Proximal leg swelling& tender

A 13 years old malay boy from Kota Bahru presented with pain of the knee joint area. He also complains of LOA, LOW. On further questioning, he reveals the history of trauma to the left leg 7 years ago.

On inspection, there is a swelling measuring about 7 X 4 cm on the proximal part of the leg slightly to the medial part of the leg. The overlying skin is red and there is a present of superficial dilated vein.

On palpation, the swelling is tender, firm in consistency, and ill-defined border.

1) Describe the abnormalities in the X ray

2) What further question you would like to ask

3) What other investigation you would request

4) What is your provisional diagnosis

Answer

1)

- Ill defined lytic lesion in proximal metadyphasis of left leg

- Cortical destruction at anterolateral aspect of upper tibia

- Codman triangle at lower part of the lytic lesion

2)

- Any family history of bone cancer

- Any infection of bone

- Is pain aggravated at night?

3)

- Full blood count

- Serum alkaline phosphatase

4) Osteosarcoma

Per vaginal bleeding in 40 years old female

A 40 years old female presented to your clinic with the history of per vaginal bleeding associated with dysparaeunia, suprapubic pain, loss of appetite and loss of weight. A cervical examination is performed and the picture shows comparison between normal appearance of cervix and patient’s cervix.

1) What other history you would like to ask

2) Describe the picture B

3) What are the investigation that you would like to perform

4) What is the common causative agent for above condition

5) Outline the Pathophysiology of the disease.

Answer

1)

- Earlier age sexual activity

-Multiple sexual partner

-Any history of infection with human papilloma virus?

-Family history of cervical cancer

-Did spouse have multiple sexual partner?

- Any history of sexual transmitted disease?

-Did spouse have sexual transmitted disease?

-Smoking, alcohol consumption

2)

- Abnormal shape of cervix

-Irregular vagina mucosa

- Cervical bleeding

3)

-PAP Smear test

-Antibody detection for HPV

4) Human papilloma virus

5)