Dr. Golam Muhamud (Suhash).
Dr. Md Nazrul Islam
MBBS, M . sc. (B M E).
• She has h/o wt. loss, and loss of appetite but she has /had
no complaints of pain, swelling and deformity in other parts
of the body. She has no history of cough , haemoptysis, DM ,
HTN and asthma.
• With these complaints she got herself admitted into Shaheed
Suhrawardy Medical college Hospital for better management.
She had no history of
• H/O taking analgesic for 3
months but could not mentioned
the name of drugs.
None of her family member suffered from
• MP-4 to 6 days
• Age of menarche-13yrs.
Immunized against –
• Appearance- Ill looking
• Body builds- Below average
• Co-operation- Co-operated
• Decubitus- Supine
• Anaemia- Moderate
• Jaundice- Absent
• Cyanosis- Absent
• Clubbing- Absent
• Lekonychia- Absent
• Lymph nodes- Not palpable
• Dehydration- No sign
• Pulse - 84 Beat/min
• Blood pressure- 100/60mm of Hg
• Respiratory rate-16/min
Fluctuation test- negative,
Patellar tap test- negative.
Shortening of limb - 3 cm.
Thigh – 4 cm.
Leg – 2 cm
Distal neurovascular status- normal
Regional lympnodes not enlarged.
walk with support.
Left knee (ROM)–
• Active flexion -Absent
• Active extension-Absent
• Patellar movement-Absent
Left hip & ankle: normal range of
Gait: Can walk with support
Inspection: Flexion attitude-
Left knee(20 degree)
Palpation: Tenderness – affected
Higher psychic function: Normal
Cranial Nerve examination: Normal
Gross Muscle wasting in left thigh &
Deep tendon reflex:
All jerks are present & normal
Sensory function test:
All the sensory functions are normal.
Inspection: Normal in size & shape of the chest-
Respiratory rate: 16 /min
Palpation: Trachea centrally placed, normal chest
Percussion: Resonant all over the chest except right
upper, middle and lower zone where dullness is present.
Auscultation: Bronchial breathing sound with diminished
breathing sound in Rt. Upper middle and lower zone.
Pulse: 84 bts/ min
B.P. 110/60 mm of Hg
JVP: Not raised.
Palpation: Apex beat in Lt 5th intercostal space,
Percussion: superficial cardiac dullness presence over the precordium.
Auscultation: s1 & s2 is audible
• Inspection: nothing abnormality detected
• Palpation: soft, non tender
• Percussion: tympanic
Auscultation: bowel sound present
Per-rectal examination: normal findings.
Ms. Fatema, 18 years ill-looking, moderately
anaemic, non icteric, nondiabetic, normotensive
woman coming from Mirpur, Dhaka admitted in
Shaheed Suhrawardy Medical College Hospital
with thecomplaints of –
• pain, just above the left knee joint 3 months back
• swelling above the left knee joint 2 months back
• The pain was initially mild , fixed, non
radiating, aching in nature but gradually it
becomes intolerable which was aggravated
during walking and worse at night &
incompletely relived by taking NSAIDs.This
pain was not associated with fever.
• She also noticed an ill defined swelling above
left knee joint which was initially.
Small in size then it increases rapidly to a
large size.It is associated with pain but not
related to trauma.
• She also gives H/O inability to walk due to
pain,swelling and restriction of movement.
• She gives H/O wt loss,loss of appetite but
she has no H/O pain,swelling,deformity in
other parts of body.
• On local examination- an ill defined diffuse
swelling occupying over the supracondylar region
of the left thigh with shiny skin and presents of
engorged vein and wasting of the thigh and leg.
• She has a deformity of knee and cannot walk
• The surface of swelling smooth, margin- ill-
defined, local temperature-raised ,
tenderness present, over lying skin is free,
consistency-hard, not movable and fixed with
• Shortening of the left limb was found 3 cm
than the right. She was unable to walk
• There was gross muscle wasting in left Lower
limb, measuring thigh- 4cm, leg- 2 cm.
• Neuromuscular status of left lower limb normal
and regional lympnodes are not
enlarged.Movement of the left knee joint absent
hip and spine are normal.
• On respiratory system examination-there was a
dullness in Rt upper and lower zone of lung and
breath sound also diminished in same
• Extensive bone destruction is seen in
the left lower femoral shaft,
condyles and tibial condyles with
soft tissue extension.
• peripheral calcification also seen.
• Bone destruction also seen in L5
Multiple metastatic nodules in both lungs along
with Rt. Sided Hydro-pneumothorax-
S. creatinine 0.6 mg/ dl
Blood urea 30 mg / dl
S. calcium 7.5 mg / dl
S. alkaline phosphates 110 IU/ L
SGPT:26 IU/L , SGOT :33 IU/L
S. bilirubin:1.0 mg/dl
• FNAC Sarcomatous leison,suggestive of
• Biopsy (incisional): Feature of osteosarcoma with
osteod formation and many giant cells.