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  #1  
Old 07-18-2011
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Rheumatology/Orthopedics Painful limp and shorter leg

A 9-yr-old boy is presents with right side painful limp on walking. On rest pain decreases and increase on activity. Past h/o is not significant for trauma, wt loss, night sweat, fever. On examination effected leg appear a bit shorter. No tubercle prominence. No catching or locking seen. Other systemic examination appears normal. Which could be the most likely diagnosis?
1. Legg-calve-perthes disease
2. Osteochondritis dissecans
3. Juvenile rheumatoid arthritis
4. Muscular dystrophy
5. Meniscal tear
6. Osgood schlatter disease
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  #2  
Old 07-18-2011
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I think its 1
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Old 07-18-2011
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I ruled out 2,3,4 and 5. Leaving 1 and 6 which i had never heard of so i searched them and i found the answer wont post cuz thats cheating
Also did anyone see these 2 diseases described before? i didnt see any mention of them in Uworld nor in the kaplan vids nor MTB
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Old 07-18-2011
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1. Legg-calve-perthes disease
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Old 07-18-2011
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both Legg calve perthes and osgood schlatter disease are given in detain in kaplan pediatrics and surgery orthopedics division.
The answer here is Legg calve perthes or avascular necrosis of the femoral head that leads to shortening of the affected side.
Osgood schlatter is avulsion of a part of the tibia with the patellar tendon at the tibial tuberosity (insertion site) because of exertion.
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Old 07-21-2011
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Quote:
Originally Posted by confident View Post
A 9-yr-old boy is presents with right side painful limp on walking. On rest pain decreases and increase on activity. Past h/o is not significant for trauma, wt loss, night sweat, fever. On examination effected leg appear a bit shorter. No tubercle prominence. No catching or locking seen. Other systemic examination appears normal. Which could be the most likely diagnosis?
1. Legg-calve-perthes disease
2. Osteochondritis dissecans
3. Juvenile rheumatoid arthritis
4. Muscular dystrophy
5. Meniscal tear
6. Osgood schlatter disease
Answer is 1. Legg-calve-perthes disease. Avascular necrosis of femoral head, restricted movement at hip joint, painfull limp , h/o thrombotic event or trauma results it.

2.Osteochondritis dissecans: Abnormal and irregular ossification, restricted movement, effusion and pain at jt, locking and catching of jt are seen.

3. Juvenile rheumatoid arthritis: Rheumatoid nodule and rheumatic factor +, mainly small jts are involved, its not the option here.

4. Muscular dystrophy: Family h/o dystrophy, urinary incontinence, h/o falls, muscle hypertrohy, diminshed reflexes are seen. Its not the option here.

5. Meniscal tear: H/o trauma, pain and restricted movement, locking and catching of jt, crepitation, swelling etc are seen . So its not an option.

6. Osgood schlatter disease: H/O trauma, excsess activity like in sports, pain, swelling, trauma at tibial tuberosity seen, trauma--> seperation a part of tibia--> gap is filled with fiberofatty tissue-->seperated part grow seperatly and attach to form prominent tibial tubercle. Its not answer here.
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Old 07-22-2011
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1. Legg-calve-perthes disease
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