3. Skin

   1. Cellulitis

1. Trauma

2. Tumour

3. Soft tissue abscess (formation of immune response due to bacterial infection, pressure will increase and sinus tract will penetrate thru the surface, releasing pus)

4. Hematoma

   
   

• Where does the patient feel the pain

Onset

• When did the symptoms start

• Gradual, sudden

Characteristics

• Type of pain (throbbing, localised, burning)

• Smell and colour of the pus

• Discharge continuous and intermittent

• Characteristics of the swelling, how does the patient walk?

• Does the limping require a supporting apparatus.

• Weakness? lethargy?

• Superficial or deep

Radiation

• Does the pain spread around the right thigh

Assoc. symptoms

• Fever

• Range of motion?

• Weight loss (appetite, unintentional weight loss, time since difference in weight)

• Night sweats

• Loss of sensation (light touch, pinprick), any numbness?

• Joint stiffness

  Time

• Worsening at night

• How long has the patient been feeling pain

• How long has been limping, swelling, sinus discharge

Exacerbating/allev fact

• Bearing weight worsens the pain

• Does the pain worsens with movement

• Any analgesics that relieve the pain (aspirin)

• Resting or sitting relieves the pain

Severity

• Effects lifestyle

• Pain scale 1-10

PMH

• Trauma

• Recent surgeries

• Any comorbidities

• Allergies

PDH

• Medications (immunosuppressive mediations, analgesics e.g. NSAIDs, OTC medications? How long? Compliant on prescribed drug? Dosage? i.e overdosage)

Family history

• Any history of cancer/tumour

• TB

• Comorbidities? (HT, diabetes)

• Genetic predisposition to bone or joint diseases e.g. rheumatoid athritis, osteosarcomma)

  
  

Social hx

• Activity, occupation

• Smoking/ alcohol, predisposes to infection

• Drug abuse

• Living conditions (crowded, unsanitary)

• Occupation

• Trauma

Travel history

• To an area with high incidence of TB

Family history.

• He also disclosed that he had no family history of diabetes mellitus or tuberculosis.

Medications.

• The patient took aspirin for his fever.

  • Can cause hematoma

Social history.

• No history of alcohol or drug abuse

Vital signs

1. Temp

2. BP

3. PP

4. RP

General examination

1. Cachexic (body habitus)

2. Alert, comfortable

3. Require any supporting apparatus

Inspection

1. Size and depth of sinus

2. Inflammation, swelling, discolouration

3. The pus (foul smelling, colour)

4. Bursting of stitches

5. Malunion

6. Gait (Active & passive range of motion)

Palpation

1. Warmth (redness)

2. Tenderness (indicates osteomyelitis, sakit)

3. Swelling (consistency, soft or firm)

4. Any palpable masses

5. Pulses

6. Lymph node assesment

7. tendon reflex

8. Checking depth of sinus (probe to bone test)

1. Pus drainage (pus C&S)

2. AFB C&S (ZN stain)

3. FBC (hemoglobin, differentiate viral, bacterial infections, platelet count i.e coagulapathies)

4. ESR (chronic conditions & non-specific)

5. CRP (acute conditions, to monitor disease progression e.g. antibiotics effectiveness, 7-14 days)

6. Blood glucose level (capillary test, to detect for DM, delayed wound healing)

Imaging

1. MRI (more detailed for soft tissues compared to CT)

2. Right thigh XRAY

3. Bone biopsy

1. Anatomy of the lower limb (big bones, group of muscles + general movement, main nerve from the thigh, route of the nerve, where it is associated, can relate to referred pain, main arteries)

2. MSK PE (lower limb examination, achilles tendon reflex etc)

3. How to differentiate normal infection inflammation w/ tumour

4. Types of fractures (classify and describe, closed/open)

5. Pathophysio 3

6. How to differentiate the top 3 differentials (symptoms, complications & prognosis)

7. Imaging 3

8. Lab investigation 3

9. conventional management 3

10. Non-invasive management 3