A 9-year-old boy presents with a limp. When he stands on his left leg, his right buttock sags downward instead of rising. During walking, his trunk lists to the left with each step on the left leg. This gait pattern is most indicative of what underlying problem?
A 15-year-old gymnast presents with several weeks of mechanical low back pain that is exacerbated by hyperextension maneuvers. Her physical exam is notable for hamstring tightness and localized tenderness over the L5 spinous process. Initial AP and lateral radiographs are negative. To confirm the suspected diagnosis, which imaging study is most appropriate?
A 17-year-old female long-distance runner presents with a 4-week history of progressive, vague anterior thigh and groin pain. She has no history of trauma. Examination reveals pain with passive hip rotation. Radiographs are unremarkable. An MRI confirms a femoral neck stress fracture on the superolateral (tension) side of the neck. What is the most appropriate next step in management?
A 9-year-old child with a displaced supracondylar humerus fracture is placed in a long-arm cast. Several days later, the mother calls because the child is complaining of a new, localized burning pain over the elbow, despite having good capillary refill in the fingers. Which complication of treatment should be most suspected?
A 7-month-old infant presents with bilateral metatarsus adductus. The deformities are rigid and cannot be passively corrected to a neutral position. What is the most appropriate initial treatment for this infant?
A 4-year-old boy presents with painful swelling of his upper back and neck following a minor fall. His mother reports similar episodes in the past, after which the swollen areas became hard. Examination reveals deformity of the great toes, which has been present since birth. Which medication was recently approved for this condition to block chondrogenesis, the initial step in the disease process?
An 17-year-old female with known hypermobile Ehlers-Danlos syndrome presents with escalating chronic musculoskeletal pain, dizziness upon standing, and profound fatigue that significantly impacts her quality of life. Her Beighton score is 8/9. Physical therapy has provided minimal relief. Which of the following is the most likely underlying pathophysiologic explanation for her nonarticular symptoms?
A 16-year-old is diagnosed with a sport-related concussion. After 48 hours of relative physical and cognitive rest, she feels well enough to begin the return-to-play protocol. According to the graduated protocol, what is the first activity-based stage she should engage in?
A 5-year-old boy presents with an acute onset of a limp and right groin pain for two days. He had an upper respiratory infection last week. He is afebrile at 37.5°C (99.5°F), is able to bear weight, and his labs show a white blood cell count of 11,000 cells/mm³ and an erythrocyte sedimentation rate of 18 mm/hr. Which diagnosis is most likely?
A neonate is born with multiple, symmetric joint contractures. The examination reveals internally rotated shoulders, fully extended elbows, flexed wrists, and severe equinovarus foot deformities. The muscles feel underdeveloped, and there is a faint midfacial hemangioma. Intelligence is expected to be normal. What is the most likely diagnosis?
