Category Archives: Clinical Reasoning

Case analysis under the concepts of Diagnostic Improvement,  showing the andcognitive and systemic bias implicated in a Diagnostic problem.

The New Diagnostic Challenge with Cancer Immunotherapy

Uncommon toxicities

Immunotherapy is now consolidated as a basic treatment of cancer. Tumors such as melanoma, kidney, and lung, have been the first to receive the benefits of this new treatment. Patients with bad clinical conditions can have an impressive tumor response,  usually after a “latency” period of 4-6 weeks. Continue reading The New Diagnostic Challenge with Cancer Immunotherapy

More is not always better

Cape Cod

A 70-year-old patient was admitted with neutropenia, moderate thrombocytopenia, and fever, following  chemotherapy. starting with antibiotics until normalization of neutrophils. As platelets persisted in values ​​of 56,000 x109/L, a transfusion was decided. Three days later there was no improvement  in the level of platelets. Continue reading More is not always better

Thinking Aloud: when reasoning calls for action

 

 

 

 

 

 

A 70-year-old male had a diagnosis of bladder cancer. One month before, he presented  with fever and chills after chemotherapy, coincident with neutropenia and thrombocytopenia. A chest x-ray showed a basal right image with doubt about a condensation. He started with antibiotics and all the symptoms resolved.

Continue reading Thinking Aloud: when reasoning calls for action

Falls and vision defect: what can be the connection?

Rome, Italy

I attended her in the last minutes of her life, and this allowed me to know her story. Fifteen years earlier, when she was on her sixtees, she began to fall on the street with some frequency. Several visits to the general practitioner, orthopaedic and rehabilitation were not very useful.

Continue reading Falls and vision defect: what can be the connection?

Real clinical scenario: How to put things together? A paresis

Iceland

A 71-year-old woman went to the hospital with pain in her right abdomen, fever and chills, and a yellowish watery diarrhea. He had no vomiting or other symptoms. The patient had had an upper digestive haemorrhage 25 years ago. The patient was diabetic type II. The initial  diagnosis was gastroenteritis with radiological signs of transverse and left colitis

Continue reading Real clinical scenario: How to put things together? A paresis