Pediatrics 407380.A 13-year-old African American boy is brought to the ED by his
mother for a complaint of right knee pain over the course of 1 to 2 weeks.
The only notable trauma that the patient can recall was jumping on a tram-
poline 1 to 2 weeks ago with friends that resulted in right lower extremity
pain. On the morning of presentation, the patient complained of increased
pain when ambulating and was noted to be limping. He denies fever. No
other trauma and no recent illness were noted by the family. On examina-
tion, the patient is afebrile with normal vital signs. He has no previous med-
ical problems and is noted to be overweight but is in otherwise good health.
The lower extremity examination reveals no swelling or erythema over any
of the joints. His knee has no focal tenderness or pain with range of motion
but the hip is noted to be painful with internal and external rotation. He has
a normal neurosensory examination of the distal extremity. A radiograph is
performed. Which of the following is the most likely diagnosis?
a. Legg-Calve-Perthes disease
b. Slipped capital-femoral epiphysis
c. Septic arthritis
d. Osgood Schlatter disease
e. Transient synovitis of the hip
381.A 4-year-old girl is brought to the ED by her mother with a 2-day his-
tory of abdominal pain and leg pain. The leg pain worsened today to where
the patient did not want to walk. She was carried into the ED by her parents.
The patient describes two episodes of nonbloody, nonbilious emesis. She
denies fever, respiratory complaints, diarrhea, and trauma. There is no signifi-
cant past medical history, no recent travel, and no family history of inflamma-
tory bowel disease. On examination, the patient has a temperature of 99.9°F,
HR 122 beats per minute, RR 24 breaths per minute, BP 95/60 mm Hg. She
is alert and interactive with no significant distress. HEENT (head, eyes, ears,
nose, throat) is normal. Lungs are clear to auscultation. Heart is regular with
no murmur. Abdomen is soft but diffusely tender with no rebound or guard-
ing. Extremities reveal bilateral swelling and tenderness of her knees. Skin
examination reveals nonblanching purple and red lesions (macules and
patches) on the flexural surface of her lower extremities and on her buttocks.
These lesions are nontender. You advise the parents that the most likely organ
system to experience any prolonged problem is which of the following?
a. Renal
b. Integument
c. Gastrointestinal (GI)
d. Musculoskeletal
e. Neurologic