Return to Scenario ListShow Learning Points most relevant to Phase 1:

Musculoskeletal lump

Clinical Discipline(s)/Organ System(s)
Musculoskeletal System, Oncology, Orthopaedics, Paediatrics, Palliative Medicine
Progress Test Topic(s)
A 15 year old Samoan boy presents, to a specialist clinic you are attending, with a slowly enlarging lump on his left proximal tibia. It has recently become mildly tender but there are no other signs of inflammation or infection. Subsequent medical evaluation reveals this to be a malignant musculoskeletal tumour.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the lower limb - inguinal region, thigh, leg and foot
   - Pathology of musculoskeletal tumours
Clinical and Communication Skills 
   - History from a patient with a new lump
   - Knowledge of the more common causes of skin/bone/joint lumps
   - Questioning around systemic symptoms that may indicate a more sinister cause
   - Examination of a lump (site, size, consistency, mobility, tenderness, warmth, redness)
   - Examination of local and distant lymph nodes
   - Distal neurovascular assessment to check for compromise of these structures
   - Indications and guidelines for biopsy
   - Appearances of bone tumours on plain X-ray
Personal and Professional Skills 
   - Understanding need for early specialist referral
   - Empathy when delivering bad news
   - Care when discussing diagnosis, prognosis, treatment options when clinically uncertain and when outside the limits of your own expertise
   - Role of multidisciplinary care and palliative care teams
   - Approach to paediatric palliative care
Hauora Māori 
   - Overcrowding/poverty and the effect of these on development of skin infections and abscesses
   - Cultural aspects of terminal care, death and dying
Population Health 
   - Knowledge of the commonness of many benign masses; awareness of rare malignant musculoskeletal tumours
Conditions to be considered relating to this scenario
lipoma, abscess, lymphadenopathy (reactive), lymphadenopathy (malignant), epidermoid cyst
Less common but 'important not to miss'
sarcoma, osteosarcoma, Ewing's sarcoma, vascular tumours, metastatic bone disease, benign bone tumours
myositis ossificans