Diagnostic Dilemma - Pediatric Oncall

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Question Category : Diagnostic dilemma
9yrs old female child weighing 28kg - at US for the past three months - now having fever for twelve days - - Father was trtd for TB 15yrs back GC good - Urine=NAD and leucocytosis is the only positive finding (Hb, Platelets & ESR normal-- Mx negative) Widal MP not done Xray chest showing fluid in the R pleural cavity Aspiration not done Can SAARSbe a DD in this case Further guidance please Check Out the Answer
Question Category : Diagnostic dilemma
12 yr old female pt. presented with h\of recurrent bouts of chronic cough for past 2 yrs ,each episode lasting for 10-15 days and subsiding on its own.Cough is so severe as to interrupt her sleep.Each episode is initially associated with hemoptysis whose severity decreases in 4-5 days.She also complains of dyspnoea onmild to moderate exertion.There is no h\of weight loss nor has she any signs of malnutrition on examination.Physical examination is not contributory.Even there are no signs of pulmonary involvement on exam..Chest X-Ray shows milld hilar prominence.Hb is 12.4gm%,TLCis 8400,Dlc is P57%,L39%,E04%,absolute eosinophil count is 360 cells,bronchialwashings show aerobic cocci,and budding yeast cells.There is no response to antiallergic or bronchodilators. Check Out the Answer
Question Category : Diagnostic dilemma
A 4 years old boy came with the complaints of sudden pain in the right knee joint which radiates upto the foot. He also complaints that he couldn't walk when he wake up at morning. He didn't complaints of any rise of temperature or swelling of the knee joint. His mother complaints that the boy did not allow to touch his right leg. With these complaints he was taken by his parents. In past history his mother told that, after 2 years complete he sometimes complaints of pain and burning sensation in both the foot and was treated by Calcium tablet for 2 months. On examination temperature was 98 degree F, pulse normal, knee joint had no swelling or redness or tenderness. On laboratory investigation his ASO titre was 200 and C-reactive protein was negative. What is the diagnosis of this case? Is there anybody who can help me? And what is the treatment of this case? Is there any query, please mail me. Thank you Dr. Md. Sharif Hasna MBBS Check Out the Answer
Question Category : Diagnostic dilemma
Hi, I have a 10 years old female patient,from a migrant family of UP with poor S.E, status and a F.H of Kochs. She c/o persistent cough,L.G.F. and pain left lower chest > on deep inspiration. Mx was positive, ESR 78,TLC 5,800 with lymphocytosis. Xray chest suggestive of Rt. lower zone Pleural thickening,hilar shadows prominant and Ultra sound showed a pocket of encysted Pleural Effusion which was tried to be aspirated with a U/S guided needle but the tap failed. Pt.received ATT -PZM,Rifa,INH,Ethambutol for 2months but the encysted Effusion did not get reabsorbed,although the consolidation resolved. ATT was continued for 6months(PZ was stopped after 2months). AS the P.E. persisted a 6weeks course of Prednisolone,Ofloxacin and 60 shots of STM also given.A CTS at the end of 9 months Rx still shows a very small pocket of encysted fluid. 1. Should ATT be discontinued or be given for somemore time? 2. Any need for a surgical intervention? Apparently the child seems to be fully cured. Dr. J.S. Chugh Consultant Pediatrician, S.N.S. Pahwa Hospital,Ludhiana Check Out the Answer
Question Category : Diagnostic dilemma
An eight years old girl with moderate grade of fever for 2weeks was treated by a local practioner,As widal titers of the child was O;320 H 120 so he gave the child three days course of I/M antibiotics but still the child was running fever so was brought to me. I repeated her blood investigations.Hb:10.5gm/,Tlc 5400,N65,lym 25.plat:adeqt,Film:n/n anaemia no haemoparasite seen. URINE Rutine examination :Normal.Blood culture:No growth. As the widal was positive I gave seven days course of Oral Cefpodoxime following which child became allright, remained afebrile for a week,now again she has started running fever low to moderate grade on and off . I'm confused Please guide. Check Out the Answer
Question Category : Diagnostic dilemma
A 13 year old boy was being treated as seronegative Juvenile Idiopathic Arthritis for last 6 months. Had Diclofenac, Solu-Medrol and a bi-weekly course of oral methotraxate. There was pain in large joints but from history, no convincing data was obtained regarding joint swelling. Now he presented with extreme pain on moving lower limbs and trunk, bed ridden. He is mentally very clear, communicates well, despite his illness, becomes 1st in the class. On Exam, ankles and legs remain flexed, afraid of truncal movement, no joints are swollen or tender. Feels extreme pain and screams on touch on lower back, but if the I sustain the pressure, pain goes away and no screaming even on deep pressure. Lower limbs initially seems spastic, he cries on movement but these can be flexed very slowly. After a while, passive movement becomes easy and painless. Adductors were seen spastic, but on slow and sustained effort, these become soft. muscles of lower trunk and lower limbs are initially spastic but on manipulation, these become soft and pain goes away for a while. Ankle and knee jerks are HYPERexagerated, ankle and patellar clonus are present but planter response is flexor. Upper limbs also show hyperreflexia to lesser extent. Can not stand or walk. On attempt, he screams on moving legs, those seems spastic!Cannot bend joints. Is there any suggestion on how to approach to diagnosis and a logical management plan? Check Out the Answer

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