A 13-Year-Old Boy Is Seen in the Office for Persistent

question 104

Multiple Choice

A 13-year-old boy is seen in the office for persistent right knee pain.  He first noticed a dull pain along the anterior knee 2 months ago.  Initially, the pain was noticeable only after basketball practice.  Two days ago, the pain worsened after the patient landed during a rebound attempt at a basketball game.  The knee pain is now constant and not relieved with ibuprofen or ice.  The patient has no chronic medical conditions.  Temperature is 37.4 C (99.3 F) .  Height is at the 75th percentile, and weight is at the 95th percentile.  The patient walks with a limp with the right foot pointed laterally.  There is no tenderness, erythema, or swelling around the right knee.  The anterior and posterior drawer tests are normal.  No abnormal findings during knee flexion and extension are present with either internal or external rotation of the tibia.  Range of motion of the right hip is limited, and the knee points laterally upon passive hip flexion.  Which of the following is the most likely diagnosis in this patient?

• A)Anterior cruciate ligament tear
• B)Medial meniscus tear
• C)Osgood-Schlatter disease
• D)Osteoarthritis of the hip
• E)Osteoid osteoma of the proximal femur
• F)Slipped capital femoral epiphysis
• G)Transient synovitis of the hip

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Definitions:

Decentralized Decision-Making

A process in which decision-making authority is distributed among various levels within an organization rather than being concentrated at a single point.

Autonomy

The right of patients to make decisions about their medical care without their health care provider trying to influence the decision.

Accountability

The obligation or willingness to accept responsibility for one's actions and the ensuing consequences.

Health Care Needs

The requirement for medical services, treatment, information, or assistance to maintain, diagnose, or treat physical or mental health conditions.