I must be getting old session 2

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I must be getting old session 2 by Mind Map: I must be getting old session 2

1. Step 6

1.1. Review session 1

1.1.1. Summary of step 5

1.1.1.1. Skin cancer: Causes and Risk Factors (in relation to symptoms)

1.1.1.1.1. Many types of skin cancers: Sqamous cells, melanoma, basal cell(the easiest to handle) --> UVB is the most harmful

1.1.1.1.2. Melanoma: most serious.

1.1.1.1.3. Rare: Kaposi sarcoma, sepacious sarcoma

1.1.1.1.4. Basal cell: do not metasize

1.1.1.1.5. Squamous cell cancrinoma: From exposure to sun

1.1.1.1.6. Risk factors

1.1.1.1.7. Mechanism

1.1.1.1.8. Causes

1.1.1.1.9. Chronic nonhealing wounds

1.1.1.2. Osteoarthritis: Causes and Risk Factors (in relation to symptoms)

1.1.1.2.1. Defined Osteoarthritis

1.1.1.2.2. Articular cartilage

1.1.1.2.3. Stages

1.1.1.2.4. Common

1.1.1.2.5. Radiographic

1.1.1.2.6. Symptomatic

1.1.1.2.7. Changes:

1.1.1.2.8. Risk factors

1.1.1.3. Underlying cause of the throbbing pain

1.1.1.3.1. Fast

1.1.1.3.2. Slow

1.1.1.3.3. Study

1.1.1.3.4. Related to tissue destruction

1.1.1.3.5. Arthritis

1.1.1.3.6. Knee tendenosis

1.1.1.3.7. Osteomeyalitis

1.1.1.3.8. Osteoarthritis

1.1.1.3.9. Common in females in menstrual cramps

1.1.1.4. Chronic infection in the skin

1.1.1.4.1. Folliculits

1.1.1.4.2. Impetigo

1.1.1.4.3. Excema

1.1.1.4.4. Leishmania

1.1.1.5. What causes the presented symptoms

1.1.1.5.1. Osteomyelaitis can lead to sqamous cell cancrinoma r endocarditis

1.1.1.5.2. Osteomyelitis

1.1.1.5.3. Similar sites-

1.1.1.5.4. Baker's cyst

1.2. Report new knowledge

2. Step 7

2.1. Inquiry plan and info gathering

2.1.1. History of presenting complain

2.1.1.1. 55 y/o

2.1.1.2. No symptoms related to infections e.g. fever

2.1.1.3. Pain Goes with rest,

2.1.1.4. Click sounds

2.1.1.5. morning stiffness

2.1.1.6. Skin sore --> non painful

2.1.1.7. when sore scratched--> bleeds

2.1.1.8. knee pain --> 3 months

2.1.1.9. Sore--> more than 3 months

2.1.2. Previous medical / surgical history

2.1.2.1. BEFORE-> sore was diagnosed with skin infection

2.1.2.2. Trauma--> while playing tennis

2.1.2.3. Site of injury --> knee

2.1.3. Drug history / allergy

2.1.3.1. ONLY painkillers for the knee pain

2.1.4. Family history

2.1.4.1. Dad had part of skin removed

2.1.4.2. Close relatives --> dad had knee pain

2.1.4.3. no chronic diseases in the family

2.1.5. Social / occupational history

2.1.5.1. single

2.1.5.2. Teacher

2.1.5.3. lives in a flat

2.1.5.4. not near any factories

2.1.5.5. Whenever he plays tennis, when weather is good --> exposed to sun

2.1.5.6. Social drinker

2.1.5.7. Smoker

2.1.5.7.1. a pack a day for the last 20 years

2.1.5.8. Straight

2.1.6. Physical examination

2.1.6.1. Vital signs

2.1.6.1.1. Nromal BP and HR

2.1.6.1.2. BMI = 180 cm, 110 kg

2.1.6.2. Knee

2.1.6.2.1. Gait= limp towards the affected knee

2.1.6.2.2. affected knee is a bit swollen and also tender

2.1.6.2.3. Limited flexion and pain when doing it

2.1.6.3. Skin

2.1.6.3.1. Diameter = 6m, circular, irregular

2.1.6.3.2. Site: left leg

2.1.6.3.3. Inguinal Lymph node involvment

2.1.6.3.4. Blackage discolouration

2.1.6.3.5. No Birthmarks

2.1.7. tests results

2.1.7.1. Xray

2.1.7.1.1. Both knees while standing. Narrowing

2.1.7.2. Chemistry normal

2.1.7.3. Skin bipsy

2.1.7.3.1. Poorly differentiated Sqamous cell cancrinoma

2.1.7.4. Normal CBC

2.1.7.5. CT scan

2.1.7.5.1. Metastatic spread in the abdomin

3. Step 8

3.1. Diagnostic decision

3.1.1. Osteoarthritis

3.1.2. Metastatic squamous cell canrcinoma

3.2. Mechanism

3.2.1. Metastatic squamous cell canrcinoma

3.2.1.1. smoking, continous exposure to the sun

3.2.1.2. Muation in sqamous layer caused the invasionm the basal layer and metastasis through lymphatics to inguinal and abdominal

3.2.2. Osteoarthritis

3.2.2.1. Mechanical trauma with multiple risk factors

3.3. Presentation

3.3.1. Knee pain

3.3.2. Limping

3.3.3. Clicks

3.3.4. Limited range of motion

3.3.5. SCC

3.3.5.1. 6cm diameter

3.3.5.2. circular, irregular

3.3.5.3. bleeding

3.3.5.4. painless

3.3.5.5. non tender

3.3.5.6. progressive

3.4. Supporting data

3.4.1. Knee

3.4.1.1. xray

3.4.1.2. physical examination

3.4.1.3. normal biochemistry test

3.4.2. Sore

3.4.2.1. Skin bipsy, CT scan