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Old 11-21-2012
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Default next step in management

A previously healthy 4-year-old girl is brought to the physician because of fever and refusal to walk for 1 day. She appears mildly ill. Her temperature is 38.6 C (101.5 F), pulse is 120/min, and respirations are 22/min. The right knee is erythematous and swollen. She holds her right knee in flexion and resists any attempted movement of her right leg. She cries when the right knee is moved. Which of the following is the most appropriate next step in management?

A) Acetaminophen with codeine therapy

B) Arthrocentesis

C) Bone marrow aspiration

D) Bone scan

E) Immobilization and traction

F ) Lyme titer

G) MRI of the spine

H) Physical therapy

I) Reassurance

J) Serum rheumatoid factor assay

K) Systemic antibiotic therapy

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Old 11-21-2012
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Quote:
Originally Posted by Hitman View Post
A previously healthy 4-year-old girl is brought to the physician because of fever and refusal to walk for 1 day. She appears mildly ill. Her temperature is 38.6 C (101.5 F), pulse is 120/min, and respirations are 22/min. The right knee is erythematous and swollen. She holds her right knee in flexion and resists any attempted movement of her right leg. She cries when the right knee is moved. Which of the following is the most appropriate next step in management?

A) Acetaminophen with codeine therapy

B) Arthrocentesis

C) Bone marrow aspiration

D) Bone scan

E) Immobilization and traction

F ) Lyme titer

G) MRI of the spine

H) Physical therapy

I) Reassurance

J) Serum rheumatoid factor assay

K) Systemic antibiotic therapy


B. Arthrocentesis. Septic Arthritis is an emergency when in a child. Quick Arthrocentesis for Diagnosis and then IV antibiotics +/- Surgery for debridement.
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B. Arthrocentesis. Septic Arthritis is an emergency when in a child. Quick Arthrocentesis for Diagnosis and then IV antibiotics +/- Surgery for debridement.
but the child is in considerable pain would you not provide analgesics first

option A ??????
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but the child is in considerable pain would you not provide analgesics first

option A ??????
"Most appropriate" next step. Your right. Analgesics should be provided, but septic arthritis is a surgical emergency in a child, so diagnosing that should be priority. According to me atleast. What's the correct answer ?
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"Most appropriate" next step. Your right. Analgesics should be provided, but septic arthritis is a surgical emergency in a child, so diagnosing that should be priority. According to me atleast. What's the correct answer ?
your right .
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yes the case look like septic arthritis so get the fluid for diagnosis......arthrocentesis............
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its B arthocentesis. you need to confirm septic arthritis. plus she has fever. you could do a usg to look for the pathology or rule out other things( not in this case coz the leg is red and swollen with fever, immobile limb) which clearly states septic arthritis. however to confirm you need arthrocentesis n culture. it shows bacteria, low glucose, high protein, increaseddddd neutrophils.
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B) Arthrocentesis
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