Module 56, General Medical Level
A nine year-old male with a diagnosis of spastic quadriplegic, cerebral
palsy presented for a follow-up exam. This patient was non-ambulatory and
non-verbal. Patient had good head control and was capable of sitting if
propped up. The patient had bilateral release of iliopsoas, gracilis, adductor
longus, distal hamstrings and right tensor facia lata release 4 weeks prior
to this examination. Now, the patient still required valium and analgesics
due to pain and muscle spasms. At this time a firm mass was palpated in
the left groin. The whole groin was warm to touch and the child was reported
to have intermittent temperature elevation to 38.5 degrees. He apetite
was also diminished.
Question 56A
The
primary concern is a deep wound infection.
Question 56B
Blood
tests are ordered with the WBC being 12,500 (normal 5500 to 12000) and
the erthrocyte sedamentation rate was 56 (Normal<20). The next step
should be an aspiration of the wound.
Question 56C
Another
possible cause of the current problem is a fracture.
Question 56D
An
x-ray is obtained and is normal. Aspiration of the wound should be the
next step in the work up.
Question 56E
Refusal
to eat maybe a serious concern and should be carefully evaluated with a
good history and laboratory evaluation.
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