A 48 Year Old Lady Presents With Difficulty Swallowing And Fatigue

A 48 year old woman who has a long history of weakness and fatigue come to see her physician because she has been feeling difficulty in swallowing for the last few weeks. This dysphagia was intermittent and is limited to solids. She denies any history of weight loss. The patient was previously prescribed iron supplements to correct her anemia and resulting fatigue but she never took the supplement
On Examination the patient is a middle aged lady looking pale and a bit anxious. On general physical the following features were seen in the nails and the tongue.

Spoon shaped nails known as Koilonychia seen in chronic long standing Iron deficiency anemia.

Smooth, red tongue with loss of lingual papillae (Atrophic glossitis)

On lab work There was microcytic hypochromic anemia and a barium swallow revealed esophageal webs on the anterior esophageal wall.

What is the most probable diagnosis?

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A 38 Year Old Woman Presents With A 2 Day History Of Severe Headache And Neck Stiffness.

A 38 year old woman is seen in the emergency department with the complains of severe headache and neck stiffness for the last 2 days. On examination she had a temperature of 101 F and BP of 120/70 mmHg. There was no rash seen on the skin. On neurological examination there was mild nuchal rigidity.
CSF analysis was done and the report is given below:

• Appearance = clear
• WCC = 20/ cubic mm (60% lymphocytes)
• Protein = 0.48 gm/l
• Glucose = 2.3 mmol/l ( simultaneous blood glucose = 4.5 mmol/l)
• Gram stain = No organism identified. 

A CT scan Of the brain was done and the image is shown below:

Normal CT scan of the brain.

What is the Differential Diagnosis?

• Aspectic Meningitis
• Viral Meningitis
• Partially treated Bacterial Meningitis
• Tuberculous Meningitis.
• Listeria infection
• Lymes Disease
• Herpes Simplex Encephalitis.

The Final Diagnosis was

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1 Year Old Child With A Dry Itchy Rash On The Face

A 1 year old boy was brought to  a general physician by his mother with the complains of irritability, trouble sleeping and a dry, scaly and itchy rash on his face. Mother says that the child has been scratching his face and is getting irritable most probably because the rash is itchy which is also disturbing his sleep. The problem has began since the changing season last month.
Two of his older siblings also have had similar skin problems and are also diagnosed with asthma.
The picture of the child is shown below:

What is the Differential Diagnosis?
?
.

• Atopic Dermatitis/Eczema.
• Scabies
• Contact Dermatitis
• Fungal Infection 
• Impetigo.

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