A common missed diagnosis: acral melanoma

Some pathological processes can appear in anatomical locations that make their diagnosis difficult and can lead to misdiagnosis. Acral melanoma is commonly found on the palms, soles, under the nails, oral mucosa and mucous membranes.  The presentation under the nails or in the soles, are especially prone to a delay in diagnosis.

Here we show a melanoma on the sole of the foot at an advanced stage due to late diagnosis.

 

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A Diagnostic Improvement Analysis: A-50-year old man with abdominal pain and thrombocytopenia.

The main objectives with the description and the analysis of this case is to show possible biases in the diagnostic process under the opinion of the analyst, searching for human cognitive and system aspects that could be improved. We do not know the real situation under which the attending physician had to act during the care of this patient

A Diagnostic Improvement Analysis: A-50-year old man with abdominal pain and thrombocytopenia
History

A-50-year old man was admitted to the hospital after several visits to the Emergency Department (ED) in a two month period. He was born in Nigeria, but he was living in Spain in the last 15 years, and the last trip to his natal country was 6 years ago. He was married Continue reading A Diagnostic Improvement Analysis: A-50-year old man with abdominal pain and thrombocytopenia.

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A Clinical Reasoning Exercise: It is a lymphoma, then start the treatment

In this Section we present real clinical cases, trying to disentangle the way of thinking of the people implicated, doctors and patients

 

 

 

 

Players

An Internist

The Patient

A Medical Oncologist Continue reading A Clinical Reasoning Exercise: It is a lymphoma, then start the treatment

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Clinical Reasoning: A blood test cannot be ordered on itself

Clinical Reasoning: A blood test cannot be ordered on itself
Clinical case

Mark, a 70-year-old man, had a previous diagnosis of metastatic kidney cancer and a mild hypertension.  He just finished his cancer treatment two months ago. Suddenly, he started to feel in a  very bad condition, with fever, disorientation, chills and oligoanuria. He has to go to the Emergency Department (ED). Continue reading Clinical Reasoning: A blood test cannot be ordered on itself

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A Clinical Reasoning Exercise: Dysmetria, Nausea, Vomiting, Trouble to Speak

A Clinical Reasoning Exercise: Dysmetria, Nausea, Vomiting, Trouble to Speak
Clinical Case

A-52-year-old man with a previous diagnosis  of an esophageal carcinoma , went to the hospital with nausea, vomiting and constipation. He had no fever or abdominal pain. The physical examination showed no bowel movements. The neurologic examination showed a gait disturbance, dysmetria and  difficulty speaking properly. A nasogastric tube was inserted and a big amount of liquid was extracted from the stomach.

Continue reading A Clinical Reasoning Exercise: Dysmetria, Nausea, Vomiting, Trouble to Speak

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A course of survival for interns and last year medical students. Chapter Four: A List of Important Clinical Entities

 

 

 

 

 

 

 

 

 

A course of survival for interns and last year medical students. Chapter Four: A List of Important Clinical Entities

Every doctor has his or her own list of clinical situations or diseases that are always in their minds, trying to answer quickly and effective in a patient with signs or symptoms compatible with them. Usually, they are important clinical entities located in uncommon places in the body or with a very low prevalence.

Continue reading A course of survival for interns and last year medical students. Chapter Four: A List of Important Clinical Entities

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Improving Diagnosis and Clinical Practice