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Question Category:Diagnostic dilemma |
K is a 2.5 yr male child presented with h/o multiple fractures of different bones at different times (within a span of 6 months).he was well apparently upto 2 yrs of age. At the age of 2 yrs (6 months back) had trivial trauma, followed by fracture (1st) of left humerus followed by sub acute osteomyelitis which was treated appropriatel.2ndfracture after 1 month gap, right arm bones with radiologically s/o periosteal reaction with F/O osteomyelitis, which needed fixation with screws.3rd was fracture seperation of right tibial epiphysis, which was treated with POP cast. At present (4th) he has swelling of left knee with radiological evidence of periosteal reaction. Otherwise apparently well child upto 2 yrs of age. (Birth and developmental history is normal Physical examination revealed swelling of left arm and right knee joint, left arm is covered with cast. No blue sclera, no hearing abnormality, otherwise well and active child. Investigations normal total count, platelet, differential count, LFT normal, calcium and alkaline phosphatase were also normal, blood culture sterile. X-rays of affected parts is showing perioteal reaction, with fracturesof bone. Bone biopsy showing evidence of new bone formation with marked osteoblastic activity with no significant inflamation. Bone culture sterile.MRI done at the time of 2nd fracture was reported as subacute osteomyelitis of left distal humerus and supracondylar fracture of right humerus. Bone scan is showing i9ncreased osteoblastic activity involving right humerus and right femur with no definite evidence of bony inflammation. Immunoglobin profile is norml, NBT reduction is also normal.
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Question Category:Diagnostic dilemma |
8 year old boy with 2 episodes of lt knee monoarthritis accompanying exudative tonsilitis in a span of 3 months.Fever settled in 7 days with a course of IV cefuroxime and ibuprofen. The monoarthritis resolved in 4 to 5 days.ESR increased from 70mm on admission to 90mm to 105mm after a week.CBC showed microcytic hypochromic anemia with normal WBC and platelets.Monospot TORCH ASOT ANA and Rheumatoid factor were negative. Xray lt Knee with soft tissue swelling but normal joint spaces.No L.nodes,rash orhepatosplenomegaly. NOTE :This boy is the sibling with chronic polyarticular JRA on treatment.
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Question Category:Diagnostic dilemma |
12 years old male presented to the casuality complaining of: fever,dry cough,S.O.B and swelling of the left face,neck and upper limb for 7 days PTA. O/E: finger clubbing grade 2, hepato splenomegaly, visible pulsations in the pericordium and supra sternal notch,tachycardia,tachypnea,stony dullness over the lower zones of the chest. Investigations done as follow.. BFFM +ve Hb% 9 gm TWBC 15.000 mainly lymphocytes ESR 115 RFT was normal x-ray shows bilateral pleural effusion (moderate amount) CT scan of the chest shows cystic bronchiectasis and basal bulle.. pleural fluid tap was hemorrhagic and it's analysis show: protiens : 4.5 g/dl sugar : 56 g/dl cells : lymphocytosis mantoux test was negative.. sputum for acid fast bacilli was negative.. echocardiography done and was normal. Rx : patient received I.V ceftrixone and ampiclox for 2 weeks and now he is on Ampiclox and cefixime capsules.. please.. help us to reach a spot diagnosis and proper management.. Thank you for being patient with us..
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Question Category:Diagnostic dilemma |
To Dr. Sarala Rajajee, Kanchi Kamarkoti Child Trust Hospital, Respected Madam, This patient initially came with fever for three days, had H/O Epistosis and the patient was admitted. On admission, SpO, Lo, NO glands blood count 21,800 (N65 L31%, platelet count 0.08%. Patient improved with platelet transfusion and IV antibiotic, Monocef, (500mg) IV BD (20.11.5005). The patient present with discharge of blood orally and with stool. Patient again on 08.12.2005 had fever and convulsion, on admit malaria vivax was +ve. Blood count within normal limit, PBS -> no abnormal cell. Platelet count 69,000. This time platelet improved without any transfusion and antimalarial drug was given and the fever subsided within two days (80,000 platelet) which improved to 2,74,000. Again on the 4th of January the platelet count came down to 1,60,000. Kindly inform me about the subsequent course of treatment.
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Question Category:Diagnostic dilemma |
HOw will u approach a 10 yr old child who presented with facial puffiness. No history of oliguria/hematuria. BP is normal. Respiratory, CVS,CNS,examination is normal.NO organomegaly. No ascites. CBC, Urine examination, chest Xray, RFTs, Serum proteins normal? What is the further line of investigations.
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Question Category:Diagnostic dilemma |
13 year old girl presented with complantis of facial puffiness-3wks,abdominal distension for 2wks,weakness and body pain lasting for 6-7 months. there is no history of hematuria or polyuria. there is no h/o breathlesness,chestpain,cough. there is no h/o jaundice,bleeding manifestations,abdominal pain,diarrhoea,vomitting. there is no h/o tuberculosis in past. o/e there is severe pallor,nolymphadenopathy,no icteruus,anasarca. there is tense ascites and no other significant findings. investigations revealed: hb 5gm% tc 12800 dc p 35 l65 e0 m0 esr 70 mm urine alb ++++ pus full field rbc abs casts abs se.sugar(r) 87 mg% se.bili T 0.9 mg% D 0.2 mg% AST 34 IU/L ALT 35 IU/L ALK PHOS 133 IU/L S.PROTEIN total 2.0 gm% alb 0.8 gm% urine culture was sterlie. blood culture was sterile. perip.smear showed rbc microcytic,hypochromic,target cells. wbc lymphocytosis. platelets 1.7 lakhs/ retic count 17% SICKLING TEST was positive. USG ABDOMEN reveals normal liver texture,gross ascites and renal parenchyma disease grade 1.ovaries normal. chest XRAY shows b/l pleural effusion and pericardial effusion. pt was started with antibiotis and oral prednisolone. fresh FFP was transfused for 7 days. BT was given for 3 units. even after 3 weeks of steroid urine alb remains ++++ and ascites remained same. diagnostic tap revealed. prot. 0.3 gm% glucose 40 mg% cells 5,800/mm3 lymphocytes 100% A D A 1.4 u/L repeated urine cultures sterile. PUS cells remains full field. HIV SCREENING neg. RESPECTED SENIORS, i just want to have your advice reg. how to procede with the case. there are features of haemolytic anemia(SICKLE CELL),nephrotic syndrome and sterile pyuria. can we proceed with starting ATT drugs or go for UROGRAMS OR GO FOR RENAL BIOPSY TO FIND OUT RENAL PATHOLOGY. yours sincerely, a junior resident in pedia.
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Question Category:Diagnostic dilemma |
what would be the most likely diagnosis of a child 4 years old coming with hepatosplemegaly,hand and feet swelling,lethargic,mild anemia ,FTT and low albumin with no proteinuria
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Question Category:Diagnostic dilemma |
what do u think canbe the dignosis for this girl.12 year old girl came to us with h/o fever for 5days,puffiness for 3 days and poor urine output for a day with lethargy and poor oral intake.on examination the child was pale,had bruises.temp 39 degrees,hepatomegaly 2.5cm below costal margin,facial puffiness,pedal edema,ascites.No s/s of failure.LFT- albumin 23g/dl,others normal,hb 7,platelet 100000,TWC 5,000.Urine protein ++,blood+++.the girl also has hypertension ,on tab nifedipine and tab captopril.blood culture and urine culture NG.retic 0.5,coombs negative,FBP pending.
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Question Category:Diagnostic dilemma |
Dear sir, 13y male child present with ataxia for one month after falling in bathroom. PMH:known case of medulloblastoma operated on 4y ago+shunt operation.Then followed by chemotherapy. After the fall he was referred to his neurosurgeon who arrange CATscan and told them it is -ve. Do you think any relation between the fall and ataxia?or it is recurrence of the tumor? what is the next step?
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