Case :
HPI: Clay is a 7-year-old male who presents in your office with complaints of right thigh pain and a limp. The pain began approximately 1 week ago and has progressively worsened. There is no history of trauma.
PE: Pleasant Caucasian boy, in mild distress. VS and growth pattern stable.
MS: flexion and internal rotation of the right hip and limited abduction of the right hip. Limb lengths are equal.
QUESTIONS TO ANSWER BELOW
What additional questions will you ask?
• Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask?
• What additional history will you need? (Think FMH, allergies, meds, prior event..etc that might be pertinent in arriving to your differential diagnoses).
• What additional examinations if any will you conduct?
• What additional diagnostic tests if any will you conduct?
•
• Discuss the 3 differential diagnoses below, explain what historical and physical exam features support your 3 rationales?
1) Legg-Calvé-Perthes disease (LCP):
2) Juvenile idiopathic arthritis (JIA
3) Slipped Capital Femoral Epiphysis (SCFE):
• What is your most likely Primary diagnosis and why?
• How will you treat this child?
-Provide medication treatment and symptomatic care.
(correct medication dosage, treatment option, referrals, follow up)
Patient Education, Health Promotion & Anticipatory guidance
-Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
-Discuss socio-cultural barriers that might impact the treatment and management plans.
• Health Promotion:
What immunizations should this child have had?
Based on the child’s age, when is the next well visit?
At the next well visit, what are the next set of immunizations?
What additional anticipatory guidance should be provided today?
(Minimum 2 references)
Sample Solution