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


Clinical Discipline(s)/Organ System(s)
Infectious Diseases, Microbiology, Musculoskeletal System, Orthopaedics, Paediatrics
Progress Test Topic(s)
A ten year old Niuean child presents with a 2 day history of limp from a painful knee. He had chicken pox over a week ago, weighs 70 kg and is 140 cm tall.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the growing skeleton
   - Signs of and response to infection in a child
   - Autoimmune phenomena including rheumatic fever
   - Pathophysiology of joint inflammation
   - Microbiology and pathogenesis of bone and joint infections plus superantigen and post-streptococcal diseases
   - Microbiology of herpes viruses
   - Nutrition, normal growth and development including fetal and maternal nutrition
   - Endocrinology of appetite, glucose metabolism, hypothalamic pituitary axis
   - Pharmacology of betalactam antibiotics; (flucloxacillin, amoxicillin-clavulinate, flucloxacillin, cephazolin)
Clinical and Communication Skills 
   - Elicit a relevant history from family/whānau/patient
   - Examination of pain in lower limb and musculoskeletal system including referred pain from hip to knee
   - Differential diagnosis for a child or adolescent with a limp
   - Approach to discussing overweight/obesity with child and family
   - Measure height, weight and head circumference, calculation of body mass index (BMI) and height velocity
   - Use growth charts and Tanners staging of puberty
   - Recognition and examination for complications of obesity
   - Radiological interpretation of hip pathology
   - Interpretation of blood test results (inflammatory markers, thyroid function)
   - Risk groups for rheumatic fever, Jones criteria and red flags for diagnosis (ethnicity, migratory arthralgia, associated murmur)
   - Outline the management of bone and joint infections
   - Role of hospital in the home and home intravenous therapy
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Empathise regarding societal norms of body shape and body image
   - The parental role and decision-making for children
Hauora Māori 
   - Recognition of disproportionate impact of obesity, rheumatic fever and infectious disease on Māori and Pacific people
   - Access to primary health care
   - Appropriate engagement and consultation with whānau
Population Health 
   - High incidence of infections/rheumatic fever in New Zealand
   - Rising prevalence of obesity among children
   - Population health measures to control obesity and effectiveness (promotion of breast feeding, maternal nutrition, healthy eating habits, regulation of food industry and advertising)
   - Vaccine-preventable disease (varicella)
Conditions to be considered relating to this scenario
osteomyelitis, septic arthritis, myositis, rheumatic fever, trauma, nutritional/exogenous obesity, slipped femoral capital epiphysis, Osgood-Schlatter disease, developmental dysplasia of the hip
Less common but 'important not to miss'
necrotising fasciitis, bone or other malignancy (e.g. leukaemia)
Perthes disease, juvenile rheumatoid arthritis, chromosomal or genetic syndrome (leading to obesity/dysmorphism), hypothyroidism, hypopituitarism