Return to Medicines ListShow Learning Points most relevant to Phase 1:

Child with abnormal gait

Clinical Discipline(s)/Organ System(s)
Musculoskeletal System, Orthopaedics, Paediatrics, General Practice
Progress Test Topic(s)
Musculoskeletal
Description
A Somali woman brings her 2 year old son to the GP, because her husband is concerned about the way he is walking. His mother wears a veil for religious reasons.
Applied Science for Medicine 
   - Anatomy and physiology of the skeletal system (bone and joints, including fetal development)
   - Nutrition in pregnancy; folic acid and spinal deformity
   - Vitamin D metabolism and deficiency
   - Genetics of Duchenne muscular dystrophy; creatine kinase (CK) screening early to allow informed family planning
Clinical and Communication Skills 
   - Perform musculoskeletal and neurological examination in infants and children
   - Common developmental skeletal anomalies (knock knees, bow legs, flat feet)
   - Normal child growth and development including milestones
   - Differential diagnosis of abnormal gait
   - Recognise the child with an abnormal gait requiring urgent investigation and management
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Having difficult conversations with parents/breaking bad news (Duchenne muscular dystrophy)
   - Consideration of patient and family/whānau cultural and spiritual support needs
   - Awareness and ability to recognise own stereotypes and biases
Hauora Māori 
   - Ethnic differences in access to primary care between Māori and non-Māori
Population Health 
   - Influence of nutrition on maternal and foetal health
   - Variations in Vitamin D deficiency across populations
   - Public health issues relating to additives in food and water at a population health level (e.g. folic acid, fluoride)
Conditions to be considered relating to this scenario
Common
transient hip synovitis, osteomyelitis, septic arthritis, orthopaedic deformity, developmental dysplasia of the hip, cerebral palsy, traumatic injury
Less common but 'important not to miss'
non-accidental injury, rickets, Guillain–Barré syndrome, malignancy, muscular dystrophies
Uncommon
spinal cord abnormalities (e.g. spina bifida, dysraphism), cerebrovascular accident