Module 35, General Medical Level

A 2 year and 6 month old white male presented to clinic with a 2-3 month history of limping on the right lower extremity. There was no history of trauma to the extremity, or a history of constitutional symptoms such as fever, chills, sweats, malaise or weight loss. Prenatal, perinatal and postnatal course were all normal.

Question 35A

A physical examination should focus on an thorough neurological examination of the lower extremity, joint and muscle examination.

Question 35B

After a complete physical examination was found to be normal, no further work up is indicated and he should be followed up in 4-6 weeks to determine if the limping resolves or gets worse.

Question 35C

If the physical examination finds a question of decreased right hip range of motion, The next step should be to obtain an x-ray.

Question 35D

This history of a limping child should raise a high suspicion of child abuse or non-accidental trauma.

Question 35E

During the examination a soft tissue mass is found on the lateral side of the left knee. The next step of the work up is to obtain a MRI scan of the knee.

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