Large CBD Stone

a20 yr old down's syndrome girl with uncontrolled epilepsy was brought by her family for rapidly progressing neck pain and dysphagia. endoscopy very edematous pharynx and larynx. xray neck showed prevertebral widening with gas formation, straightening of cervical vertebrae and suspected foreign body at post cricoid level. ? large retropharyngl abcess on questioning the parents they give history that she hurriedly had fish a few days ago. As it was a high risk condition she wasn't taken up at many places. it was heart wrenching looking at her , she's unable to understand what's happening to her all that she wasn't able to swallow anything and had excruciating pain. she was taken up for exploration under GA under high risk thanks to my anaesthetist who dared to give her anesthesia. intra op big sharp fish bone was found at post cricoid region anteriorly abutting laryngeal mucosa posteriorly piercing pharyngeal mucosa, after it's removal 20 ml of foul smelling pus evacuated. it was very difficult to make her retain her ryles tube post surgery, with a lot of her mischief we managed to keep it for 4 days and she made a good diet speedy recovery. *parents of MR children should never leave them unattended when they are consuming food with Sharp particles like meat, and small round food items (can cause aspiration). *we have to take calculated risks *retropharyngeal abcess should be managed before they turn into near fatal mediastinitis.

one and half yr old presented with fever for 10days and blackish discolouration of toes since 8days which is increasing. Liver just palpable and 1cm spleen. Pansystolic murmur on mitral area on auscultation. Discuss.

Fever, dyspnea, and dry cough 7 days ago. Diagnosed with COVID-19 with positive nasal swab and IgM antibodies. Worsening dyspnea over the past 2 days. D-dimer 9.05. What are your suggestions on this?

24 female C/o- dry cough for last 6 weeks present only at night just after going to bed when she coughs vigorously about 20 times ....absent thoroughout the day.. No h/o - fever She is on OCP after consulting gynaecologist for excessive menstrual bleeding Cough not releived by - SYR. LEVOCLOPERASTINE 10 ml tds Syr. Brozedex Tab cefuroxime 500bd for 5 days Pan 40 Tab montelukast + fexofenadine for 14 days Following are the reports Chest xray is awaiting...how to proceed further?

A 74-year-old woman presented a 3-day history of lower abdominal pain, nausea, and vomiting. A plain-film radiograph of the abdomen showed marked dilatation of bowel loops and abrupt termination of gas within the descending colon, referred to as a colon cutoff sign. The colon cutoff sign is classically described in association with which disease process? A) Diaphragmatic hernia B) Acute pancreatitis C) Toxic shock syndrome D) Lead poisoning E) Crohn’s disease