🤔 MEDIUM

Often limping is because you slept on it funny.  But really, there are some important paediatric orthopaedic causes of limp that you will come across over-and-over in med school.  Have a crack at these three patient conditions right now … good luck!

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child limp

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Question 1

Stem 1 of 5

A 14 year-old male presents to his GP with left-sided groin and knee pain. On examination he has global restriction of range of motion ipsilaterally, but notably at rest the (left) leg is partially externally rotated. His past medical history is notable for hypothyroidism, managed with daily PO medication.
Were the patient to be commenced on the first-line medication for his hypothyroidism today, what would the initial dose be before adjustment?
A
10micrograms
B
20micrograms
C
30micrograms
D
40micrograms
E
50micrograms
Question 1 Explanation: 
Source: Children’s BNF, 2021.
Question 2

Stem 2 of 5

What is the most likely diagnosis?
A
Slipped upper femoral epiphysis
B
Perthes’ disease
C
Transient synovitis
D
Septic arthritis
E
Paget’s disease of the bone
Question 2 Explanation: 
SUFE is a classic diagnosis of an older child, more likely male and obese, with a limp.
Question 3

Stem 3 of 5

What is the first line investigation ordered?
A
Plain radiograph hip
B
Ultrasound scan hip joint
C
CT hip
D
MR hip
E
Plain radiograph ankle
Question 3 Explanation: 
An XR of the hip joint is diagnostic
Question 4

Stem 4 of 5

Which sort of movement of the hip joint is more likely to be restricted in this condition?
A
Abduction
B
Adduction
C
External rotation
D
Flexion
E
Internal rotation
Question 4 Explanation: 
The hip joint will be locked in external rotation, with passive internal rotation painful ± limited.
Question 5

Stem 5 of 5

A screw is inserted into the femoral head, transecting the growth plate. How long is the patient expected to be non-weight bearing?
A
A month
B
A week
C
No time
D
Six weeks
E
Two months
Question 5 Explanation: 
Usually post-operative rest is as follows: several days bed-rest then non weight-bearing for up to six weeks.
Question 6

Stem 1 of 4

A five-year old female patient presents with a limp. On examination, there is localised right hip pain with a reduced range of motion globally.
A diagnosis of Legg-Calvé-Perthes disease is made. Which blood vessel is more likely impinged?
A
Medial circumflex femoral
B
Lateral circumflex femoral
C
Anterior circumflex femoral
D
Posterior circumflex femoral
E
Superior circumflex femoral
Question 7

Stem 2 of 4

What is the more likely long-term complication of this disease?
A
Osteoarthritis
B
Osteochondritis
C
Osteomalacia
D
Osteopenia
E
Osteoporosis
Question 8

Stem 3 of 4

What is the first line investigation to order?
A
Plain radiograph hip
B
Ultrasound scan hip joint
C
CT hip
D
MR hip
E
Plain radiograph ankle
Question 9

Stem 4 of 4

Of the options below, select all that may be appropriate first line therapies
A
Analgesia (simple)
B
Bed rest
C
Crutches
D
Physiotherapy
E
Traction
Question 10

Stem 1 of 4

A 10 year-old male presents with a limp. His right lower limb is abducted and laterally rotated at the hip joint, with pain localised to this joint. He has a history of a cold a week before, and denies a subjective fever.
What is the most likely differential in this patient?
A
Developmental dysplasia of the hip
B
Non-accidental injury
C
Perthes disease
D
SUFE
E
Transient synovitis
Question 11

Stem 2 of 4

What is the first line investigation in this patient?
A
CT non-contrast joint
B
Joint aspiration
C
No investigation
D
Plain radiograph joint
E
Ultrasound scan joint
Question 11 Explanation: 
Hip pain with constitutional signs (either localised or systemic) require work-up for septic arthritis first line - even if not the most likely cause (it rarely is).
Question 12

Stem 3 of 4

What is the most common causative organism of septic arthritis?
A
Esherichia coli
B
Group A streptococcus
C
Haemophilus influenzae
D
Neisseria gonorrhoea
E
Staphylococcus aureus
Question 13

Stem 4 of 4

The patient is discharged with simple analgesia. When does NICE recommend you should follow-up with the patient?
A
One day
B
Two days
C
Three days
D
Four days
E
Five days
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