Module 59, General Medical Level
An 8 year old boy presented with a seven month history of intermittent
right elbow pain and swelling. He stated that his discomfort first began
when his right arm was twisted by a girl who "got the best of him".
This injury was associated with pain, swelling, and loss of ROM in his
right elbow. It was initially treated with ice packs with much improvement
over the next several days. He had three subsequent episodes of pain and
swelling in his right elbow not precipitated by trauma with almost complete
resolution of pain between each occurrence. The last episode, occurring
three days ago, did not respond to ice packs and significantly limited
his elbow ROM. The patient denied history of fevers, chills, or rashes.
Question 59A
This
is likely due to chronic effects of the injury and the first test to perform
is to obtain an x-ray.
Question 59B
Blood
tests including CBC, ESR, Rheumtoid factor, and ANA is all that is required.
Question 59C
The
elbow is aspirated and straw colored fluid is obtained. The WBC count 31,000
all polys. This suggests rheumatoid arthritis.
Question 59D
The
synovial fluid can also be send for lyme titer which is usually positive
if the child has Lyme disease.
Question 59E
While
waiting the results of the blood tests the child should be started on antibiotics.
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