Case Study #901 Pathophysiology textbook McCanne and

Case Study #901 Pathophysiology textbook McCanne and Huether eighth edition Initial Patient Presentation: An 18-year-old male high school basketball player presents with a chief complaint of pain in the left knee. He first noticed vague pain in the knee approximately six months ago, during a summer canoe trip. He denies any specific evidence of trauma and, at the time, attributed his discomfort to kneeling in the canoe for long periods. During preseason basketball practice, the pain persisted and became the most bothersome. Family History: Lives with his mother, father, and two younger brothers, ages 10 and 14. His father has high blood pressure. His maternal grandmother has type II diabetes. No other significant family history. Social History: • Never smoker • Denies marijuana and illicit drug use • Denies alcohol use • Not sexually active Physical Exam GENERAL: Alert, oriented x 3, no acute distress. VITAL SIGNS: BP 115/65 mmHg, RR 16/minute, Pulse 62/minute, Temp. 98.6°F, Weight 180 lbs., Height 72 in. HEENT: Pupils are equal, round, and reactive to light and accommodation. Extraocular movements intact bilaterally. Fundi benign. Tympanic membranes intact. Mucous membranes of the oral cavity are pink and moist. LUNGS: Clear to auscultation bilaterally. HEART: Regular rate and rhythm. ABDOMEN: Soft with positive bowel sounds. No hepatosplenomegaly, bruits, or tenderness. BACK: No costovertebral tenderness. MUSKULOSKELETAL/EXTREMITITES: Pulses 2+ throughout. Full range of motion. Strength 5/5 throughout. Trace edema of the left knee and some tenderness to palpation, but no warmth or erythema of the overlying skin. Section One: Initial Information Patient Case 1. Create a problem list based upon this patient’s initial presentation and exam findings. Section Two: Differential Diagnosis & Definitive Diagnosis Patient Case 2. Create a differential diagnosis list that is supported by problem-based rationale. Labs/Diagnostics: Complete blood count (CBC): normal Comprehensive metabolic panel (CMP): normal except for an alkaline phosphatase of 200 IU/L Urinalysis: normal Chest x-ray: normal, specifically no concerning lymphadenopathy or nodules X-ray: Anteroposterior view of the left knee shows an ill-defined mixed sclerotic and lytic lesion in the distal left femoral metaphysis. (see image below) Coronal magnetic resonance imaging (MRI) after radiography better defines the extent of tumor involvement with lateral soft tissue tumor involvement. (see image below) X-ray MRI The lesion was biopsied, and pathology showed a high-grade osteosarcoma. Section Three: Explanation of Results Patient Case 3. Why is the alkaline phosphatase above the adult reference range? When responding to this , consider the age of the patient. Patient Case 4. What would you do for the patient once you have the biopsy results? Patient Case 5. The clinical stage of a cancer is the extent of the cancer based upon result of physical exams, imaging tests, blood tests, and biopsies that are taken before treatment starts. What is the clinical stage of this cancer? The patient received a course of neoadjuvant (preoperative) chemotherapy, followed by surgical resection of the distal femur. Final surgical pathology showed no tumor present at the femoral surgical margin. Section Four: Pathophysiology of Disease Process and Symptoms Patient Case 6. What is the etiology, pathogenesis, and epidemiology of an osteosarcoma? Patient Case 7. Which bones and what age groups are most affected by osteosarcoma? Patient Case 8. Compare this osteosarcoma lesion morphologically, clinically, and radiologically with chondrosarcoma and Ewing’s sarcoma. For ease in responding to this , you may make a chart/table. Patient Case 9. What is the relationship of osteosarcoma to Paget’s disease? What is the relationship of osteosarcoma to previous radiation exposure? Section Five: Disease Course, Management, & Outcome Patient Case 10. Why is neoadjuvant chemotherapy often given before surgical resection of an osteosarcoma? Patient Case 11. Based upon the diagnosis and treatment that this patient received, what is his patient’s 5-year survival rate? SCIENCE HEALTH SCIENCE NURSING NURSIN 650

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."