A 2-year-old presents with a history of limping, fever, and refusal to walk or bear weight on an extremity. INITIAL management includes

A 2-year-old presents with a history of limping, fever, and refusal to walk or bear weight on an extremity. INITIAL management includes

• A. referral to hospital emergency department
• B. thorough physical examination assessing for asymmetry and inflammation
• C. referral to pediatric orthopedic surgeon
• D. laboratory evaluation including CBC with differential and ESR

Answer: (B)

Starting with a thorough physical examination is essential because it reveals focal signs of inflammation or asymmetric findings that point to a potentially serious infection or injury. In a 2-year-old with fever and limp who won’t bear weight, you want to identify whether a joint is involved, if there is warmth, swelling, or focal tenderness, and how movement and weight-bearing are affected. Detecting signs such as a suprapatellar or hip joint effusion, marked local tenderness, or limited range of motion helps distinguish urgent conditions like septic arthritis or osteomyelitis from other causes such as transient synovitis. The exam then guides the next steps—whether to proceed with urgent imaging and laboratory workup, and whether an ED or specialty referral is needed. Referrals to emergency care or orthopedic specialists, and ordering labs, are important but depend on what you find during the exam. A lab panel and imaging are adjuncts used to confirm inflammation or infection after the initial assessment, and an orthopedist would be brought in for surgical evaluation if septic arthritis or significant fracture is suspected.

Starting with a thorough physical examination is essential because it reveals focal signs of inflammation or asymmetric findings that point to a potentially serious infection or injury. In a 2-year-old with fever and limp who won’t bear weight, you want to identify whether a joint is involved, if there is warmth, swelling, or focal tenderness, and how movement and weight-bearing are affected. Detecting signs such as a suprapatellar or hip joint effusion, marked local tenderness, or limited range of motion helps distinguish urgent conditions like septic arthritis or osteomyelitis from other causes such as transient synovitis. The exam then guides the next steps—whether to proceed with urgent imaging and laboratory workup, and whether an ED or specialty referral is needed.

Referrals to emergency care or orthopedic specialists, and ordering labs, are important but depend on what you find during the exam. A lab panel and imaging are adjuncts used to confirm inflammation or infection after the initial assessment, and an orthopedist would be brought in for surgical evaluation if septic arthritis or significant fracture is suspected.