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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 4 & 1/2 year old girl born to consanguineous (2 degree) parents presented with, seizures( staring look & unresponsiveness) at the age of 2 years. He was put on gardinal (but seizures recurred shifted to eptoin 3 months back 6 months later (at the age of 2 & 1/2 years), child started having episodes of vomiting nonbilious & non projectile,15-20 per day. each episode lasting for 10-12 days, for every 3-4 months initially, later every 1-2 months. He had loss of appetite and weight Development was normal. history of patient revealed death of elder sister at the age of 3 years with c/o vomiting, & suspected liver disease (reports n a) o/e----poorly built and nourished vitals--- hr 110 / min. bp 124/90 (hypertension) rr 26/min. hepatomegaly (mild) no spleen. Orther systems are normal. investigations revealed CBP--- hb 10 TLC-- 5600/cumm plt -- adequate. rft---normal. abg--- normal.uppar gi endoscopy --- mild esophagitis.barium meal f/t normal, montoux -- negative. usg abd --- mild hepatomegaly. csf --normal. ct---normal. sr ammonia, pyruvate -- normal. lactate--- elevated(twice upper limit) urinary VMA and urinary protoporphyrinogen negative. please suggest further investigations, diagnostic dilemma and management. Check Out the Answer
Question Category : Diagnostic Dilemma
A 4 years old boy presented fever since 10 days, associated with chills and vomiting, non bilioous, no pallor, no jaundice or lymph adenopathy. USG : hepatosplenomegaly, mesentric nodes, ileal wall thickening, no ascites, urine and blood C/S no growth CT scan normal study TC ; 8000, N 64 L36, ESR 7 & 10 widal :1:60 oand h positive, smear Normal study. Check Out the Answer
Question Category : Diagnostic Dilemma
A 1 month old present with cyanosis and apnea during feeding barium swallow don show GERD and pation on nesogastric tube feeding. CT scan of BRAIN was normal. What will be other differntial diagnosis? What is the work up for swallowing in coordination to diagnoses? Check Out the Answer
Question Category : Diagnostic Dilemma
A 4 days old neonate brought with complaints of convulsions, which appeared on day 3 of life, GTS,4 episodes, each episode lasted for few minutes. Antenatally mother had PIH, taken antihypertensives. But delivered at home. Delivery was assisted by dai. Baby cried immediately after birth. After delivery they consulted local doctor as baby was tiny. Birth weight is 1.5 kg. Baby was not fed properly for initial 2 days. On examination, Asymmetrical IUGR, Lethargic, Icterus present, plethoric conjunctiva, Vitals are stable, AF is level CNS Examinatioin-lethargic,no cry and activity,pupils-NSRL,NNR-absent, hypotonia other systems are normal INVESTIGATIONS:Hct-59%,TSB 15mg%,Sepsis screening-negative, CSF analysis-normal, RBS and Calcium ,Mg, Electrolytes are normal. NSG-cerebral edema NO seizures after admission, But baby is lethargic. What is the diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
8 year old boy born from non consanguineous parent has been complaining from one and half years of generalized muscle ache and recurrent falling and numbness especially at finger tips plus burning sensation there and sometimes arthralgia in elbow and knee joints. Parents observed laxity of his joints especially at elbow joint and wrist joint with moderate ability of acrobatic movement at these mentioned joints 1 year ago they came for medical advice after observing the progressive course of this manifestation and many investigations were done of which all showed normal values. Examination show normal looking child with mild obesity, no special facieses observed with normal mental status. abdomen examination - lax mobile with no rigidity or tenderness or organomegaly chest examination normal heart examination shows mild prolepses at mitral valve which was confirmed by echo on heart head neck examination normal no lymphadenpathy nor organo megaly. Neurological examination show mild reduction in muscular motor power with intact sensation. motor reflexes normal away from laxity of joints especially at elbow and wrist joint with some acrobatic movements observed and mild hypertrophy of muscle of calf and deltoid no other abnormalities in muscular system investigations were as follow/ s.urea and s.creatinin = normal s. calciium total =10.3 serum phosphorus =6.7 normatl (3-6) ck -total =122 repeated one month later and found to be 70 normal up to 195 esr 1st hour 12 and 2nd 25 na=145 s.potassium 4.5 s.magnesium =201 n(1.2-2.1) antids-dna negative rf and crp negative asot=200 tu cbc away from mild thrombocytosis 415000 no abnormality in blood picture was observed with normal deferential count emg conclusion (slight reduction in the interference pattern and normal sensorimotror conduction can any one have suggestions? or help? thanks doctor Reda Fadle egypt email- dr_reda63@hotmail.com cell number 0020106576936 Check Out the Answer
Question Category : Diagnostic Dilemma
A baby boy brought on day 6 of life with lethargy, decreased feeding, icterus. Birth history: born out of non consanguineous marriage by full term lscs wt:2.8 kg rest uneventful.o/e:pallor, pustules over extremities and trunk, icteric till thighs, AF leveled, CRT instant, suck rooting was good,RS CVS:NAD, P/A:distended,soft liver 3cm with tenderness on palpation, spleen just palpable. On admission blood sent for metabolic workup and CBC, CRP,blood culture. He was given 10% dextrose, push started on 10% isolyte-p Maintenance fluid iv taxim,ampoxin & amikacin started double surf p t.feeding tube kept in situ on 3rd day of admission coffeebrown RT aspirates iv cepime fortum added taxim amikacin omitted. given platelet concentrate and packed rbc's once. Investigations as follows:On D1 - Hb 11.1 WBC 13700, P70L28E1M1,PLATELET 1LAC/cmm ,PCV 31,total bili 13.7 indirect 11.9 direct 1.8, crp +ve (1:16dil), blood culture no growth after 72 hours of incubation. On D3- Hb11, wbc14700,p51l32 band forms13% platelet 1.6 lac malarial parasite not seen. csf : 2cells, no rbc's ,csf glucose39.3, protein 18.72 mg%. csf grm stain afb negative. RBS 59.65mg% PT 20sec/control 13sec, aPTT 35 sec/ control 30sec.bili total9.2mg% indirect 8.2mg%. BUN 15.3 CREAT 0.52. On D4 of admission USG abdo: liver homogenous echotexture shows multiple tiny focal hypoechoeic lesions in the right and left lobes. measure 1-2 mm in size and distributed in the periportal region. no cysts seen. biliary radicles & hepatic veins are normal. s/o multiple hepatic abcesses.kidneys normal in size with no cysts seen. Repeat USG after a week of antibiotics showed minimal impovement but multiple tiny hypoechoeic lesions were still present On D10 of admission CT ABDOMEN: multiple ill defined non enhancing lesions predominantly in right lobe of liver in periportal region possibilities are developing abcesses, inflammatory pseudotumor, hemangioendothelioma. On D11 Hb 10.6 PCV 32.8 WBC 17800 P34 L64 B1 M1 PLATELET 1.89 MCV 104.1 MCH 33.7 MCHC 32.2 RBC 3.1 million, RDW 64.2fl baby discharged after 14 days of iv antibiotic with probable diagnosis of late onset sepsis (though not proven by lab tests). my dialema is what were those multiple tiny hypoechoeic lesions periportally in right lobe of liver. Check Out the Answer
Question Category : Diagnostic Dilemma
From a brief description could you help tell me what this condition is? . This is about a baby born full term @ 6lb 10oz. The doctors said the baby has small limbs and has a condition but didn't know what. the baby has quite a large forehead kept on sticking it's tongue out from the moment is was born was wide awake for hours the baby now has puffy cheeks after about 1 week and looks quite big for its age. Do you know what this conditions could be? As it would be a great help just to research the information you may give as it takes a very long time for the blood results to come through. Thank you for your time. Check Out the Answer
Question Category : Diagnostic Dilemma
This is about a 8 month old boy with complaints of failure to thrive, recurrent high grade fever, gross developmental delay. on examination child has pallor, tachypnea with intercostal retractions, tachycardia, bronchial breathing in infrascapular area bilaterally, hepatospleenomegaly, perianal excoriaton. Investigations done-hb 9.2gm/dl,wbc-22500,serum electrolytes-s.na-118,s.k-4.55,s.cl-100.chest x ray showed left lower lobe consolidation, homogenous opiate infiltrates present bilaterally significantly on right side, ABG showed normal values, at present the child is being treated with oxygen inhalation at 5 lit/min,inj.amoxycillin-clauvulunate,injgatifloxacillin,injmetranidazole,inj flucanozole,salbutomol nebulization along with antipyretics. Present problems are inspite of one month of therapy baby is not showing any signs of improvement and is not maintaining oxygen saturation, kindly advise me how to manage this case further? our working diagnosis is acute bronchopneumonia/tb/immunodeficiency disorders. Check Out the Answer
Question Category : Diagnostic Dilemma
13 years old female child first issue of 20 con marriage came with complaints of epitaxis--recurrent since one year of life with multiple ecchymotic patch over upper and lower extremity. She noticed it since 7 year of life. no history of hematuria/ jt swelling/fever with rash/other system affection. no significant birth/family/developmental history on examination-- short stature vitals stable ecchymotic patches over extremities refractive error-- hypermetropic{+13d} s/e--spleen 3cm firm inv--hb-6.6,tlc-6,600;ps-hypo micro platelet-1,60,000 pt-{inr}1.32 aptt-normal diagnosis//how to approach next?? Check Out the Answer

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