Estimated reading time: 7 minutes

In a soulful discussion filled with gratitude, humility, and inspiration, Dr. Thallapalem Chaithanya shared his wholesome journey of preparing for and passing the DNB Anesthesia practical examination with an excellent score.
His ultimate success story not only highlights his pure dedication but also exhibits how eConceptual created such a structured learning approach that helped him turn anxiety into achievement.

Meeting His Mentor

“He said, It’s a pleasure to meet you, ma’am. You are one of my idols. Your wonderful teaching style feels like storytelling; the way you explain things makes us think, imagine, and understand medicine creatively.”

Those were the first words Dr. Thallapalem Chaithanya shared with Dr. Jhanvi Bajaj, while expressing his commendation for her teaching ways that perfectly merge with clarity and curiosity. His curiosity and excitement were very obvious; after all, meeting one’s mentor after achieving success is always an emotional milestone.

Although Dr. Jhanvi Bajaj heartily congratulated him, while also acknowledged that clearing the DNB practicals is not that easy to clear. The discussion that followed was a deep and perspective discussion about all the preparation strategies, useful resources, and lessons for future aspirants.

The Preparation Strategy

When she asked about how he prepared for the practicals, Dr. Thallapalem Chaithanya shared his perfectly structured plan:

“His clear-cut words were,” The only resource I used was eConceptual, along with the Tata Memorial book, and nothing else.”

Overall, after receiving his DNB theory results on August 15th, he found that the practical exam date was scheduled for September 3rd. Later, his batch was shifted to September 23rd, giving him extra time, which he utilised fully.

“He said, I started by watching all OSCE videos on the app and completed 70% of case discussions, which was really helpful. I also revised videos on JVP, pulse, and blood pressure, the basics that sometimes come up unexpectedly in exams.”

He used to revisit videos multiple times because it helps to improve his conceptual clarity and confidence, especially during the final week before the exam.

His Key Strategies That Made the Difference:

• He used to go through with eConceptual’s Case Discussion videos and PYQs, which helped him to understand the real-life anesthesia cases and examiner expectations.
• He depends upon the core anesthesia textbooks just to strengthen the conceptual foundations and communicate theory with eConceptual’s video learning.
• He slightly maintained a perfect balance between theory and practical preparation, which ensures that both exam performance and clinical reasoning skills are improved.
• He managed his valuable time in revision productively and prioritised the repeated review of important topics before the final exam.

The Power of eConceptual’s Learning Ecosystem

Dr. Thallapalem Chaithanya later discovered the eConceptual a year before his exam through Instagram. The app’s interactive interface and comprehensive study resources caught his attention immediately, so he decided to go with it in further studies.

“The most appreciable feature of eConceptual is its books, the Master Solutions series. I used only these for theory and scored 245 out of 400. The explanations are generally reflected with images and color-coded layouts that make the learning process efficient and memorable for me.”

He foregrounded that reading from Master Solutions twice can directly help him cover approximately 80% of his actual exam questions. The visual diagrams and simple flowcharts allowed him to reproduce answers confidently and understand the part perfectly during the written and oral exams.

Download the official Conceptual Anesthesia App now to explore the same resources that helped Dr. Chaithanya achieve his dream!

Practical Exam Experience

Recalling his practical experience, Dr. Chaithanya mentioned two long cases:

• Chronic Liver Disease with Diabetes Mellitus for lower limb debridement
  
• 80-year-old male for Total Knee Replacement (TKR)

Examiners focused on basic concepts like the dose of buprenorphine and differences between hyperbaric and isobaric drugs. The eConceptual videos prepared me for exactly these kinds of questions.”

He also attended the ISA Target Conference in Hyderabad, where real-time case discussions and viva simulations refined his clinical reasoning.

“The conference taught me one thing: never stay silent. Examiners don’t want to fail you; they just want to see your thought process.”

From Nervous to Confident

When asked if he was nervous before the exam, he smiled:

“No ma’am, I felt confident because I had used the extra time wisely. eConceptual’s videos and books gave me both conceptual clarity and mental calmness.”

He shared how watching even the basic MBBS-level videos helped him prepare for unexpected questions, a reminder that in medicine, fundamentals always matter.

Suggestions for Improvement

Dr. Thallapalem Chaithanya had thoughtful feedback for the eConceptual team:

“It would be great to have a book for OSCEs, since many of us are new to that format. A written guide, along with the videos, will be revised faster.”

He also appreciated the recent updates in the app, including the new drug summaries and simplified simulation diagrams in Master Solutions.

“The diagrams make it easier to remember and revise. It’s almost like visual memory training.”

Words of Gratitude

Throughout the conversation, Dr. Chaithanya’s humility stood out. He thanked his faculty, colleagues, and family, especially his wife, an OBGYN resident who also scored remarkably in her exams.

“My wife stood by me through everything, taking care of our baby while I studied. My parents and in-laws also supported me immensely. Having such a support system made all the difference.”

He also expressed heartfelt gratitude toward his fellow department and mentors for providing a favourable environment to study and grow.

His Thoughts on eConceptual Faculty

In a touching moment, he acknowledged the legendary faculty who made his journey special:

“Dr. Gobind Rai Garg Sir’s pharmacology classes, Dr. Gurushanthi Ma’am’s detailed case discussions, Dr. Gargi Deshpande Ma’am’s cardiac anesthesia sessions, and Dr. Saurabh Dhananjay Sir’s lectures on TBI, each of them helped me at different stages.”

He added that eConceptual’s collaboration-based learning allowed him to prepare seminars and presentations during residency seamlessly.

“Whenever I had to give a seminar, I just searched the topic on my Conceptual Anesthesia app, watched the video, and used the notes. It made my presentations much stronger.”

Message to Juniors

His advice to upcoming residents is simple yet powerful:

“Even if you have a month before exams, start using eConceptual. The combination of books, videos, and updates gives complete coverage.”

He believes printable books with visuals and structure are rare assets in digital learning, and that’s where eConceptual stands apart.

Looking Ahead

Before wrapping up, he requested that Dr. Jhanvi Bajaj make a special video for post-residency guidance for future doctors. So they can also cover fellowships, shadowing, and academic pathways. She promised him that we are already working on such content, including the Super Speciality (SS) Recall Question Bank with video explanations.

Final Thoughts

Dr. Thallapalem Chaithanya’s professional journey demonstrates that success in medicine stems from a combination of compatible conceptual learning, disciplined revision, and the right guidance. With the conceptual anesthesia app’s well-organized resources and expert mentorship, he transformed exam stress into achievement.

Watch the full official interview of Dr. Thallapalem Chaithanya and Dr. Jhanvi Bajaj, a must-watch for every anesthesia resident preparing for DNB or MD practicals.

Click here to watch the interview

Estimated reading time: 3 minutes

Hemolytic anemia happens when red blood cells are destroyed faster than the body can replace them. It is often seen in ICU patients, but it can occur in many other situations. Knowing what causes it, how it presents, and how to manage it is important, both in exams and in clinical practice.

Causes You Should Know

Hemolytic anaemia can arise due to several factors:

• Autoimmune conditions: Warm or cold autoimmune hemolytic anaemia.
  
• Medications: Drugs like 5-FU, methyl dopa, quinine, dicloquinac, penicillins (especially piperacillin), and cephalosporins.
  
• Infections: Malaria, viral hepatitis, Epstein-Barr virus, or septic shock.
  
• Transfusion reactions: Sometimes anemia appears after a blood transfusion.
  
• Medical devices: Patients on ECMO, Impella, or other extracorporeal devices can develop hemolysis.
  
• Underlying conditions: SLE, L-syndrome, G6PD deficiency.
  
• Toxins and bone marrow suppression: Certain chemicals or marrow problems can trigger it.

Exam tip: A patient’s history often gives the clue. Look for recent blood transfusions, new drugs, fever, or travel history.

Click Here to Watch: Understand Hemolytic Anemia by Dr. Kishore Mangal

Clinical Signs to Watch

Physical examination and history are very helpful:

• Jaundice: Most patients show unconjugated hyperbilirubinemia.
  
• Urine color: Dark urine suggests conjugated bilirubin. Pale urine usually indicates unconjugated bilirubin.
  
• Extravascular hemolysis signs: You may notice splenomegaly.
  
• Vascular complications: Seen in conditions like sickle cell anemia.

History points to consider:

• G6PD deficiency: Triggers include surgery, infection, or certain oxidant drugs.
  
• Weight loss or night sweats: Could indicate hematological malignancy.
  
• Joint pain: May suggest autoimmune disease such as SLE.

Lab Clues

Certain lab tests can help confirm hemolysis:

• Peripheral blood smear:
  
  • Schistocytes indicate microangiopathic hemolytic anemia (like TTP, HUS, or DIC).
    
  • Microspherocytes are typical of autoimmune hemolytic anemia.
    
  • Sickled cells appear in sickle cell disease.
    
  • Bite cells suggest G6PD deficiency.
    
  • Target cells and basophilic stippling indicate thalassemia or alcohol abuse.
    
  • Ringed sideroblasts can be seen in congenital disorders or myelodysplastic syndromes.
    
• Other lab markers:
  
  • Reticulocyte count is usually high—showing active marrow response.
    
  • LDH is often elevated.
    
  • Haptoglobin is low in hemolysis.
    
  • Direct Coombs test helps differentiate warm vs. cold hemolytic anemia.

Warm vs. Cold Hemolysis

• Warm hemolysis: IgG antibodies attack RBCs at body temperature. Causes include idiopathic autoimmune anemia, infections, certain drugs, lymphoproliferative disorders, and SLE.
  
• Cold hemolysis: IgM antibodies act at cooler temperatures. Often post-infectious, like EBV or influenza, or paroxysmal cold hemoglobinuria.

Management

Treatment depends on type and severity:

• Acute hemolysis: Plasmapheresis may be necessary in emergencies.
  
• Warm hemolysis: Steroids are first-line. Refractory cases may need splenectomy or immunosuppressants. Rituximab is also useful. IVIG has a limited but occasional benefit.
  
• Cold hemolysis: Avoid cold exposure. Severe cases may require plasmapheresis. Rituximab can help if the problem persists.

Intravascular vs. Extravascular Hemolysis

• Intravascular: RBCs are destroyed in circulation. Labs show free hemoglobin in plasma or urine, very low haptoglobin, high LDH, and abnormal RBC shapes.
  
• Extravascular: RBCs are destroyed in the liver and spleen. Less free hemoglobin is released, LDH is mildly elevated, and blood smears may show fewer abnormalities.

Takeaway

Hemolytic anemia has many faces, from autoimmune causes to infections, drugs, and genetic conditions. Careful history, thorough examination, and targeted lab tests are key. Knowing the differences between warm and cold hemolysis, as well as intravascular vs. extravascular destruction, guides treatment and improves patient outcomes.

Estimated reading time: 5 minutes

When any resident enters modern anesthesia, local approaches have transformed how we manage pain before, during, and after surgery. Instead of depending upon systemic medications, these unified techniques allow all the anesthesiologists to target all the specific nerves, which include reducing pain and enhancing recovery. Let’s walk through some essential nerve blocks, their mechanisms, and clinical applications in a very clear form, as it will be easy to follow. 

The Erector Spinae Plane Block: A Rising Star in Thoracic Surgery

Have you ever imagined a patient has been undergoing thoracic surgery for a lobectomy? Basically, the anesthesiologists depend upon the thoracic epidurals or paravertebral nerve blocks, which help to control pain. While epidurals are familiar and widely practiced, they often deal with challenges like they have to suffer from technical difficulty, risks of hypotension, and sometimes they have limited postoperative use.

This is where the Erector Spinae Plane (ESP) block shines. That is usually performed under ultrasound guidance, as it is kind of simple and safe, which helps to make it increasingly popular.

Anatomy in Action

The erector spinae group consists of three muscles, spinalis, longissimus, and iliocostalis, running parallel to the spine, anchored over the transverse processes of the vertebrae. From superficial to deep, these muscles are covered by the trapezius and rhomboid, before resting directly over the transverse process.

During an ESP block:

• The ultrasound probe is placed longitudinally, just parallel to the spine.
• The three muscle layers (trapezius, rhomboid, erector spinae) are visualized clearly.
• A needle is advanced until it touches the transverse process.
• About 20 ml of local anesthetic, like bupivacaine (0.125–0.25%) or ropivacaine (0.2%), is deposited beneath the erector spinae muscle.

As the drug spreads, it lifts the muscle off the transverse process, creating a visible “plane.” This diffusion blocks the dorsal rami, providing pain relief for 2–3 dermatomal levels. With some spread, even ventral rami and intercostal nerves can be affected, extending analgesia to the anterolateral chest wall.

Clinical Use

The ESP block is excellent for:

• Thoracic surgeries
• Spine surgeries
• Rib fractures
• Some breast surgeries (though paravertebral blocks remain superior for mastectomies)

Its mechanism? Diffusion of the anesthetic into the paravertebral and epidural spaces, covering both dorsal and ventral rami. Simple, elegant, and effective.

The Greater Occipital Nerve Block: Relieving Headaches

Headaches can be tiring, especially when it is linked to subcortical neuralgia or a person who has

 migraine syndromes. So now, here is the Greater Occipital Nerve Block (GONB) provides targeted relief.

Finding the Right Spot

It is necessary to find the right spot, so the greater occipital nerve runs close to the occipital artery, which makes the landmarks essential:

• Occipital protuberance, there is a prominent bump at the back of the head)
  
• The mastoid process is basically behind the ear bone.

Draw a line between the two, and at about one-third from the occipital protuberance, you’ll find the injection point. Alternatively, you can palpate the occipital artery and inject just medial to it.

Another quick trick? Go 2 cm inferior and 2 cm lateral to the occipital protuberance.

Only a small volume, 2–3 ml of local anesthetic (often 0.25% bupivacaine with dexamethasone), is required.

Indications

• Migraine
• Cluster headaches
• Cervicogenic headaches
• Post-dural puncture headaches

By blocking the greater occipital nerve, patients often experience remarkable relief, making this a simple but powerful tool.

Trigeminal Ganglion Radiofrequency Ablation: Pain Relief with Risks

For patients with long-standing trigeminal neuralgia unresponsive to medications, radiofrequency ablation of the trigeminal ganglion is considered. But, like all procedures, it carries potential complications.

The trigeminal ganglion gives rise to three divisions:

• V1 (ophthalmic) – sensory to forehead, scalp, upper eyelid, cornea, and tip of the nose
  
• V2 (maxillary) – sensory to cheeks, upper lip, and lower eyelid
  
• V3 (mandibular) – sensory to the jaw + motor to muscles of mastication

If V1 is affected, complications include corneal anesthesia, which risks eye injury due to loss of protective sensation. Patients may also experience dysesthesia—an unpleasant burning or tingling sensation.

Thus, while effective for pain, this procedure demands precision and careful patient selection.

Interscalene Brachial Plexus Block: A Double-Edged Sword

Moving from the head and spine to the shoulder—consider a patient scheduled for elective orthopedic surgery. The interscalene block, performed under ultrasound, is a trusted method for shoulder analgesia.

Anatomy Snapshot

• The brachial plexus roots (C5, C6, C7) sit in the interscalene groove between the anterior scalene (medial) and middle scalene (lateral).
  
• A needle is introduced laterally to medially, and local anesthetic is deposited in the groove.

The Catch

Right above the anterior scalene lies the phrenic nerve, which powers the diaphragm. There the large drug volumes (e.g, 15 ml), local anesthetics can spread and block the phrenic nerve, which leads to hemidiaphragmatic paralysis.

You know what, the most healthy patients tolerate this issue well, but those who have compromised lung function may develop respiratory distress.

This is why modern practice favors:

• Lower drug volumes (~10 ml)
  
• Precise ultrasound guidance
  
• A lateral-to-medial approach to minimize phrenic involvement

Conclusion

Regional anesthesia is all about exactness, safety, and patient comfort. For patients ESP block has now become the simplest yet powerful option for thoracic and spine surgeries. The GONB offers very quick relief for headaches, while trigeminal ganglion procedures target stubborn neuralgia with some sensory risks. The interscalene block remains excellent for shoulder surgeries but requires care to avoid phrenic nerve paralysis.

In essence, each block has its place; when chosen wisely, these techniques not only control pain but also speed recovery and improve overall surgical outcomes.