8yrs female child, joint pain, fever on and off :. 3 months

11 years old female, pain in joints from 1 month moderate, inflammation of elbow,wrist, knee, ankle from 20 days, fever high grade from 4 days, deformity of metacarpal joints from 3 years, TB contact +ve (mother & sibling). O/E: inflammation of elbow, wrist, MCP, wrist, knee & ankle joints symmetrical, warm & tender, nodules on MCP, joints pigeon chest, chest b/l clear, GCS 15/15, anterior fontanelle wide open. Ix: WBC 12, HB 10, plt 394, Spinal XRay shows mild Kyphosis, Platyspondyly at lumbosacral joint, ASOT -ve, XRay both hand & feet shows soft tissue calcification, bone density mildly reduced, USG joints: no joint effusion. GeneXpert: not detected. Diagnosis & Management?

rash with fever.....make the dx and do the Rx plz

1.5 Yr old female child. came with complaints of swelling in joints and fever since age of 6 months. pt has been admitted to hospital 4 times in this period. child has been given IVIG aspirin prednisolon naprpxen methotrexate. child has been diagnosed soJIA multiple times past report has been done. bone marrow shows normal but hypercellular. ANA negative. now patient came to me for not good result I have done these investigation now how to approach further?

May be useful for General practitioners and Medical Students. Common Nail Findings associated with diseases. 1. BEAU'S Lines- These are transverse grooves or depressions parallel to the lunula. Caused by the conditions that cause the nail to grow slowly or even cease to grow for short intervals. The point of arrested growth is seen as a transverse groove. Often associated with - infections (Typhus, Acute Rheumatic Fever, AIDS) -Protein deficiency -Pellagra -Raynauds disease -Diabetes -Hypothyroidism -Hypocalcemia -Chronic Pancreatitis 2. MEES' Bands- White transverse line or band parallel to lunula resulting from poisoning or systemic illness.seen in -Chronic arsenic poisoning -Hodgkins disease -CHF -Leprosy 3. LINDSAY'S Nails- also called half & half nails. Proximal portion of Nail bed is whitish whereas distal part is red or pink. commonly associated with -Chronic Renal Failure -Azotemia 4. TERRY'S Nails - are white nail beds to within 1 to 2 mm of distal border of nail associated with -Hepatic Failure -Cirrhosis -Hypoalbuminemia -Chronic CHF -Hyoerthyroidism 5. SPLINTER HAEMORRHAGE. These are formed by extravasation of blood from longitudinal nail bed blood vessels to adjacent troughs. These are most often related to local, light trauma. Classically associated with -Subacute Bacterial Endocarditis. May be seen in -Leukemia -Vasculitis -Rheumatoid Arthritis -SLE 6. KOILONYCHIA - Spoon Nail is a dystrophic state in which the nail plate thins and a cup like depression. develops. Commonly associated with - Iron deficiency Anemia. 7. CLUBBING - Angle between the normal nail bed and finger is approx 160 degrees and nail bed is firm. This angle is referred to as LOVIBOND'S angle. When clubbing develops, this angle straightens out to be greater than 180 degrees & nail bed becomes spongy and has a bullous shape with exaggerated horizontal and longitudinal curvature. Most commonly associated with -Congenital Cyanotic Heart Disease -Cystic Fibrosis -Mesothelioma of Pleura -Pulmonary Neoplasms -Bronchogenic Carcinoma. 8. PITTING of Nails is seen in Psoriasis. SOURCE. TEXTBOOK OF PHYSICAL DIAGNOSIS. MARK. H. SWARTZ.

57 Yrs.Male C/O- General weakness only (No any relevant history or investigation reports and clinical diagnosis) CBC and Peripheral Smear for your valuable opinion.