(MCQS 307-309 ):A 12 year old girl presents with acute onset of pain in the right knee, which started in the hip

Correct Answer: F
Rotaviruses derive their name from their wheel-like appearance when seen by transmission electron microscopy. They cause severe gastroenteritis in infants and young children, particularly between the ages of 6 months and 2 years, manifested by severe diarrhea and vomiting, which often leads to dehydration and occasional deaths. In temperate climates, illness occurs mainly in the winter, is commonly associated with nosocomial infection, and is spread primarily person to person by the fecal-oral route. The incubation period is approximately 2 days

Correct Answer: G
These features are suggestive of toxicity with g) phenylalkylamines Several phenylalkylamines are listed under Schedule I of the CFR as hallucinogens: Ecstasy (methylenedioxymethamphetamine ) is a street name for the drug "M.D.M.A." It is a designer phenylalkylamine drug, which means it is a synthetic chemical designed to produce effects similar to those of other drugs. Because they are often much stronger than the drugs that they copy, the risk of overdose from designer drugs is greater. Ecstasy may also contain contaminants due to the illicit manner in which they are developed. Ecstasy comes in capsules or in a powder form which can be inhaled or injected. It acts as a depressant, as a mild hallucinogen, produces anxiety, and can result in respiratory failure. With the rise of rave culture in the UK reports of severe reactions, including fatalities after the use of 'ecstasy' appeared in the medical literature. The predominant toxicity patterns that emerge from these reports are fulminant hyperthermia, convulsions, disseminated intravascular coagulation (DIC) (blood clotting in the blood vessels), rhabdomyolysis (dissolution of skeletal muscle), and acute renal (kidney) failure. DIC and rhabdomyolysis may be brought about by the hyperthermic condition, and rhabdomyolysis can also be caused by acute renal failure. Acute liver failure is another serious complication reported in association with the use of MDMA and can also precipitate from a hyperthermic condition. Cardiac arrhythmia (irregularities in the heart rhythm) are often also noted in emergencies that are brought in and are probably another way by which death may precipitate, especially in those that are predisposed by having cardiac abnormalities. The increase in blood pressure and rise in heart rate caused by MDMA may be deleterious in people with heart problems

Correct Answer: C
Slipped femoral epiphysis is a disorder of adolescents in which the femoral head moves (through the growth plate) relative to the rest of the femur. The femoral head remains in the acetabulum but moves relatively posteroinferior, as can be seen on a radiograph. From an external perspective, the most notable features are the outward rotation of the lower femur and leg, as well as the limp. Patients Signs/Symptoms May be acute (<3weeks) or chronic (>3 weeks) and vary in severity. Pain occurs in the groin, medial thigh, or knee. Signs: Decreased internal rotation of the hip as compared to the contralateral side. A gait abnormality such as a Trendelenburg gait (during stance on the affected side the upper body leans toward the affected side), antalgic gait (the patient bears weight on the affected side as little as possible), or externally rotated gait. Hip pain and limp are characteristic of a slipped femoral capital epiphysis in adolescents or avascular necrosis of the femoral head (Legg-Calvé-Perthes disease) in younger children. The pain sometimes is referred to the knee or anterior thigh. Early diagnosis dramatically improves the outcome. Slippage generally is slow and occurs most commonly in obese adolescent boys. It is bilateral in 20% of patients. The cause is unknown, but hormonal factors are suspected. X-rays confirm the diagnosis and exclude acetabular dysplasia and degenerative changes. Treatment requires surgical placement of a pin through the femoral head and the epiphyses to prevent further slippage


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