iiinova — where your digital self keeps evolving

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josh farkas 💊 @pulmcrit.bsky.social · 22/06/2025

a nonfocal septic patient presents with the labs shown here 👇 can you guess the diagnosis? how would you treat this? answer: same diagnosis as this case: emcrit.org/pulmcrit/sho... #EMIMCC

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josh farkas 💊 @pulmcrit.bsky.social · 12/05/2025

this is a super interesting case. I don’t want to spoil it for you, so take a minute and go thru it. In the wisdom of 20/20 hindsight, can you figure out what happened?? #EMIMCC 🧵 #1/2

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Michael Arcieri, MD @mikearcieri.bsky.social · 12/05/2025

Episode 12 is out! Join us as we discuss one of the most common problems we encounter as internists. Is this red leg infected or not? #MedSky @asanchez.bsky.social

open.spotify.com

Episode 12: Diagnostic Dilemma - Acute "Red Leg"

Diagnostic Atypia · Episode

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Michael Arcieri, MD @mikearcieri.bsky.social · 28/04/2025

Episode 11 dropped today! How do we approach management of a symptomatic mass when we are unable to obtain a biopsy? Tune in this week for our thoughts. We'd love to hear your own! Teaching on the episode is available here: www.dxatypia.com/episodes/epi... #MedSky

open.spotify.com

Episode 11: Diagnostic Dilemma - Back Pain & Dysuria

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Andrew Sanchez @asanchez.bsky.social · 14/04/2025

And we're back! Dr. Maddy Conte joins us to discuss a case of pancytopenia 🦴 Come flex your blood smear skills! 👇

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The Clinical Problem Solvers @cpsolvers.bsky.social · 04/04/2025

🚨New Schema Podcast Episode🚨 Tune in as @madellenaconte.bsky.social , @saklawimd.bsky.social and @asanchez.bsky.social walk us through their bradycardia schema as they tackle a case of bradycardia presented by Noah! 🫀🩺 Use the link➡️ clinicalproblemsolving.com/2025/04/03/e... #ClinicalReasoning

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Andrew Sanchez @asanchez.bsky.social · 31/03/2025

Episode 9 of Diagnostic Atypia features another brilliant @mikearcieri.bsky.social discussion, this time on Rapid Atrial Fibrillation ⚡️ The CXR is normal, but SpO2 92%. Are you done?

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Andrew Sanchez @asanchez.bsky.social · 31/03/2025

Episode 9 of Diagnostic Atypia features another brilliant @mikearcieri.bsky.social discussion, this time on Rapid Atrial Fibrillation ⚡️ The CXR is normal, but SpO2 92%. Are you done?

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Peter M. Shane @petermshane.bsky.social · 28/03/2025

The question I've been asked most as we endure the legal dumpster fire that is the Trump Administration is, "What can we do about it when it's not election season?" @timothynoah.bsky.social has an outstanding essay in the @newrepublic.com addressing that question. newrepublic.com/article/1931...

newrepublic.com

Fighting Back: A Citizen’s Guide to Resistance

Ordinary people have more power than they know.

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NEJM.org @nejm.org · 29/03/2025

In the API-CAT trial involving patients with active cancer and venous thromboembolism, extended anticoagulation with reduced-dose apixaban was noninferior to full-dose apixaban for preventing recurrent thromboembolic events. Full results: nej.md/41YkRZK #ACC25 | @accintouch.bsky.social

A graph showing the cumulative incidence of recurrent venous thromboembolism (primary efficacy outcome) among patients who received apixaban at a reduced (2.5 mg) or full (5.0 mg) dose twice daily for 12 months.

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Dominique Guerrot @dguerrot.bsky.social · 25/03/2025

Can a #MedEd #Podcast improve your OSCE score? Yes—and now it’s published! This RCT by V.Dupont et al. shows that listening to #NephrOdio leads to: 🎧 +3.5 OSCE score boost 💪 Better self-perception of clinical skills (42% vs 16%) ✅ 96% would use the podcast again 👉🏼 doi.org/10.1186/s129...

doi.org

Evaluating podcasts as a tool for OSCE training: a randomized trial using generative AI-powered simulation - BMC Medical Education

Introduction Objective Structured Clinical Examinations (OSCEs) are critical for assessing clinical competencies in medical education. While traditional teaching methods remain prevalent, this study i...

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Michael Arcieri, MD @mikearcieri.bsky.social · 17/03/2025

Tune in for a discussion of falls & more! Teaching points from the episode are available at www.dxatypia.com/episodes/epi...

open.spotify.com

Episode 8: Diagnostic Dilemma - Falls in a Young Man

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Andrew Sanchez @asanchez.bsky.social · 17/03/2025

Great article Importantly, while ICI pneumonitis reviews mention that radiographic presentations can be multifactorial, very few mention UNILATERAL-predominant presentation of ICI pneumonitis... 🔥

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Andrew Sanchez @asanchez.bsky.social · 17/03/2025

A case of "gravity is winning" masterfully dissected by Mike🚶 Episode 8 of www.dxatypia.com out now...

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The Clinical Problem Solvers @cpsolvers.bsky.social · 13/03/2025

Check out the newest episode in our Clinical Unknown Series with Rabih Geha 🎧 Embark on this diagnostic journey with us using the link below 👇 bit.ly/4hsfo2N

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Zaven Sargsyan @sargsyanz.bsky.social · 11/03/2025

I've never been to an M&M about kidney injury attributable to iodinated contrast. I've been to several M&Ms for adverse outcomes from missed/delayed diagnoses because people hesitated to use IV contrast for fear of what we now know to be a ghost

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Rep. Sam Liccardo @liccardo.house.gov · 07/03/2025

Academic freedom and independence still live. Thank you, Georgetown University, for teaching our Justice Department about the 1st Amendment!

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 03/03/2025

This table from @drjmluther.bsky.social needs to be disseminated more widely (We added it to our @cmaj-jamc.bsky.social 5 things for that reason www.cmaj.ca/content/196/...) #NephMadness

Table of drugs and substances that can cause hypertension

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Andrew Sanchez @asanchez.bsky.social · 08/03/2025

@notion.com really charging me $134.49 for accidentally sharing with students a link to my notebook intended for simple viewing: no projects, simple mistake. Great service, Notion! You maintain great fairness & consistency in taking people's money!

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Luis Zaman @luiszaman.bsky.social · 07/03/2025

This CDC "survey" getting sent to grantees is wild yall. This is some serious "Kiss my Ring" level bullshit.

Survey for CDC grants that include "no DEI" "no environmental justice" or climate related work, the biologically bullshit argument that "protecting women against gender ideology"

more MAGA propaganda (with receipts since it links an executive order under most questions). "Do you counter malign influence, including Chinga?", "What impact does this project have on preventing illegal immigration"?

What impact does this project have on protecting religious minorities, promoting religious freedom, and combatting Christian persecution? Establishment of the White House Faith Office and Eradicating Anti-Christian Bias
What impact does this project have in increasing American influence, trust and reputation within foreign governments?

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Michael Arcieri, MD @mikearcieri.bsky.social · 03/03/2025

Come check out our first Guestpisode!

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Andrew Sanchez @asanchez.bsky.social · 03/03/2025

Helloooo #MedSky! Our first Guestpisode! featuring Dr. Alec Rezigh is here! 🤝 The differential is blown wide open by some abnormal imaging. Are you ready to correlate clinically? We are the Diagnostic Atypia podcast 👇 @mikearcieri.bsky.social @asanchez.bsky.social

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 02/03/2025

For better or for worse (worse), MEASLES are back, so here's a #skytorial on recognizing this once thought eradicated disease. MEASLES: a tutorial! #dermsky #medsky #MedEd 1/

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F. Perry Wilson, MD @fperrywilson.bsky.social · 25/02/2025

If you were on social media during the pandemic, you came across #DiedSuddenly. Stories of young people, healthy, suffering fatal cardiac arrest out of nowhere. The implication? Those evil vaccines. It was all bullshit. But I want to talk about why it was so effective. 🧵

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Andrew Sanchez @asanchez.bsky.social · 22/02/2025

ILD DDx is hard. I've tried to summarize it all in this note w/ many nested pages. ddx-notebook.notion.site/Interstitial...

ddx-notebook.notion.site

Interstitial Lung Disease (ILD) | Notion

Signature ✍️

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Michael Arcieri, MD @mikearcieri.bsky.social · 20/02/2025

One of the most puzzling cases I’ve seen so far as an attending! If you like what you hear, please consider subscribing and rating us on Spotify. It really helps us reach more learners 😄 #MedSky @asanchez.bsky.social

open.spotify.com

Episode 6: Diagnostic Dilemma - Severely Elevated Transaminases

Diagnostic Atypia · Episode

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Alejandro Alvarez @aletakesphotos.bsky.social · 17/02/2025

Big, growing crowd just west of the U.S. Capitol protesting Trump, Musk and DOGE on President’s Day. “Hey Congress, grow a spine,” they shout, gathering for a rally around the reflecting pool.

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Andrew Sanchez @asanchez.bsky.social · 17/02/2025

DxAtypia.com vacation over! @mikearcieri.bsky.social presents a case of severely elevated transaminases that captures the perfect diagnostic arc 🌈 The social history is king here, & it isn't the only king in the room... 👑

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Adam Rodman @adamrodmanmd.bsky.social · 08/02/2025

There is a lot of buzz about our new paper in Nature Medicine on the effects of LLMs (GPT-4) on physician management reasoning! I had TONS of fun working on this -- but what it MEANS requires some unpacking. A 🧵⬇️ bsky.app/profile/ucsf...

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The Clinical Problem Solvers @cpsolvers.bsky.social · 06/02/2025

Finally here! Officially on @bsky.app 🏥🧠 Excited to explore #ClinicalReasoning—follow along! #MedSky

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@IM_Crit_ @imcrit.bsky.social · 01/02/2025

ICU Mini-Stories: Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:

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BK. Titanji @boghuma.bsky.social · 27/01/2025

Hidradenitis Suppurativa is usually a derm run consult but occasionally ID gets involves to help w antibiotic therapy in the setting of a severe acute flare. This seminar in @thelancet.bsky.social is a fantastic update on the condition. I learned a lot. #IDSky www.thelancet.com/journals/lan...

thelancet.com

Hidradenitis suppurativa

Hidradenitis suppurativa is a chronic inflammatory disease characterised by painful, deep-seated nodules, abscesses, and draining tunnels in the skin of axillary, inguinal, genitoanal, or inframammary...

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Andrew Sanchez @asanchez.bsky.social · 27/01/2025

Aaaaand we're back! Episode 5 of DxAtypia.com out now 🎉 @mikearcieri.bsky.social discusses a seemingly straightforward case of AKI... but the patient is then found to have tender bone lesions 🦴 Join us to learn how radiographic findings sometimes lead to more questions than answers!

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Sophie @sophiefrommars.bsky.social · 20/01/2025

Japan's Akatsuki spacecraft takes the clearest picture of Venus ever made

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NEJM.org @nejm.org · 20/01/2025

A 66-year-old woman with a history of metastatic breast cancer presented to the dermatology clinic with a 1-month history of an asymptomatic, lacy rash on her left thigh. Read the full case details: nej.md/4fVEhU1 #MedSky #DermSky #Oncology

Images in Clinical Medicine
Livedo Racemosa

Panel A: Photo of the patient's legs.
Panel B: A skin-biopsy sample obtained from the left thigh. Inset shows vascular occlusion caused by the aggregation of these atypical large cells.

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Andrew Sanchez @asanchez.bsky.social · 16/01/2025

Some reflections on why we don't often think about the microbiologic DDx of pneumonia up front, & how to make diagnostic progress after initial empiric therapy failure. How else can we think about this? 🤔 Help!

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Andrew Sanchez @asanchez.bsky.social · 13/01/2025

Probably my favorite case of our podcast so far -- the ending leaves you with a pathophysiologic, analogic reasoning principle you can carry forward to distant problems. @mikearcieri.bsky.social's brilliant case & teaching now available for you all at the links below!

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Andrew Sanchez @asanchez.bsky.social · 09/01/2025

@juancarlosqvelez.bsky.social for undiagnosed SLE GN (understanding there are different subtypes), if you trend UAs will you sometimes see the # of RBCs wax/wane - where for few days you have many, then months later, none? Have case of UAs like this w/ non-nephrotic range proteinuria.

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Edgar V. Lerma 🇵🇭 @edgarvlermamd.medsky.network · 05/01/2025

Early Doctors Diagnosed Disease by Looking at Urine #Nephpearls #NephSky - Nowadays, as nephrologists, we still look at the urine to provide us answers to diagnostic inquiries 👉 daily.jstor.org/early-doctor... 👉 pubmed.ncbi.nlm.nih.gov/30626576/

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Zaven Sargsyan @sargsyanz.bsky.social · 01/01/2025

Example of an appropriately low testing threshold 90%+ of the time it’s sepsis, malnutrition, exposure. But life-threatening and easily treatable endocrinopathies diagnosable with a couple-dollar lab test? Only need a 1/50 (if not lower) probability to be worth testing

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Eric Strong @ericstrong.bsky.social · 30/12/2024

I was recently thinking about the fact that discharge summaries are often more important than H&Ps, but we spend less time teaching how to write them, and they have less standardization in format & content. Does anyone have a favorite “definitive” guide to what a dc summary should look like?

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DJ Smithers @djsmithers.bsky.social · 30/12/2024

Related to this post: we should really start emphasizing that dc summaries are not just useful for continuity of care post-discharge, but also help learners refine their management reasoning. Writing a good dc summary helps the writer refresh what did and didn’t go well during the hospitalization.

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Andrew Sanchez @asanchez.bsky.social · 30/12/2024

#MedSky Episode 3 of @mikearcieri.bsky.social & I's clinical reasoning podcast (Diagnostic Atypia) out now! A case of severe anemia challenges the classic board exam schemas: how can a common lab test trick us and help us at the same time? 👇 Come check it out 👇

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