Module 71, General Medical Level
This 9 year old female presented to the emergency room with a four
day history of mild right knee pain. She limps on the affected extremity
when ambulating but has minimal to no pain at rest. There is no history
to suggest trauma. She apparently has had mildly elevated temperatures
over the last several days according to the mother. There is no history
of joint stiffness or chronic fatigue. No other joints are involved. There
is no history of tick exposure. She has been otherwise healthy in the past.
On physical examination of the right knee there is no limitation in flexion
or extension. There is mild diffuse tenderness that is poorly localized
over the medial femoral condyle. There is no soft tissue swelling or joint
effusion noted. No pain is elicited with ROM of the knee. The remaining
extremities are without tenderness or swelling. Temperature was 38.3 C.
Question 71A
Only
the following laboratory tests are required; CBC, ESR, Blood cultures and
Lyme titer level.
Question 71B
An
AP and lateral x-rays of the knee should be obtained.
Question 71C
Because
of the insurance company, this girl must to go to a laboratory 10 miles
away to have her laboratory tests performed. You allow her to go and return
to see you the next day with the results of the lab tests.
Question 71D
At
this age when children are very active, occult trauma is a frequent cause
of this type of minor knee complaint.
Question 71E
On
further history this girl was found to have had poison ivy for which she
is being treated. The swelling and tenderness is therefore thought to be
more significant.
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