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


Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Musculoskeletal System, Orthopaedics, Paediatrics, Radiology
Progress Test Topic(s)
A mother presents to the Emergency Department with her 2 year old NZ European child who is not using their right arm.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Structure and function of the growing skeleton
   - Normal growth and developmental milestones of infant
   - Microbiology and pathogenesis of bone and joint infections
   - Pharmacology of pain relief, specific to children, including non-medication techniques
   - Pathophysiology and genetics of disorders of bone development and structure
Clinical and Communication Skills 
   - Examination of the young unco-operative child, including evaluation of sepsis and/or acutely unwell child
   - Detailed history and documentation from family/caregivers of an event; obtaining validation from other carers
   - Differential diagnosis of a child not using a limb
   - Interpretation of plain X-rays in infants and children
   - Features (important red flags) for non-accidental injury in history, examination and presentation time
   - Management of pain in a young child
   - Management of musculoskeletal injury in outpatient setting and indications for orthopaedic referral
Personal and Professional Skills 
   - Non-judgemental attitude to history of events
   - Discussion of non-accidental injury with the parents
   - What to do when you suspect non-accidental injury including professional and legal obligations
   - Establish a relationship with patient and family/whānau
Hauora Māori 
   - Self-reflective competencies: awareness of possible personal stereotypes/assumptions around Māori and about child abuse
   - Awareness of disproportionate impact of socioeconomic deprivation on Māori and appropriate response
   - Recognition of disproportionate impact of preventable injury in childhood on Māori and Pacific people
Population Health 
   - Paediatric orthopaedic and acute surgical services in NZ
   - Preventable accidents and safety in the home and community
   - Prevalence, risks and resources for non-accidental injury and resources; strategies for prevention
   - Roles of Child, Youth and Family/Puawaitahi services
Conditions to be considered relating to this scenario
fracture, osteomyelitis, septic arthritis, deep skin or soft infection, pulled (dislocated) elbow
Less common but 'important not to miss'
non-accidental injury, malignancy
neurologic event, osteogenesis imperfecta