Complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.
• Po Stroke
• Multiple sclerosis
• Transient Ischemic Attack
• Myasthenia gravis
• Headache
• Seizure disorders
• Head injury
• Spinal cord injury
• Inflammatory diseases of the musculoskeletal system
• Osteoporosis
• Osteopenia
• Bursitis
• Tendinitis
• Gout
• Lyme Disease
• Spondylosis
• Fractures
• Parkinson’s
• Alzheimer’s
Three basic bone-formations:
• Osteoblasts
• Osteocytes
• Osteoclasts
Scenario 1: Gout
A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain the pathophysiology of gout.
Scenario 2: Gout
A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain why a patient with gout is more likely to develop renal calculi.
Scenario 3: Osteoporosis
A 78-year-old female was out walking her small dog when her dog suddenly tried to chase a rabbit and made her fall. She attempted to try and break her fall by putting her hand out and she landed on her outstretched hand. She immediately felt severe pain in her right wrist and noticed her wrist looked deformed. Her neighbor saw the fall and brought the woman to the local ER for evaluation. Radiographs revealed a Colles' fracture (distal radius with dorsal displacement of fragments) as well as radiographic evidence of osteoporosis. A closed reduction of the fracture was successful, and she was placed in a posterior splint with ace bandage wrap and instructed to see an orthopedist for follow up.
Question:
Discuss what is osteoporosis and how does it develop pathologically?
Scenario 4: Rheumatoid Arthritis
A 48-year-old woman presents with a five-month history of generalized joint pain, stiffness, and swelling, especially in her hands. She states that these symptoms have made it difficult to grasp objects and has made caring for her grandchildren problematic. She admits to increased fatigue, but she thought it was due to her stressful job.
FH: Grandmothers had “crippling” arthritis.
PE: remarkable for bilateral ulnar deviation of her hands as well as soft, boggy proximal interphalangeal joints. The metatarsals of both of her feet also exhibited swelling and warmth.
Diagnosis: rheumatoid arthritis.
Question:
The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA?
Scenario5: Multiple Sclerosis (MS)
A 28-year-old obese, female presents today with complaints for several weeks of vision problems (blurry) and difficulty with concentration and focusing. She is an administrative para-legal for a law firm and notes her symptoms have become worse over the course of the addition of more attorneys and demands for work. Today, she noticed that her symptoms were worse and were accompanied by some fine tremors in her hands. She has been having difficulty concentrating and has difficulty voiding. She went to the optometrist who recommended reading glasses with small prism to correct double vision. She admits to some weakness as well. No other complaints of fevers, chills, URI or UTI
PMH: non-contributory
PE: CN-IV palsy. The fundoscopic exam reveals edema of right optic nerve causing optic neuritis. Positive nystagmus on positional maneuvers. There are left visual field deficits. There was short term memory loss with listing of familiar objects.
DIAGNOSIS: multiple sclerosis (MS).
Question:
Describe what is MS and how did it cause the above patient’s symptoms?
Sample Solution
Scenario 1
Question: Explain the pathophysiology of gout.
Answer:
Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate (MSU) crystals in the joints. MSU crystals form when uric acid levels in the blood become too high. This can happen for a number of reasons, including diet, genetics, and certain medical conditions.
When MSU crystals are deposited in a joint, they trigger an inflammatory response. This response causes the joint to become swollen, red, and hot. It can also be very painful.
Full Answer Section
Scenario 2
Question: Explain why a patient with gout is more likely to develop renal calculi.
Answer:
Patients with gout are more likely to develop renal calculi because uric acid can also crystallize in the kidneys. This can lead to the formation of kidney stones, which can be very painful and can even block the flow of urine.
There are a number of factors that can increase the risk of developing kidney stones in patients with gout, including:
- High uric acid levels
- Dehydration
- Acidic urine
- Certain medical conditions, such as diabetes and obesity
Scenario 3
Question: Discuss what is osteoporosis and how does it develop pathologically?
Answer:
Osteoporosis is a condition in which the bones become weak and brittle. This is due to a decrease in bone density. Osteoporosis can develop for a number of reasons, including:
- Age
- Sex (women are more likely to develop osteoporosis than men)
- Race (Caucasians and Asians are more likely to develop osteoporosis than African Americans)
- Family history
- Certain medical conditions, such as hyperthyroidism and Cushing's syndrome
- Certain medications, such as corticosteroids
Pathologically, osteoporosis is characterized by a loss of bone mass. This is due to an imbalance between the two types of cells that are responsible for bone remodeling: osteoclasts and osteoblasts. Osteoclasts are cells that break down bone, while osteoblasts are cells that form new bone. In osteoporosis, osteoclasts break down bone at a faster rate than osteoblasts can form new bone. This leads to a decrease in bone density and an increased risk of fractures.
Scenario 4
Question: The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA?
Answer:
The patient's symptoms, including generalized joint pain, stiffness, and swelling, are all associated with rheumatoid arthritis (RA). RA is an autoimmune disease that causes inflammation in the joints. It can also affect other organ systems in the body, such as the skin, lungs, and heart.
The difference between RA and osteoarthritis (OA) is that RA is an autoimmune disease, while OA is a degenerative disease. RA is caused by a problem with the immune system, while OA is caused by wear and tear on the joints.
RA is also more likely to affect multiple joints, while OA is more likely to affect a single joint. Additionally, RA can cause systemic symptoms, such as fatigue and weight loss, while OA does not.
Scenario 5
Question: Describe what is MS and how did it cause the above patient’s symptoms?
Answer:
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS). It is caused by damage to the myelin sheath, which is the protective coating that surrounds nerve fibers. This damage can lead to a variety of symptoms, including:
- Vision problems
- Difficulty with concentration and focusing
- Weakness
- Tremors
- Difficulty walking and balancing
- Bladder and bowel problems
The patient's symptoms are all consistent with MS. Her vision problems are likely due to optic neuritis, which is inflammation of the optic nerve. Her difficulty with concentration and focusing is likely due to lesions in the white matter of the brain. Her weakness, tremors, and difficulty walking and balancing are likely due to lesions in the spinal cord. Her bladder and bowel problems are likely due to lesions in the brain and spinal cord that control bladder and bowel function.
Conclusion
These are just a few examples of how the pathophysiology of various diseases can explain the symptoms that patients experience. By understanding the pathophysiology of a disease, clinicians can better diagnose and treat the condition.