Module 60, General Medical Level
The patient is an 8 year and 7 month old white male who reported that
he injured his left knee about two weeks ago when he fell off his bicycle.
He had not noticed much pain until 3 days ago when he started to complain
of pain and swelling and difficulty moving his left knee. He has been able
to bear weight and ambulate with a limp. On ambulation the left knee was
held in mild flexion. The left knee lacked full range of motion. Extension
was approximately 10 degrees short of full. Flexion was to approximately
120 degrees, about 20 degrees less than the opposite side. There was a
moderate effusion evident by blotting of the patella. There were no specific
areas of tenderness although ranging the knee was bothersome with mild
apprehension. No ligamentous instability was noted during the exam. Exams
of the hip and ankle were normal bilaterally as was the right knee.
Question 60A
This
probably represents an occult knee ligament injury.
Question 60B
An
x-ray is the first test which should be obtained.
Question 60C
A
rheumatoid work up should also be initiated.
Question 60D
A
Lyme titer should be required in the work up.
Question 60E
The
first test should be an aspiration of the knee.
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