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  #1  
Old 08-20-2014
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Default Nbme 7 q

A 14-year-old boy sickle cell trait is brought to the emergency department because of a 1-day history of severe pain in his left thigh and knee. He has been unable to bear weight on his left leg since the pain began. He has not had swelling, locking, or “catching" of his knee. Six days ago, he was evaluated in the emergency department after he twisted the knee during a basketball game. An x-ray of the knee taken at that time is shown. He was instructed to take a nonsteroidal anti* inflammatory drug and apply ice packs to the knee. He also was given crutches and told to bear weight as tolerated. His symptoms improved during the next 3 days, and he discontinued use of the crutches and medication at that time. On arrival, he is walking with the assistance of crutches. He is 173 cm (5 ft 8 in)tall and weighs 95 kg (210 lb);BMI is 32 kg/m2_ His temperature is 37c (98 6。F), and blood pressure is 110/70 mm Hg. Examination of the left lower extremity shows joint line tenderness of the knee; there is no effusion. Range of motion of the left hip is limited by pain. The remainder of the examination shows no abnormalities. His leukocyte count is 8000/mm3,and erythrocyte sedimentation rate is 10 mm/h. Which of the following is the most appropriate next step in management?

A)X-ray of the lumbar spine
B)X-ray of the left hip
C) Whole-body bone scan
D) MRI of the left knee (Wrong)
E) Aspiration of the left knee
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  #2  
Old 08-20-2014
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I guess its a hip pathology now that i read the whole question without stress, so B (Slipped capital femoral epiphysis), but i can justify "joint line tenderness of the knee"
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  #3  
Old 08-20-2014
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avascular necrosis: xray of hip
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  #4  
Old 08-20-2014
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but its just sickle cell trait
and please explain the "joint line tenderness of the knee"
thank you
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  #5  
Old 09-06-2014
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I put D) thinking it was something of ligament, and got it wrong, but now reading it again maybe XR of hip thinking about Slipped capital femoral epiphysis, because 1: male, 2: age 3: overweight 210lbs.
Now the joint line tenderness can be an Anserine bursitis (uworld Q 3303).
What troubles me is the radio opaque image over the distal femur, I can't tell what that is, but his ESR is normal, should that be ignored?
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  #6  
Old 09-06-2014
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that's a good question. I guess they put the knee X ray and the tenderness just as a distractor. I am guessing since his knee trauma was recent the joint tenderness would be expected. The main current problem is hip pain and inability to move hip. That's where the trick is.
The X ray of the knee is normal. There is no abnormalities as far as I can tell, I think what you meant by opacification is the patella.
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  #7  
Old 01-29-2015
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In trauma, examination of the joint proximal to symptomatic joint is necessary if symptomatic joint's X-ray is normal. This case is neither associated with slipped capital epiphysis nor with sickle cell trait. It is simple sports injury question.
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