Diagnostic Dilemma FAQs - Pediatric Oncall

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Diagnostic Dilemma

Clinical Tools

Clinical Vignettes

Diseases & Conditions

Drugs Interaction Calculator

Podcasts

Patient Management Online

Diagnostic Dilemma

Question of the Day

Medical Quiz

Interactives

Ask Queries

SPECIALIST ANSWERS

Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

Video Podcast

Videos in Medicines

Medical Training Videos

Clinical Video Resource

Videos on Asthma

Audio Cast

Lecture on Pediatrics

Medical Training Audios

Clinical Audio Resources

Audios on Asthma

Mobile (wap)

Staying connected to Pediatric Oncall is now easier with Pediatric Oncall Mobile . You can now download selected content from the latest issue of Pediatric Oncall.

Research Grant

FIND DIAGNOSIS

VACCINE REMINDER

Get the Vaccine Schedule for your child."

	Specialist Answers
Question Category : Diagnostic Dilemma
8 day old male baby, born of nonconsaguinous marriage, was brought with complaints of passing brown colour urine, staining the nappies brown. Otherwise the baby has no problems. Previous male sibling had similar complaints, now the staining has decreased. No history of similar compaints in the parents. urine dep -nil, no RBCs in urine. How to proceed to arrive at a diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
A case of 16,month, old presented by fever which respond to antipyretics after 2 days generalized lymphadenopathy appear. We did monospot test which was negative and differential leucocytic count was neutrophils 15%,lymphocytes 80%,monocytes 4%,eosinophils 1%basophils 0%,CBC was Hb 11.0,haematocrit 33.8, RBCs 4.3, MCV 79,MCH 26,MCHC 33,platelets 130,total WBCs 5.4,there is mild splenomegaly. What is the diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
Can I use this site to request help with a differential for an I.D. problem? If so, here is the presentation: 18 year old black female with 3-4 days of fever 102-103, myalgias arms and legs, headache without meningismus, although h/a with motion of head and her eyes; she has NO rash, menses occurring, She had been to the Caribbean one week earlier for an overnight with family in Jamaica, NO hx tic bite; maybe one or two mosquito bites, sweats and chills at night 1-2 nights. No real cough of any significance. Mom with history of colitis (u.c.), and lupus. PExam notable: not toxic, although she is ill with malaise. Moderate upper lid has edema without erythema or tenderness. No other visible edema is noted. Small residual induration present without pain or erythema at upper gluteal cleft. She is on the last day of Bactrim for treatment of a pilonidal cust infection. It looks good and appears to be a red herring. Lab: WBC 2.5 (leukopenia), nl diff, nl h/h; u/a +3 blood but MENSES; neg protein. CRP, Sed RAte, Blood culture, CMP pending. Your thoughts???? Thanks, Marc Tanenbaum, MD Atlanta, GA Check Out the Answer
Question Category : Diagnostic Dilemma
A mother of female patient came to my clinic and asked me about something strange Her daughter aged 14 years old was yawning her mouth was wide open Then a crow suddenly came on her head and threw its faeces in her mouth The girl then had bluish discoloration of her mouth margins coldness of her hands and sore throat.....WHAT SHOULD I DO FOR THIS CASE?.... Check Out the Answer
Question Category : Diagnostic Dilemma
A 5 five years old boy, for the last 8 months has been having sterotyped symptoms of feeling unwell, headache, hallucinations and vomiting. He has documented history of fever of upto 104F. Giving calpol relieves the fever and after fever is relieved ,he is normal in his routine work. He has 10-12 episodes in a day and it used to occur every 3 days, and then every 3 weeks. It was such that he has now 10-15 episodes since January. There is no constitutional symptoms. No tummy pain, no joint pains. On examination now he has a temp of 104F. Apart from temperature ,his examination is absolutely normal. His full blood count, LFT, Immunoglobulins are normal. Only what wories is the raised CRP of 42. Please help me to arrive at the diagnosis and help this little kid. Waiting anxiously for the reply soon Check Out the Answer
Question Category : Diagnostic Dilemma
A 7 months old female child previously treated for obstructive hydrocephalous with VP Shunt at the age of 4 months, now is presenting with acute onset of fever and floppiness of all limbs of 4 days duration. O/E Hypotonia more in LL, DTR just present, Plantar- Bil. Flexor. Other systems- WNL. What is probable clinical diagnosis before proceeding to Investigations? Check Out the Answer
Question Category : Diagnostic Dilemma
Hello,I am a pediatrician. I have a patient. He is 9 months old.He has short stature, low weight and small head circumference. He has not increased in his head circumference. In his lab test :TSH=9 & has mild anemia. I prescribed levothyroxin 12.5microgram & ferrous sulfate for him. After pne week I increased dose of levothyroxine to 19microgram.Immediately after that he became restless. He just took one dose of 19microgram & I immediately discontinued it, but he has not changed & has become even worse. He is severely pale, tachypneic & restless? Hb=10 PLT=120000 RBC=3.500000 WBC=125000 Would you please guide me? Is that because of levothyroxine? Thank you. Check Out the Answer
Question Category : Diagnostic Dilemma
Sending here with a case history. Kindly comment on differential diagnosis and management. A 11 year old female, whose parents had a non-consanguious marriage( rajsthani ) presented with c/o-abdominal pain since 20 days. She was tired on walking or accustomed work but no dyspnoea. Vomiting was once every 2nd or 3rd day, nonprojectile, no relation to food. mild fever occurs daily but resolves after antibiotics. All comp since 20 days. Father also noticed yellowness of eyes since 20 days. All come more or less at same time . Baby was admitted to a hospital 10 days before. 2 blood transfusions were given. O/E-pallor++ icterus++ vital stable , hepatomegaly 8cm firm regular surface, well defined edge, splenomegaly 5cm along axis, notch not felt soft, previous h/o of exactly similar c/o hospitalization and transfusion 6 month back given 2 transfusion at that time in between absolutely symptom free. please guide about d/d and diagnostic approach. Check Out the Answer
Question Category : Diagnostic Dilemma
I would be happy if someone helps in diagnosis of this problem. 13 yr old child presented to us with fever with chills she had recurrent episodes since her 9 yrs of age, every time requiring long duration of hospital stay. We got hepato splenomegaly(massive) and few temporary lymph nodes. Every work up for malaria, dengue, UTI, Cholangitis came negative. Then we proceeded with work up for connective tissue disorders which was also found negative. Bone Marrow showed Erythroid Hyperplasia. This time when she was admitted, she collapsed and went into picture of DIC. It was very difficult for us to revive her out of it. Brucella, Leishmaniasis work up was also negative. THe only positive report we got in the previous admission was TB PCR positivity in CSF. We started her empirically on ATT. We feel she has some immuno deficiency that makes her succumb to recurrent fatal infections. However her HIV Status was negative. Whole body gallium scan also showed nothing. At present she is out of ICU in the ward waiting for the next episode of infection. Can u help us in diagnosis? How to rule out immunodeficiency? We have sent samples for complement analysis and Immunoglobulin Electrophoresis and results are awaited. Work up of sarcoidosis is going on. What else to rule out? Check Out the Answer
Question Category : Diagnostic Dilemma
I would like to bring to your attention the case of a full term baby weighing 3.2 kgs at birth with normal birth history who developed tonic clonic convulsions lasting few seconds at 14 days of age, 2 episodes in all. There was no fever or reduced feeding during or after the episodes. On examination there was no organomegaly or abnormality found on general examination regarding congenital anomaly or abnormal faeces. His random blood sugar was normal. But his serum calcium turned out to be 4mg/dl. While his serum sodium was normal, his serum potassium was 6meq. After managing for hypocalcemia ( inj. Calcium gluconate 2ml/kg iv stat and maintenance) his electrolytes were repeated. His serum calcium had improved but was still low and his serum potassium had increased over the hours to 7meq. Baby's serum phosphate, vitamin D levels, serum alkaline phosphatase have not been done. His GBP and hemogram are also normal. The renal and liver profiles are normal. The child's mother had an uneventful antenatal history and suffers from no known systemic illness. Mother's serum PTH and Vitamin D levels also had not been done. The baby was on mixed top and breast-feeding since birth. After discharge from the hospital his serum calcium is 9.2mg% and serum potassium is 6meq. Can you suggest me some causes for the strange electrolyte levels and its treatment in case convulsions recur. The parents have reported them once after discharge for a brief period despite normal serum calcium levels. Please reply at the earliest.. Check Out the Answer

Next: Diagnostic Dilemma Page No. 6

Diseases & Conditions

Pediatric Oncall Journal

Case Reports

Original Research

Letter to Editor