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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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Question Category : Diagnostic Dilemma
An 8 year old girl of non consanguineous parentage present with diffused thyroid swelling was from 3 years, on dexedrine since 1 and 1/2 years for ADHD, average school performance, head circumference - 67 cm,height, weight normal. History of good growth inspite of anorexia. Her IQ is 67,systems are normal, thyroid fuction test was normal, thelarche +,Thyroid scan revealed diffused goiter. what is the diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
50 days old child was admitted earlier at the age of 7 dayswith history of loss of weight from 2.3 to 1.7 kg referred from peripheral centre after few days of hospital treatment. During first admission, it was diagnosed as partially treated suspected sepsis, documented thrombocytopenia presented as rectal bleed treated with platelet concentrate. It recovered, and started accepting breastfeeds. On second admission, it was documented to have repeat low platelet 50000, neutropenia 900, leucopenia 2700, CRP positive, Metabolic acidosis with anion gap 17 which was corrected by bicarbonate. What are the likely possibilities? Check Out the Answer
Question Category : Diagnostic Dilemma
Dear Colleagues, I have come across a baby aged 3 months old, born of non consanguineous marriage. She is a complete albin. Baby had foetal ascites with no leading cause. Ascites subsided prior to delivery only to reappear now. She also has got a splenohepatomegaly. Primary hematological workup and L.F.T. & R.F.T. are normal. Congenital infection workup is negative. We are planning for a liver biopsy. Do we need to do anything else? Check Out the Answer
Question Category : Diagnostic Dilemma
Jyoti, eight and half years old female child was brought to me with following positive points and investigations: Consanguineous parents ( father and mother were real cousins before marriage) Yellow eyes, anasarca with ascites, red urine ( duration 1 month) with burning micturition. Past history of hospitalization before five years for fever with altered sensorium which she recovered smoothly and completely. Family history of consanguinity. Two previous male siblings died. First at the age of 7 age and the cause was not known. But he had some renal problem at the time of death. Second male sibling died at the age of 13 with chronic liver disease.(papers are not available). Third male sib has mental retardation with gait disturbances. She has apparently normal male siblings, one 23 year old and another 11 years old. On examination , Temp was normal, pulse was 108/min, BP was 130/70 mm of Hg, Yellow sclera, anemia, anasarca, ascites, liver 1.5 cm and spleen 1 cm below costal margin. She is conscious, alert, awake and not looking ill. Investigations, Hb 9.9, TC 12,100, s.bil total 1.9 ( normal upto 1.2) direct 1.4 ( normal upto 0.4) indirect 0.5 (normal 0.1 to 1.0) SGPT 82 , s. alk phosphatase normal s. protein total 6.1, albumin 2.76, globulin 3.39 bl sugar random 170 urine albumin trace, urine sugar ++ ( child had sugarcane juice prior to urine report but not prior to blood reports), pus cells 13 /hpf and plenty of RBCs/hpf USG abdomen showing right renal and ureteric calculus with mild hydronephrosis with hydroureter. Our further plans: Urine for metabolic screening Bl urea creatinine. Liver viral serology and wilsons disease profile. Are we dealing with genetic / metabolic disorder? Can u guide us further? Check Out the Answer
Question Category : Diagnostic Dilemma
Dear sir neurosurgery play any role in the management of microcephalic children? Check Out the Answer
Question Category : Diagnostic Dilemma
11 months female, underweight 6.75kg. birth weight 3.1kg. urine ketone test positive, random blood sugar and culture normal, urine sugar normal, no casts and rbc in urine, milestones normal, no hepatomegaly or speenomegaly, Test was done 3 days after fever. Child passes small quantity of urine. no history of consanguinity. child doesn't have epileptic seizures. please reply urgent. Check Out the Answer
Question Category : Diagnostic Dilemma
A two year boy came with history of pain in the abdomen followed by sweating all over body. This happens once in a month what is the diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
10 month/F presented with F/S/O ARI. But from very begining, she was dull, not tachyneic. CNS exam. Revealed normal. Hepatomegaly 5 cm soft, non-tender. Throat - no membrane, but tonsil enlarged. CSF normal, SGPT-17, B. SUGAR Thrice Came AROUND 50 MG/DL, CT scan normal. Blood ammonia could not be done. Is that a possibility? If not what next. Check Out the Answer
Question Category : Diagnostic Dilemma
3 month old male child of nonconsanguinity was presented with tonic convulsions with no neck control till time. Routine investigations for convulsions are normal. CT scan of the brain showed frontotemporal atrophy, how is that significant at this age?. S.ammonia is also 3 times the normal value. Convulsions were under control with 3 drugs. Check Out the Answer
Question Category : Diagnostic Dilemma
Searching for diagnosis in a 12 year old female with a h/o mesenteric adenitis x 2 months, and with symptoms like occasional hoarse "crow like" cough, palor, fatigue, slight anemia and painful lymph nodes?????? Check Out the Answer
Question Category : Diagnostic Dilemma
A 2 year old male child was presented with recurrent eosinophila. Despite treatment with 2 courses of 21 days hetrazan and 1 short course of steroids transient response was seen. What could be the further course of action? Please post on diagnostic dilemma. Check Out the Answer
Question Category : Diagnostic Dilemma
An infant was presented with Acute upper respiratory tract infection and accompanying vomiting and lethargy. Upper respiratory symptoms subsided but vomiting persisted. Family history was not contributory. There is a doubtful history of contact with Tuberculosis. On examination, the baby was found afebrile with hepatosplenomegaly, vaginal candidiasis. On investigations, the child was found to have ketonuria and glycosuria with euglycemia. Blood picture showed microcytic hypochromic anemia with thrombocytosis and lymphocytosis. Serum uric acid was normal but triglycerides were increased with normal cholesterol. ESR was 6 mm/in first hour. What are the differential diagnoses for this kind of picture? Check Out the Answer
Question Category : Diagnostic Dilemma
Newborn one day old present with excessive sweating, drowsiness, frothy mouth, grunting, followed by deep sleep. Family history is positive for previous 2 siblings. He died after 2 days. On examination, everything is normal serum ca. rand. blood sugar both were normal. Check Out the Answer
Question Category : Diagnostic Dilemma
A 7 month female infant present with severe vomiting since 4month s.t.projectile. Previous 2 deaths in the infantile age without definite dx. On examination FTTill looking infant dehydrated. vital data are normal. CVS & chest are normal. Abdominal exam. Revealed hepatosplenomegaly, no mass. Barium study is suggestive of pyloric stenosis. Surgery was performed. No clear olive was found but just mild thickening which splitted. The liver was enlarged, was yellowish, and was not smooth but with gritty sensation. Mild bleeding occurred from the wound. Questions; 1.Was the surgery mandatory? 2.what is the real dx? 3.What is the management? ? Check Out the Answer

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