Septic arthritis and transient synovitis (pediatrics) Quiz: Ace Your Exams
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A 2-year-old girl is brought by her parents to the emergency department for evaluation of a new limp. The patient has had fevers over the past 4 days and has been complaining of left groin pain. For the past day she has refused to walk and to move the left leg. The patient was ill with a viral upper respiratory tract infection (URI) one week ago but has no significant past medical history and does not take any medication. The patient was born full-term, and vaccinations are up-to-date. Temperature is 38°C (100.4°F), blood pressure is 88/45 mmHg, pulse is 140/min, respiratory rate is 28/min, and oxygen saturation is 97% on room air. On physical examination, the patient is in no acute distress. She is sitting in bed with the left hip flexed, slightly abducted, and externally rotated. Examination reveals tenderness to palpation of the left groin. She starts crying when the examiner attempts passive motion of the joint. The patient refuses to move the left leg and to bear weight on the left lower extremity. Which of the following findings is most concerning for a serious bacterial infection?
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