Test Your Skills w/Differential

[MUBiomed]

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A 5-year-old Caucasian female who presents to the pediatric clinic with severe right knee pain. The pain has been present for approximately one month, but has worsened over the past two days and is now accompanied by fever and the inability to walk.

Differential GO!

(Feels like House doesn't it?)

 

[skatertudoroga]

A 5-year-old Caucasian female who presents to the pediatric clinic with severe right knee pain. The pain has been present for approximately one month, but has worsened over the past two days and is now accompanied by fever and the inability to walk.

Differential GO!

(Feels like House doesn't it?)

what about chest? other joints? rheumatic fever.but u'd have to give more info.

 

[Encephalectomy]

would obviously need more info to know but my stab at a differential...

rheumatic fever

lyme's disease

Juevenile rheumatoid arthritis (with something else causing the fever)

Ghonnorrea (sexual abuse?)

Genetic defect in purine synthesis--> some sort of gouty attack (very unlikely as the patient is a child + a female, but...)

osteomyelitis

 

[WashMe]

whine-itis?

 

[Marcus Brody]

It's a toomah

 

[Gabby]

I'm all about cancer pathology right now, so I'm going to say Ewing's Sarc, but we really do need more information.

My other thought that's already been mentioned would be osteomylitis.

 

[MUBiomed]

It was a question sent out by a professor, unfortunately that is all the info they gave. They are having a "mock" contest to see best differential diagnoses. I thought I would tap into the SDN database to see if it correlated with my ownideas...

 

[Encephalectomy]

keep us in the loop about what we missed

 

[KnuxNole]

It's obviously AIDS

 

[reedman]

septic arthritis
.
.
.
.
trauma (sprain, fracture)
tendonitis
bursitis -infection or other

of course, take vitals to rule out sepsis.
physical exam then xray. possible tap.
might as well get a cbc for...i don't know. if she looks sick get a blood culture too.

fever could mean unrelated illness that just made her cranky and increased her perception of pain. or she feels sick and is really working that knee pain for attention.

if it's not obvious what is going on after exam/tap/films/history/ whatever other common tests-> go see ortho. don't eff around playing dr. house.

 

[auburnO5]

A 5-year-old Caucasian female who presents to the pediatric clinic with severe right knee pain. The pain has been present for approximately one month, but has worsened over the past two days and is now accompanied by fever and the inability to walk.

Differential GO!

(Feels like House doesn't it?)

 

[greatnt249]

No mention of vaccine history or rash, but...dare I say, Rubella?

 

[VenusinFurs]

How can you choose a "best answer" based on that much info? 😡

My best guess is septic arthritis. But I despise this excercise.

 

[Rendar5]

Not gonna bother giving you the differential, but what I will tell you is that you should not look solely at the knee. Hip issues present as knee pain in kids. So make sure your expanded differential includes hip pathology (although please leave SCFE out of it =p)

 

[bombas238]

Not gonna bother giving you the differential, but what I will tell you is that you should not look solely at the knee. Hip issues present as knee pain in kids. So make sure your expanded differential includes hip pathology (although please leave SCFE out of it =p)

Thought of this immediately.

 

[MUBiomed]

I should know the "answer" this Friday. I will make sure to post here and let you know what it was. Thank you for the help with the differential btw!

 

[mglavin]

Medical student please tell me all that things that might cause a patient to be sick.

 

[hoqhuuep]

Loopus!

 

[MUBiomed]

For all of those people waiting with baited breath.....the "answer" was ALL. Its all so obvious now!!

 

[reedman]

lol, yeah soooo obvious. at least i said i would get a cbc.

bone pain and fever, sure it makes sense. i bet most of us would be thinking malignancy after ruling out infection and trauma.

 

[MUBiomed]

He said during the case presentation that the peripheral smear came back with a high concentration of blasts.....


That little nugget would have made the diff too easy though I guess...🙄

 

[reedman]

lol, there is always some golden nugget that would change everything.

 

[Bacchus]

Too bad I read this now, I immediately thought ca. with nodal pain. Oh well :\

 

[m1lktea]

Is there a website that allows us to plug in sx and hx to generate a ddx?

My attending told me my school has a subscription to something like that. His accent was heavy, so I wasn't really able to catch it. I'm pretty sure he's not referring to Diagnosaurus on Accessmedicine...'

Ideas?

Thanks!

 

[Funky]

 

[isoquin]

15 year old female with knee pain on the boards is gonorrhea until proven otherwise.

 

[shenanigi]

A 5-year-old Caucasian female who presents to the pediatric clinic with severe right knee pain. The pain has been present for approximately one month, but has worsened over the past two days and is now accompanied by fever and the inability to walk.

Differential GO!

(Feels like House doesn't it?)

Obvious that the parents beat the kid and make her sleep in a sauna.