Name – A.R.

Age – 8 y/o  

Race – Caucasian

Date – 3/11/21

Time – 10:AM

Location – Premier Pediatrics

Source of information- Mother (Reliable)/ Patient

Mode of transport – Personal vehicle

CC: “She has a limp that isn’t going away.”

HPI: A.R. is an 8 year old white female with no significant past medical history, who presents with a persistent limp after falling while playing with friends 3 weeks ago. Patient badly scraped and bruised both knees and experienced greater swelling on the left knee than on the right. The patient initially presented with a limp, but this was thought to be due to superficial wounds and wound dressings. However, the limp has persisted for 2 weeks despite resolution of bruising and abrasions. Physical exam was notable for left sided limp and indurated suprapatellar swelling. Patient’s mother denies signs of weight loss, fever, or night sweats. Mother also denies changes in muscle strength and confirms patient was playing with friends and sledding a few days ago.

PMH

Past Medical Illness – Denies past medical illness

Surgeries- Denies surgical history

Allergies- Denies any known drug or environmental allergies  

Immunizations- Up to date on all immunizations

Medications – Denies medication use

Past Family/ Social History  

Patient lives at home with both parents with no siblings. She has a pet dog and both parents are non-smokers. The parents confirm she sleeps adequately and is distance learning from home due to the COVID-19 pandemic. She also is very active and plays with friends frequently. She denies any sick contacts or recent travel.

ROS

General – Denies fever, fatigue, cough, weight gain or loss.  

Respiratory – Denies any difficulty breathing or adventitious breath sounds.

Cardiac- Denies any history of murmurs or palpitations.

MSK – Confirms painful joint and swollen knee.

Neuro -Denies any dizziness, changes in hearing. Confirms gait change with limp favoring right side.

Psych- Denies depression, anxiety, changes in sleep habits.  

Physical Exam

Vitals:

P: 107 bpm

RR: 20

Wt: 50

Temp: 99 F

BP: 101/66

General – Well developed well nourished, no acute distress

Skin – No rashes, petechiae

Head – normocephalic, no trauma, good hair distribution

Eyes – PERRL, EOMI, conjunctiva clear

ENT – Canals clear, TMs WNL,

Septum, turbinates WNL

Pharynx, tonsils, uvula WNL

Neck – supple, tracheal midline

Nodes – WNL

Thorax – Lungs CTA

Heart – RR, No murmurs

Breasts – Symmetrical

Abdomen – Soft, NT, ND

Extremities – Left suprapatellar/lower quad swollen compared to right, gait favors right

Back – Straight, FROM

Genitalia – NL external genitalia

 Neuro – NL reflexes, Sensory WNL

Assessment:

Limp/ knee pain

DDx:

1. Septic Joint
2. Osteomyelitis
3. Bursitis
4. Occult Fracture
5. Ligament injury
6. Osteosarcoma

Plan:

1. CBC – WC: 11.8, Plt: 36.8, H&H: 13.8 / 41.7 – Rules out infectious process
2. Stat X ray – X ray reveals lytic lesions consistent w/ osteosarcoma
3. Resection