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?

Case description: A mother comes to a pediatric outpatient clinic with her 7,5 years old son, who's been having weak for a week, doesn't want to go to school (although he likes it much), has pain in his right leg, especially his knee. Temperature - 36,8 C (measured under his arm), the throat is clear. In the tension is increased in the area of a right knee , enlarged liver, small petechiae on his cheeks and chest .

The mother says that her son has never suffered from any serious diseases, also nobody suffers from any serious disease in their family. She asks you if something serious is happening with her son? 

Quiz questions: What should you tell the mother? What are your suspicions? What tests should you order to confirm your diagnosis? What are differential diagnoses?