A New Born After A Difficult Delivery Is Seen To Have Asymmetrical Moro's Reflex.

A new born is examined in the nursery after a difficult delivery and a prolonged second stage of labor that involved some pulling on the shoulders. The baby looks healthy and weighs 8.5 lbs.
On attempting a Moro's reflex it was asymmetrical with the right arm having little or no movement at all. While the baby was lying flat it was noticed that his right shoulder was adducted and internally rotated , the elbow was extended and pronated while the wrist was flexed. Brachial plexus damage and Erb's Palsy was suspected. The picture of the new born is shown below:

Case Discussion:
Erb's Palsy also know as Erb- Duchenne palsy is the paralysis of the arm caused by injury to the upper group of the arm's main nerves.
The brachial plexus is a network of nerves near the neck from which arises all the major nerves to the upper arm. Most commonly during a difficult labor and delivery the upper part of these nerves are damaged leading to paralysis of the arm.

A 2 Year Old Child Is Seen By A Pediatrician For Bowing Of Legs

A 2 year old child is brought to a pediatrician for the evaluation of delayed growth, muscle weakness and bowing of the legs. The mother gives the history that the child was weaned early as she was expecting again and since the child frequently suffered from diarrhea he was given almost little or no milk. They live in a close apartment with almost no sunlight exposure. The child's diet mainly consists of vegetables and rice. His mental development seems to be normal for his age but he has delayed walking and still falls while playing.
On examination, the child was quiet and cooperative. He looks malnourished with signs of growth delays. On standing he had bowing of the legs, the picture is shown below:

His wrists were widened and there was frontal bossing of the skull.
His vitals were normal. There were some coarse crackles on auscultation of the lung fields. The rest of the examination was within normal limits.

What is the Diagnosis?
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Rickets

A 30 Year Old Man Presents With Headaches And Symptoms Of Transient Visual Loss

A 30 year old man come to his physician complaining of chronic headaches that has started about 6 months ago. He describes the headache as a diffuse pain, worse in the mornings and sometimes associated with nausea. The pain extends into the neck and the back. He was not much concerned about his headaches but for the last few weeks he is having episodes of transient visual loss in one or both eyes that lasts for up to 30 seconds. The visual loss is sometimes related to changing posture. .

On examination patient is a well appearing obese man with normal vitals.
The fundoscopic findings are shown below:

The features of Papilledema (optic disc swelling ) is seen.

Definition Of Papilledema: Is the swelling of the optic disc caused by a raised intracranial pressure. It is usually bilateral.

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A 45 year Old Man Taking Immunosuppressant Drugs presents With Jaundice And Fever

A 45 year old man with a 7 year history of rheumatoid arthritis presents with cough, high fever and a painless jaundice. Over the past 16 months his symptoms of joint pain were not controlled by NSAIDs alone and so he was switched to immunosuppressant drugs which helped in controlling his symptoms. Patient is a non smoker and consumes less than 2 units of alcohol per week.
On examination;

•  patient looks unwell and deeply jaundiced.

• He had a temperature of 102 F. 
• Examination of the oral cavity shows yeast infection.

• On auscultation of the lung fields there were coarse crackles at the right lung base. 
• On abdominal examination spleen was palpable 3 cm below the left costal margin.

Investigations done are shown below:

A 35 year Old Man Presents With A Long History Of Backpain

A 35 year Old man is seen in The Physician office for a prolonged history of back pain. The patient says the back pain started about 12 years back and is progressively getting worse. The pain is disabling him and he cannot participate in any kind of sports which he is very interested to take part. He takes ibuprofen for the pain which he now feels is not helping. For the past two years he has also noticed intermittent pain and swelling in both of his knee joints.
On examination of the locomotor system there was pain and loss of lumbar lordosis. His knee joints were swollen, with bilateral effusion.
On general Physical examination, he was noticed to have bluish discoloration of his ear cartilage. The picture is shown below:

He was advised some lab work to be done that also included a routine urine analysis. The lab technician forgot his specimen on the table for a few hours and when returned observed a color change shown below.

The physician was noticed about the color change of the urine and he ordered to test urine homogentisic acid levels which came out elevated.

What is the Diagnosis?
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