Module 14, General Medical Level

This patient is a 14 year old boy who presented complaining of pain in his right leg for 9 months and a contracture of the right knee which has developed over this period. There is no history of significant trauma. He was born 3 weeks premature with bilateral renal hypoplasia and a seizure disorder. Three renal transplants have failed and he currently receives peritoneal dialysis four times a day. Stunted growth and developmental delays during childhood include short stature, standing at 16 months and walking at 2 years. He sustained a right tibia and fibula fracture 6 years prior to presentation after minimal trauma. On physical examination he was noted to have poor dentitia, right knee 15 degree flexion contracture, painful ROM of right hip and knee.

Question 14A

This knee problem is due to his chronic renal failure.

Question 14B

An important blood test to order is a serum calcium level.

Question 14C

Because he is developing a knee flexion contracture he should be referred to physical therapy to work on a stretching program so this contracture does not get worse.

Question 14D

This boy needs to have x-rays of the hip, because the hip deformity causes even more long term disability than the knee complaints.

Question 14E

This bone problem is largely non-reversible and he will have life long bone weakness.

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