A bright spot in the brain

10 year old girl headache

What is the diagnosis?
 

Troubled deep breathing

17 year old male with Down syndrome developed respiratory distress following extubation. He had perineal Incision and Drainage of  abscess.
His one other finding was bilateral sub conjunctival bleed.

His previous CXR is posted for comparison

What is the diagnosis and pathophysiology behind this?

Reference:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148265/
 

Medical or surgical?

2 week old male infant presents with vomit which is non-bilious and no stool for 7days. His primary care doctor switched regular formula to lactose-free formula.  He has lost some weight and takes about 2 to 2.5 ounces every 2-3hours. Parents have diligently burp and keep upright as instructed, though he don't all the time.

His Abdominal x-ray below: (small barium in the rectum from previous upper GI series done by primary care, which was normal)

 



Name a condition to rule out that is done in newborn state screen.


What is a very sensitive question you will ask the mother about the baby in the immediate postnatal period?

Name a diagnosis if mother mentions small blood in stool, stool guaiac positive and no anal fissure.
 

Catch it in the scan

9 year old girl with abdominal pain and fever

Name the non - E.coli pathogens associated with above.

Mention at least three broad aspects of management of this child.

http://dx.doi.org/10.1097/01.ju.0000179537.36472.59

Eye popping

5 year old previous healthy Caucasian boy presents with left eye pain, fever and redness. He is diagnosed with left eye orbital cellulitis. CT Scan with contrast of his orbit is shown.

"Add it up"

17 year old with sickle cell anemia, ADHD and Asthma admitted to intensive care for acute chest syndrome and asthma exacerbation. His social history is concerning for compliance and also not having a stable family.

Medication at home:
Impiramine
Albuterol prn

　

CBC:

Detail	Value w/Units	Normal Range
WBC	24.6 K/CMM	4.5-13.5
RBC	2.53 M/CMM	4.20-5.40
Hgb	7.6 g/dL	11.5-15.5
Hct	20.4 %	34.5-46.5
MCV	80.7 fL	75.0-95.0
MCH	30.1 pg	27.0-31.0
MCHC	37.2 g/dL	32.0-36.0
RDW	23.9 %	11.5-14.5
Platelet	353 K/CMM	133-450
MPV	9.0 fL	7.4-10.4

　

Hemoglobin electrophoresis:

Detail	Value w/Units	Normal Range
Hgb S %	84.8 %	0.0-0.0
Hgb A %	4.5 %	95.8-97.8
Hgb A2 %	3.2 %	2.2-3.2
Hgb F %	7.5 %	0.0-1.0
Hgb C %	0.0 %	0.0-0.0

　

　

　

What is the appropriate intervention?

A. Start antibiotics for high WBC
B. Add penicillin prophylaxis
C. Obtain Bone Marrow biopsy
D. Start hydroxyurea
E. None of the above
　
Reference:

http://pediatrics.aappublications.org/content/122/6/1332.short
　

　

Asthmonia

Chest X ray of child with status asthmatics

 

 



source : reference below

 

 

 

 

Name the organism commonly involved and an appropriate test.

 

 

 

 Does the length of hospitalization, ICU stay, days on oxygen, continuous albuterol aerosol requirements change with antimicrobial? (see reference)

 

 

Simkania negevensis- What is its relationship with the above pathogen?

 

References:

 

1. Hanhan et al

2.Simkania