A 5-year-old girl is seen by the orthopaedic specialist after experiencing a worsening limp for 4 weeks. Her blood tests were normal, and x-rays revealed a hip joint effusion without any significant femoral head structural abnormalities. The doctor diagnosed her with Perthes’ disease. What would be the most suitable initial management plan for this child?
A 4-week old baby is seen by the GP. The baby was born in breech position at 38+4 weeks gestation without any complications during delivery. However, two days after birth, the baby developed jaundice and was treated with phototherapy. The newborn physical examination was normal. The mother has a medical history of anaemia, asthma, and coeliac disease. The baby is currently thriving and is on the 45th centile. What investigations should the GP consider referring the baby for based on their medical history?
A 3-day-old neonate born at term is presenting with tachypnoea, grunting, and cyanosis. The baby is unable to feed and has an oxygen saturation of 70% on room air. On auscultation, a loud S2 and systolic murmur are heard, which is loudest at the left sternal border. The doctors suspect transposition of the great arteries and have started the baby on intravenous fluids, antibiotics, and scheduled surgery. What additional medication should be given in the meantime?
A premature neonate is delivered via category II emergency caesarean section at 34+3 weeks for fetal distress. The obstetrician notes the baby is delivered with the cord wrapped around its neck and appears floppy and ‘blue’. The neonatal team immediately begins resuscitation as the initial APGAR score is 3. At 10 minutes, the score is 5 due to cyanosis, heart rate of 120 bpm, minimal response to stimulation, poor tone, slow and irregular respiratory effort with a respiratory rate of 12/min. What is the most appropriate management of this premature neonate to reduce hypoxic ischemic encephalopathy (HIE)?
Sophie is a 6-year-old girl who requires a blood transfusion after a serious accident. Her condition is critical and she needs urgent resuscitation. Sophie has suffered significant blood loss and will not survive without a transfusion. However, her parents are Jehovah’s Witnesses and are present, but they refuse to provide consent for the blood transfusion. What is the most appropriate course of action?
A 5-year-old girl comes to the GP with a sudden onset of limp. She appears to be in good health. During the examination, she displays an antalgic gait. An MRI scan reveals decreased blood flow to the left hip, leading the doctor to suspect Perthes’ disease. What is the most suitable course of action?
A 6-year-old girl walks with a limp due to right hip pain, which is relieved by rest and made worse by walking or standing. Her vital signs are normal. The Trendelenburg sign presents when she stands on her right leg.
X-rays reveal periarticular right hip swelling in soft tissue. A bone scan reveals reduced activity in the anterolateral right capital femoral epiphysis.
What is the most likely diagnosis?
A 10-year-old boy comes to the GP with his father, complaining of right-sided hip pain that has been present for the past 3 weeks. The pain has gradually worsened over time. When asked to point to the location of the pain, he indicates his right hip and groin area. Upon examination, his heart rate is 71 bpm and temperature is 37.3ºC. He is able to walk, but with moderate discomfort and an antalgic gait that causes him to out-toe. Passive movement of the hip reveals a loss of internal rotation of the right leg in flexion. What is the most likely diagnosis?
A 4-year-old girl is brought to the emergency department by her father due to pain in her left hip. She has been complaining of pain and is hesitant to put weight on her left leg. She has a normal range of movement in both legs. Her father reports that she has been feeling sick with cold symptoms for the past few days and she currently has a temperature of 37.8 ºC.
What is the probable diagnosis?
A 14-year-old boy comes to the GP complaining of left groin pain and a limp that has been gradually developing over the past 5 weeks. He has no medical or family history and his right leg is unaffected. Upon examination, there is a noticeable decrease in internal rotation of the left leg, but no swelling or warmth around the joints. The patient’s vital signs are normal, and his height is in the 50th percentile while his weight is in the 95th percentile. What is the most probable diagnosis?