MedBugs: SAQ #92

Case: Fever and limp

A 2-year-old girl is brought into your ED with 5-days of fevers and limp. Mum states she had first noticed limping initially, then today the child had refused to weightbear on her left leg. The first fever appeared 3 days previously and have fluctuated. She has had a runny nose and a mild cough but few other symptoms. Mum doesn’t recall any falls. She is partially immunised having missed her 18-month vaccines due to minor URTI and she is developmentally normal. Her clinical exam is as follows : Alert and flushed, calm when not examined but obviously upset when approached

Temp 38.1 HR 130 BP 100 systolic RR 22 Sats 98% RA

R hip

• Tender + on palpation around hip
• Symmetrical inguinal creases / nil obvious swelling
• Painful ROM

L leg and R knee / ankle NAD Gait

• Crying when forced to stand
• Reluctant to bear weight on R leg

1. Give (3) MSK and (3) non-MSK initial differential diagnoses 6 marks

Her investigations are as follows : ESR 80 CRP 120 WCC 15 with neutrophils 13 / Plt 400 / Hb 109 Normal EUC and blood film You obtain an ultrasound of the R hip but no effusion is seen. The child remains febrile despite anti-pyretics.

2. What is your likely diagnosis at this stage? 1 mark

3. What three imaging modalities might you choose to confirm the diagnosis? List (1) advantage and (1) disadvantage of each. 6 marks

4. What antibiotic therapy would you consider? 1 mark

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Case: Fever and limp

1. Give (3) MSK and (3) non-MSK initial differential diagnoses 6 marks

2. What is your likely diagnosis at this stage? 1 mark

3. What three imaging modalities might you choose to confirm the diagnosis? List (1) advantage and (1) disadvantage of each. 6 marks

4. What antibiotic therapy would you consider? 1 mark

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