We want to develop here real clinical situations with a patient, enhancing the importante of the cognitive and systemic aspects involved in a clinical decision. We believe this way is the best to teach clinical practice.
He was my patient. A serious and educated 55- year-old man with a diagnosis of metastatic colon cancer waiting to start chemotherapy. I started my usual physical examination, normal conjuntival coloration, normal heart sounds, but something keeps my attention: no ventilation in the left basal lung. No signs of pleural effusion or atelectasia. No dyspnea or thoracic pain. I asked for a thoracic X-ray but nothing attracts my attention.
A-72-year-old man with a previous diagnosis of Chronic Obstructive Pulmonary Disease had a diagnosis of pneumonia after three days with high fever, cough and a productive sputum. He stayed at the hospital and started with antibiotics, enoxaparin, and oxygen, with a favourable clinical evolution. The doctor ordered a new X-ray but the patient started with dyspnea during his journey to the radiology department. Can you suggest a reason for that?