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step2ck_form7/Block 3/Question#44 (reveal difficulty score)
A 14-year-old boy who has sickle cell trait ...
X-ray of the left hip🔍,📺
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 +5 
submitted by carolebaskin(85),

This is a normal x-ray!

Like veggievendor said, this is a kid with sickle cell disease and limited hip ROM, so check the hip for osteonecrosis




 +2 
submitted by dreamyyn(7),

I would be concerned for slipped capital femoral epiphysis, as the kid has thigh & knee pain instead of groin pain and has obesity. The referred knee pain is a clue for slipped epiphysis, although slipped epiphysis can lead to avascular necrosis, the necrosis from SCD is more of groin pain.

Just my thought on this question. It doesn't change the answer.

lilmonkey  I agree. Slipped epiphysis seems more likely to me considering BMI 32 and basketball activity. The sickle trait is just a trait, not SCD. +  
prasadnadendla  I agree. I think this is SCFE since he is obese and was playing a high impact sport for his joints. +  



 +1 
submitted by veggievendor(1),

Is this because its a patient with SCD and you are worried about osteonecrosis?




 +0 
submitted by step_prep5(196),
  • Young patient with sickle cell trait presenting with 1-day of atraumatic thigh and knee pain with limited hip range of motion, concerning for avascular necrosis of the left hip
  • Causes of avascular necrosis: CASTS Bent LEGS (Corticosteroids, Alcohol, Sickle cell disease, Trauma, SLE, “the Bends”, LEgg-Calve-Perthes disease, Gaucher disease, SCFE

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 +0 
submitted by nala_ula(122),

I got this wrong, thinking it was myositis ossificans due to the history (six days ago he was evaluated for twisted knee at a game with improvement of sxs until one day ago).. guess i should have payed more attention to his PMH