MLA Domain 5 · Presentation

Limping child

6 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 3

Perthes disease

Bilateral disease → consider epiphyseal dysplasia/hypothyroidism; older child with acute slip = SUFE

Slipped upper femoral epiphysis (SUFE)

Acute unstable slip (unable to weight-bear) — urgent; bilateral in ~20%; endocrinopathy if atypical age

Transient synovitis (irritable hip)

Fever, systemically unwell, unable to weight-bear, raised inflammatory markers → treat as septic arthritis until exclude

recognised feature · 2

Developmental dysplasia of the hip

Late presentation; bilateral disease (subtle); irreducible dislocation

Juvenile idiopathic arthritis (JIA)

Eye involvement (uveitis often asymptomatic → screen); macrophage activation syndrome in systemic JIA

differential of the above · 1

Septic arthritis

A hot swollen joint = septic arthritis until proven otherwise → URGENT aspiration before antibiotics → joint washout