PEDIA WARD

WORK
WEEK 2
CASE DISCUSSION
PRESENTATION BY:
ALEDIA, PATRICIA
ATAYDE, MICAELA
CARAIG, CHRISTINE
CARLOS, JEREMY
 OUTLINE
DIAGNOSTIC
SALIENT FEATURES EXAMINATION & RISK
FACTORS

DIAGNOSIS & REFERRAL LETTER &

DIFFERENTIALS MANAGEMENT
 Salient Features:
FROM HISTORY FROM PE
Patient: Ronalyn De Guzman (+) swelling of the distal 3rd of
Chief Complaint: Right knee the right femur, including the
pain
right knee
HPI: vague right knee pain w/
right knee circumference: 35
VAS of 4-5/10 (once to twice a
cm, left knee circumference:
week)
30 cm
Slightly increased serum uric
(+) tenderness on the right
acid (6.9 mg/dL)
knee
Medications were not effective
BMI: 14.8 kg --> Underweight
Pain progressed to 6-7/10
(+) swelling at the knee
Past medical Personal and
history Social
Unremarkable Only child of two parents
Grade 9 student
Plays volleyball with her peers
Worried about sudden weight loss
Anxious of the nature of the mass
in her right lower extremity.
She feels sad because of the
persistence of pain in the affected
extremity and limited ambulation.
Family History Review of
Systems
Father: (+) Hypertension General: (+) 10% weight loss
Mother: (+) Asthma Skin: Poor skin turgor
(-) cough, colds, dyspnea
 Birth and Maternal,
Nutritional, , and Immunization History
Developmental History
BGC (1 dose)
Reactions: erythema, induration at
post-injection
Unremarkable
Pentavalent (3 doses)
Reactions: fever, swelling on post-
injection site

Pneumococcal (3 doses)
Reactions: fever, mild cough

Measles (1 dose)
Reactions: fever, mild cough & cold
P.E.
Height: 160 cms
Weight: 38 kg
BMI: 14.8 kg/m2
BP: 100/70mmHg
O2 sat: 99%
HR: 90 bpm
RR: 20 cpm
Temperature: 36.9 C
P.E.
Skin:
Color brown & poor skin
turgor
Eyes:
Normal findings
Chest and Lungs:
Normal findings
P.E.
Abdomen:
Normal findings
Extremities:
(+) swelling of the distal
3rd of the right femur,
including the right knee,
right knee circumference:
35 cm, left knee
circumference: 30 cm.
(+) tenderness on the right
knee
 Diagnosis
OSTEOSARCOMA

Most common bone malignancy in children that commonly

arises at the metaphysis of the most rapidly growing bones
such as the distal femur and proximal tibia.
Presents with local pain and local swelling as well as limping
and decreased in the range of motion.
Mostly occurs in adolescence
DIFFERENTIAL DIAGNOSES

EWING OSTEOMYLETIS
SARCOMA

RHABDOMYOSARCOMA
 EWING SARCOMA

Rule In Rule Out

(+) Age (-) Fatigue
(+) Knee pain (-) Fever
(+) Weight loss (-) Paralysis / Incontinence
(+) Swelling of the knee
 OSTEOMYELITIS
Rule In Rule Out
(+) Age (adolescents) (-) Fever
(+) Swelling of knee (-) Erythema
(+) Knee pain (-) Chills
 RHABDOMYOSARCOMA
Rule In Rule Out
(+) Age (-) Vision changes
(+) Affects extremities (-) Neurology changes
(+) Swelling (-) Difficulty in urination
Diagnostic Examniation
Conventional X-ray (Chest X-ray)
Chest CT Scan

Biopsy
MRI
PET CT Scan
Plain X-rays of the affected bone
Bone Scan
Blood Tests
 Issues / Risk factors
Common psychological issues encountered when dealing with cases of
osteosarcoma include issues with disfigurement and growth and
development problems.

Enjoyed playing volleyball prior to her illness. She admits feeling

unhappy that she cannot spend time with her peers.
She is worried about her sudden weight loss.
Anxious of the nature of the mass in her right lower extremity
She feels sad because of the persistence of pain in the affected
extremity and limited ambulation.
Wearing of protective gears
 REFERRAL LETTER
November 16,2022

To: Dr. Juan Santos

De La Salle University Medical Center
1747
Dasmarinas City, Cavite

Subject: Patient Referral

Good day Dr. Santos,

Respectfully endorsing patient Ronalyn De Guzman, a 14 y/o, Female , Medically diagnosed with
suspected Osteosarcoma on Right knee to Oncologist, Orthopedic surgeon and Onco-radiologist for
appropriate management. Thank you!

With high regards,

JD
Jane Doe, MD
License no. 12345
PTR# 123456
Management
Surgery (definitive resection)
Histological examination of the
resected bone
Chemotherapy
Palliative Care
Thank you for
listening!