A 2 Year Old Child With A Fever

A 2 year old female child is brought to the clinic by her mother with a complain of fever for 2 days. The mother reports that the child has been tired, and not playing with her toys or watching TV as she usually does. The fever was gradual in onset , intermittent in character and high grade. The child has no appetite and is refusing to eat anything. she has been pulling on her ears and has difficulty swallowing and sleeping for the past 2 days. Her past history is unremarkable and she is vaccinated up to date. Her developmental history is also appropriate for her age.
On physical Examination she had a temperature of 101 F and was very irritable. Her Respiratory rate was 42 breaths / minute and the lungs were clear on auscultation. She had no rash. On otoscopic examination following was seen:

The above picture shows a bulging , erythematous tympanic membrane, with indistinct landmarks and a displacement of the light reflex.

Diagnosis : Acute Otitis Media

Case Discussion:
Acute otitis media is a n infection of the middle ear that may be caused by bacteria or viruses and usually accompanies an upper respiratory tract infection. It can occur at any age but is most commonly seen in children 3 months to 3 years of age.
The signs and symptoms include:

A 56 Year Old Man, Chronic Smoker Complains Of Worsening Cough And Weight Loss

A 56 year old man who is a chronic smoker as well as have a past history of chronic bronchitis comes to the clinic with a complain of worsening cough over the last month. The cough is productive of 2 teaspoonfuls of  yellowish mucus, with streaks of blood. Patient has noticed dysnpnea on exertion as well as fatigue, decreased appetite and a weight loss of 12 pounds during the last 2 months. he has no history of recent travel or exposure to tuberculosis patient. .

The X Ray of his chest is shown below:

What is the diagnosis?
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Lung Cancer.

Case Discussion:

A 33 year Old female With Knee Pain For 2 Days

A 35 year old female presents to the clinic with a complain of pain in the right knee that started 2 days ago. The pain is associated with difficulty in walking but she denies any trauma to her knee. She has swelling ans redness in her right knee joint along with a mild fever. she denies having pain in any other joints of the body, any rash, or photo sensitivity.
Her past history is significant for an episode of acute left big toe arthritis 5 years back,

Physical Examination:

• Erythema, tenderness, pain and restricted range of motion on flexion and extension of the right knee joint.
• All other joints including the left knee are normal on examination.
• No abnormalities detected in any other organ system. 

The picture of her knee joints is shown below:

What is the Differential Diagnosis?

A 19 Year Old Woman With A Red Eye

A 19 year old woman presents to her school health officer after she woke up this morning with a red and a painful left eye. She says that she had some mild itching in her left eye when she went to bed the previous night. She also reports that she never had these symptoms previously. her eye feels mildly painful, itchy and teary. She has no visual difficulties and denies any problem in the right eye, fever, headache, neck pain sore throat or ear pain. She has no significant illnesses in the past but mentions working at a daycare 3 times in a week.

Physical Examination:

• Sclera and the conjunctiva of her left eye are inflamed. 
• No purulent discharge is notable.
• Left eye is watery.
• Her right eye has slight inflammation of the conjunctiva.
• Pupils are symmetrical and reactive to light.
•  Fundoscopic examination detects normal vascular markings in each eye.
• Slit lamp examination with fluorescein staining detects no corneal defects.
• Her periauricular lymph node is palpable on the left side.

The picture of her left eye is shown below:

Based on the history , physical examination and the picture shown what is the differential diagnosis?

Differential Diagnosis:

• Conjuctivitis
• Uveitis
• Closed angle glaucoma
• Corneal Abrasion

3 Year Old Boy Brought To Ophthalmologist For A White Eye

A 3 year old boy is brought to an ophthalmologist by his mother for evaluation of his right eye. The child's mother says that when she took a photo of her son 2 weeks ago she noticed that one of his eyes has a white spot in the center of the pupil. When she looked at his eyes afterwards she did not notice any abnormality but found that the white spot was reproduced when a light was shined in his eyes. She says her son has not been complaining of any pain in the eye or has not noticed and strange behavior recently. He has no fever, recent colds or trauma to his right eye. There is no family history of eye diseases.

Physical Examination:

• Well appearing child, appropriate development for his age.
• When light is shined in his eyes, the left eye has a normal red reflex, but the right eye has a central white appearance. 
• His pupils react normally, and he is able to tract objects well.
• His conjunctiva are pink and sclera are not injected.
• Fundoscopic slit lamp examination detects a whitish growth involving the posterior wall of the retina.
• No corneal or lens defects. 

The picture taken of the child is shown below:

And the fundoscopic examination showed the following picture;

Diagnosis: Retinoblastoma

A 72 Year Old Man With Complaints Of Chronic Right Knee Pain

A 72 year old man presents to his primary care physician with a complaint of chronic right knee pain that has gradually worsened over the past few years. the patient denies any significant trauma to his knee. he says that he feels minimal pain in the morning , but the pain gets worse as the day passes. The pain particularly occurs when he stands or walks for a long time. He says that his knee feels stiff but he does not have any episodes of the joint locking or giving way. Sometimes he has felt his knee making grinding sounds when he walks. he has been talking ibuprofen for the pain which does reduce the symptoms to some extent. He denies similar symptoms in other joints.

Physical Examination:

• A well appearing man in no distress.
• The right knee does not appear swollen or erythematous and there is no effusion.
• He has a dull pain along the tibial-femoral joint line.
• He has mild deep pain with range of motion that worsens at the extremes of flexion and extension.
• There is a palpable crepitus during movement. 
• Neurological examination is normal.

The X ray of his knee joint is shown below:

Based on the above history, examination and the x ray findings what is your diagnosis?

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