Diagnostic Dilemma - Pediatric Oncall

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Rakesh Kumar, Puja Bhagat Department of Pediatrics, Katihar Medical College, Katihar, Bihar, India ...

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Question Category : Diagnostic dilemma
12 yr girl went to matheran in jan2006 and from then she has started losing wt.she lost 10kgs wt over 6mths. she presented 7yesterday with persistent vomiting and symptoms of abdominal obstn.settling on medication. invtgn-cbc-hb 10.4gm%,tlc 8400(p-78,l21),band forms seen.platelets adequate. Any suggestive diagnosis Check Out the Answer
Question Category : Diagnostic dilemma
2 & half year baby h/o cold & cough,high grade fever 2 days back. stridor positive. markly decreased intake. little respiratory distress unable to speak since 1 day.(decreased speech volume.) conscious,oriented, what will be most suitable treatment? inj.ceftriaxone,dexa,nebulisation,frequent liquid diet given. Check Out the Answer
Question Category : Diagnostic dilemma
Dear pediatrics on call, i have a child with the following symptomatology- fever past 7 days, dysentery and now melena past 4 days, altered sensorium, thrombocytopenia, mild azotemia, grossly deranged LFT'S, peripheral smear could not be sent pre BT, normal CSF examination and electrolytes. He has a normal urine output so far. PT PTTK MILDLY DERNAGED. Till now has received 2 bt's , one PRP,IV ANTIBIOTICS. Could it be TTP( throbotic thrombocytopenic purpura) But the liver derangement doesn't explain it. Please give me few alternate diagnoses? Check Out the Answer
Question Category : Diagnostic dilemma
a 6 yr old with rec. resp. inf. with tc - 24,000, poly - 76%, skiagram chest showing prominent BV markings. what could be probable dd? Check Out the Answer
Question Category : Diagnostic dilemma
Dear sir 5y old boy present to ED as fever+prolonged febrile fit & treated as such.The next day was still febrile+ deep coma.No history of trauma ,drugs or recent chicken pox.On exam. nothing apart from fever + deep coma which persist for 10 days.Investigation done 1.normal csf 2.cbc normal 3.widal-ve 4.cxr is nomal &cat scan mild brain atrophy 5.EEG global dysfuntion.The pt. was treated as viral encephalitis[iv zovirax + cefitriaxone + steroid +mannitol + ng feeding] what else can be done for this poor pt.? Check Out the Answer
Question Category : Diagnostic dilemma
Dear Doctor This is regarding my 9 months old daughter, who, at the time of birth was diagnosed with hypotonia, hyperflexibility of joints and cynosis. Now she is having developmental delays and poor muscle tone. She smiles but can not sit without support. The neck holding has come just a month back. She has short limbs, funnel shaped chest, small & inverted nipples. Her blood chemistry is as below. 1. Free T3 - 2.27 pg/ml 2. Free T4 - 0.92 ng/dl 3. TSH (Third generation) - 2.03 ulU/ml 4. Serum Calcium (Conventional)- 0.7 mg/dl 5. Alkaline Phosphatase(Conventional) - 229.00 U/l 6. Phosphorus (Conventional) - 14.40 mg/dl 7. Red Cell Count - 2.95 10^12/l 8. Hemoglobin - 7.1 g/dl 9. Hematocrit - 21.50 % 10. MCV - 72.90 fl 11. MCH - 24.10 pg 12. Lymphocytes - 55.00 % 13. RBC - Mild anisopoikilocytosis. Predominantly microcytic hypochromic with ovalocytes. 14. WBC - Eosinophilia present Her skeletal survey is normal. EMG and NCV is normal. 2D echo of the heart is normal. She is having motor delays and excessive sweating in the head. She vomits too often and is having a narrow face. Can we pin point the syndrome she is having or she is having some nutritional/vitamin deficiency??? Check Out the Answer
Question Category : Diagnostic dilemma
dear netters > a 9 yr old female is admitted in hospital & she > is k\c diabetic ketoacidosis with diffuse brain > damage. she had cardiac arrest & resuscitate > succesfully.Tracheostomy was done at appolo hospital > delhi & pt on ventilator & unable to wean off because > as we remove the ventilator,respiratory distress > occurred. > In present status pt. had decerebrate > posturing on & off & requires insulin drip to maintain > the blood sugar & no chage was noted in cns status.EEG > suggestive of generalized slowing with diffuse brain > damage > any one can suggest regarding further > management & prognosis. > > dear netters > a 9 yr old female is admitted in hospital & she > is k\c diabetic ketoacidosis with diffuse brain > damage. she had cardiac arrest & resuscitate > succesfully.Tracheostomy was done at appolo hospital > delhi & pt on ventilator & unable to wean off because > as we remove the ventilator,respiraory distress > occured. > In present status pt. had decerebrate > posturing on & off & requires insulin drip to maintain > the blood sugar & no change was noted in cns status.EEG > suggestive of generalized slowing with diffuse brain > damage > any one can suggest regarding further > management & prognosis Check Out the Answer
Question Category : Diagnostic dilemma
5 and half yrs old f child born of nonconsanguinous marriage maratha by caste presented with h/o vaginal bleeding intermittently every 3-4 months and lasting for about a month once started .she bleeds heavily around 15 cc per day and requires transfusion for that .this is ongoing since last three yrs i.e.from the age of 2 yrs of the child .she has received multiple transfusions for that and it was observed by parents that the child stops bleeding after taking the transfusion by around 7-8 days.she is investigated for the same and lh/fsh , thyroid assay are normal.x ray limbs are not s/o mc cune alright syndrome.platelet count is normal and they are seen in clumps.pt/pttk are normal.how to investigate further Check Out the Answer
Question Category : Diagnostic dilemma
pt. with microcephaly,deafness,packed nose,delay motor stones,hypotolerisium,small mandiable what the syndrome fits all these criteria? Check Out the Answer
Question Category : Diagnostic dilemma
3.5 yrs girl,II degree consaguinity product,2 normal older sibs,mother had jaundice in 1st TM of pregnancy,mild dev.delay. Had grade I hepatic encephalopathy with HAV 6mths back. 3 episodes of para/quadriparesis of mod-severe degree & loss/grossly altered speech lasting for 5-10days over last 15 mths.fever ppt.once,focal seizures once. Workup(KEM-PUNE)-gen.Spikes & wave on EEG,CT(old)-WNL,MRI-enhancement-rt.temporal/parietal lobes & choroid plexus,normal myelination.blood & csf lactates raised. LFT-WNL. ?MELAS/Leighs suggest diagnosis & further workup... Check Out the Answer
Question Category : Diagnostic dilemma
11 years old presented with hemiplegia lucopnia ,high seru ferritin ana anti double strand dna neg. eye exam normal what are the possibility Check Out the Answer
Question Category : Diagnostic dilemma
sir i have a patient aged 10 yrs rt handed boncm presented with tremors pinrolling type in the left hand associated with head bobbing movements .child was fine 5 days back when he was given some medication for cough ,there was no vomiting and fever .after that the child started with these tremors.there is no rigidity postural instability or gait changes.there is no loss of higher functions and there are no cerebellar signs. what can be the probable etiology? mri done no changes in brain Check Out the Answer
Question Category : Diagnostic dilemma
hello sir , i have some queries if u can give me the answers for these i will be thankful to you. 1) classification of mental retardation on the basis of rehabiltation 2) pyuria in female child 3) complications of thalasemia major Check Out the Answer

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