Module 25, General Medical Level

This 9 year old female presented to the emergency room with a four day history of mild right knee pain. She limps on the affected extremity when ambulating but has minimal to no pain at rest. No history of trauma was reported. She has had mildly elevated temperatures over the past several days according to the mother. There is no history of joint stiffness or chronic fatigue. No other joints are involved. There is no history of tick exposure. She has been otherwise healthy in the past. On physical examination of the right knee there is no limitation in flexion or extension. There is mild diffuse tenderness that is poorly localized over the medial femoral condyle. There is no soft tissue swelling or joint effusion noted. No pain is elicited with ROM of the knee. The remaining extremities are without tenderness or swelling. Temperature is 38.8* C. LABS: WBC 13,400 Differential-- 73% polys, 8% lymphs, 1% bands, Sed rate 41 mm/hr.

Question 25A

The only other labs which should be drawn include Lyme titer and rheumatoid factor.

Question 25B

This child should be started on an oral keflex.

Question 25C

Based on this information the child can be discharged home from the emergency room.

Question 25D

Because of pain in the leg with walking the child should be placed on crutches and instructed not to walk on the limb.

Question 25E

As the mother was leaving she asked if the child can continue to take the poison ivy medicine which the child has been on for the last week. You assure her that this will be fine.

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