A 7-Year-Old Boy Is Brought to the Emergency Department Due

question 697

Multiple Choice

A 7-year-old boy is brought to the emergency department due to right leg pain.  His mother says that he was running around the house and fell on the carpet an hour ago.  The patient has been crying and experiencing thigh pain since the fall.  He did not hit his head or lose consciousness.  Medical history is notable for 3 fractures after seemingly minor injuries.  Temperature is 36.7 C (98 F) , blood pressure is 100/60 mm Hg, pulse is 148/min, and respirations are 20/min.  On physical examination, the patient is crying but is alert and cooperative.  His teeth appear translucent and gray but he otherwise appears well-kept.  There is hyperlaxity of the joints of the hands, and upper extremity strength is 5/5 bilaterally.  The right thigh is markedly tender to palpation with obvious deformity.  X-ray demonstrates fracture of the proximal femur and does not involve the growth plate, which appears normal.  Which of the following is most likely diagnosis in this patient?

• A)Child abuse
• B)Duchenne muscular dystrophy
• C)Ehlers-Danlos syndrome
• D)Osteogenesis imperfecta
• E)Paget disease of bone
• F)Rickets

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Definitions:

Maintaining Temperature

The process by which living organisms regulate their internal temperature within certain limits despite external environmental changes.

Shivering

An involuntary response to cold temperatures, producing heat through rapid muscle contractions to maintain body temperature.

Negative Feedback System

A regulatory system in which a change in some steady state triggers a response that counteracts, or reverses, the change, restoring homeostasis (e.g., how mammals maintain body temperature). Compare with positive feedback system.

Integrator

In homeostasis, a control center.