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Old 07-22-2012
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Bones Sickler With Very Bad Bone Pain!

A 14-year-old African–American boy is brought to the emergency department by his mother for severe pain in his right leg. The pain is severe and unremitting, localized to the right mid-thigh. Vital signs are within normal limits, except for a slightly increased respiration rate. Examination is nearly impossible, as the boy will not permit anyone to touch him. His past medical history is remarkable for homozygous sickle cell trait. What is the most likely diagnosis?

a) Acute leukemia
b) Bone infarction
c) Faux pain
d) Osteogenic sarcoma
e) Osteomyelitis
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Old 07-22-2012
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B....vitals normal so osteomyelitis ruled out
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Old 07-22-2012
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No fever- bone infarct V-O crisis
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Old 07-22-2012
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b) Bone infarction, the most common areas of bone pain are: ribs, spine, pelvis, abdomen, sternum, long bones of legs and arms.

A sickle cell crisis (also known as a vaso-occlusive episode or VOE) is triggered when the abnormal blood cells block the small blood vessels that supply the body’s tissues.

In older children and adults with sickle cell anaemia potential triggers include: alcohol, cigarettes and illegal drugs such as cocaine and cannabis.

Certain triggers, such as: sudden changes in body temperature; either the result of an infection causing a high temperature or a change in the outside environment, dehydration, hypoxia, stress.
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Old 07-27-2012
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Default correct answer :)

b) bone infarction

Sickle cell disease is well known for causing bone infarction, and also osteomyelitis, often due to Salmonella. Since he has no fever, and the pain is so severe, infarction is most likely.
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