ZANYA

  PRE-TEST: A 5YR OLD GIRL PRESENTS WITH LIMPING OF   MORE THAN 6WEEKS DURATION. SHE HAS A SWELLING IN HER KNEES AND GAIT DISTURBANCE .THE SYMPTOMS ARE BETTER WITH ACTIVITY BUT MORE PROMINENT AFTER A PERIOD OF REST. ON PHYSICAL EXAMINATION, EFFUSION AND STIFFNESS OF KNEES. THERE IS NO DETECTABLE CAUSE, ESR AND CRP ARE NORMAL. ANA IS NEGATIVE. WHAT IS THE MOST LIKELY DIAGNOSIS? NORMAL GAIT LIMP IS DEFINED BY A DEVIATION FROM THE NORMAL GAIT PATTERN EXPECTED FOR A CHILD’S AGE. IN ORDER TO HELP /ASSIST A CHILD WHO LIMPS,WE NEED TO KNOW THE NORMAL GAIT PATTERN AND VARIATION IN CHILDREN ACCORDING TO THEIR AGE. TODDLERS : THEY NORMALLY HAVE POOR BALANCE AND IMMATURE MOTOR PLANNING AND SO WHEN THEY WALK,THEY HAVE; -A WIDE BASE OF SUPPORT -SHORT AND SOMETIMES ASYMMETRIC STEPS -OCCASIONAL FOOT SLAPPING AS THEY PICK UP SPEED -ARM MOTION NOT RECIPROCAL WITH THEIR LEGS AND THEY FALL FREQUENTLY. 3-5YEARS: THEY HAVE IMPROVEMENT IN MOTOR DEVELOPMENT AND SO THEY TEND TO HAVE; ...

  QUESTION 1): A 24YEAR OLD MAN COMES TO THE EMERGENCY DEPARTMENT COMPLAINING OF RIGHT SIDED ABDOMINAL PAIN. HE WAS WELL UNTIL THE PAIN BEGAN IN THE PERI-UMBILICAL AREA 24HRS AGO, FOLLOWED BY SOME EPISODES OF NAUSEA AND VOMITING. IT HAS NOW MOVED TO THE RIGHT LOWER QUADRANT AND REMAINS THERE. THE PATIENT IS ANOREXIC. HE DENIES ANY SIGNIFICANT MEDICAL HISTORY. HE STATES HE HAS NOT HAD ANY EPISODES LIKE THIS PRIOR TO THIS ONE. HE DENIES BLOOD,MUCUS,CONSTIPATION,DIARRHEA,DYSURIA,HEMATURIA. A) GIVE 4 DIFFERENTIAL DIAGNOSES B)WHAT IS THE MOST LIKELY CONDITION? C) WHAT IS THE NEXT APPROPRIATE STEP IN THE MANAGEMENT OF THIS CASE?   ASSESSMENT A)DIFFERENTIAL DIAGNOSES: i)ACUTE APPENDICITIS ii)PEPTIC ULCER iii)RENAL COLIC iv)URINARY TRACT INFECTION   B)MOST LIKELY DIAGNOSIS= ACUTE APPENDICITIS   C)APPENDICECTOMY QUESTION 2): A 12YR OLD BOY WAS BROUGHT BY HIS MOTHER TO THE EMERGENCY DEPARTMENT COMPLAINING OF ABDOMINAL PAIN FOR THE PAST 6 DAYS. ACCORDING TO THE MOTHER, PAIN STA...