Module 68, General Medical Level
This 11 year old female presented to Orthopaedic Clinic complaining
of right knee pain . There was no history of trauma. This pain increased
with activity and decreased at rest and had been present for approximately
one year. A past history of osteomyelitis of the right tibial shaft at
age two was elicited. This infection was treated with IV antibiotics and
the child had no problems until the recent symptoms started one year ago.
When asked to localize the pain the patient pointed directly to the tibial
tubercle. Prominence of the right tibial tubercle was noted as compared
to the left.. The tibial tubercle was warm, slightly red, swollen and tender
to palpation. There was pain with resisted knee extension but no pain to
passive knee range of motion.
Question 68A
The
initial work up should include CBC, ESR, and blood cultures.
Question 68B
A
bone scan should be obtained.
Question 68C
Aspiration
of the swollen red and warm anterior aspect of the tibia should be considered.
Question 68D
The
girl has a temperature of 37.5 and lymphadenopathy. She can be started
on oral antibiotics and observed for a response for 1 week.
Question 68E
The
girl should be instructed to limit her activities especially avoid jumping
sports and return for a follow up evaluation in 4 weeks.
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