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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
12 years old girl went to Matheran in Jan 2006 and from then she has started losing wt. She lost 10 kg wt over 6 months. She presented yesterday with persistent vomiting and symptoms of abdominal obstruction. Settling on medications. Investigation- cbc-hb 10.4gm%, TLC 8400 (p-78,l21), band forms seen. Platelets adequate. Any suggestive diagnosis. Check Out the Answer
Question Category : Diagnostic Dilemma
A 2 & half year baby history of cold & cough, high grade fever 2 days back. stridor was found to be positive. markly decreased intake. She had little respiratory distress and is unable to speak since 1 day.(decreased speech volume.) she is conscious and oriented, what will be most suitable treatment? Inj. ceftriaxone, dexa, nebulisation, frequent liquid diet given. Check Out the Answer
Question Category : Diagnostic Dilemma
Dear pediatric oncall, I have a child with the following symptomatology- fever past 7 days, dysentery and now melena past 4 days, altered sensorium, thrombocytopenia, mild azotemia, grossly deranged LFT'S, peripheral smear could not be sent pre BT, normal CSF examination and electrolytes. He has a normal urine output so far. PT PTTK MILDLY DERNAGED. Till now it has received 2 BT?s , one PRP,IV ANTIBIOTICS. Could it be TTP ( throbotic thrombocytopenic purpura) But the liver derangement doesn't explain it. Please give me few alternate diagnoses? Check Out the Answer
Question Category : Diagnostic Dilemma
A 6 year old with rec. respiratory infection with tc - 24,000, poly - 76%, skiagram chest showing prominent BV markings. What could be probable differential diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
Dear sir 5 years old boy present to ED as fever+ prolonged febrile fit & treated as such. The next day was still febrile+ deep coma. No history of trauma , drugs or recent chicken pox was present. On examination nothing apart from fever + deep coma which persist for 10 days was observed. Investigation done included 1.normal CSF 2.cbc was also normal 3.widal test was megative 4.CXR is nomal &cat scan revealed mild brain atrophy 5.EEG global dysfuntion. The patient was treated as viral encephalitis[iv zovirax + cefitriaxone + steroid +mannitol + ng feeding] what else can be done for this poor patient.? Check Out the Answer
Question Category : Diagnostic Dilemma
Dear Doctor This is regarding my 9 month old daughter, who, at the time of birth was diagnosed with hypotonia, hyperflexibility of joints and cynosis. Now she is having developmental delays and poor muscle tone. She smiles but cannot sit without support. She has been able to support the neck just a month back. She has short limbs, funnel shaped chest, small & inverted nipples. Her blood chemistry is as low. 1. Free T3 - 2.27 pg/ml 2. Free T4 - 0.92 ng/dl 3. TSH (Third generation) - 2.03 ulU/ml 4. Serum Calcium (Conventional)- 0.7 mg/dl 5. Alkaline Phosphatase(Conventional) - 229.00 U/l 6. Phosphorus (Conventional) - 14.40 mg/dl 7. Red Cell Count - 2.95 10^12/l 8. Hemoglobin - 7.1 g/dl 9. Hematocrit - 21.50 % 10. MCV - 72.90 fl 11. MCH - 24.10 pg 12. Lymphocytes - 55.00 % 13. RBC - Mild anisopoikilocytosis. Predominantly microcytic hypochromic with ovalocytes. 14. WBC - Eosinophilia present . Her skeletal survey is normal. EMG and NCV is normal. 2D echo of the heart is normal. She is having motor delays and excessive sweating in the head. She vomits too often and is having a narrow face. Can we pin point the syndrome she is having or she is having some nutritional/vitamin deficiency??? Check Out the Answer
Question Category : Diagnostic Dilemma
Dear netters > a 9 year old female is admitted in the hospital & she is k\c diabetic ketoacidosis with diffuse brain damage. She had cardiac arrest & resuscitated succesfully. Tracheostomy was done at Apollo hospital delhi & she was put on ventilator & was unable to wean off because as we removed the ventilator, respiratory distress occurred. In present status patient. had decerebrate posturing on & off & requires insulin drip to maintain the blood sugar & no change was noted in CNS status. EEG suggestive of generalized slowing with diffuse brain damage. Can any one suggest regarding further management & prognosis(content repeated) Check Out the Answer
Question Category : Diagnostic Dilemma
5 and half years old child born of non-consanguineous marriage and maratha by caste was presented with h/o vaginal bleeding intermittently every 3-4 months and lasting for about a month once started. She bleeds heavily around 15 cc per day and requires transfusion for that. This is ongoing since last three yrs ie when the age of the child was 2 yrs She has received multiple transfusions for that and it was observed by parents that the child stops bleeding after taking the transfusion by around 7-8 days. She is investigated for the same and LH\FSH, thyroid assay are normal. X ray limbs are not s/o McCune-Albright syndrome. Platelet count is normal and they are seen in clumps. Pt/pttk are normal. How to investigate further? Check Out the Answer
Question Category : Diagnostic Dilemma
Patient with microcephaly, deafness, packed nose, delay motor stones, hypotolerisium, small mandiable was presented. What syndrome fits all these criteria? Check Out the Answer
Question Category : Diagnostic Dilemma
3.5 yrs girl, II degree consanguinity product,2 normal older siblings, mother had jaundice in 1st TM of pregnancy ,mild dev .delay. She had grade I hepatic encephalopathy with HAV 6months back. 3 episodes of para/quadriparesis of mod-severe degree & loss/grossly altered speech lasting for 5-10days over last 15 mths were present. Fever ppt. once, focal seizures occurred once. Workup(KEM-PUNE)-gen. Spikes & wave on EEG,CT(old)-WNL,MRI-enhancement-rt.temporal/parietal lobes & choroid plexus,normal myelination. blood & csf lactates were raised. LFT-WNL. ? MELAS/Leighs. suggest diagnosis & further workup... Check Out the Answer
Question Category : Diagnostic Dilemma
11 years old presented with hemiplegia, leukopenia, high serum ferritin ana anti double strand DNA neg. Eye exam normal. What are the possibility? Check Out the Answer
Question Category : Diagnostic Dilemma
Sir, I have a patient aged 10 years right handed bon/cm presented with tremors pin rolling type in the left hand associated with head bobbing movements. Child was fine 5 days back when he was given some medication for cough, there was no vomiting and fever. After that the child started with these tremors. There is no rigidity, postural instability or gait changes. There is no loss of higher functions and there are no cerebellar signs. What can be the probable etiology? MRI done, no changes in brain. Check Out the Answer
Question Category : Diagnostic Dilemma
Hello sir , I have some queries if u can give me the answers for these I will be thankful to you. 1) classification of mental retardation on the basis of rehabilitation 2) Pyuria in female child 3) complications of thalassemia major. Check Out the Answer

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