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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
A newborn, term baby, 3kg, mother having no positive history, was brought in half hour of delivery with grunting and severe respiratory distress. It cried immediately after birth according to obstetrician. As baby was in intermittent apnea and SaO2 50%. Baby was intubated and blood was coming out of endotracheal tube (non-traumatic intubation). Baby was put on ventilator but baby SaO2 was 60-70% on Fio2-1 and Pip-25. Rates - 30. X-ray chest was done in 3 hours of birth which showed total whiteout in both lung fields. The SaO2 never improved. USG chest ruled out possibility of congenital diaphragmatic hernia. Finally baby succumed to death in 20 hours as the SaO2 did not improve and gradually fell down. Endotracheal suction revealed bleeding intermittently. Baby is conscious and passed urine 4 times and stools once. What could be the diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
Please suggest some condition where patient is not able to walk in straight line ,high step gait, searches for support while walking ,Walks looking straight without looking down on floor, is not able to recognize some relatives MRI NAD no h/o fever,headach,vomitting, Age 7 years asymptomatic 15 days back these symptoms develop after 7 days loose stool. Other systems NAD,CNS conscious eats normally walks with support. Check Out the Answer
Question Category : Diagnostic Dilemma
I would like to have most probable diagnosis of an infant (3 months) with persistent anemia (requiring regular transfusions since birth) failure to thrive, delayed development, only hepatomegaly on examination, candidiasis, with history of 3 sibling deaths at 3-6 months of life, consanguineous marriage of parents.. Following investigations were normal- TORCH, HIV, BONE MARROW ASPIRATION, THALASSEMIA PROFILE (except low serum iron), SKELETAL SURVEY, ONLY LFT's WERE DERANGED with hypoalbuminemia, raised SGPT. Check Out the Answer
Question Category : Diagnostic Dilemma
I would like to have most probable diagnosis of an infant (3 months) with persistent anemia(requiring regular transfusions since birth) failure to thrive, delayed development, only hepatomegaly on examination, candidiasis, with history of sibling deaths at 3-6 months of life, consanguineous marriage of parents.. Following investigations were normal- TORCH, HIV, BONE MARROW ASPIRATION, THALASSEMIA PROFILE (except low serum iron), SKELETAL SURVEY, ONLY LFT's WERE DERANGED.Could it be a storage disorder? He has a history of septicemia with hyperbilirubinemia requiring phototherapy and then herpes hepatitis in neonatal period but repeat herpes titres at 2 months of age were normal. Although thyroid function tests were never performed so could it be due to hypothyroidism too?? Check Out the Answer
Question Category : Diagnostic Dilemma
9 month male complaining of generalized tonic clonic convulsion without fever. Since 1 month his antinatal, natal & POSTNATAL HISTORY WAS NORMAL,FAMILY HISTORY was POSITIVE FOR MIGRAINE NO HISTORY OF epilepsy. His INVESTIGATIONS: CBC.URA.ELECTROLYTES. BLOOD SUGAR WERE NORMAL. EEG&CT SCAN ARE NORMAL. Check Out the Answer
Question Category : Diagnostic Dilemma
What are the management options for the subdural hygroma presenting with the seizures, no signs of raised ICT or the mass effect, or focal deficit? Check Out the Answer
Question Category : Diagnostic Dilemma
4 months old male child came with fever, irritability since 2 days. Infant was feeding well till then. There was history of third dose of DPT/Polio given 2 days back. He was given Paracetamol. Next day fever & irritability continued coupled with refusal to feed. On examination : Temp. 99degF, Heart rate 110 per min., RR 40, AF being narrow could not be well appreciated. ENT was Normal, Per abdomen Soft, Liver 1cm palpable firm, Spleen not palpable. Baby was then admitted & put on maintenance I.V. fluids. CBC showed : Hb 11.3, WBC 10100, N49, E2, L49, Low Platelets of 63000.Smear for Malaria parasite negative. Fever subsided but irritability & refusal to feed continued for next day. CBC was repeated on second day of admission showed Hb 11.1, WBC 8300, N36, E5, L56, M3, Platelets dropping further to 55000, Serum Proteins 7.9 with albumin 3.6 , SGPT 385, PT 14 with control 14, PTT 39 with control 29, Serum Electrolytes : Na 145, K 5.2, Cl 109. Child is haemodynamically stable with good urine output. What is the probable diagnosis and further line of treatment? Check Out the Answer
Question Category : Diagnostic Dilemma
Ivona, 19 months old baby girl was born with 6 toes, and diagnosed with increased kidneys (they were not fully developed) and hypocalcaemia; she was treated at the University Child Hospital in Belgrade, Serbia. She was released from the hospital after 7 days, without any particular diagnosis, and parents were advised to continue to bring her for regular check-ups. Regular pediatric check-ups did not find anything irregular. Over time, her kidneys have developed to the right size, and her level of calcium was normalized. Within the first two months, when only breast fed, she weighted 7.2Kg (3.5 kg at birth), and even today, she continues to have a high appetite for her age. Compared to other kids of her age, she sleeps less, cries a lot, and hasn't lost any weight, after being put on reduced calories diet. She started walking when she was 16 months old, and isn't as stable as should be, she is also unable to get from a sitting to a standing position. Until now, she hasn't spoken a single words, the only sound she makes is when she cries. She doesn't react to calls (and her hearing is fine, as confirmed by ear specialists). When Ivona was 18 months old, child psychologist confirmed that Ivona is falling behind in her development, and that she is at the level of 11 months old baby. She is also diagnosed with strabismus, astigmatism, and shortsighted on one eye. Neurologist suggested that she may have metabolic abnormalities related to amino acids and the blood analyses. In the meantime, as we are still waiting for the blood results and final diagnosis, dialectologist-physical therapist are working with her every other day, 45 minutes and she attends toddler school for an hour per day, but only cries and shows no interest in the other kids. She is drinking plenty amounts of liquids, mostly water. I believe her baby bottle has more of a calming effect, than she is thirsty. She is almost constantly crying, very sadly, like she is asking for help, but we are unable to do so. She loves to be comforted, reaches to everyone, no matter if it a stranger or close relative. When her parents are back from work, she doesnt react, interact with them, or doesnt show any signs of happiness, as she doesnt recognize them as her parents. On the other hand, she looks for her water bottle, and cries when she doesn't find it. Check Out the Answer
Question Category : Diagnostic Dilemma
An apparently normal 3.5 years old girl child is passing stool which contains blackish fly like insects which really fly on coming out from body. What is the diagnosis and treatment? Check Out the Answer
Question Category : Diagnostic Dilemma
Children in the age group of 5-15 yrs presenting with fever 7 days, ascites, bilateral pleural effusion, some with seizures, delirium,no icterus or pallor,hepatosplenomegaly in some, dengue and malarial test negative.mild liver enzymes elevation in 100s,with prerenal failure..., lepto igM positive, but mat for lepto normal panbio <3 units are currently treated as gram neg sepsis. what else could it be? Check Out the Answer
Question Category : Diagnostic Dilemma
13 years old male child presented with a history of fever since 2 weeks, developed maculo papular erythematous rash all over the body on 3 day of fever. on 8 th day rash faded but fever persisted. There were severe chills with lip cracking on fifth day of fever. fever subsided on 10 th day but again started on 13 th day. there was a history of increased bowel movements during the episode.history of cough +.history of throat pain+. History of desquamation from ther finger tips from the 10 th day on wards including feet. on examination child was sick looking malnourished pallor+ cyanosis-jaundice- jugulo diagastric lymphadenopathy+ posterior cervical nodes both sides palpable no pedal edema vitals stable systemic examinations normal on investigations Hb is 11 gm% platelet 5.48 lacks ESR is 70 1sthr, 140 2nd hours all oter investigations normal including CBP< montoux was negative. Check Out the Answer
Question Category : Diagnostic Dilemma
Dear sir, a one year old child presented with obesity (17kg, mentally normal, milestone normal ),severe metabolic acidosis,shock and convulsion.child died within a day. what could be the possible diagnosis? Check Out the Answer

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