OSCE Case prep 4

14-year-old presents to the ED with knee pain.

Instructions:
1.Take focused hx
2.Ask for examination findings
3.Examiner will ask questions at 8 minutes.
Hx:
A 14-year-old male patient presents to the emergency department with severe pain in
his right knee. The pain has been intermittent for the past 10 weeks, appearing and
disappearing sporadically. The discomfort has grown more regular in the last week and
is now compounded by marked swelling around the knee. Further interview reveals
that the patient plays on a youth soccer team, and his knee feels especially painful
during practice. His parents attributed the symptoms to “growing pains,” as the
patient’s height and weight have been increasing appropriately for his age, and he has
had no known skeletal diseases—nor any serious conditions—prior to onset of the pain.

PE:
BMI normal. Vital signs are evaluated and found to be normal. No systemic symptoms
are noted. Physical examination reveals a large, palpable mass on the anterior aspect of
the right proximal tibia. The mass is tender to palpation, but not warm to the touch.
ROM normal.

Questions to ask:
1. Give 3 differentials diagnosis (osteosarcoma, ewing’s sarcoma, chondrosarcoma,
subacute osteomyelitis, giant cell tumour or growing pains)
2. Outline investigation you want to do.
3. If student answers X-ray AP and lateral view of R knee, show the X-ray below.
4. Outline your management for patient.
a. Refer to Orthopaedic Department (tx is normally neoadjuvant
chemotherapy + surgical resection + adjuvant chemotherapy)
b. Do PET scan for any mets and to also confirm this tumor is not a mets
from a primary tumor
c. Analgesics for pain (acetaminophen/NSAIDs)
5. What staging do you know is used for osteosarcoma?

Case link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343432/