Chief Complaint: SP is a 4-year-old male who presents to the office with decreased appetite, left lower leg pain, and fe

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Chief Complaint:
SP is a 4-year-old male who presents to the office with
decreased appetite, left lower leg pain, and fever, who is now
having an increasingly difficult time walking since this
morning.
History of Present Illness:
As per SP’s mother, the patient’s fever started 4 days ago
with a tmax of 102.5°F. DP began complaining of left lower leg pain
2 days ago, and then began limping yesterday. His mother remembers
that he did fall while playing on the playground about one week
ago. He has been taking fluids as normal but is eating less than he
normally does.
Past Medical History:
Birth History- Born vaginally at 38 weeks gestation, no
complications with pregnancy or birth
No known allergies.
No hospitalizations. No surgeries.
Immunizations: up to date
Social and Family history:
SP lives with both parents and an older sibling that is 6 years
old. There is no smoking in the home. DP goes to daycare 3 times a
week, and his maternal grandmother provides childcare the other
days. Neither DP’s mom, dad, or brother have pertinent medical
history. Maternal grandmother has a history of high blood pressure,
and paternal grandfather has type 2 diabetes.
Current medications:
OTC multivitamin once daily
Review of Systems:
General: SP recalls falling on his knees about a week ago while
playing on the playground. No inconsistencies in DP’s recall of
events than his mother’s.
HEENT: Denies trauma to head. Denies neck pain, or dizziness.
Denies any recent ear infections. Denies nasal congestion or
drainage. Denies complaints of sore throat. Denies any neck pain or
stiffness.
Respiratory: Denies cough.
Gastrointestinal: Denies nausea, vomiting, or diarrhea. Reports
decreased appetite for about 2 days. Denies abdominal pain.
Musculoskeletal: SP is complaining of left lower leg pain for
about 2-3 days. The pain is worse when he bears weight. He has been
limping since yesterday. SP’s mother noticed localized redness on
his left leg this morning, and that his left leg looked a bit
bigger than his right.
PHYSICAL EXAMINATION (Significant findings)
Vital signs: Temperature: 101.2 °F Heart rate:
110 Respiratory
rate: 26
Blood pressure: 105/60
Musculoskeletal:
Left lower extremity- Left tibia pain upon ROM; pain increased
upon flexion/extension, adduction/abduction, and internal/external
rotation. Warmth, swelling, and tenderness to patient’s left
proximal tibia. +1 localized edema of left tibia.
Right lower extremity- Full ROM, no pain, tenderness, or
swelling.
Unsteady gait with left leg limp, patient unable to fully bear
weight. Legs are equal in length.
Questions: