See Below Mm Case Studies  Tweek The Answer And Add References    Case 1: 49-Year-Female

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Case #1: 49-year-female assembly worker at automotive manufacturer presents to your clinic complaining of increasing back pain over the last week. Back pain is in the central low back region and radiates into both gluteal regions – no leg pain. Has been off work for the last 6 months with no improvement in pain.

1. Create a list of possible differential diagnoses?   
2. Discuss the evidence you would need to obtain to rule in or rule out each differential? 
3. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?  

Case #2:  A 65-year-old Caucasian female has a follow-up appointment with a family orthopedist after visiting the emergency department for a wrist fracture. The orthopedist then turns her case over to you to schedule a bone mineral density (BMD) testing. Results of the BMD test show a T-score of -3.0, indicating osteoporosis. Her past medical history includes mild hypertension which is currently managed with propranolol. She also takes a daily multivitamin. She drinks and smokes occasionally and she has no children or spouse.

1. What is the difference between degenerative bone disease and osteoporosis? Explain the pathology of each.
2. What treatment options should be discussed with the patient?
3. What lifestyle changes should be recommended to the patient?

 

Answer & Explanation

Solved by verified expertRatedHelpfulAnswered by bellosillosem

Answers:

Case#1

1)Diffrential diagnosis of Low back pain.

a)Spinal stenosis-

b) Sciatica

c)Slipped disc

d) Kidney stone-Nephrolithiasis

e)Spinal fracture

2)Discuss the evidence to rule in and rule out each dffirential diagnosis?

a)Spinal stenosis-numbness weakness in lower extremities ,pain radiating to buttock and leg ,-only numbness no pain and only radiate at gluteal ,present on the above case..

b)Sciatica-numbness and weakness only at lower extremities ,pain radiating to buttocks and legs. In scenario above no numbness and weakness no pain and radiate at gluteal region.

c) slipped disc-pain on one side of the body and pain also affect upper extremities.

d)kidney stone – pain radiate on groin and present of blood in urine ,which not present in case # 1

e)Spinal fracture-present of tenderness on palpation,, case # 1 only pain mentioned that radiate gluteal area .

3) Additional history and physical examination provide additional information about diagnosis.?

-ask for any history of trauma ,did she carry heavy object,is she sitting for long time ,and prolonged walking. She fever recently?

–Physical examination ,

Palpation check for present of stiffness,tenderness ,of the back ,legs and check knee joint flexion , check knee jerk reaction.

Answers case # 2

1)What the difference between degenerative bone disease and osteoporosis?

-Degenerative bone disease -usually affect in the spine , morphological changes lumbar and intervertebral disc due to decrease in bone mineral density and common to elderly women.

-Osteoporosis- the bone become brittle and  weak even just bending or coughing van cause fracture and usually affects ,hips ,wrist,and spine.

2)What treatment option should be discuss with the patient?

-Treatment that should be discussed ,the patient must know whats the cause especially in female hormonal changes on menopause ,, and life style like if smoke she must stop smoking ,,foods to eat rich in calcium ,vitamin D supplement or sunlight,,mild exercise ,,and should take medication for osteoporosis ,denosumab and hormonal therapy.

3)What life style changes should be recommend to the patient?

-stay healthy as possible , healthy food rich in calcium ,green leafy vegetables, dairy products, Vitamin D supplements, stop smoking and other activities bad for health ,, regular exercise like walking ,,avoid sports required physical contact. ,have enougj rest and sleep ,visit doctor regularly ..