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Osteomyelitis — MRCPCH FOP MCQ

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HardInfectious diseasesOsteomyelitisMRCPCH FOP

A 9-year-old boy has fever and focal pain over the proximal tibia for four days. He limps, has raised CRP and plain radiograph is normal. What is the most appropriate investigation?

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Correct answer: D — MRI of the affected limb

Early osteomyelitis may have normal plain radiographs, and MRI is the most sensitive imaging test when focal bone pain and raised inflammatory markers are present. Growing pains are bilateral, nocturnal and not associated with fever or raised CRP. D-dimer does not assess bone infection in this context. The pearl is that a normal initial x-ray does not exclude osteomyelitis.

Reference: NICE CKS Limp in children; BOA paediatric bone and joint infection guidance