Criteria of growing pains

A 12-year-old obese boy presents to your office complaining of bilateral leg pain that occurs only at night. His mother denies any pain during the day and reports he has not had a limp. The most likely diagnosis is :

A) slipped capital femoral epiphysis
B) Legg-Calve-Perthes disease
C) Osgood Schlatter's disease
D) patellofemoral syndrome
E) growing pains

Answer and Discussion

The answer is E.
A diagnosis of growing pains must meet three criteria:
(1) the leg pain is bilateral;
(2) the pain occurs only at night; and
(3) the patient has no limp, pain, or symptoms during the day.
To inaccurately diagnose a limping child with growing pains can be dangerous, as the physician risks missing the underlying pathology. However, if a child does fit the criteria for growing pains, the parents should be reassured that this is a benign, self-limited process that occurs for unknown reasons.

Algorithm for Examination of acute swollen knee

Algorithm for the assessment of a swollen knee. (IV = intravenous; WBC = white blood cell; ACL = anterior cruciate ligament)

 Press on it for enlargment

Myocardial ischemia in older patients

Which of the following symptoms is more likely to represent myocardial ischemia in older patients?

• A) Chest pain
• B) Dyspnea
• C) Diaphoresis
• D) Back pain
• E) Jaw pain

Answer and Discussion

The answer is B.
Exertional angina (chest pain) is the most common manifestation of myocardial ischemia in young and middle-age persons. Because of their more sedentary lifestyle or possibly a difference in pathophysiology, this may not be true in elderly patients. Instead of exertional chest pain, ischemia may be more commonly manifested as dyspnea in elderly patients. Other elderly patients with CAD may be completely asymptomatic, although silent ischemia may be demonstrated by stress testing or Holter monitoring.

Note:

Instead of exertional chest pain, ischemia may be more commonly manifested as dyspnea in elderly patients.

About head lice infestations

Which of the following statements is true regarding head lice infestations?

• A) Females are more likely affected.
• B) Retreatment with pyrethrin is rarely needed.
• C) Head lice can live off the body up to 1 week.
• D) Low socioeconomic children are more likely affected.
• E) Dogs are a common vector for head lice.

The answer is:  ( A ).

Head lice are thought to be the most common type and are developing resistance to commonly used pediculicides. Every year, between 6 million and 12 million people in the United States, primarily children 3 to 10 years of age, are infested with head lice. Girls are at greater risk because..............

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Suturing Workshop

A discussion and demonstration of suturing techniques with Lee Dresang, MD from the University of Wisconsin Department of Family Medicine.