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Group 2 B:
General Data
1/19/17
Group 2B Rhambdomyosarcoma
10 months PTC:
o Hit on the left infraorbital surface of his face
o Pain on the left infraorbital area (pain scale 5/10)
o Left eye: erythematous and pruritic without discharge
o Ice pack was placed on the affected area for pain relief for two weeks.
o No consult done and medication taken.
1/19/17
Group 2B Rhambdomyosarcoma
History of Present
Illness
1/19/17
Group 2B Rhambdomyosarcoma
History of Present
Illness
Group 2B Rhambdomyosarcoma
History of Present
Illness
1/19/17
Group 2B Rhambdomyosarcoma
History of Present
Illness
A month PTC:
o Symptoms of left infraorbital pain recurred
o Bulging tissues from left lower eyelid is progressively enlarging
o Patient to decide to continue the chemotherapy and radiation cycle.
On the day of consult: Patient went back to Bahay Aruga to start a new cycle of
chemotherapy.
Medications currently taking are the following:
o Vincristine (unknown dosage)
o Tramadol 100 mg tablet for pain relief, taken only as needed.
1/19/17
Group 2B Rhambdomyosarcoma
History of Present
Illness
1/19/17
Group 2B Rhambdomyosarcoma
Review of Systems
General:
Skin:
Respiratory
Cardiovascular:
Gastrointestinal: (+) nausea and vomiting, loss of appetite; (-) change in bowel
habits, colored stool, abdominal pain, hematemesis, melena,
hematochezia
Genitourinary:
Group 2B Rhambdomyosarcoma
Maternal History
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Maternal History
Mothers
Age
GENDER
20
Female
G1
G2
35
Patient
G3
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Male
1/19/17
PLACE OF BIRTH
House
(Midwife
Assisted)
MODE OF
DELIVERY
OUTCOME/COMPLICATIONS
NSD
37 weeks; no complications
NSD
37 weeks; no
complications
NSD
37 weeks; no complications
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Birth History
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Feeding History
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Developmental History
Started to walk alone at 10 months, write full name at the age of 2 and half years
and speak a full sentence by 2 years old.
HEADSSS:
o Home: Not close with his mother. Elder sister is his primary care giver.
o Education: Supposed to be in coming Second Year College where he is
taking up HRM. Attends class regularly and studies diligently. Have a good
relationship with classmates
o Eating Habits: Eats three times a day comprises of rice, meat and vegetables.
o After school and during weekends, patient used to hang out in his friends
house and they usually drink there almost two to three times every week. He
denies taking any illicit drugs.
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Developmental History
HEADSSS:
o Sexuality: Claims not to have any sexual relationship right now. First
and only sexual experience was at the age 16 years old with his first
girlfriend. Used condom as a mode of contraception and denies any
history of STDs.
o Suicidal Ideation: Denies any suicidal ideation even before being
diagnosed to have cancer.
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IMMUNIZATIONS:
o Had the following immunizations in the health center in
PAST ILLNESSES:
o No known illnesses in the past
o Never had measles, varicella, mumps and pertussis
o Never hospitalized
o No known surgeries, accidents and drug sensitivities.
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Family History
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Living with his parents and 2 siblings in a two bedroom house that is well ventilated
Denies smoking cigarette and illicit drug use
Used drink 3 500 ml bottle of redhorse 3 times per week but currently not drinking
any alcohol drinks.
Water source is from nawasa.
Food is prepared at home by eldest sister.
Garbage is thrown away twice a week
Mother works as a family maid.
Father is a smoker and drinks alcohol most of the time. He used to work as a family
driver.
Both parents deny taking illicit drugs.
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Physical Examination
percentile = normal)
o Weight: 49.1 kg (CDC age for weight = below 5 th
percentile)
o BMI = 16.98 = 17 = CDC BMI for age 0-20 boys = below
5th percentile = Underweight
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Physical Examination
Vital Signs
o Temperature: 36.6 C (afebrile)
o Pulse Rate: 72 beats/ mins (normal)
o Respiratory Rate: 16 breaths/ min (normal)
o Blood Pressure: 120/80 mmHg (normotensive)
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Physical Examination
HEENT
o Head: Scalp hair is equally distributed with light brown color.
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Physical Examination
o Ears:
Pink mucous membranes and midline nasal septum was noted. Left
maxillary sinus tenderness. (-) nasal discharge, bleeding, foreign
bodies, nasal flaring.
o Mouth and Throat:
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Physical Examination
o Neck:
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Physical Examination
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Physical Examination
Heart:
o Adynamic precordium, no visible pulsations.
o Regular heart rate and rhythm.
o Apex beat at 5th ICS MCL, S1> S2 at apex.
o (-) Murmurs, extra heart sounds, thrills and heaves,
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Physical Examination
Abdomen:
o Abdomen is flat, symmetrical, and has normoactive
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Physical Examination
Genitourinary:
o No palpable inguinal lymph nodes.
o Both testes are descended. Penis is circumcised.
o Tanner stage: Both external genitalia stage and pubic hair is
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Physical Examination
Cerebrum
o Mental State: Patient is oriented to person, place and time;
Cranial Nerves
o CN I Patient was able to smell coffee.
o CN II Right pupil reactive to light and accommodation; distinct
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Physical Examination
o CN VII right and left facial movement intact
o CN VIII Webers Test: Rinnes Test: Bone conduction was
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Physical Examination
Motor:
o Normal and steady gait.
o Good muscle bulk and tone; full ROMs
o Motor Strength Right UE & LE = 5/5; Left UE & LE = 5/5
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Physical Examination
Reflexes:
o Deep Tendon Reflexes: all ++ on both UE and LE (biceps
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DIFFERENTIALS:
o Viral Conjunctivitis
o Orbital Lymphoma
DIAGNOSIS: Alveolar
Rhabdomyosarcoma (Stage 4)
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Discussion
Rhabdomyosarcoma
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