Clinical Challenge

Cultural considerations in diabetes: controlling HbA1c in a patient observing Ramadan

Cultural considerations in diabetes: controlling HbA1c in a patient observing Ramadan

A patient with type 2 diabetes is undergoing dialysis and needs to control his HbA1c levels while fasting during Ramadan.

An unusual cause 
of respiratory distress in an infant

An unusual cause 
of respiratory distress in an infant

A congenital condition is found in an infant with respiratory and gastrointestinal symptoms.

Odorous stools, laboratory abnormalities after gastric bypass surgery

Odorous stools, laboratory abnormalities after gastric bypass surgery

A patient comes to her yearly nutrition check-up 11 years after undergoing gastric bypass surgery with reports of loose stools with significant odor several times per day.

Managing nephropathy in a patient with type 2 diabetes

Managing nephropathy in a patient with type 2 diabetes

A patient with type 2 diabetes presents with elevated microalbumin levels and a recent history of elevated glucose due to bedtime snacking.

Wrist pain after a fall: a simple fracture?

Wrist pain after a fall: a simple fracture?

After a fall on an outstretched hand, wrist injuries are common, but ligament tears should also be considered in adults.

Markedly elevated serum transaminase levels

Markedly elevated serum transaminase levels

An incidental finding in an asymptomatic woman is followed by rapid deterioration of her condition.

Avoiding hypoglycemia in a hospitalized patient with diabetes and increased physical activity

Avoiding hypoglycemia in a hospitalized patient with diabetes and increased physical activity

While undergoing physical therapy after a stroke, a patient with type 1 diabetes has a hypoglycemia-related stroke.

Achieving sustained weight loss in an obese patient

Achieving sustained weight loss in an obese patient

After steadily gaining weight for 10 years, an obese patient seeks help in achieving sustained, long-term weight loss.

Severe insulin resistance in a patient with type 2 diabetes

Severe insulin resistance in a patient with type 2 diabetes

Patients with type 2 diabetes and severe insulin resistance may require large doses of insulin to achieve glycemic control.

Painful red spot 
and fever in an infant

Painful red spot 
and fever in an infant

The child and her twin tested positive 
for influenza B infection one week earlier. The child's pulse, respirations, and blood pressure were within normal limits.

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