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Clinical Image: From arterial blood gas to bedside diagnosis

From arterial blood gas to bedside diagnosis

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation
A 37-year old man, with a medical history of obesity, insulin-dependent type 2 diabetes mellitus and asthma was admitted to the emergency room. For the last couple of days, he had been sick with fever, nausea, vomiting, weakness, and shortness of breath. He did not use any alcohol or party drugs. Today, when his girlfriend returned home, she met him in a confused state and called an ambulance. At the emergency room, physical examination shows decreased consciousness, a temperature of 38.4 degrees Celsius, blood pressure of 141/78 mmHg, heart rate of 116/min, and a respiratory rate of 31/min with SpO2 of 94%. Auscultation of heart and lungs revealed no abnormalities. The arterial blood gas is presented below (TABLE 1). Furthermore, X-ray revealed no infiltrate.

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Clinical Image: A child with kidney stones

A child with kidney stones

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Case

This Syrian boy, the second child of consanguineous parents, presented with kidney stones in his country of origin at the age of 5½ years. In the following years he developed end stage kidney disease. He started hemodialysis treatment at the age of 11 years. In 2012 he underwent a kidney transplant, which failed soon after surgery. Hemodialysis was resumed. The following year he lost his ability to walk. In 2015 the patient moved to the Netherlands. Upon arrival, he was found to be underdialysed, underfed and to suffer from severe bone disease. An abdominal X-ray was performed.

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Clinical Image: A hairy problem

A hairy problem

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation

A 9-year old boy with a long history of frequently relapsing nephrotic syndrome was reviewed at the pediatric outpatient clinic soon after recent immigration from another country. One striking feature on physical examination was excessive hair growth. The hair growth was restricted to his back and existed of long, dark hairs. Upon further examination, there were no signs of sexual development, such as testicular enlargement or pubic hair.

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Clinical Image: A 69 year-old woman with chest pain and syncope

A 69 year-old woman with chest pain and syncope

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation

A 69-year-old woman, with a medical history of myocardial infarction and hypertension, visits the doctor with the following symptoms: fatigue, confusion, chest pain and syncope. These symptoms occur a few times a week. Ambulatory ECG monitoring for two weeks was indicated. During her symptoms the ECG shows the following:

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Clinical Image: An abnormal ovary

An abnormal ovary

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation

A 31 year-old woman consulted the gynecologic outpatient clinic complaining of dysmenorrhea, dyspareunia and daily abdominal discomfort since several months. The pain is progressive since ceasing the oral contraceptive pill in order to conceive.  She has a regular cycle, with an average duration of 28 days and a menstruation lasting 3-4 days.

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Clinical Image: A 65-year-old female with an unusual object

A 65-year-old female with an unusual object

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation

A 65-year-old woman was presented with an unusual object sticking out of her chest. The patient has no pain, dyspnoe or fever. Her medical history included a mitral and tricuspid valve repair 15 years ago. Six months ago, a central venous catheter was placed for dialysis.

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Clinical Image: A 3 year-old girl with a severe skin disease

A 3 year-old girl with a severe skin disease

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation

Hanke is a 3-years old girl with constitutional eczema and respiratory problems, who you know from your paediatric outpatient department. By prescribing class 2 corticosteroid a temporarily effect has been achieved. During a telephone call her mother tells you that since 2 days the eczema has exacerbated and new spots have developed.

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Clinical Image: A 14-year-old girl

A 14-year-old girl

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]
Presentation

At the outpatient a 14-year old girl is seen with progressive blue-purple discolorization of her feet. Walking was painful. Upon physical examination discolorization is noted of her toes and the front parts of her feet. There were some blisters on her toes.

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