Gaurab Shrestha

Dr.🚑🚑..
Real Madrid fan⚽⚽..

[Dr. Marish Asudani @AsudaniMarish]

There were so many comments,

That my DMs stopped working.

Here’s the direct link to HY NUTRITION-

https://t.co/VNgYyofsTg

[olama @MohamedOlama10]

Made this

https://t.co/dC7oVD6HBq

[Jason Ryan @jasonryanmd]

Step 1 cardiac valve question cheat sheet:

Age > 70 = aortic stenosis
Age 20s-30s or pregnant = mitral stenosis (from rheumatic fever as a child)
Low ejection fraction = mitral regurgitation from dilated LV
Sudden onset dyspnea and murmur = mitral regurgitation from ruptured pap muscle or cord
Repaired tetralogy of Fallot = pulmonic regurgitation
History of IV drug use or carcinoid syndrome = tricuspid regurgitation
Tricuspid stenosis = almost never the right answer (very rare)
Pulmonic stenosis = almost never the right answer (also super rare) except for Noonan syndrome or Congenital Rubella

[Manish Yadav @dr_manish_ydv]

Orthopedics cheat sheet for #neetpg2026

1. Young male + HLA-B27 + morning stiffness + ↓ chest expansion → Ankylosing spondylitis

2. Young female + inflammatory back pain + MRI sacroiliitis (X-ray normal) → Non-radiographic axial spondyloarthritis

3. Elderly + acute back pain + steroid use → Osteoporotic compression fracture

4. Old male smoker + back pain + weight loss + pedicle destruction → Metastasis spine

5. Child + night pain relieved by NSAIDs + nidus <1.5 cm → Osteoid osteoma

6. Young adult + expansile posterior element lesion → Osteoblastoma

7. Elderly + neurogenic claudication + relief on flexion → Lumbar canal stenosis

8. 30–50 yrs + radicular pain + +SLR → Lumbar disc prolapse
Child + gibbus + cold abscess → Spinal TB

9. Child 3–8 yrs + limp + limited abduction → Perthes disease

10. Obese adolescent + external rotation deformity → SCFE

11. Newborn + positive Ortolani/Barlow → DDH

12. Elderly fall + shortened externally rotated limb → Neck of femur fracture

13. Steroid/alcohol + crescent sign → AVN femoral head

14. Young athlete + twisting injury + locking → Meniscal tear

15. Sports injury + +Lachman → ACL tear

16. Dashboard injury + posterior sag sign → PCL tear

17. Adolescent + tibial tubercle pain → Osgood-Schlatter disease

18. Old female + medial joint pain + varus → Knee OA

19. Child + fever + refuses weight bearing → Septic arthritis

20. Elderly diabetic + global restriction shoulder → Adhesive capsulitis

21. Seizure/electric shock + “light bulb” sign → Posterior shoulder dislocation

22. Painful arc 60–120° → Impingement

23. Night pain + weak abduction → Rotator cuff tear

24. Child + FOOSH + posterior fat pad → Supracondylar fracture

25. Lateral epicondyle pain → Tennis elbow

26. Medial epicondyle pain → Golfer’s elbow

27. Middle aged female + nocturnal numbness 1–3 fingers → Carpal tunnel Syndrome

28. Elderly FOOSH + dinner fork deformity → Colles fracture

29. Punch injury + 5th metacarpal → Boxer’s fracture

30. DIP nodes + Heberden → Osteoarthritis

31. Morning heel pain → Plantar fasciitis

32. Diabetic + rocker bottom foot → Charcot joint

33. 1st MTP red hot joint + hyperuricemia → Gout

34. Valgus deformity great toe → Hallux valgus

35. 10–15 yrs + sunburst pattern → Osteosarcoma

36. 5–15 yrs + onion peel periosteum → Ewing sarcoma

37. Child + metaphyseal cupping → Rickets

38. Teen athlete + cortical stress line → Stress fracture

39. FOOSH + snuff box tenderness → Scaphoid fracture

40. Dashboard injury + flexed adducted hip → Posterior hip dislocation

41. Elderly fall + intertrochanteric fracture → Most common hip fracture

42. Severe pain on passive stretch → Compartment syndrome

43. Symmetrical small joint arthritis + RF/anti-CCP → Rheumatoid arthritis

44. CKD + brown tumor → Renal osteodystrophy

45. Bone pain + ↑ALP + mosaic pattern → Paget disease

46. Steroid use + fragility fracture → Osteoporosis

#MedTwitter

[TEMP-U @We_Are_TEMPU]

How to Create an FSMB Account (IMG Guide)

Step 1 – Go to FSMB
• Open the FSMB login page
• Click “Sign up now” (even if you already have ECFMG / USMLE)

https://t.co/2ZNaEhLcPe

[Gaurab Shrestha @GaurabShresth11]

@AsudaniMarish DIP

[Gaurab Shrestha @GaurabShresth11]

@imghelpinghand Step1

[Dr. Kratik Agarwal @_Kratik_Agarwal]

Classic childhood exanthems. Should be on your tips!
INICET, NEETPG or USMLE.
#MedTwitter

[Dr. Kratik Agarwal @_Kratik_Agarwal]

Here is a high yield image bank i used for my STEP 1 USMLE. Equally useful for INICET/NEET PG

https://t.co/f97FLhZpht

[Jason Ryan @jasonryanmd]

MUST KNOW IMAGE FOR USMLE EXAMS: Anytime you see a hypersegmented neutrophil (≥5 lobes), bone marrow DNA synthesis is impaired and cells cannot divide normally. Failed attempts at division produce additional lobes. This finding is always associated with megaloblastic anemia (↑ MCV ↓Hct/Hgb). Classic causes include vitamin B12 and folate deficiency, but it also occurs with chemotherapy agents that impair DNA synthesis (MTX, 5-FU, hydroxyurea, etc). Burn this image into your memory.

[O.sama @OsamaMhawish_MD]

هذا الدرايڤ لا غنى عنه لأي أحد بحضّر لل USMLE

https://t.co/UepTiXIUd1

[Gaurab Shrestha @GaurabShresth11]

@BarcaUniversal They hate him because he barks louder than his mouth..

[Gaurab Shrestha @GaurabShresth11]

@BarcaTimes My god!! These Barca fans are just insane... Seems like these guys don't know about self realization...

[Gaurab Shrestha @GaurabShresth11]

@theMadridZone I want @realmadrid to win not for 3 points, just to shut this over confident Yamal..

[Ravi Kumar @RheumattDoc]

🧬 Monoclonal Antibody Nomenclature (WHO 2021 Update)

💡 The WHO completely revised antibody naming rules in 2021.
The old –omab / –ximab / –zumab / –umab endings (based on murine → human origin) are obsolete.
Now, antibodies are classified by structure, function, and complexity, not by species source.

🔹 1️⃣ The “–tug” Family — Full-Length Monoclonal Antibodies 🧩

🧠 Meaning: Conventional, full-length IgG antibodies (both heavy & light chains present).
🎯 Structure: Standard Y-shaped antibody; intact Fc region; can mediate ADCC, CDC, etc.
💊 Use: Oncology, autoimmune, infectious, and inflammatory diseases.
⚙️ Example: Nivolotug (PD-1 inhibitor; corresponds to Nivolumab in the old scheme).
🧾 Note: “–tug” is the new universal default stem for typical monoclonal antibodies.

🔹 2️⃣ “–bart” — Engineered Full-Length Monospecific Antibodies 🧩

🎯 Meaning: Full-length antibodies that are monospecific but contain engineered constant (Fc) regions.
🔀 Purpose: Modifications can extend half-life, reduce effector function (ADCC/CDC), or improve stability.
🧠 Function: Maintain single-target binding while optimizing pharmacokinetics or safety.
💡 Example: Ozoralbart — engineered IgG with Fc modifications.
✨ Key point: “Bart” = engineered Fc in a full-length mAb, not inherently bispecific.

🔹 3️⃣ “–ment” — Fusion Proteins 🔗

⚙️ Meaning: Hybrid proteins where one part binds a target and another part performs a biologic function.
🧬 Often receptor extracellular domain fused to Fc fragment (e.g., TNFR–Fc).
🌿 Example: Emapalment (receptor–Fc fusion, like etanercept).
💡 “Ment” = merge / segment → signifies engineered fusion.

🔹 4️⃣ “–mig” — Multispecific or Immune-Modulating Antibodies 🌈

🔄 Meaning: Complex constructs that modulate immune pathways or target multiple cell types.
🧠 Includes tri-specific antibodies, T-cell engagers, or checkpoint modulators with advanced Fc engineering.
💥 Example: Abelomig.
💬 Mnemonic: “Mig” = modulating immune globulin.

🔹 5️⃣ “–pag” — Antibody Fragments 💧

⚡ Meaning: Smaller antibody fragments such as Fab, scFv, or nanobodies.
🚀 Rapid tissue penetration, short half-life, no Fc region.
🧬 Example: Ozoralpag (similar to certolizumab-type constructs).
💡 Mnemonic: “Pag” = partial antibody globulin.

🔹 6️⃣ “–cap” — Conjugated Antibodies 💣

💥 Meaning: Antibodies linked to a payload — cytotoxic drug, isotope, or imaging agent.
🎯 Mechanism: The antibody directs delivery; the payload executes killing or tracing.
🧠 Example: Datopotocap (represents ADCs like trastuzumab-emtansine).
⚡ Mnemonic: “Cap” = carrying a payload.

🧠 7️⃣ Infixes Still Used

Although stems changed, middle syllables (infixes) still indicate the target system:
•💢 –li– / –lim– → immune or inflammatory targets (e.g., interleukins, immune cells)
•🎗️ –tu– / –tug– → tumor or oncology targets
•🌿 –ki– / –kin– → cytokine or interleukin systems
•🧬 –ne– → nervous system targets
•🦠 –vi– → viral or infectious targets

🧩 8️⃣ Why WHO Changed It

🚫 Old classification (–omab, –ximab, –zumab, –umab) reflected species origin (murine → chimeric → humanized → human).
🔬 Today, almost all antibodies are human or humanized - those distinctions no longer matter.
🌍 Modern antibodies vary by design - bispecifics, fusion proteins, ADCs, nanobodies - not by species.
✅ New naming = neutral, descriptive, adaptable.

💡 9️⃣ Big Picture Summary

🔹 Old era → “Human vs. Mouse”
🔹 New era → “Format & Function”

🧩 –tug → classic full IgG
⚔️ –bart → artificial immunoglobulin
🔗 –ment → fusion protein
🌈 –mig → immune-modulating / multispecific
💧 –pag → fragment
💣 –cap → conjugate

#RheumatDocX #MedTwitter #RheumTwitter #rheumatology @IhabFathiSulima @DrAkhilX @CelestinoGutirr

[Abdul Muqtadir Abbasi @AbbasiMuqtadir]

Residents!!! Here comes vwd cheat sheet.

#MedTwitter

[Ahmed Ata @Ahmedata7777]

Norepinephrine infusion dose calculation in shock state

Formula to use for mL/h:
[Dose (mcg/kg/min) / Concentration (mcg/mL)] x 60
​
▪︎(According to my hospital policy) usually dilute 2 ampoules (4 mg/4 ml)>>> total concentration (8 mg/8 ml) in 42 ml NS or D5W>>>> new concentration (8 mg/50 ml)= 160 mcg/ml

▪︎Dose of Norepinephrine 0.2 to 1 mcg/kg/min

If 70 kg patient, Dose 1 mcg/kg/min

1 x 70 x 60/160= 26.25 ml/hr (Maximum dose)

How do you use it according to your hospital policy in shock state? 🤔

[Journal of Brown Hospital Medicine @BrownJHM]

1 minute Neuro hand exam: ‘Check your 6'. Ask your pt to give a boy scout salute (three finger salute- median/ulnar), an Ok (ant interosseus), then play 'Rock (median), Paper (radial), Scissors (Ulnar) &amp; sign off w/ a 👍🏼 (radial) @bobvarkey #Neurology

[Mohini Maheshwari @mohinimaheshwa]

Free vs Paid AI Tools you must know!🔥

[M.Zeeshan Ghani @Zeeshan_Ghani24]

🚨 𝙉𝘽𝙈𝙀 𝙟𝙪𝙨𝙩 𝙙𝙧𝙤𝙥𝙥𝙚𝙙 𝙁𝙤𝙧𝙢 32 𝙛𝙤𝙧 #𝙐𝙎𝙈𝙇𝙀 𝙎𝙩𝙚�� 1

Must practice before exam ✅
Other key self-assessments:
✔️ NBME 26–31
✔️ UWSA 1 &amp; 2
✔️ Free 120 (old &amp; new)

Best predictors of test day readiness .
#Step1 #NBME #MedicalStudents