A young female aged 18 yrs presented with history of Fever with chills , breathlessness since 5-6 days and altered sensorium since 1 day.....On taking history from attendants, it was revealed that She has had 2-3 episodes of Jaundice in last 2 yrs and 3 PRBC transfusions were also done 8 months back due to severe anemia....She was foundto have clubbing...Discuss this interesting case and possible differentials...

12 yo female of 33 kg admitted with c/o periumbilical pain, intermittent fever,loss of appetite, yellowish discoloration of eyes, Sensorium wnl Icterus++ PALLOR + Clubbing absent LN non palpable stool Malena urine yellowish chest b/l not clear with costophrenic crepts P/A soft with +3cm liver, spleen non palpable RR 22pm PR 121 SPO2 80 % without O2 ,>95%on o2 Via nasal Our ddx acute liver failure with enteric fever vs acute viral hepatitis with Pulmonary Koch kindly add ddx Kindly comments on CXray what may be pathophysiology AC to you thanks

V v v important DRUGS OF CHOICE ---------------------------------- 1. Paracetamol poisoning- :- - acetyl cysteine 2. acute bronchial- asthma :- salbutamol 3. acute gout :- NSAIDS 4. acute hyperkalemia:- calcium gluconate 5. severe DIGITALIS toxicity :- DIGIBIND 6. acute migraine :- sumatriptan 7. cheese reaction :- phentolamine 8. atropine poisoning :- physostigmine 9. cyanide poisoning :- amyl nitrite 10. benzodiazepine poisoning:- flumazenil 11. cholera :- tetracycline 12. KALA-AZAR :- lipozomal amphotericin- B 13. iron poisoning :- desferrioxamine­ 14. MRSA :- vancomycin 15. VRSA :- LINEZOLID 16. warfarin overdose :- vitamin-K (NIPER- 2009) 17. OCD :- fluoxetine 18. alcohol poisoning :- fomepizole 19.Epilepsy in pregnancy: carbamezepine safe among older epileptics & lamotrigine, levitracetam safe in newer AED! 20. anaphylactic shock :- Adrenaline 21. MRSA Infection-Vancomycin 22. Malaria in Pregnancy-Chloroquine 23. Whooping Cough or Perteusis- Erythromycin 24. Kawasaki disease-IV Ig 25. Warferin Overdose-Vit-K 26. Heparin Overdose-Protamine 27. Hairy Cell Leukemia-Cladirabine 28. Multiple Myeloma- Melphalan 29. CML-Imatinib 30. Wegner's granulomatosis-Cyclophosphamide 31. HOCM- Propranolol 32. Delirium Tremens-Diazepam 33. Drug Induced Parkinsonism-Benzhexol 34. Diacumarol Poisoning-Vit-K 35. Type-1 Lepra Reaction-Steroids 36. Type- 2 Lepra Reaction-Thalidomide 37. Allergic Contect Dermatitis-Steroids 38. PSVT- 1st-Adenosine, 2nd-Verapamil, 3rd-Digoxin 39. Z-E Syndrome- Proton Pump Inhibitor 40. Chancroid-Cotrimoxazole 41. Dermatitis Herpetiformis-Dapsone 42. Spastic Type of Cerebral Palsy-Diazepam 43. Herpis Simplex Keratitis-Trifluridine 44. Herpes Simplex Orolabialis-Pancyclovir 45. Neonatal Herpes Simplex-Acyclovir 46. Pneumocystis carinii Pneumonia-Cotrimoxazole For Nodulo 47. 47. Cystic Acne-Retinoic acid 48. Trigeminal Neuralgia-Carbamezapine 49. Actinomycosis-Penicillin 50. Plague- Streptomycin 51. Opioid Withdrawal- Methadone 2nd-Clonidine 52. Alcohol Withdrawal- Chlordiazepoxide 2nd-Diazepam 53. Post Herpetic Neuralgia- Fluphenazine 54. WEST Syndrome-ACTH 55. Diabetic Diarrhoea- Clonidine 56. Lithium Induced Neuropathy-AmilorideCommunicable Disease: 57. Tetanus: PEN G Na; TETRACYCLINE; (DIAZEPAM 58. Diphteria: PEN G K; ERYTHROMYCIN 59. Pertusis: ERYTHROMYCIN; AMPICILLIN 60. Meningitis: MANNITOL (osmotic diuretic);DEXAM ETHASONE (anti-inflammatory); DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS stimulant) 61. Cholera: TETRACYCLINE 62. Amoebic Dysentery: METRONIDAZOLE 63. Shigellosis: CO-TRIMOXAZOLE 64. Typhoid: CHORAMPHENICOL 65. Rabies: LYSSAVAC, VERORAB 66. Immunoglobulins: ERIG or HRIg 67. Malaria: CHLOROQUINE 68. Schistosomiasis: PRAZIQUANTEL 69. Felariasis: DIETHYLCARBAMAZINE CITRATE 70. Scabies: EURAX/ CROTAMITON 71. Chicken pox: ACYCLOVIR/ZOVIRAX 72. Leptospirosis: PENICILLIN; TETRACYCLINE;ER YTHROMYCIN 73. Leprosy: DAPSONE, RIFAMPICIN 74. Anthrax: PENICILLIN 75. Tuberculosis: R.I.P.E.S. 76. Pneumonia: COTRIMOXAZOLE; ProcainePenicillin 77. Helminths: MEBENDAZOLE; PYRANTELPAMOATE 78. Meningitis: MANNITOL (dec. ICP) ;DEXAMETHASONE ( relieve cerebral edema) ;DIAZEPAM ( anticonvulsant); PENICILLIN 79. Syphilis: PENICILLIN 80. Gonorrhea: PENICILLIN...

12yrs male child *Chief Complaints* Fever since 5days Cough Abdominal pain *Vitals* Stable *Physical Examination* RS- B/L crepts P/A- Tenderness + *Investigations* Weil felix- negative Dengue- negative CRP- 75 CBC n CXR attached *Diagnosis* ?? *Management* ??

5 yrs old female c/o rhinitis ,cough ,off and on fever with normal apetite since last 8days. clinical examination insignificant wt 15 kg. Rv neg ,ESR 93, creat 0.84, urine nil. BSL 46. plz comment on approach to this case.