Case description: Mrs. XY is a Caucasian 22 yo female that sees double when looking to the right. She says that this appeared 2 days ago. At first she attributed it to tiredness but as the symptom insisted she finally decided to visit a GP. She additionally mentions that for the last 3 months she suffers from haedaches and pains in the joints and muscles, has a poor appetite and feels tired most of the time. Her physical as well as the neurological examination were normal with one exception. Upon examination of the extra-ocular movements and as the patient was looking to the right, the left eye didn't seem to move at all, while the right was fully adducted with simultaneous nystagmus.

Question: What is the differential diagnosis?

Case description: A 3-year-old girl is brought to you because her mother noticed a lump in her abdomen as she was bathing her.

Questions: What do you expect to find from PE?

What is your DD?

What exams will you order?

A 10-year-old boy with Down's syndrome is presented to you with fever and malaise. The fever started 12 days ago and fluctuates between 38,2 and 38,7 °C. Upon clinical examination you palpate an enlarged spleen (2-3 cm) and find painful reddish skin lesions on the toes and fingers.

What is the diagnosis?

Case description: The child presented with gross developmental delay and one episode of seizure, there is polysyndactyly and broadening of the wrist joint, teeth are crowded. The hemogram reveals hb of 7, RBC count is 3.32,TLC is 3.0. USG reveals chronic renal parenchymal disease. CXR shows white near the rib. Serum phosphate level is normal.

Question: What could be the probable diagnosis?

Mr. X is a 52 years old egyptian male who lived in the states for 20 years where he worked in a fast food restraunt. he is back home 6 month ago. he statred to complian of constipation 3 month ago...he tried many things from high fiber diet, laxatives and even enemas, and all had temporary effect. he came to my office asking for help..abdominal palpation was free. hyperaudible bowel sounds were remarkable. no history of pain during defecation..ferquency of  defecation is once every 3 to 4 days..

QUIZ questions: What is the most important single examination i didn't mention..and what is its contrainducation?