Reference no: EM132680614

CLINICAL CASES

Clinical Case 5

Skeletal System: Osteoporosis
Margaret Donovan, a 72-year-old white female, was brought to the emergency room after falling in her bathtub. She was previously in good health, despite leading a relatively sedentary lifestyle and having a 30-pack-year history of cigarette smoking. The only medication she currently takes is for mild hypertension. She fell upon entering the bathtub when her right leg slipped out from under her; she landed on her right hip. She reports severe pain in the right hip and upper thigh, and was unable to get up after her fall. An injection of oxymorphone hydrochloride helped relieve her pain.
Physical Examination: The right thigh and hip were extremely tender and were immobilized by a leg splint.
Radiology Report: The X-ray of the right hip revealed a complete, comminuted, intertrochanteric fracture of the right hip. No other fractures were noted in the right leg. There were also long-term osteoporotic changes in the femur, tibia, and fibula.
Questions:
1. What is meant by a "complete, comminuted, intertrochanteric fracture of the right hip"?
2. The radiologist reported signs of osteoporosis. Describe the characteristics of an osteoporotic femur as seen on an X-ray. (How does it differ in appearance from a normal femur?)
3. Describe the changes (steps) that a broken bone undergoes as it is healing.
4. During her long recovery, Margaret is advised by her physician to begin weight-bearing as soon as she can. How does weight-bearing influence the process? (Be specific in your answer and describe what weight-bearing does to bone at the microscopic level.)
5. Why Margaret's physician want her to avoid a prolonged period of bed-ridden inactivity? Why astronauts find loss in bone volume upon their return to earth?
6. What risk factors does Margaret have for osteoporosis?
7. Which part of the skeletal system is affected more by osteoporosis?

CLINICAL CASE 6

The Muscular System
Robert Smith is a 19-year old male, immobile and hospitalized for pneumonia. In the first year of his life, Robert reached many gross motor skill milestones, such as holding his head up, rolling over, sitting, and standing. However, he did not walk until age 16 months, and by age two, started to assume a lordotic posture while standing. A Gower's sign was noted by age four, as was a Trendelenberg gait. Over the next several years, he suffered progressive muscle weakness, most notably in the proximal musculature of the arms, pelvis, and legs. By age 9, he required orthotic braces to assist his walking, and by age 11, he was confined to wheelchair ambulation. In his early teen years, Robert was still able to use eating utensils, write, and type on a keyboard, though these functions have declined over the past year. At 16, he was hospitalized with bronchitis. The only medications that he normally takes are calcium and fluoride supplements. Robert has a younger sister in good health and a younger brother (age 10) who is confined to a wheelchair with problems similar to Robert's.
Questions:
1. Robert suffers from a condition called Duchenne muscular dystrophy. Explain the full meaning of this name.
2. At age 4, Robert underwent a biopsy of the right gastrocnemius muscle and were found histopathologic changes suggestive of Duchenne muscular dystrophy. Describe the typical microscopic changes.
3. Which muscles are most severely affected by this disease process?
4. Robert had an elevated serum creatine kinase (i.e. creatine phosphokinase) level of 26,000 IU / L (normal level is <160 IU / L). What is creatine kinase, and why was this level elevated in Robert's blood?
5. What is a Gower's sign, and why did Robert have it as well as a lordotic posture early on?
6. Why did Robert develop scoliosis and why is it important for Robert to take calcium and fluoride supplements?
7. Describe the pathogenesis, the genetics as well as the prognosis of the Duchenne muscular dystrophy.
8. How might an occupational therapist or a physical therapist help Robert?
9. Have you read about any possible new treatments for this condition?