one of our colleague c/o left sided headache intermittently, relieved after few minutes. also had c/o URI and intermittent nasal block. PNS reported normal. ur opinion?

18M having painful spasm in right hand only after starting writing for few minutes. He was diagnosed having Writter's cramp and was prescribed medicines. Medicines helped him little but causes drowsiness. One neuro physician recommended him Botox therapy though explained to about doubtful results. Boy having board exam next month and he's worried that this problem will limit him from writing and completing 3 hrs exam papers. So what are best options for this patient..? Will botox help..? Are there any medications that may help him without any side effects.? He only wants full ability to write off exam papers for complete 3 hrs for few days only in next month. Attached is his consultation and MRI report.

HELLO DEAR FRIENDS AND FELLOW CUROFIANS,, HERE IS AN INTERE CASE --34 YR OLD MALE HAS CAME TO ME WITH COMPLAINTS OF UNEASINESS,, LEFT HAND AND SHOULDER PAIN,, DOE,, PROSTRATION,, LOSS OF SLEEP SINCE FEW DAYS,, F/H/O--MOTHER IS DIABETIC AND HYPOTHYROID,, FATHER HAS IHD ON RX.. NO ANY ADDICTION,,, H/O--ALLERGIC SINUSITIS/RHINITIS ON AND OFF RX,,, O/E--AFEBRILE,, B. P-140/90 MM OF HG,, HR-64/MIN,,CHEST --B/L CLEAR,, SPO2-95PERCENT,,, ANXIETY ABOUT HEALTH ++,,,KEEPING IN MIND ALL THESE I ADVISED HIM TO GO FR INVESTIGATIONS,, SO FRNDS BELOW R THE REPORTS ATTACHED,, PLZZ LOOK CAREFULLY AND GIVE UR VALUABLE AND EXPERT COMMENTS

Dear Friends, Fever of unknown origin is a very important clinical condition in our day to day practice.. I thought to have an UPDATE on this The subject needs longer discussions.. So will be presented in two parts Let's have the initial one… Fever of unknown origin (FUO) in adults is defined as a (1)Temperature higher than 38.3 C (100.9 F) (2)Lasts for more than three weeks (3)With no obvious source despite appropriate investigations. COMMON ETIOLOGIES OF FEVER OF UNKNOWN ORIGIN.. INFECTIONS Tuberculosis (especially extrapulmonary) Abdominal abscesses Pelvic abscesses Dental abscesses Endocarditis Osteomyelitis Sinusitis Cytomegalovirus Epstein-Barr virus Human immunodeficiency virus Lyme disease Prostatitis Sinusitis MALIGNANCIES Chronic leukemia Lymphoma Metastatic cancers Renal cell carcinoma Colon carcinoma Hepatoma Myelodysplastic syndromes Pancreatic carcinoma Sarcomas AUTOIMMUNE CONDITIONS Adult Still's disease Polymyalgia rheumatica Temporal arteritis Rheumatoid arthritis Rheumatoid fever Inflammatory bowel disease Reiter's syndrome Systemic lupus erythematosus Vasculitides MISCELLANEOUS Complications from cirrhosis Factitious fever Hepatitis (alcoholic, granulomatous, or lupoid) Deep venous thrombosis Sarcoidosis Drug-induced fever DRUGS COMMONLY ASSOCIATED WITH DRUG -INDUCED FEVER.. Allopurinol Captopril Cimetidine Clofibrate Erythromycin Heparin Hydralazine Hydrochlorothiazide Isoniazid Meperidine Methyldopa Nifedipine Nitrofurantoin Penicillin Phenytoin Procainamide Quinidine The approach to diagnose the patient and investigations needed ...will be covered in the second and concluding part if HELPFUL to you Thanks Dr K N Poddar

5 yrs male child with dark circles under eyes plz advice possible Dx & Rx