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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
An Infant of 6 month old ,born from a consanguineous marriage, with a history of birth asphyxia, developed intermittent fever since 5 months. This was accompanied with hypotonia, developmental delay, treated by antimalaria was quinin infusion and cefitriaxon for persumed sepsis but fever persists , hb electrophoresis AS , torch screen was normal urine showed Wbc > 20. The infant was treated for UTI according to culture but showed no response. Bone marrow revealed eosinophilia. mantoux was 9 mm , trial by antiTB started 20 days ago but she still is febril, hypotonic more pale Brain CT scan showed mild cortical atrophy. What you suggest to do with this child? Check Out the Answer
Question Category : Diagnostic Dilemma
A 6 year old Hindu male boy, a product of non consanguineous marriage, home del uneventful postnatal period, Ht:- 98 cm/ Wt:- 13 ½ Kg. presented with History and features of sudden tonic extension of neck with occasional upward gaze, duration lasted for a fraction of a second to 2 sec. and several times/day. O/E no neuro deficit was detected during attack. Consciousness was preserved. No H/O passage of urine or stool during attack. No F/H/O epilepsy or stroke. BP of the child - 97/69 mm of Hg. EEG reveals and interpreted by an adult neurologist - drug induced (pedichloryl) sleep record shows diffuse slowing mixed with fast beta activity. There is spike and slow wave pattern with lots of artifacts. Please help me in arriving at a diagnosis and treatment protocol.patient. is very poor and cannot afford CT scan. Dr. Binayak Roy. Check Out the Answer
Question Category : Diagnostic Dilemma
We have a child aged 10 years suffering from all and she is on chemotherapy. she is now on third cycle of maintenance. She has also developed carpopedal spasms of right hand. On repeated examinations of her serum, calcium was found to be normaland only her right hand is affected. Has anyone come across such a condition before???????? Check Out the Answer
Question Category : Diagnostic Dilemma
6 years old male with fever of 14 days,jaundice-8 days, icterus + heaptosplenomegaly, Hb-9 gm, tc-11800, P40, L53, M7 bilirubin-T-5,D-3.9,I-1. 1,SGPT-1170, alk phosphatase-1020, MP-neg, Widal Neg, Urine-N, sr protein_T-5, alb-2.5,g-2.5. Sonography abdominal-Hepatosplenomegaly with minimal free fluid Recd-cefotaxim & Quinine. The patient continues to have high grade fever. What could be the reason? Check Out the Answer
Question Category : Diagnostic Dilemma
I have a 5 year old male patient who presented with 49 days of fever and pallor. He was admitted twice for which only a complete blood count was done which revealed pancytopenia. Packed RBC transfusions were given on these 2 admissions. On Physical examination he has slight hepatosplenomegaly. The Mantoux test we did at our hospital turned out to be positive. His CXR revealed infiltrates and paratracheal lymphadenopathies. What do you think is the closest diagnosis of this patient and how do I approach it? Check Out the Answer
Question Category : Diagnostic Dilemma
My patient is 8 years old and male. He presented to us with high fever, generalized lymphadenopathy, hepatosplenomegaly and purpura. His platelet count is 500,00/cmm with normal TLC and DC. His bone marrow study is normal. He also has hematuria. FDP is normal. What is the most likely diagnosis? Check Out the Answer
Question Category : Diagnostic Dilemma
I would like to post my query regarding this case of a Child age 6 years. Presenting to us with a history of fever and reduced appetite for past ten days. She had jaundice for 6 days, pallor for 5 days and increased respiratory movements for past three days before admission respectively. On examination the child was tachypneic with pallor, moderate grade fever, icterus, no lymphadenopathy, mild abdominal distention, tender heaptomegaly extending 5 fingers below SC margin firm margins and smooth surface, B/L equal chest entry. Rest of the systems were within normal limits. On lab investigations:- Hb 6.7gm%, TLC 5000 with a slight polymorphonuclear predominance, S. bilirubin 5.6 direct 3.8, SGPT 377U, platelets 20,000 , GBP confirmed the above findings and no hemoparasite was found neither in the GBP nor in the QBC. Widal was not confirmatory. Total serum proteins were 4.4 gms, S albumin 2 gms. PT was normal. Urine routine microscopy was WNL too. Abdominal USG of the child showed hepatomegaly with mild parenchymal involvement and mild ascites. The child was put on iv ampicillin and iv gentamycin, iv D10% with MVI and inj HEPAMERZ, syp lactulose, inj vit k, ranitidine, oxygen by mask and an urgent fresh whole blood was transfused. The child was 24 hrs. under this treatment when his tachypnea improved slightly but his liver size increased . The fever also was unrelenting. The antibody tests for dengue were also negative. I am in a fix over the diagnosis and further line of treatment. Keeping in mind the tests mentioned above, all suggestions would be welcome. Check Out the Answer
Question Category : Diagnostic Dilemma
This is a case for section "Diagnostic Dilemma". Full term Neonate born by LSCS--Indication-- Primi breech,was severly asphysiated at birth. After resuscitation by usual protocols she was found to have the following cong anamolies; Joint contractures at hip and knee joints, dislocated wrist joints, muscle hypoplasia, generalized hypotonia, B/L undesended testis with poorly developed scrotum ,low hair line with short neck, high arched palate. On second day she developed a systolic murmur without cyanosis or failure- probably VSD. On Fourth day she developed progressively increasing jaundice with acholic stools. Investigations so far:CBC+platelets-Normal CRP-1:16, S.Bilirubin-27mg%Direct-20.4mg%,SGPT-30IU/L,S.Alk Phospatase-141IU/L,TORCH IgM Negative,S.Urea Creatinine-Normal, USG Abd and Brain is normal ,Kiddigram -absent fibula Rt. What could be the probable diagnosis? How can rpt SGPT be normal despite such high direct bilirubinemia? Check Out the Answer
Question Category : Diagnostic Dilemma
A 4 years old child was presented with recurrent episodes of vomiting, fever, cough. On examination, child was conscious, mildly dehyrated, chest-crepts ++,wheeze+ cvs, cns-n.a.d, abd-soft ,no organomegaly!l. F.T was normal, urea, creatinine were within limits, MRI was alsonormal study of barium meal was normal, study of endoscopy-laxed l.e.s. what's the diagnosis & line of management? Check Out the Answer
Question Category : Diagnostic Dilemma
I have a 10 years old white male with 5 day history of severe abdominal pain, a febrile with negative exam, specifically no rash. FH dad with history of kidney transplant due to glomerulonephritis and a history of renal stones. Child had TNTC red cells. No proteinuria. H/H 41.9/15 smear revealed a few microcytes and mild poikilocytosis. MCV 79 platelets 345K. BUN 10, Creatinine 0.5. Calcium 7.5, ionized Calcium 3.18, Mg 2.28, Phosphate 5.3. Albumen 4.9, globulin 7.4. CT of abdomen and pelvis with and without contrast neg for hydronephrosis or calcification. Any ideas on differential diagnosis and suggestion for further workout??. Check Out the Answer
Question Category : Diagnostic Dilemma
10 years girl presented with history of severe muscle pain and fever for 15 days, systemic reveiw and examination are NAD. INVESTIGATIONS: ALL ARE NORMAL EXCEPT HIGH ESR. Check Out the Answer
Question Category : Diagnostic Dilemma
A child on the unit, known to have hemiplegic cerebral palsy, came with status epilepticus, also had persistent metabolic acidosis, and deranged liver function tests, which improved after 3-4 days. Vital signs were stable, airway was self maintained except that she did not wake up after the anticonvulsants were stopped. On day 5, she had 2 massive pneumothoraces, requiring intensive care. Urine organic and amino acids were normal, no infective focus was found. EEG reveals an encephalopathic picture. Echocardiogram was normal. We still do not know the cause for her persistent metabolic acidosis. She also required platelet transfusion for falling platelet counts. She also has gone into Acute tubular necrosis. She is currently being ventilated. What could be the reason for the persistent metabolic acidosis? Check Out the Answer
Question Category : Diagnostic Dilemma
Neonate 22 days old - urine turns brown on leaving for 1 hour. Fresh urine is pale yellow and urine r/m is normal. General and systemic examination is normal. What is the further course of evaluation? Check Out the Answer
Question Category : Diagnostic Dilemma
Hi, My patient 4 years old male without significant past history presented with breathlessness. In ER, child was admitted and diagnosed as Empyema. The child was put on ICD. Child used to have persistent fever inspite of taking Cultured proven antibiotic Vancomycin and Cefotaxim. Still there is haziness in RLL the CT no sepation or multilpe loci. No mechanical problems with ICD. now serous fluid has started coming out. Child MTx, HIV is negative but still fever is present. Should we start AKT, but how to explain the Negative mountex ? Check Out the Answer

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