Aiims - Nov 2008 - Pediatrics - 6 Questions

Bronchiolitis obliterans is the correct diagnosis because the patient's symptoms and findings on CXR and PFT are consistent with this condition. Bronchiolitis obliterans is characterized by inflammation and scarring of the small airways, leading to airway obstruction. The non-productive cough and mild stridor that the patient initially presented with may have been indicative of early bronchiolitis obliterans, but the sudden development of wheeze, productive cough, fever, and hyperlucency on CXR suggests worsening obstruction and inflammation. The obstructive curve on PFT further supports the diagnosis. Follicular bronchitis, pulmonary alveolar microlithiasis, and hemosiderosis do not fit the clinical picture or findings.

Behaviour therapy would be the best advice in this situation. The child's restlessness and inattentiveness could be symptoms of attention deficit hyperactivity disorder (ADHD), which can be effectively treated with behaviour therapy. This type of therapy focuses on teaching the child new behaviours and skills, as well as helping them develop strategies to manage their symptoms. It can be a helpful approach for both the child and the parents to address the concerns and improve the child's ability to focus and engage in their studies.

Rubella in first trimester Syphylis in Second trimester.

The correct diagnosis in this case is Neonatal Pulmonary Alveolar Proteinosis. This is supported by the ground glass appearance on X-ray, which is a characteristic finding in this condition. The baby's respiratory distress at birth, lack of response to surfactant, and normal echo findings are also consistent with Neonatal Pulmonary Alveolar Proteinosis. The history of a previous sibling who died before adds further suspicion for this diagnosis.

Cladirabine is the correct answer for the treatment of refractory histiocytosis. Refractory histiocytosis is a rare disorder characterized by the abnormal accumulation of histiocytes, a type of white blood cell, in various tissues and organs. Cladirabine is a chemotherapy drug that works by inhibiting the growth of these abnormal cells. It is specifically used for the treatment of refractory histiocytosis when other treatments have been ineffective. High dose cytarabine, high dose methotrexate, and fludarabine are not commonly used for the treatment of refractory histiocytosis.

The next step in the management of this patient would be to administer Dexamethasone. This is because the child is presenting with symptoms of croup, which is a viral infection that causes inflammation and narrowing of the airways. Dexamethasone is a corticosteroid medication that helps reduce inflammation and can improve symptoms such as the barking cough and stridor. Antibiotics and blood culture would not be necessary as croup is typically caused by a viral infection. Racemic epinephrine nebulization may be considered if the child's symptoms are severe, but Dexamethasone is the initial treatment of choice. Nasal wash for influenza or respiratory syncytial virus may be considered if there is suspicion of these specific viral infections, but it is not the next step in management based on the given information.