BED SIDE TEACHING

Siska Sarwana
712015035

dr. Rizal Daulay, Sp.OT, MARS

 IDENTIFICATION

Name : Fitria Binti M.Sario

Gender : Female
Age : 33 years old
Address : Segaran Street, No.481, 15 Ilir Palembang
Religion : Moslem
Occupation : Waitress
 CHIEF COMPLAIN

•A lump with pain on her

Female, 33
years old
right thigh
 CLINICAL HISTORY

The patient said, A lump on her right thigh appeared since 6

years ago. In the beginning, the size of the lump was as big as a
marble and without pain. Then, the lump slowly getting bigger.
Around two months ago, the size of the lump was like a mango
and the patient started to felt pain on her lump, especially when
she walked. Then, the patient went to a doctor, but the doctor
said the lump was a genetic disease and she just gave pain
relievers. The symptoms didn’t get reduced.
Until one month ago, the size of the lump rapidly getting bigger
and the pain and heat on the lump felt more intense. The pain
required even when she was take a rest.
Then the patient went to the surgeon in Muhammadiyah Hospital and X-
Ray examination had performed on this patient.
According to the patient statement, she had multiple lumps in another
part of her body since she was a child. But the size of the lump in another
part of her body never get extend and without pain.
The patient like to consume instant food. There is no decreased in
appetite, and no weight loss. The patient denied any complain about pain
in bone, difficult to move or cough and out of breath after the lump
appeared. Fever (-) nausea (-) vomitting (-).
Family history with the same case denied. Past Injury denied.
 PHYSICAL EXAMINATION

VITAL SIGN
General condition : Good
Sens : Compos Mentis
Blood Pressure : 120/80 mmHg
Heart Rate : 82x/minute
Respiratory Rate : 20x/minute
Temperature : 36,6 C
Spesific Location Examination :
Right Thigh
Look : Lump 25x30 cm, single, Eritem (+) , Venectation (+) Café-au-lait spot (+)
Feel : Flat surface, mobile, strict line, tenderness (+), warm (+), hard consistency (+)
Move : Normal ROM
Café-au-lait spot
RONTGEN

 Alligment :
in one line
 Bone :
Fracture (-)
Deformity (-)
 Cartilage:
Dislocation
(-)
 Soft tissue:
swelling (+)
LABORATORY RESULTS (17 OF NOVEMBER 2016)

Haemoglobin • 12,9 g/dL (11,7-15,5 g/dL)

Leucosit • 8700 g/dL (4000-11000 g/dL)

LED • 30 mm/hour ( <15 mm/hour)

Diffcount • 1/0/1/73/16/9 (1-2/0-1/3-5/54-62/25-33/3-7)

CT • 7’ (< 15minute)

BT • 2’ (1-8 minute)

HBSAg • Negative (Negative)

Blood Type • Ab+

DIFFERENTIAL DIAGNOSTIC

Neurofibroma

Malignant
Peripheral
Nerve Sheath
Tumor
 ASSESSMENT

Susp. Malignant
Peripheral Nerve
Sheath Tumor
TREATMENT

Excision
Biopsy
THANKYOU