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A 19-year-old woman presents with fever, anemia, a new pansystolic murmur and sudden painless loss of vision in one eye. Examination suggests an embolic retinal artery occlusion secondary to infective endocarditis.

Which investigation is most important for identifying the underlying cause?

Case

A 6-day-old neonate presented with:

Reluctance to feed for 1 day

Drowsiness

Two episodes of staring gaze

Pedalling movements noticed today


On Examination

Drowsy

Poor suck

Poor response to stimuli

Hypothermic

Chest examination: normal

Cardiovascular examination: normal

Per-abdominal examination: normal

Poor peripheral pulses


Laboratory Investigations

TLC: 15,000/mm³ ↑

CRP: 25 mg/L ↑

pH: 7.25 ↓

HCO₃⁻: 15 mmol/L ↓

Lactate: elevated

Random blood sugar: 35 mg/dL

LFTs, RFTs and serum electrolytes: normal


Questions

1. What is your most likely diagnosis?


2. What differential diagnoses must be kept in mind?


3. How would you investigate this patient?

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Enumerate the differential diagnosis for an acute lower respiratory illness in a child under 2 years of age, highlighting the most probable diagnosis.

An 18-month-old infant presents with an acute respiratory illness. Based strictly on the patient's age group, which of the following should top your differential diagnosis?

A) Bronchial Asthma
B) Acute Bronchiolitis
C) Atypical Pneumonia
D) Epiglottitis

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