EMQs in Clinical Medicine.pdf - Peshawar Medical College

114 Orthopaedics and rheumatology
44 Pain in the hip
A
B
C
D
E
F
G
slipped femoral epiphysis
osteoarthritis
congenital dislocation of hip
fracture pubic ramus
transient synovitis
tuberculous arthritis
rheumatoid arthritis
H
I
J
K
L
M
septic arthritis
fractured sacroiliac joint
fractured neck femur
Charcot joint
idiopathic growth retardation
Perthes’ disease
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
1 An obese 12-year-old boy presents with pain in his right hip. On examination
the hip is flexed, abducted and externally rotated. His mother has suffered from
TB in the past.
2 A 6-year-old boy presents with a pain in the hip and a limp. All movements at
the hip are limited. His radiograph shows decrease in size of the nuclear femoral
head with patchy density.
3 A 3-year-old girl presents to the orthopaedic clinic with a waddling gait. Her
mother says that there has been a delay in walking. On examination there is an
extra crease on the left thigh.
4 An 80-year-old woman presents to A&E after a fall. On examination the left hip
is adducted, externally rotated and excruciatingly painful.
5 An 8-year-old boy presents to A&E with marked limping and pain in the right
hip, which resolves within 48 h. His radiographs show no abnormality at the hip
or other joint involvement. Bone scan 2 weeks later is also normal. The patient’s
mother suffers from osteoarthritis.
Answers: see page 126.