Andrew Sanchez @ASanchez_PS
Hospitalist @BIDMC_IM Teaching/Learning Dx @harvardmed❓, Co-host @Dx_Atypia 🦓 🐎, @CPSolvers Academy🕵🏽♂️, @YaleIMed @ColumbiaPS @UF 👨🏽🎓 DxAtypia.com Boston, MA Joined May 2009-
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🌟 Important pearls from today’s lecture 🌟
🌟 Important pearls from today’s lecture 🌟 https://t.co/jYv2vlH2T3
Breaking News: In a win for Harvard University, a judge said that the government broke the law by freezing billions of dollars in research funds. nyti.ms/3UV5VbH
Myositis and factors associated with malignancy risk ⬇️ likelihood of malignancies in IIM patients, such as ILD, arthritis, arthralgia and Raynaud’s ⬆️ anti-TIF1γ, anti-NXP2-positive, Dysphagia, Necrotising Myositis abs #Rheumatology #MedTwitter
Antibiotic therapy for severe bacterial infections 🔥🔥🔥This must be one of the greates review about ID of the year. https://doi. org/10.1007/s00134‐025‐08063‐0.
However, there are malignant J waves. Their morphological features include: 1. a J wave height > 0.2mV 2. horizontal or down-sloping ST segment, & 3. some ECG leads showing those changes (eg, II, III & aVF & V4-6)
What are hyperacute T waves, you ask? Right this way!
After 30 years of primary PCI we now have an objective definition of the most common #ECG pattern of STEMI. Hyperacute T-waves specific for acute coronary occlusion now defined using #AI in @JACCJournals!
@Rheumat_Aravind @IhabFathiSulima @DrAkhilX Polymyositis is an extremely rare disorder. Some argue that is even not a thing anymore. Most cases thought to be polymyositis are now classified as overlap myositis, immune-mediated necrotizing myopathy or IBM. Drs. Amato and Griggs wrote an editorial on this 20+ years ago.…
【Rash on the palms and soles: ID DDx】 The differential diagnosis is broad, but hopefully this helps you remember! Level: Intermediate #IDMedEd #IDFellow #IMResident #MedEd
@JuliePaikMD and I wrote a review about the current state of novel B cell and plasma cell-targeting therapies (including CAR-T cells + bispecifics) in myositis. Lots of promising agents are on the horizon for IIM! frontiersin.org/journals/immun… @jhrheumatology @TheMyositisAssc
1/5 SPLENOMEGALY/HYPERSPLENISM Mechanisms of splenomegaly: • Congestive • Work hypertrophy • Infiltrative What enlarges? • Red pulp: macrophages, sinusoids, blood • White pulp: lymphocytes, plasma cells • Infiltrative: tumor, storage cells, granulomas, amyloid #MedEd
We are back! 🦓 Come listen to our Choose Your Own Adventure episode & we'll give you the answer next week 👇 open.spotify.com/episode/7lQZim…
Our Glass Health mobile app is now available on iOS!📱 ✅ Evidence-based answers to clinical questions ✅ Deeply researched diagnostic and treatment plans ✅ High-quality documentation Download from the App Store today: apps.apple.com/us/app/glass-h… #ClinicalAI #AICDS #MedTwitter
@WilliamAird4 Curious if PTH was high and they had a parathyroidectomy at some point? Apparently primary hyperPTH can drive monoclonal gammopathies of undetermined significance, smoldering myelomas, etc
DISAPPEARING M PROTEIN I saw a patient today (not my first) with a previous positive SPEP/IFE that is now normal. It seems that MGUS can rarely go away. Either a tiny clone regresses, or the original “M-spike” was spurious. Have you seen this?

Dr Joshua Walinjom @walinjom
103K Followers 16K Following #ECFMG Certified #AAMC ID: 16486652 #Cardiology Fellowship @ #Kings #College #London, #Cardiologist UY1 🩶#Interventional #Cardio #Christian #Jesus is #Lord.
Avraham Z. Cooper, MD... @AvrahamCooperMD
116K Followers 3K Following Pulm/Crit physician and PD @OSUPCCM_Fellows • Podcast @curiousclinpod • Dad/husband • FORTHCOMING BOOK: WHY DOESN’T YOUR STOMACH DIGEST ITSELF? (W.W. Norton)
Nick Mark MD @nickmmark
64K Followers 2K Following Intensivist | Husband, Dad² | created the #1 critical care podcast @CritCareTime & infographic site @OnePagerICU | passionate about MedEd & MedTech innovation
Manual Of Medicine @ManualOMedicine
224K Followers 16K Following Creating and sharing pictures, infographics, diagrams etc. in the field of medicine. #foamed #meded #medtwitter
William Aird @WilliamAird4
29K Followers 320 Following Professor of Medicine at Harvard Medical School #Hematology #MedEd Founder of @TheBloodProjec1
André Martin Mansoor @AndreMansoor
54K Followers 391 Following Clinician. Author of #FrameworksForInternalMedicine. Cofounder https://t.co/iXxv1ZNGbj. https://t.co/1javJYYL59
Nihar Ranjan Nayak @nihar_nayak2
14K Followers 1K Following DM Cardiology trainee(YR-2)-AIIMS, New Delhi MD Medicine- AIIMS, New Delhi. MBBS- AIIMS Bhubaneswar. Learning from my mistakes.
2things @2thingsteam
6K Followers 96 Following A team of 7 physicians in various stages of their career and across different institutions get together here to share 2 things they have learnt everyday.
Rabih Geha @rabihmgeha
19K Followers 2K Following Bub. In sync with older brother @DxRxEdu on https://t.co/A2e9Y4BLWP Co-founder @CPSolvers
Top Biomedical Scienc... @imedverse
90K Followers 9K Following Biomedical Science that Inspires. #medicine #medtwitter #meded #Science #Research #Technology #News
Parth @flozinatorMD
3K Followers 842 Following PGY 5 | Internal Medicine (AIIMS, New Delhi) | Alma mater (GMC, Rajkot)
Mark D. Siegel @MarkDSiegel1
6K Followers 2K Following I am a Pulmonary and Critical Care physician and Residency Program Director. Comments are my own.
1-min ID consult @1min_IDconsult
24K Followers 1K Following Small bite learning✒️, easy to read during a short break☕️, make it simple📖, for all busy residents and fellows🩺 #IDMedEd @TakaMatsuo_ID 🇺🇸
John Damianos, M.D. @john_damianosMD
24K Followers 1K Following @MayoClinicGIHep Gastroenterology & Hepatology Fellow. Yale Internal Medicine, Dartmouth Med. Microbiome, probiotics, brain-gut, diet, motility, IBD, MedEd 🇬🇷
Satyendra Dhar, MD SF... @DharSaty
12K Followers 346 Following Assistant Clinical Professor; Hospital Medicine ; The more I read, the more I acquire, the more certain I am that I know Nothing 🥣Tweets are mine🍁https://t.co/Isw9w11KVZ
Medicalposts_SQU @MedPostsSQU
14K Followers 720 Following MD || Sultan Qaboos University 🇴🇲 || A medical account where mostly child health-related content will be posted || ENJOY!! 💉💊
❗NTE®️N🅰️L ... @pgMedicine
61K Followers 922 Following 📖🩺💊💉🤳💎✍👨⚕️👩⚕️ 📣📣🏥 🧐🤜🤛 ℹNTE ®️NAL Ⓜ️EDℹ©️ℹNE 🧑⚕️👩🏻⚕🧠🫀🫁👅👁👀🦴🦶👂👃💪 https://t.co/xu71tUG50W
Jamir Pitton Rissardo @theneurolander
23K Followers 8K Following MD 🇧🇷 @UFSM_oficial @CooperNeuroRes | Neurology 🧠 | Writer ✍️ | Reviewer | Illustrator | Guitarist ♬🎸 World J Clin Cases editorial board member.
Gisela Giselar. @Gisela66821
107 Followers 841 Following مدير أعمال، روح سعيدة، ولد ونشأ في دبي، فنان مكياج
Faizan A Malik, MD @DrFaizanMalikMD
1K Followers 6K Following Match 2025 Applicant | Cardiology 🫀 Enthusiast | AAMC# 16109834
DrAcHaYaN @DrAcHaYaN
141 Followers 262 Following
Baaqaws @Baaqaws216019
91 Followers 3K Following
Addison 🇪🇺 @Adi_0819
869 Followers 868 Following If you find it in your heart to care for somebody else, you will have succeeded. #Healthcare #Music #Coffee #Foodie #Traveler 🚫crypto ‼️
Michael Arcieri @ArcieriMichael
0 Followers 18 Following Hospitalist | Co-Host of diagnostic reasoning podcast @Dx_Atypia with @ASanchez_PS
ModernMedics @ModernMedicss
11K Followers 11K Following 🌟 Doctor | USMLE | MRCP | ABIM ,Delivering daily top-tier medical content, exam tips, & health insights 📚 Inspiring learners & empowering all 🩺 #MedEd
Dr.Fatoom Ahmed @FatoomA94653171
7 Followers 283 Following
diego gonzalez rivas @Diegogonzalz10
67 Followers 955 Following
Htootyklim @Htootyklim
31 Followers 1K Following
Debnayan Das @d_debnayan
7 Followers 139 Following
Yuhu Yes @yes_yuhu
1 Followers 74 Following
Claire @claire22660736
1K Followers 945 Following 🇺🇸 Golf is a day spent in a round of strenuous idleness| I love golfing 🏌️♀️ ⛳️
𝐘𝐚𝐫𝐚 @YaraMD_
7 Followers 10 Following 𝐏𝐞𝐫𝐬𝐨𝐧𝐚𝐥 𝐚𝐜𝐜𝐨𝐮𝐧𝐭| 𝐑𝐞𝐬𝐞𝐚𝐫𝐜𝐡𝐞𝐫 | 𝐏𝐚𝐬𝐬𝐢𝐨𝐧𝐚𝐭𝐞 𝐚𝐛𝐨𝐮𝐭 𝐝𝐢𝐬𝐜𝐨𝐯𝐞𝐫𝐢𝐧𝐠 & 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞
Niran @nrnszr13
0 Followers 41 Following Last year medical student from Turkey, aspiring physician, proud IMG 🇺🇸🇹🇷
Dr Alexey Kulikov @KulikovUNIATF
63K Followers 50K Following Head of Partnerships and Operations, Deputy Head of Secretariat, @UN Task Force on #NCDs. Support @WHO countries achieve #health related #SDGs. PhD MPH MD.
NG7 @NG1234567g
0 Followers 111 Following
Rahul Garg @RahulGarg_89
2K Followers 5K Following MD| ID Fellow| Clinical Microbiologist #Bugs & #Drugs, #AMS, #IPC, #Sepsis
Avinash Arya @meavinasharya
56 Followers 1K Following अविद्या का नाश और विद्या की वृद्धि करनी चाहिये - स्वामी दयानंद सरस्वती
Miguel Ramos @MiguelR88666100
9 Followers 4K Following
Pravin Krishna @pkrishna4
28 Followers 1K Following
Y0ur_Neighb0ur @Y0ur_Neighb0ur
585 Followers 597 Following Very severe #MyalgicEncephalomyelitis in #LongTermCare w/ #Gtube. #MGUS. Dad, 🏍 enthusiast, former hobby 🚜 and tradesman 🔧 Future GRAMPA!
Schema.app @useschema
151 Followers 1K Following The smartest way to remember what matters. Built for people who never stop learning.
Ahmad Habib @ahmadhabibbebo
31 Followers 394 Following
Eesawjui @Eesawjui540535
78 Followers 2K Following
Krithika K @Krithik05725511
0 Followers 5 Following
🇺🇸 Andy 🇺�... @aikyx38773498
378 Followers 767 Following Love travelling and making friends Dentist , #rihanna #katyperry #taylorswift13 #ladygaga #ArianaGrande
محمد @mhmd25189320928
75 Followers 3K Following
Shahkar Abidi @abidi_shahkar
2K Followers 8K Following Automotive Journalist @AutocarPro. Formerly @DNA & @HT. Exploring cognitive biases & their impact on communications.
Nehal @Nehalismworld
11 Followers 861 Following
Dr.Hause @MeezoZeezo
29 Followers 860 Following
Radhe shah @radhekshah
22 Followers 83 Following
Mehrdad Heravi. MD @heravimehrdad73
498 Followers 2K Following #Internalmedicine resident | MHPE student | Podcast host | #Meded | https://t.co/qAVBrcGwaf
Albandari @btsotb
7 Followers 227 Following
bhunesh kumar rawat @bhuneshrawat
37 Followers 1K Following
Godfrey Mungwadzi @GMungwadzi
108 Followers 257 Following
Studying Medicine @StudyingMedici
21 Followers 98 Following
namatullah sharifi @namatullahshar1
0 Followers 20 Following synching with society while preserving the real me.
Aravind Palraj @Rheumat_Aravind
9K Followers 2K Following Senior Resident, Clinical Immunology and Rheumatology | MMC, Chennai | Making autoimmunity easy to understand | DM open | 🛑 Tweets ≠ Medical Advice |
Avraham Z. Cooper, MD... @AvrahamCooperMD
116K Followers 3K Following Pulm/Crit physician and PD @OSUPCCM_Fellows • Podcast @curiousclinpod • Dad/husband • FORTHCOMING BOOK: WHY DOESN’T YOUR STOMACH DIGEST ITSELF? (W.W. Norton)
Nick Mark MD @nickmmark
64K Followers 2K Following Intensivist | Husband, Dad² | created the #1 critical care podcast @CritCareTime & infographic site @OnePagerICU | passionate about MedEd & MedTech innovation
Manual Of Medicine @ManualOMedicine
224K Followers 16K Following Creating and sharing pictures, infographics, diagrams etc. in the field of medicine. #foamed #meded #medtwitter
William Aird @WilliamAird4
29K Followers 320 Following Professor of Medicine at Harvard Medical School #Hematology #MedEd Founder of @TheBloodProjec1
Tony Breu @tony_breu
84K Followers 913 Following Hospitalist, VA Boston. Assistant Professor, @harvardmed and @HMSbioethics. Co-host, @CuriousClinPod. Usually at #AMreport. Views are my own.
Robert Oubre, MD | Th... @Dr_Oubre
37K Followers 522 Following Helping busy inpatient doctors write notes faster and reduce lawsuits while demystifying billing. | Have transformed 730+ with my video courses.
André Martin Mansoor @AndreMansoor
54K Followers 391 Following Clinician. Author of #FrameworksForInternalMedicine. Cofounder https://t.co/iXxv1ZNGbj. https://t.co/1javJYYL59
2things @2thingsteam
6K Followers 96 Following A team of 7 physicians in various stages of their career and across different institutions get together here to share 2 things they have learnt everyday.
Joel M. Topf, MD FACP @kidney_boy
63K Followers 4K Following Saying the product of the kidneys is urine is like saying the product of a factory is pollution. Urine is a by-product. The product is homeostasis COI: link👇🏼
Neurophilia @bobvarkey
33K Followers 303 Following Neuro-intensivist & Interventionalist, Autodidact, Philomath, Iconoclast, Esoterist, Bibliophile, Technophile & Investor@ Kochi, Kerala.
Rabih Geha @rabihmgeha
19K Followers 2K Following Bub. In sync with older brother @DxRxEdu on https://t.co/A2e9Y4BLWP Co-founder @CPSolvers
Parth @flozinatorMD
3K Followers 842 Following PGY 5 | Internal Medicine (AIIMS, New Delhi) | Alma mater (GMC, Rajkot)
Elliot Tapper @ebtapper
42K Followers 693 Following Hepatologist @michiganliver @vaannarbor; #cirrhosis; encephalopathy; frailty; quality improvement; father; husband. #livertwitter Co-EIC of @HepCommJournal
Mark D. Siegel @MarkDSiegel1
6K Followers 2K Following I am a Pulmonary and Critical Care physician and Residency Program Director. Comments are my own.
1-min ID consult @1min_IDconsult
24K Followers 1K Following Small bite learning✒️, easy to read during a short break☕️, make it simple📖, for all busy residents and fellows🩺 #IDMedEd @TakaMatsuo_ID 🇺🇸
Prathit Kulkarni, MD @PrathitKulkarni
8K Followers 943 Following Inf Dz+Int Med faculty+ID fellowship Prog Dir @BCMHouston|Asst Chf of Med|Fmr @CDCgov EIS|Husb+dad|Opinions own|RT+likes not endorsements|Tweets not med advice
Michelle Kittleson MD... @MKIttlesonMD
41K Followers 394 Following #kittlesonrules | Cardiologist | Prof of Medicine @CedarsSinai | Author Mastering the Art of Patient Care available at https://t.co/zdJT2MWl6J
Dr Khaled Ahmed Abuze... @khaledzeid
15K Followers 134 Following Clinical Radiologist from Egypt interested in Chest Imaging and trying to make it interesting to others everywhere
Mark S. Zaid @MarkSZaidEsq
126K Followers 928 Following Attny handling cases re: national security, security clearances, govt investigations, Freedom of Information Act & whistleblowing. @UofR grad. Non-partisan
Aravind Palraj @Rheumat_Aravind
9K Followers 2K Following Senior Resident, Clinical Immunology and Rheumatology | MMC, Chennai | Making autoimmunity easy to understand | DM open | 🛑 Tweets ≠ Medical Advice |
Derya Unutmaz, MD @DeryaTR_
320K Followers 7K Following Professor, biomedical scientist, human immunologist, aging & cancer immunotherapy. ALL IN ON AI. Interests: longevity, robotics, Scifi, space. Personal opinions
Max Witt MD @MaxWittMD
750 Followers 632 Following Infectious Disease fellow at University of Colorado. Former Committee of Interns and Residents (@CIRSEIU) delegate.
Chubbyemu @chubbyemu
105K Followers 277 Following Clinical Adjunct Professor, University of Illinois. tox, hobby youtube, host @hemereview secret channel @Bigemus
A Tchakarov @ATchakarov1
441 Followers 109 Following Nephropathologist, Pathology Residency APD, and Nephropathology Fellowship Director. Views are my own.
Sam Rawal, MD @samarthrawal
1K Followers 227 Following MD + Computer Science, working on Clinical AI. Internal Med Resident @MayoClinic. // MD @ILLINOISmed; CS @ASU.
HemOncBytes @HemOncBytes
382 Followers 3K Following Your Antidote to the Oncology Information Flood | Bite-Sized Learning, Built for Busy Schedules. 🔥Largest Hem/Onc Qbank in existence!! #MedTwitter #HemeOnc.
Rupert @rururupert
738 Followers 95 Following Occasionally make suggestions and art for OSRS. I may be burnt in-game but will never burn out on the community
Channel 5 @Channel5iveNews
47K Followers 0 Following More content on https://t.co/0oXBNexsU0. tweets not by Andrew (mostly)
Malcolm Moyer, MD @DrMalcolmM
30 Followers 52 Following @KaiserOaklandIM '25 | @msumd '22 | @ucdavis '15 | #1stgen IM 🩺. Anime 🤓. 🕹 master. 🎶 buff. 🏀 follower. Trying to be the change I want to see.
nathan fielder @nathanfielder
527K Followers 218 Following
Silvija Gottesman MD @SGottesmanMD
9K Followers 3K Following Assistant Prof #Dermatology & #Pathology NorthShore University Hospital; Founder @dermpathJC; @ProfsofDerm #dermpath committee; Views are my own not my employer
Kiran Musunuru @kiranmusunuru
4K Followers 86 Following Cardiologist, geneticist, and gene editor. Author of #TheCRISPRGeneration and #GenomeEditingAPracticalGuide
Hanna Knauss MD @HKnaussMD
283 Followers 248 Following PGY3 Resident @BIDMC_IM via @ohiou & @UToledoMed l Aspiring Cardiologist, Medical Educator l Part-time Runner & Amateur Plant Mom l Views are my own.
Grace Choung, MD 박�... @grace_choung
740 Followers 317 Following Renal pathologist @CedarsSinai #renalpath #kidneydisease opinions are my own https://t.co/vkOgdAdxu8
Tara Krishnan @_TaraKrishnan_
429 Followers 400 Following PGY4 Clinical Pathology Chief Resident @UWLMPathRes | ‘26-‘27 #breastgyn fellow @UWLMPathRes | @UMKCmedschool alum | loves black coffee & digital pathology👾🌺
sikandar adwani @SikandarAdwani
4K Followers 449 Following 🧠 Neurologist ( Gold Medalist) | 📺 Host of "Grey Matters" on you tube | Advocate for Brain Health and Awareness 🌟 Inspiring Minds, Empowering Communities
Harvard University @Harvard
1.7M Followers 727 Following Official account for Harvard University. Devoted to excellence in teaching, learning, and research, and to developing leaders who make a difference globally.
Michael Barbaro @mikiebarb
248K Followers 2K Following Host of The Daily. Brooklyn dad. Unabashed Sinatra fanatic.
Vinson Yew @Dokutah_Vyew
402 Followers 796 Following 🇭🇰Respiratory/IM resident, Ex-NHS Dr, MRCP🇬🇧 Lung US beats CXR 😛 POCUS fanboy
Eric Reinhart @_Eric_Reinhart
40K Followers 548 Following Political anthropologist, psychiatrist, and psychoanalyst. I work with individuals and collectives globally via remote connections.
Cory Booker @CoryBooker
4.5M Followers 78K Following U.S. Senator from New Jersey. Most tweets (and typos) are mine, some are my team’s.
MeidasTouch @MeidasTouch
1.3M Followers 2K Following The official account of the MeidasTouch Network. Unapologetically pro-democracy.
Will Lippert @wclippertMD
278 Followers 966 Following Associate Professor of IM. APD @WFIMRes. Academic #Hospitalist @wakehealthHM. PGY-11. Views are my own.
Samantha Kumarasena M... @srkumarasena
35 Followers 65 Following @BIDMC_IM PGY2 | Former engineer, @OlinCollege Interested in Heme-onc, Palliative care. MedEd, systematic approaches and checklists, antiracism/DEI
Harvard Medical Facul... @HMFPBoston
450 Followers 139 Following 2,200+ physician organization at @BIDMChealth and affiliated with @harvardmed.
Anita Vanka @VankaAnita
520 Followers 307 Following Hospitalist, medical educator, course director, advisor/mentor, runner, cat lover and foodie....tweets are my own
Divvy K. Upadhyay @DivvyKant
407 Followers 1K Following MD,MPH,CPHRM,CPPS. Implementing a program to learn from diagnostic errors @GeisingerHealth. #patientsafety Prior: Health Policy @urbaninstitute & @healthaffairs
Roger Rodby @NephRodby
16K Followers 4K Following Academic nephrology, gardening, golfing, biking, not necessarily in that order. Always learning.
Alan Karthikesalingam @alan_karthi
6K Followers 2K Following Medical AI @GoogleDeepMind: AI co-scientist, AMIE, Med-Gemini, MedPaLM, MedPaLM-2, MedPaLM-M & Flamingo-CXR. Hon Lecturer Vasc Surgery @ImperialVasc
Tao Tu @taotu831
903 Followers 456 Following Research Scientist @GoogleDeepMind | Medical Gemini | PhD @Columbia in Neuroimaging
Abhijit Das, MD @AbhijitSurgPath
6K Followers 44 Following Associate Professor; Love Surgical Pathology; Facebook page "Dr.AbhijitDas, Make SurgiPath Easy"; MD, AIIMS (New Delhi), India; Passionate Artist, Nature Lover
Burhan Azeem, Cambrid... @realBurhanAzeem
4K Followers 1K Following Fighting for Housing & Transit | @MIT Alum @AbundantHomesMA Board
Joseph L. Mills MD @jmills1955
14K Followers 2K Following Professor, Vascular & Endovascular Surgery; Diabetic foot; Endo & Leg bypass; AAA; Carotid disease; Health Care; Science; Evolution ~ Tweets often my opinions
Prof Peter Hotez MD P... @PeterHotez
405K Followers 8K Following Texas Medical Center (TMC) Professor-Vaccine Scientist-Author; Member, Philosophical Society of Texas and TAMEST; Dallas Morning News Texan of the Year 2022
UDN @UDNconnect
4K Followers 133 Following The Undiagnosed Diseases Network has archived this account. Past posts are preserved for reference.
Farzad Mostashari @Farzad_MD
58K Followers 2K Following Founder, Aledade Former National Coordinator for Health IT NYC Health Dept/ CDC EIS Officer views my own
(((Dorit Reiss))) @doritmi
14K Followers 11K Following Professor of Law UC SFLaw, teaches torts, administrative law, etc'. Writes on vaccines & law. Vaccine advocate. Mom. Tweets my own. She/her.
Lera Novotnaia @LNovotnaya
37 Followers 87 Following Medical graduate from Saint Petersburg. Big Friends, Internal Medicine, and Clinical Reasoning fan. Even bigger @CPSolvers fan.