Musculoskeletal Function

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G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. My arthritis hasnt improved a bit this summer though, she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to loosen up with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.

Case Study Questions

Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.
Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.

Case Study Questions

Name the most common risks factors for Alzheimers disease
Name and describe the similarities and the differences between Alzheimers disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Define and describe explicit and implicit memory.
Describe the diagnosis criteria developed for the Alzheimers disease by the National Institute of Aging and the Alzheimers Association
What would be the best therapeutic approach on C.J.

 

Sample Solution

Case Study 1: G.J.

Osteoarthritis vs. Osteoporosis

  • Osteoarthritis (OA): A degenerative joint disease characterized by the breakdown of cartilage, the cushioning tissue between bones. It causes pain, stiffness, and reduced flexibility in the joints. (This is likely G.J.’s diagnosis)
  • Osteoporosis: A disease that weakens bones, making them more susceptible to fractures. While both can cause joint pain, osteoporosis doesn’t typically cause the stiffness and reduced flexibility associated with OA.

Risk Factors for Osteoarthritis in G.J.’s Case:

  • Age: Osteoarthritis is more common in older adults.
  • Weight: G.J.’s recent weight gain puts extra stress on her knees.
  • Previous injury: Not mentioned, but could be a factor.
  • Joint overuse: G.J.’s job or activities might have stressed her joints.
  • Family history: Not mentioned for OA, but relevant for osteoporosis.

Osteoarthritis vs. Rheumatoid Arthritis:

Feature Osteoarthritis Rheumatoid Arthritis
Cause Cartilage breakdown Autoimmune disease attacking joints
Symmetry Usually affects one or a few joints, often asymmetrically Often affects multiple joints symmetrically (both hands, knees)
Morning stiffness Less common, usually less than 30 minutes Common, lasting for hours
Joint redness and swelling Less common More common
Small joints Less common Can affect small joints like hands and feet
Diagnosis X-ray, physical exam Blood tests, X-ray, physical exam

Treatment Options for G.J.:

Non-pharmacological:

  • Weight loss: Reduces stress on joints.
  • Exercise: Improves flexibility and strengthens muscles.
  • Physical therapy: Teaches exercises and pain management strategies.
  • Heat/cold therapy: Can help relieve pain and stiffness.
  • Assistive devices: Canes or braces can provide support.

Pharmacological:

  • Acetaminophen: For pain relief (safer than NSAIDs for G.J.).
  • Topical pain relievers: Creams or gels applied directly to the joints.
  • Injections: Corticosteroids for short-term pain relief (use cautiously).

Osteoporosis Management:

  • Diet and calcium supplementation: To improve bone density.
  • Weight-bearing exercise: To strengthen bones.
  • Medications: Bisphosphonates or denosumab to slow bone loss.
  • Referral to a specialist: For a bone density scan and further management.

Addressing G.J.’s concern:

  • Explain the difference between OA and osteoporosis.
  • Reassure her that osteoporosis medications can help prevent future fractures.
  • Discuss the importance of a bone density scan for diagnosis.

Case Study 2: H.M.

Risk Factors for Alzheimer’s Disease:

  • Age: H.M.’s age is a significant risk factor.
  • Family history: Not mentioned for Alzheimer’s but could be a factor.

Dementia Types:

  • Alzheimer’s disease (AD): Most common, characterized by progressive memory loss and cognitive decline.
  • Vascular dementia: Caused by strokes that damage brain tissue. Can cause memory loss and difficulty thinking.
  • Dementia with Lewy bodies: Abnormal protein deposits in the brain cause memory loss, hallucinations, and movement problems.
  • Frontotemporal dementia: Affects the frontal and temporal lobes, leading to personality changes, language difficulties, and behavioral problems.

Similarities between dementias: All cause memory loss, difficulty thinking, and impaired daily function.

Differences:

  • Cause: Varies for each type.
  • Symptoms: May have specific symptoms like hallucinations (Lewy body) or personality changes (frontotemporal).
  • Progression: Rate of decline can vary.

Explicit vs. Implicit Memory:

  • Explicit memory: Conscious recall of facts and experiences (e.g., remembering your birthday).
  • Implicit memory: Unconscious memories that affect behavior (e.g., riding a bike).

Diagnosis of Alzheimer’s Disease:

  • National Institute on Aging and Alzheimer’s Association (NIA-AA) criteria:
    • Cognitive decline impacting daily life.
    • Progressive worsening of symptoms.
    • Evidence of Alzheimer’s pathology in the brain (through scans or autopsy).

Treatment for H.M.:

  • Medications: Acetylcholinesterase inhibitors or memantine may help manage symptoms.
  • Cognitive therapy:

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