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Childhood Limp – Acute (P)
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1. What is the most common cause of acute limp in a child aged 3–10 years?
*
Septic arthritis
Slipped capital femoral epiphysis
Transient synovitis
Juvenile arthritis
2. Which red flag symptom would prompt urgent referral in a limping child?
*
Intermittent limp with no pain
Afebrile child who can weight bear
Fever, inability to weight bear, and severe pain
Mild stiffness in the morning
3. What is transient synovitis typically preceded by?
*
Trauma
Recent viral illness
Allergy
Vaccination
4. In septic arthritis, what is the usual joint fluid characteristic?
*
Clear and straw-colored
Purulent
Bloody
Normal synovial fluid
5. What investigation is most helpful to differentiate septic arthritis from transient synovitis?
*
Pelvic X-ray
Ultrasound and joint aspiration
CT abdomen
Foot X-ray
6. Which hip position is typical in transient synovitis?
*
Internal rotation and adduction
Flexion, abduction, and external rotation
Neutral rotation and extension
Straight leg without preference
7. What is the first-line imaging modality for a limping child with suspected hip pathology?
*
MRI
X-ray
Ultrasound
CT
8. Which age group is most affected by slipped capital femoral epiphysis (SCFE)?
*
0–2 years
3–5 years
10–15 years
16-21 years
9. What is the primary management for transient synovitis?
*
Urgent surgical drainage
Antibiotics
NSAIDs and rest
Casting and splinting
10. Which condition presents with sudden hip pain and inability to walk, especially in boys aged 4–10?
*
Septic arthritis
Legg-Calvé-Perthes disease
Juvenile arthritis
Growing pains
11. What is the Kocher criteria used for?
*
Assessing scoliosis
Predicting risk of SCFE
Differentiating septic arthritis from transient synovitis
Grading osteomyelitis severity
12. What sign might indicate osteomyelitis in a limping child?
*
Eye redness
Localised bone tenderness and fever
Bilateral limb weakness
Painless limp
13. In which childhood condition is limb length discrepancy a common late finding?
*
#NOF
SCFE
Juvenile arthritis
Osgood-Schlatter disease
14. What is an appropriate next step for a child with a limp but no red flags and a normal examination?
*
Urgent MRI
Observation and review in 48 hours
Refer to A&E
Start antibiotics
15. Which lab test is most useful in suspected septic arthritis?
*
Liver enzymes
CRP and WCC
Calcium
Amylase
16. Which feature supports a diagnosis of growing pains?
*
Worsening with exercise
Present in daytime
No effect on sleep
Occurs at night and resolves by morning
17. What is an important feature of pain in juvenile idiopathic arthritis?
*
Worse in evening
Associated with rash and fever
Sudden onset after trauma
Always bilateral
18. Which joint is most commonly affected in transient synovitis?
*
Knee
Ankle
Hip
Shoulder
19. Which presentation suggests non-accidental injury in a limping child?
*
Consistent history and location of injury
Isolated limp with known fall
Inconsistent story and multiple bruises
Pain only with sport
20. What is the typical duration of symptoms in transient synovitis?
*
<24 hours
2–3 days
1–2 weeks
Several months