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Question Category:Diagnostic dilemma |
infant of 6 month old ,consangiunous marraige, history of birth asphyxia, developed intermittent fever since 5 months with hypotonia developmental delay, treated by antimalaria was quinin infusion and cefitriaxon for persumed sepsis but fever persist , hb electrophoresis AS , torch screen was normal urin showed Wbc > 20 treated for UTI according to cultur but no response.bone marow revealed eosinophilia. mantoux was 9 mm , trial by antiTB started 20 days but still febril, hypotonic more, pale, brain CT scann showed mild cortical atrophy.what you suggest to do with this child
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Question Category:Diagnostic dilemma |
A 6year old Hindu male boy, a product of non consanguineous marriage, home del uneventful postnatal period, Ht:- 98 cm/ Wt:- 13 ½ Kg. presented with History and features of sudden tonic extension of neck with occasional upward gaze, duration- fraction of a second to 2 sec. several times/day. O/E no neuro deficit detected during attack. Consciousness preserved. No H/O passage urine or stool during attack. No F/H/O epilepsy or stroke. BP of the child - 97/69 mm of Hg. EEG reveals and interpreted by an adult neurologist - drug induced (pedichloryl) sleep record shows diffuse slowing mixed with fast beta activity. There is spike and slow wave pattern with lots of artifacts. Please help me in arriving at a diagnosis and treatment protocol.pt. is very poor and can not afford ct scan. Dr. Binayak Roy.
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Question Category:Diagnostic dilemma |
we have a child aged 10yrs suffering from all and she is on chemotherapy.she is now on third cycle of maintainance.she has devoleped carpopedal spasms of right hand.on repeated examinations of her serum calcium was normal.and she is only getting on her right hand.did any one has come across this condition????????
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Question Category:Diagnostic dilemma |
6yrs old male with fever of 14days ,jaundice-8days, icterus+ heaptosplenomegaly, Hb-9gm,tc-11800,P40,L53,M7 bilirubin-T-5,D-3.9,I-1.1,SGPT-1170,alk phosphatase-1020,MP-neg,Widal Neg,Urine-N , sr protein_T-5,alb-2.5,g-2.5 Sonography abd-Hepatosplenomegaly with minimal free fluid Recd-cefotaxim& Quinine patient contiuesto have high grade fever Reason?
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Question Category:Diagnostic dilemma |
i have a 5 yeor old male patient who presented with 49 days of fever and pallor. He was admitted twice for which only a complete blood count was done which revealed pancytopenia.Packed RBC transfusions were given on these 2 admissions. On Physical examination he has slight hepatosplenomegaly. The Mantoux test we did at our hospital turned out to be positive. His CXR revealed infiltrates and paratracheal lymphadenopathies. What do you think is the closest diagnosis of this patient and how do i approach it.
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Question Category:Diagnostic dilemma |
My patient is 8 years old and male. He presented to us with high fever, generalized lymphadenopathy, hepatosplenomegaly and purpura. Platelet count is 500,00/cmm with normal TLC and DC. His bone marrow study is normal. He also has hematuria. FDP is normal. What is the most likely diagnosis?
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Question Category:Diagnostic dilemma |
I would like to post my query regarding this case of a Child age 6 yrs. Presenting to us with a history of fever and reduced appetite for past ten days. Jaundice for 6 days, pallor for 5 days. Increased respiratory movements for past three days before admission respectively. On examination the child was tachypneic with pallor, moderate grade fever, icterus, no lymphadenopathy, mild abdominal distention, tender heaptomegaly extending 5 fingers below SC margin firm margins and smooth surface, B/L equal chest entry. Rest of the systems were within normal limits. On lab investigations:- Hb 6.7gm%, TLC 5000 with a slight polymorphonuclear predominance, S. bilirubin 5.6 direct 3.8, SGPT 377U, platelets 20,000 , GBP confirmed the above findings and no hemoparasite was found neither in the GBP nor in the QBC. Widal was not confirmatory. Total serum proteins were 4.4 gms, S albumin 2 gms. PT was normal. Urine routine microscopy was WNL too. Abdominal USG of the child showed hepatomegaly with mild parenchymal involvement and mild ascites. The child was put on iv ampicillin and iv gentamycin, iv D10% with MVI and inj HEPAMERZ, syp lactulose, inj vit k, ranitidine, oxygen by mask and an urgent fresh whole blood was transfused. The child was 24 hrs. on this treatment when his tachypnea improved slightly but his liver size increased . The fever also was unrelenting. The antibody tests for dengue were also negative. I am in a fix over the diagnosis and further line of treatment. Keeping in mind the tests mentioned above, all suggestions would be welcome.
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Question Category:Diagnostic dilemma |
Case for section "Diagnostic Dilemma" Full term Neonate born by LSCS--Indication-- Primi breech,was severly asphysiated at birth.After resusitation by usual protocalls was found to have the following cong anamolies;Joint contactures at hip and knee joints,dislocated wrist joints,muscle hypoplasia, genralized hypotonia,B/L undesended testis with poorly developed scrotum,low hair line with short neck,high arched palate.On second day deloped a systolic murmur without cyanosis or failure- probably VSD.On Fourth day developed progressively increasing jaundice with acholic stools.Investigations so far:CBC+platelets-Normal CRP-1:16, S.Bilirubin-27mg%Direct-20.4mg%,SGPT-30IU/L,S.Alk Phospatase-141IU/L,TORCH IgM Negative,S.Urea Creatinine-Normal,USG Abd and Brain normal,Kiddigram -absent fibula Rt. What could be the prabable diagnosis?How can rpt SGPT be normal despite such high direct bilirubinemia?
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Question Category:Diagnostic dilemma |
a 4yrs child,with recurrent episodes of vomiting,fever,cough.on exm. child concious,mildly dehyrated,chest-crepts++,wheeze+!cvs,cns-n.a.d,abd-soft,no organomegaly!l.f.t normal,urea,creatinine-within limits,m.r.i-normal study,barium meal-normal study,endoscpy-laxed l.e.s.what's the diagnosis & line of management?
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Question Category:Diagnostic dilemma |
I have a 10 y/o white male with 5 day hx of severe abdominal pain, afebrile with neg exam, specifically no rash. FH dad with hx of kidney transplant due to glomerulonephritis and a Hx of renal stones. Child had TNTC red cells. No proteinuria. H/H 41.9/15 smear revealed a few microcytes and mild poikilocytosis. MCV 79 platelets 345K. BUN 10, Creatinine 0.5. Ca 7.5, ionized Ca 3.18, Mg 2.28, Phos 5.3. Albumen 4.9, globulin 7.4. CT of abdomen and pelvis with and without contrast neg for hydronephrosis or calcification. Any ideas on differential dx and suggestion for further w/u.
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Question Category:Diagnostic dilemma |
10 years girl presented with history of severe muscule pain and fever for 15days , systemic reveiw and examination are nad. investigations;all are normal except high esr
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Question Category:Diagnostic dilemma |
a child on the unit, known to have hemiplegic cerebral palsy, came with status epilepticus, also had persistent metabolic acidosis, deranged liver function tests, which improved after 3-4 days. vital signs were stable,airway was self maintained except that she did not wake up after the anticonvulsants were stopped.on day 5, she had 2 massive pneumothoraces, requiring intensive care. urine organic and amino acids were normal, no infective focus was found.EEG reveals an encephalopathic picture. echocardiogram was normal.we still do not know the cause for her persistent metabolic acidosis.she has also required platelet transfusion for falling platelet counts.she also has gone into Acute tubular necrosis.she is currently being ventilated.what could be the reason for the presistent metabolic acidosis?
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Question Category:Diagnostic dilemma |
Neonate 22days old- urine turns brown on leaving for > 1hour. fresh urine is pale yellow and urine r/m is normal. general and systemic examination is normal what is the further course of evaluation.
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Question Category:Diagnostic dilemma |
Hi, My patient 4 yrs old Male without sigificant past history presented with breathlessness presented in ER , child admitted diagnosed as Empyema and child put on ICD child used to have persistent fever inspite of taking Cultured proven antibiotic Vancomycin and Cefotaxim . Still there is haziness in RLL the CT no sepation or multilpe loci. No mechanical problems with ICD now serous fluid coming. Childs MTx,HIV negative but still fever present shoul;d we start AKT but how to expalin the Negative mountex ?
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