NMBE forum4 - silvy

[ArchivalUser]

13 year old 2 weeks history of left hip pain and associated limp. no redness or swelling, no history of trauma or musculoskeletal problems. temperature 37.5 pulse 80 BP 120/70. He holds his left extremity in slight external rotation and hip flexion at rest. internal rotation and abduction are decreased. range of motion of the knee and ankle is full there is no swelling or eritema. he walks with a limp and is unable to bear his full weight on the left. which of the following ?
a acute inflamation of the synovia covering left hip
b avn
c bacterial infection of the hip
d disruption of the femoral head epiphyseal plate
e inflamation ligament of the hip

[ArchivalUser]

D.Slipped capital femoral epyphysis>>>> Surgery.

[ArchivalUser]

thanks! doesn;t he have a fever?

[ArchivalUser]

nope sylvi occurs in general in overweight ( obese) adolescent ( 11-16 yo).

[ArchivalUser]

i think its aaa as thers no h/o of obesity.and aaa is more likely with h/o of uri

[ArchivalUser]

will go for D

[ArchivalUser]

silvy

what is the answer/

can it be B..avascular necrosis of capital femoral epiphysis

Legg Perthes Disease....limp with hip pain

[ArchivalUser]

SCFE versus LCP
SCFE: adolescent 10-16yold, Hip or knee pain, left leg mostly affected than right, patients often hold their affected hip in passive external rotation,
PE: lower extremity EXternally rotated and aBductec with gentle hip flexion), decrease internal rotation.

LCP: mostly btw 3-12 years old
hip or groin pain ( thigh).
decrease INTERNAL rotation, and ABduction.
PE:guarding or spasm especially with internal rotation.

[ArchivalUser]

I am sure it is not A because I marked A and NBME says is wrong (I was mislead by the low fever the guy has). I think it is D as Algeria says cause he has painful limp while LCP is a painless limp

[ArchivalUser]

Silvy did not choose SCFE due to absence or presence of pain, cause pain may be present also in case of LCP.
could you explain why it is SCFE and NOT LCP? cause the presence of pain is not the reason )
PS: important to understand and integrate these diseases+ Osgood Slatter ( you ll see them again in exam for sureeeee)