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

 

 



Anemia : Greek- "anaimía" ; want of blood

10 month infant who is on formula feeds has CBC as below:

Detail	Value w/Units	Normal Range
WBC	12.1   K/CMM	5.5-18.0
RBC	4.99   M/CMM	4.00-5.40
Hgb	11.5   g/dL	10.5-13.5
Hct	33.6   %	31.5-40.5
MCV	67.3   fL	80.0-94.0
MCH	23.1   pg	27.0-31.0
MCHC	34.3   g/dL	32.0-36.0
RDW	13.8   %	11.5-14.5
Platelet	368   K/CMM	133-450
MPV	7.8   fL	7.4-10.4

Hemoglobin Electrophoresis

Detail	Value w/Units
Hgb S %	0.0 %
Hgb A %	64.2 %
Hgb A2 %	4.0 %
Hgb F %	1.3 %
Hgb C %	30.5 %

What is the diagnosis?

Did  the Mentzer index help you?

Was RDW a tie breaker?


Answer:

Normal values

Interpretation


 

Famous names 1

What is the diagnosis named after this physician?
He described from his first patient who was miserable for 12years and end up amputating the leg. The bone showed new bone layers and center of lesion filled with dark colored pus.

 Reference: http://hkoa.org/hkjos/2005-2/079-86%20Great%20names.pdf
 

"Rash"ionale - 2

How do you differentiate urticarial rash from Erythema multiforme?

What is the role of corticosteroid treatment?





Name a bacterial cause.



Arch Dis Child 2011;96:i34-i37 doi:10.1136/adc.2011.214734

Lessons from the cat

4year child with Tracheotomy on home ventilator. His parent had difficulty in putting back the dislodged tracheotomy tube.

Describe "Macklin effect".


Hint: Drawn by the author in his original paper

credit:
Can Med Assoc J. 1937 April; 36(4): 414–420.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1562024/

Asthma comorbidity

7yr girl with asthma but has inspiratory dyspnea as well

This is a spirometry  (illustration is not related to this patient)

Hint:

What phase of breathing does stridor usually manifest?

Resource:

Wheezing and vocal cord dysfunction mimicking asthma

PMID: 11140406 [PubMed - indexed for MEDLINE]

"Rash"ionale 1

This is an infant on a parent lap. (The following questions are not linked to each other and describes seperate entity)

1.What is the most life saving management if the child is "ill appearing" with high fever?



2.What is the role of steroids if your diagnosis is a "vasculitis disorder" in a well appearing child?

http://www.ncbi.nlm.nih.gov/pubmed/22311342


3. Name the childhood vaccine associated with "autoimmune" disease presenting like this.


4. What is the indication for bone marrow aspiration in this child?

Arch Pediatr Adolesc Med. 1998 Apr;152(4):345-7.

Blood teaser

9 month infant admitted for skin abscess. What is the hematologic diagnosis?  Name the hematologic index that would help further test for this diagnosis.

WBC  (K/CMM)	7.8
RBC  (M/CMM)	4.66
Hb  (g/dL)	9.7
HcT (%)	29.6
MCV (fL)	63.5
MCH (pg)	20.8
MCHC (g/dL)	32.7
RDW (%)	17.0
PLT (K/CMM)	211
MPV (fL)	8.3

Hint:

The six discrimination indices are:

• Mentzer Index  (MI): MCV / RBC
• Green & King Index (G&K): MCV  × RDW / (Hb × 100)
• RDW Index (RDWI): MCV × RDW / RBC
• England & Fraser Index  (E&F): MCV − RBC-(5 × Hb) − k [k = 6.4]
• RDW
• RBC count

 

 

Based on one of the above index what is next test to order?

 

1. Hb A2 (Hemoglobin electrophoresis)

2. serum ferritin

3. vitamin B12

4. bone marrow aspiration

5. serum lead

Nagging neck pain

10 yr old boy  with neck pain and high fever. He had two weeks of upper respiratory tract infection.

What is the diagnosis? And identify the markers.

What is the diagnosis?

5 year old with massive hepatomegaly

CT Abdomen shows increased vascularity and calcification in the liver.

What happened to this patient?

This is an infant who was post-op and started getting drowsy while on intravenous and oral fluids.
What is the explanation?

Legend: Na-sodium; S.Osm- serum osmolality; U.Osm-urine osmolality;
I/O- input/output fluids; ins- fluid intake (oral and intravenous)

CT Head without contrast