| CLINICAL HISTORY:2-year-old boy previously healthy boy with limp, swollen knee and refusing to bear weight . |
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| QUESTION 1: Describe the findings on these knee x-rays. |
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| QUESTION 2: What is the next best test? |
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| QUESTION 3:Describe the findings on these ultrasound images. |
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| QUESTION 4:What is the next best test? |
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| QUESTION 5:Describe the findings on these MRI images ? |
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| QUESTION 6:What is your differential diagnoses? |
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| QUESTION 7: Answer(T/F) |
| a. Marrow edema is a classic feature of transient synovitis? |
| b. What are some clinical features of septic arthritis? |
| c. What joint is most commonly affected by Lyme arthritis? |
| d. MRI readily distinguishes between oligoarticular JRA, septic arthritis, and Lyme arthritis? |
| e. The presence of fever (oral temperature> 38.5 c). Non-weight bearing, ESR >40 mm per hour, and a WBC> 12,000 favor diagnosis of septic arthritis. |
| f. MRI also in used to evaluate complication of septic arthritis, including epiphyseal ischemia, growth arrest, secondary osteomyelitis, and premature degenerative changes. |
| g. The diagnosis of septic arthritis is made when there is a positive culture from joint aspiration or a white blood cell count in the joint fluid>50,000 cell/mm3 with a positive blood culture. |