Discover and read the best of Twitter Threads about #clinicalreasoning

Most recents (7)

1/ #MedTwitter, it’s time for #ClinicalReasoning practice with Bayes’ Theorem!

Follow along and let us know what you’re thinking!

72-yo-woman with HTN, DM, & knee replacement (10 days ago) p/w pleuritic chest pain, dyspnea and cough.
2/ As you walk down to the ER, you have diagnoses in your mind that are somewhere between unlikely and very likely.

This likelihood is known as:
3/ ANS: Pretest probability

On exam, her temperature is 100.1F, HR 108 and SaO2 88% RA. Her lower extremities are without swelling, tenderness, or erythema.

Basic labs are in process. What else would you order?

We’d love to see your reasoning in the replies!
Read 10 tweets
1/

A TALE OF TWO STENTS

a #twitternist #clinicalreasoning and #implicitbias reflection

Wanted to share 2vignettes with you #medtwitter, w permission (identities, some details changed)

Both involve rapid thinking, stretched foci of attention, unanticipated clinical events->
2/ first vignette :

Seeing last pt in morning session, 45 mins back

Finishing up, see another pt’s e mail & message on desk phone

Need 2finish up w pt in front of me, but odd message left in both places

Call back - 72 yo man, remote preDM but got that BMI to 23 long ago, ->
3/ mild lipids on lo dose statin, chronic bronciectasis, reflux. Know him 15 yrs as pt.

Pt: Dr. C, I feel better now, but ..(uh oh) when I woke had a discomfort in my L neck, felt sweaty. That’s all gone for a few hours now, I think I’m fine. But I don’t have my appetite ->
Read 16 tweets
I had a bit of an “ah ha moment” while attending in our #dermatology resident clinic a month ago.

The way I run this clinic means that when the timing is right, I try to have our senior resident precept the junior resident. I try to stay silent and literally say nothing.

1/
When this happened, we had a brand new senior and a brand new first year. Essentially both residents were settling into their respective roles.

In typical fashion, the junior resident presented the key points to the senior resident as I listened on.

2/
Jr: the patient doesn’t have a rash today, but the pictures look like wheals. He says that pressure causes it. Diphenhydramine doesn’t work that well. He doesn’t have dermatographism.

Sr: what do you think it is?

::both look at me to see what I’m thinking/about to say::

3/
Read 13 tweets
1/ A quick glance at the foot of the bed unravels a rare answer to a common complaint... another #tweetorial to sharpen our #clinicalreasoning skills, #medtwitter! Try to solve this mystery case and see if you can... nail it!
2/ A 58 year-old man presented with gradual, progressive dyspnea. Two months ago he had no trouble ambulating, now he is limited to several blocks.
3/ Take a mental pause here to practice how you might approach “dyspnea”, and then listen to @BBroderickMD take us through it: bit.ly/32fCXXr
Read 18 tweets
It's time for #TwitterReport! Get out your illness scripts and problem representations.

Case: A 65yoM with metastatic melanoma goes to the ER with RLE edema: doppler shows a femoral DVT. He also says he's been getting more tired over the last 4wk.

What else do you want to know?
PMH: HTN, HL, T2DM (now diet controlled), metastatic melanoma
PSH: none
Meds: HCTZ, metoprolol, atorvastatin, pembrolizumab/ipilimumab (last cycle 2 weeks ago)
Social: lives with wife and dog at home. From a local rural area. Never smoker/alcohol. Former construction worker.
ER Triage Vitals:
-Temp 37*C
-HR 60
-BP 90/54
-RR 12
-SpO2 98% on room air

What else do you want to know?
Read 17 tweets
1) aim to “understand deeply.” Admitting that you don’t understand puts you in a mind-set to learn
2)”fail effectively.” Try & falter-learn a little each time you don’t succeed
3) create questions.” Think slowly through specifics that challenge you getabstract.com/en/summary/mak…
4) “go w/ the flow of ideas.” Connect your thinking. Think through a topic to connect it with other disciplines, ideas and subjects

5) be open to change.” Keep an open mind; be willing to see things differently

Take charge of your learning; don’t wait for others to educate you!
Read 3 tweets
1/Hey, #medtwitter, bust out your schemas - it's time for another CPSers tweetorial! #FOAMed #clinicalreasoning #medthread
2/A 46F presented with 2 weeks of diffuse abdominal pain, nausea and vomiting. Pause and reflect on how you’d approach her abdominal pain, and then check out this schema: clinicalproblemsolving.com/dx-schema-abdo…
3/On exam, her VS were T 36.2C BP 178/100 HR 82 and RR 16. She had sclerodactyly as well as shiny/thickened skin over her face, arms, and chest with telangiectasias. There was 2+ pitting BLE edema.
Read 13 tweets

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