robin082006
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A 5-year-old African-American boy is brought to the office by his mother for a pain in the right hip, which started 2 days ago. The child has a history of pharyngitis 2 weeks ago, treated with a 10-day course of penicillin G. On examination, his temperature is 37.2C(99F) and movements of the right hip joint elicit pain. Laboratory findings are significant for elevated ESR, and X-ray examination of both the hip and knee joints reveals nothing abnormal. Which of the following is the most appropriate treatment for this child’s condition?
A. Bed rest for 7 days with right hip in position of comfort
B. Repeat a ten-day course of penicillin G
C. Bed rest for 7 days & a ten-day course of penicillin G
D. Bed rest for 7 days & aspirin
E. IV nafcillin treatment
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| vanshita
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C?
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| MHP
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A? I think is not infectious because he hasn´t fever, is necessary ATB?
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| Guptashutosh
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two things comes in my mind
1.Either this is reeactionary pain for which he needs bed rest only option A
2 nd thing is if he has fever 99, then there could be septic focus for which he `ll need joint aspiration and culture 1st and then put him on nafcillin , but here he might haVE high fever
3. elevated ESR will be present in both
4 this could be rheumatic arthritis but tha is migratory
diff to choose one , i`ll go with A bed rest with rt hip in position of comfort
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| anjushree
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E
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| sarika
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osteomyelitis due to heamtogenous spread...xray is usually normal upto 10=14 days...i would go with nafcillin i/v
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| webjeee
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C or E
robin, what's the answer? skeletal infection highly suspected.
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| MRMAVERICK
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I THINK ITS ARTHRITIS NOT OSTEOMYELITIS-IT SEEMS MORE RELATED TO RHEUMATIC FEVER
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| robin082006
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ANSWER IS A
THIS IS TRANSIENT SYNOVITIS
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| young_doc
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"Transient synovitis (TS) is the most common cause of acute hip pain in children"
"Recent history of an upper respiratory tract infection, pharyngitis, bronchitis, or otitis media is elicited from approximately half of patients with TS."
"Children with TS are usually afebrile or have a mildly elevated temperature"
http://www.emedicine.com/ped/topic1676.htm
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| fox
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good q
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| fox
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nice to meet u again in step 2 forum young doc.
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| young_doc
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the pleasure is all mine fox!!
I rarely have time to come here (currently doing IM rotation), but i do come here every chance i get!
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