Musculoskeletal examination and the limping child — branching viva

Opening question

A five-year-old boy is febrile at 39 degrees, holds his right hip flexed and abducted, refuses to bear weight, and has had a viral illness in the past week. Describe your pGALS and pREMS approach, apply the Kocher prediction rule, and give your probability of septic arthritis. [1] [4]

Branch 1 — the Caird refinement

The bloods return with a C-reactive protein of 45. What does the Caird study add to the Kocher rule, why is the C-reactive protein the strongest individual predictor, and how does it change your decision to aspirate? [6] [4]

Branch 2 — the age-stratified differential

The examiner changes the scenario. A thirteen-year-old overweight boy presents with three weeks of vague left knee pain and walks with external rotation of his leg. What is the likely diagnosis, why is the knee pain misleading, and what imaging confirms it? [2] [4]

Branch 3 — the pGALS screen and the missed rheumatic disease

The examiner asks: how does pGALS catch the chronic disease that the limping child alone may miss, and what is the complication of oligoarticular juvenile idiopathic arthritis that demands a slit-lamp? [1] [2]

Closing — coordination and safety

In one sentence, what is the principle of managing the limping child across the age span, and why does the general paediatrician sit at the centre of a plan that runs from the pGALS screen to the orthopaedic emergency? [1] [4]