Neurological and Musculoskeletal Disorders Essay

Neurological and Musculoskeletal Disorders Essay

Neurological and Musculoskeletal Disorders Essay

QUESTION 1

1. 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.

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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.

Gout occurs due to hyperuricemia, whereby serum urate levels increase above 6.8 mg/dL or 0.4 mmol/L. Elevated urate levels cause the precipitation of monosodium urate crystals in and around joints, which often causes recurring acute or chronic arthritis (Murdoch et al., 2021). The higher the level and duration of hyperuricemia, the higher the chances of gout developing. Urate levels increase due to reduced renal or gastrointestinal excretion, increased production, or increased purine consumption combined with decreased excretion (Murdoch et al., 2021). The monosodium urate crystals are deposited in the synovium of the joints, causing inflammation that causes a sudden onset of pain.

QUESTION 2

1. 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 why a patient with gout is more likely to develop renal calculi.

Renal calculi are similar to gout because they are both caused by a high concentration of uric acid in the serum. Patients with gout have an increased risk of developing renal calculi since the kidneys excrete high levels of uric acid that make the urine more acidic (Alelign & Petros, 2018). This makes the uric acid highly likely to form kidney stones. Factors linked with the development of renal calculi in gout patients include elevated serum uric acid levels, low urine pH, and a high excretion of urate in the urine, which causes the formation of uric acid stones.

QUESTION 3

1. Scenario 2: 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? 

Osteoporosis is a progressive metabolic bone disorder characterized by a decrease in bone mineral density (BMD) with a deterioration of the bone structure. Increased bone resorption is the major pathological mechanism of bone loss in osteoporosis (Barnsley et al., 2021). This results in reduced bone mass and deterioration in the microarchitectural of the bone. The mechanism of bone loss can be due to impaired formation response during bone remodeling, likely caused by age-related decline in the number and activity of osteoblasts. This is partly associated with cytokine-mediated increases in the protein sclerostin (Barnsley et al., 2021). Furthermore, inadequate dietary intake of phosphorus, calcium, magnesium, and vitamin D predisposes one to bone loss.

QUESTION 4

1. Scenario 3: 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? 

RA is a chronic systemic autoimmune disorder that primarily affects the joints. It causes damage mediated by chemokines, cytokines, and metalloproteases. The prominent immunologic abnormalities in RA include immune complexes produced by synovial lining cells and inflamed blood vessels (Lin et al., 2020). Inflammatory mediators that are released cause the systemic and joint manifestations of RA, including cartilage and bone destruction. Systemic symptoms of RA include generalized fatigue and malaise, early morning stiffness of affected joints, anorexia, generalized weakness, and occasional mild fever (Lin et al., 2020). Thus, the patient’s joint pain, stiffness, swelling, and fatigue can be attributed to the release of inflammatory mediators that cause systemic and joint symptoms.

RA is an autoimmune, degenerative joint disease with both local and systemic symptoms, while OA is a non-inflammatory disorder that manifests only with local symptoms (Lin et al., 2020). Besides, RA involves multiple joints, and joint symptoms are bilateral and symmetrical. On the other hand, OA affects one joint, and symptoms are unilateral.

QUESTION 5

1. 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?

MS is a chronic autoimmune-mediated inflammatory disorder that affects the CNS, causing deficits. MS is characterized by disseminated patches of demyelination in the spinal cord and brain. It usually results in severe physical or cognitive incapacitation and neurological problems (Lane & Yadav, 2020). The common clinical manifestations include visual and oculomotor deficits, paresthesias, spasticity, weakness, urinary dysfunction, and mild cognitive symptoms.

The patient’s blurred vision can be attributed to demyelination of the optic nerves and brainstem involvement. Concentration and focusing difficulties can be due to the involvement of the cerebral cortex. Fine hand tremors and weakness can be due to MS involvement in the cerebellum, which causes incoordination, imbalance, vertigo, and tremors (Lane & Yadav, 2020). Furthermore, the difficulty in voiding is probably due to the involvement of the spinal cord since the peripheral and spinal connections support the voiding reflex.

References

Alelign, T., & Petros, B. (2018). Kidney Stone Disease: An Update on Current Concepts. Advances in Urology, 2018, 3068365. https://doi.org/10.1155/2018/3068365

Barnsley, J., Buckland, G., Chan, P. E., Ong, A., Ramos, A. S., Baxter, M., Laskou, F., Dennison, E. M., Cooper, C., & Patel, H. P. (2021). Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clinical and Experimental Research, 33(4), 759–773. https://doi.org/10.1007/s40520-021-01817-y

Lane, M., & Yadav, V. (2020). Multiple Sclerosis. Textbook of Natural Medicine, 1587–1599.e3. https://doi.org/10.1016/B978-0-323-43044-9.00199-0

Lin, Y. J., Anzaghe, M., & Schülke, S. (2020). Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells, 9(4), 880. https://doi.org/10.3390/cells9040880

Murdoch, R., Barry, M. J., Choi, H. K., Hernandez, D., Johnsen, B., Labrador, M., … & Dalbeth, N. (2021). Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout. RMD Open, 7(2), e001623. https://doi.org/10.1136/rmdopen-2021-001623

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Week 7: Concepts of Neurological and Musculoskeletal Disorders – Part 1
Woohoo! You just completed your mid-term exam! Please take a brief moment to listen to the valuable advice and inspiration from faculty and a proud graduate of the MSN program who is using her Education for Good.

Transcript – Congratulations, Advanced Pathophysiology Students! [PDF]

Anatomists often use the analogy of a house to explain the human body, with skeletal systems, respiratory systems, and circulatory systems represented as a home’s framing structure, ventilation, and piping, respectively. Such analogies further emphasize the point that relationships between systems can result in complications when issues arise in one system.

With hundreds of diseases that can impact the brain, spine, and nerves, neurological disorders represent a complicated array of issues that present significant health concerns. Disorders such as strokes and Parkinson’s disease not only affect the nervous system, however; they can have secondary impacts in other areas, especially the musculoskeletal system.
This week, you examine fundamental concepts of neurological disorders. You explore common disorders that impact these systems and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.

Learning Objectives
Students will:

Analyze concepts and principles of pathophysiology across the lifespan
Learning Resources
Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Chapter 15: Structure and Function of the Neurologic System
Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions); (Parkinson’s Disease); Summary Review
Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review
Chapter 47: Structure, Function, and Disorders of the Integument (section on Lyme Disease)
Chin, L. S. (2018). Spinal cord injuries. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4

Required Media (click to expand/reduce)

Module 5 Overview with Dr. Tara Harris

Dr. Tara Harris reviews the structure of Module 5 as well as the expectations for the module. Consider how you will manage your time as you review your media and Learning Resources throughout the module to prepare for your Knowledge Check and your Assignment. (3m)

Accessible player
Khan Academy. (2019b). Ischemic stroke . Retrieved from https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/stroke/v/ischemic-stroke

Note: The approximate length of the media program is 8 minutes.

Osmosis.org. (2019, June 12). Osteoporosis – causes, symptoms, diagnosis, treatment, pathology [Video file]. Retrieved from https://www.youtube.com/watch?v=jUQ_tt_zJDo

Note: The approximate length of the media program is 9 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 15, 16, 18, and sections of Chapters 44 and 45 that relate to the neurological and musculoskeletal systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

Knowledge Check: Neurological and Musculoskeletal Disorders
In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.

Possible topics covered in this Knowledge Check include:

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

Photo Credit: Getty Images/Science Photo Libra

Complete the Knowledge Check By Day 7 of Week 7
To complete this Knowledge Check:

Module 5 Knowledge Check