Scenario

Tutorial 1, page 1
Mr R, a 45th year old man, came to a GP pain and swollen in his right thigh for the
last one week as the chief complaint.
This complaint made him unable to walk normally & need a kruk. He denied had
diabetic disease or got animal bites such as snake or poison insect.
Further history taking showed that the patient had trauma in motorcycle traffic
accident. He works as a motorcycle taxi driver (ojek), for last ten years. The
accident occurred about three weeks ago, he felt from his motorcycle after
crushing the tree because he was sleepy while driving. After accident he didnt
come to hospital, he just visiting alternative therapy(sangkal putung) for his leg &
did the white diet (only eat rice) for his traditional believe.
He usually works all day, include in holiday. He just sleep for 3-4 hours in a day.
He is a hardworker because of his family, he had 4 children, but he didnt permit
his wife to get a job to help him make money.
Instruction
1. Identify Mr. R problems?
2. Base on the problems, generate your hypothesis
3. What more information do you need?

Tutorial 1, page 2
Physical exam
Vital Signs:
Blood pressure 130 / 80
Pulse rate 100x/m
Respiratory rate 26-28x/m
Temperature 38o C
Body Weight 60 kg
Body Height 165 cm
Status Localis:
Right Thigh Region:
Look : bigger than the opposite leg, oedematous, hiperemy, ulcus with pus
Feel : warm, tenderness, painful
Move : limited range of extremity movement
Other examination within normal limit.
Instruction
4. Identify Mr. R problems?
5. Base on the problems, generate your hypothesis
6. What more information do you need?

Tutorial 1, page 3
Finally after serial examination, radiology & laboratory tested, the GP assumed
that the patient got acute osteomyelitis after trauma, & send him to orthopedics to
get definitive treatment.

Epilogue
The orthopedics give him operative treatment & advised him to improve his
nutrition status in order to get healing soon.