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Musculoskeletal Function

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 hasn’t 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 Alzheimer’s disease
Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Define and describe explicit and implicit memory.
Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
What would be the best therapeutic approach on C.J.

Sample Answer

Case 1: G.J. – Knee Osteoarthritis

Osteoarthritis vs. Osteoarthrosis

These terms are often used interchangeably. Osteoarthritis (OA) is the more precise term referring to a degenerative joint disease characterized by cartilage breakdown and inflammation. Osteoarthrosis is a less commonly used synonym for OA.

Risk Factors in G.J.’s Case:

Age: G.J.’s age (71 years) is a significant risk factor for OA.
Overweight: Recent weight gain (20 pounds) puts additional stress on weight-bearing joints like knees.
Previous Injury: The case doesn’t mention injuries, but they can contribute to OA.
Family History: Not mentioned in the case for knee OA, but family history can be a risk factor.
Biomechanics: Joint misalignment or abnormal gait can increase risk.
Occupation: Certain occupations with repetitive stress on joints can contribute.

Full Answer Section

Differences Between Osteoarthritis and Rheumatoid Arthritis:

Feature	Osteoarthritis (OA)	Rheumatoid Arthritis (RA)
Cause	Cartilage degeneration	Autoimmune disease attacking joints
Symmetry	Usually affects both sides of the body (though may not be symmetrical)	Can affect joints on one or both sides of the body, often asymmetrical
Joint Involvement	Primarily weight-bearing joints (knees, hips, spine)	Can affect any joint, including small joints in hands and feet
Morning Stiffness	Stiffness after inactivity, improves with movement	Prolonged morning stiffness (lasting over 30 minutes)
Inflammation	Low-grade inflammation	Can cause significant joint swelling, redness, and warmth
Diagnosis	X-ray, physical exam	Blood tests, X-ray, physical exam

Treatment Options for G.J.:

Non-pharmacological:

Weight Loss: Reducing weight can significantly improve OA symptoms.
Exercise: Regular low-impact exercise (e.g., swimming, walking) strengthens muscles and improves joint flexibility.
Physical Therapy: Can provide pain relief and improve joint function.
Heat/Cold Therapy: Heat can help relax stiff muscles, while cold can reduce inflammation.
Assistive Devices: Cane or brace can provide support and reduce stress on joints.

Pharmacological:

Acetaminophen: For mild pain relief.
Topical NSAIDs: Creams or gels applied directly to the painful area may offer localized pain relief with fewer side effects than oral NSAIDs.
Duisulfhydrazine (DMSM) supplements: Emerging research suggests potential benefits for OA pain, but more studies are needed. (Discuss with doctor before using)

Osteoporosis Concerns:

History & Risk Factors: G.J.’s family history and age increase her risk for osteoporosis.
Evaluation: A bone density scan can assess osteoporosis risk.
Education: Educate G.J. about osteoporosis risk factors, prevention strategies (calcium and vitamin D intake, weight-bearing exercise), and treatment options if diagnosed.

Case 2: H.M. – Potential Dementia

Risk Factors for Alzheimer’s Disease:

Age: H.M.’s age (67 years) is a risk factor, though younger onset is possible.
Family History: Not mentioned in the case, but a family history of dementia increases risk.
Genetics: Certain genes increase Alzheimer’s risk.

Types of Dementia:

Alzheimer’s Disease: Most common form, characterized by progressive memory loss and cognitive decline.
Vascular Dementia: Caused by problems with blood flow to the brain, leading to cognitive decline. Symptoms can be similar to Alzheimer’s but may also include sudden changes in thinking and behavior.
Dementia with Lewy Bodies: Abnormal protein deposits in the brain cause dementia, along with movement problems and hallucinations.
Frontotemporal Dementia: Affects the frontal and temporal lobes of the brain, leading to personality changes, language difficulties, and problems with judgment.

Explicit vs. Implicit Memory:

Explicit Memory: Conscious recall of facts and experiences (e.g., remembering your birthday).
Implicit Memory: Unconscious memories that influence behavior (e.g., riding a bike without consciously thinking about the steps).

Diagnosis of Alzheimer’s Disease:

The National Institute on Aging and Alzheimer’s Association recommend a comprehensive evaluation including:

Medical History and Physical Exam: To rule out other causes of cognitive decline.
Cognitive Tests: To assess memory

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