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Question Category : Diagnostic Dilemma
A 9 years old female child weighing 28 kg - at US for the past three months now has fever since twelve days Father was treated for TB 15 years back. GC is good - Urine=NAD and leucocytosis is the only positive finding (Hb, Platelets & ESR normal-- Mx negative) Widal MP was not done. X-ray of chest showed fluid in the R pleural cavity. Aspiration was not done. Can SAARS be a DD in this case. Can you give further guidance please Check Out the Answer
Question Category : Diagnostic Dilemma
12 years old female patient presented with history 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 on mild to moderate exertion. There is no history 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%,TLC is 8400, Dlc is P57%, L39%, E04%, absolute eosinophil count is 360 cells, bronchial washings showed aerobic cocci, and budding yeast cells. There is no response to antiallergic or bronchodilators. Check Out the Answer
Question Category : Diagnostic Dilemma
A 4 year old boy came with the complaints of sudden pain in the right knee joint which radiates upto the foot. He also complained that he couldn't walk when he woke up at morning. He didn't complain of any rise in temperature or swelling of the knee joint. His mother complained that the boy did not allow to touch his right leg. With all these complaints he was brought here by his parents. In past history his mother told that, after completing 2 years he sometimes complaint of pain and burning sensation in both the feet 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 year old female patient, from a migrant family of UP with poor S.E, status and a F.H of Kochs. She complaints of persistent cough, L.G.F. and pain in left lower chest on deep inspiration. Mx was positive, ESR 78, TLC 5,800 with lymphocytosis. X-ray of the chest suggestive of Rt. lower zone Pleural thickening, hilar shadows prominent 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. Patientreceived ATT -PZM, Rifa ,INH, Ethambutol for 2months but the encysted Effusion did not get reabsorbed, although the consolidation was resolved. ATT was continued for 6 months(PZ was stopped after 2months). AS the P.E. persisted a 6 weeks 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 2 weeks was treated by a local practioner. As Widal titers of the child was O = 320, H = 120. he gave the child three days course of I/M antibiotics, but still the child had fever so was brought to me. I repeated her blood investigations. Hb = 10.5gm/, TLC 5400, N 65, Lym 25. Platelets adequate, Film: n/n, anaemia no haemoparasite seen. URINE Routine examination: Normal. Blood culture: No growth. As Widal was positive, I gave seven days course of Oral Cefpodoxime following which child became alright, remained afebrile for a Week, now again she has 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. He 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, comes 1st in the class. On Examination, ankles and legs remained flexed, afraid of truncal movement, no joints are swollen or tender. He feels extreme pain and screams on touch on lower back, but if the I sustain the pressure, pain goes away and no screaming is observed even on deep pressure. Lower limbs initially seem 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 HYPER exagerated, ankle and patellar clonus are present but planter response is flexor. Upper limbs also show hyper reflexia to lesser extent. He Cannot stand or walk. On attempt, he screams on moving legs, those seems spastic! He cannot bend his joints. Is there any suggestion on how to approach to diagnosis and a logical management plan? Check Out the Answer

Next: Diagnostic Dilemma Page No. 10

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