderstood part of CVS examination, Yet the single most informative tool of RIGHT HEART function Let’s decode the JVP🧵1/9 #CardioTwitter #MedTwitter #FOAMed #MedEd #MedX #JVP

Now the answer : That’s a giant v-wave + rapid y-descent → Tricuspid Regurgitation The JVP is a measure of not just your right atrial pressure, but also your exam pressure. 😂 Follow @AshutoshSinghMD if you like the thread 😇

Bonus: 🏆 Hepatojugular reflux: Sustained hepatic pressure → transient rise in JVP > 3 cm indicates RV failure. Inspiratory changes: Normal fall in JVP; rise indicates pathology Earlobe or scalp pulsations: Suggest severe TR. 9/9

Blunted Y descent: Cardiac tamponade. (Hampered RV filling ) Kussmaul’s sign: Inspiratory rise in JVP—seen in constrictive pericarditis, restrictive CM. Absent A wave: Atrial fibrillation. 8/9