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Q1
A7-year-:,,hislefthiphassignificantlylimitedrangeofmotion,-rayofthepatient'spelvisisshownbelow:
Whichofthefollowingismostlikelyresponsibleforthispatient'scondition?
A1
Correctanswer:C
X-rayofthispatient'spelvisshowsaflattenedandfragmentedleftfemora!:
Theseclinicalandradiographicfindingsarecharacteristicofidiopathicavascularnecrosisofthefemoralcapitalepiphysis,orLegg-Calve-Perthesdisease,Thisconditionmostcommonlyaffectsboysbetweenages4and10,,,thesepatientsaremanagedconservativelywithobservationandbracing,thoughsurgerymaybeindicatedincaseswherethefemora!headisnotwellcontainedwithintheacetabulum.
(ChoiceA)Inslippedcapitalfemoralepiphysis(SCFE),.
(ChoiceB)Inpediatricpatients,.
(ChoiceD)Duchennemusculardystrophy,themostcommonchildhoodmyopathy,.
(ChoiceE).
(ChoiceF)OsteosarcomaisaprimarybonecancerthatproducesafindingcalledCodman',butwhichtendtoaffectthediaphysesoflongbones.
Educationalobjective:
Unilateralsubacutehippaininamalechildcoupledwithaprogressiveantalgicgait,thighmuscleatrophy,decreasedhiprangeofmotion,andcollapseoftheipsilateralfemoralheadonplainpelvicx-raysarefindingssuggestiveofidiopathicavascularnecrosisofthefemoralcapitalepiphysis(Legg-Calve-Perthesdisease).
A2
Correctanswer:B
Thispatient'ssynovialfluidanalysisandhistoryofacutemonoarticulararthritisfollowingmonthsofmigratoryarthralgiasandatriptoiflameareconsistentwithLymearthritis,,aspirochetecarriedbythedeertick(Ixodesscapularis),andcausesdisseminatedinfectionbyhematogenousspreadandmigrationintovarioustissues.
Earlysymptoms(eg,erythemamigrans,fever),,000/mm³;Gramstainandcultureareusuallynegative,althoughpolymerasechainreaction(doneforinvestigativepurposes)-linetreatmentforLymearthritisIntheabsenceofconcurrentneurologicmanifestations.
(ChoiceA)Autoimmunearthritis(eg,rheumatoidarthritis)typicallycausesachronic,symmetric,inflammatoryarthritisthatfavorsthesmalljoints.
(ChoicesCandG)Staphylococcalanddisseminatedgonococcalinfectioncancauseanacuteinflammatorymonoarthritis,butthejointfluidispurulent(highercellcount)andGramstainispositive,,.
(ChoiceD)-of-motiontestingwillshowlockingorpoppingratherthanamilddecreaseinflexion.
(ChoiceE)Reactivearthritis(formerlytermedReitersyndrome)presents1-,asymmetricinflammatoryarthritis,oftenwithurethritisandconjunctivitisoruveitis.
(ChoiceF),carditis,andneuropsychiatricsigns(eg,chorea).
Educationalobjective:
,,butGramstainandcultureareusuallynegative.
Q3
A6-day-.
,.
Whichofthefollowingisthebestnextstepinmanagementofthispatient?
A. Footradiographs
B. Karyotypeanalysis
C. Reassurance
D. Serialmanipulationandcasting
E. Ultrasoundofhips
A3
Correctanswer:C
Metatarsusadductus(MA),themostcommoncongenitalfootdeformity,-borninfants,likelyduetothecrowdedpositioninginasmaller,primigraviduterus.
Over90%ofcasesarecharacterizedbyflexiblefeetthatovercorrectbothpassivelyandactivelyintolateraldeviation(abduction),;therefore,treatmentisusuallyunnecessary.
(ChoiceA)MAisaclinicaldiagnosisanddoesnotrequireimagingformanagementunlessthedeformityispersistentand/.
(ChoiceS),MAisnotassociatedwithanunderlyingsyndrome.
(ChoiceD),stretchingexercisesand/orserialcastingcanbeconsidered.
(ChoiceE),acontraindicationtovaginaldelivery,andnotwithMA.
Educationalobjective:
,thefootisflexibleandtheconditionresolvesspontaneously.
Q4
A3-year-,thegirlkeepsherhandinapronatedposition,refusestouseherhand,,andthechildstopscryingandstartstouseherarm.
Whatisthemostlikelyetiologyofthischild'ssymptoms?
Q5
A13-year-,-steroidalanti-,.
Whichofthefollowingisthemostlikelycauseofthispatient'skneepain?
Q6
A7-year-,.
Whichofthefollowingismostlikelyassociatedwiththispatient'sunderlyingcondition?
Q7
A1-year--.
Whichofthefollowingisthemostappropriatenextstepinmanagementofthispatient?
-rayoftherightarm