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Pathophysiology Case studies and class discussion of…
Pathophysiology Case studies and class discussion of
Musculoskeletal system
CASE 1:
Trevor, an 18-year-old, arrives at the ER following a significant skiing accident. While
racing his friend down the hill, he directly impacts a large tree at a high speed. He is
brought to the hospital by ambulance with c-spine immobilization and strapped to a
backboard. He complains of severe pain in his right thigh, pelvis, right shoulder and right
ankle.
While assessing Trevor, the nurse notes a deformed right shoulder, a very swollen right
thigh with a laceration on it and a swollen right ankle.
Past medical history: unremarkable
Allergies: none
Last meal: 4 hours ago
Medications: none
Immunizations: up to date including tetanus 3 years ago
Initial vitals in the ER: Temp:37.2c BP:88/60 HR:128/min O2 sat97%
1) Discuss the concept and importance of the “primary survey” in a trauma patient.
(SLIDE 29)
2) Discuss in further detail the components of ABCDE in the primary survey.
After completing the primary survey, a full assessment is performed plus x-rays of the c-
spine, chest, right shoulder, pelvis, right femur, and right ankle. They reveal no neck
fracture but an anterior shoulder dislocation, a pelvic fracture, a mid-shaft femur fracture
with air in the soft tissue and a soft tissue injury to the ankle with no fracture.
1) Discuss the term “soft tissue injury”, what parts of the musculoskeletal system can
be involved. How do sprains differ from strains? (SLIDES 31-32)
2) Review the cardinal signs and symptoms of soft tissue injuries. (SLIDE 33)
3) How are most soft tissue injuries being treated? (SLIDE 34)
4) How does a contusion, ecchymoses, and hematoma differ from each other? (SLIDE
35)
5) Discuss the various terms used to describe fractures in the module slides. What are
stress fractures? Pathologic fractures? (SLIDES 36-38)
6) Discuss compound fractures. Does Trevor potentially have one? If so, what is the
immediate treatment of a compound fracture, and the potential complication of a
compound fracture? (SLIDE 38)
7) Discuss the term “Osteomyelitis”, What is the pathophysiology resulting in this
condition? What is the treatment of this condition? (SLIDES 51-53)
8) Discuss the abnormal “vital signs” on initial arrival to the hospital. What are the
likely causes of them?(SLIDE 39-40)
Case 2:
A 5-year-old, Aaron, sustains an injury to his left forearm while playfighting with his older
brother. His left forearm has an obvious deformity with associated significant swelling. X-
rays reveal a displaced fracture of the radius and ulna.
1) What is the priority assessment when initially assessing his Left arm?
2) Discuss the sequential steps of bone healing following a fracture. (SLIDE 43)
3) Review the common symptoms related to fractured bones. (SLIDE 40)
3) Fractures can be associated with potential complications. Review the complications
and their pathophysiology. (SLIDE 44-48)
4) Discuss the 6 Ps associated with compartment syndrome. (SLIDE 47) What is the
long-term complication of this condition? (SLIDE 45) What is emergency treatment
of this condition? (SLIDE 47)
Aaron is given an IV sedative (midazolam) and analgesic (fentanyl) allowing for a closed
reduction of his forearm, followed by a full arm cast for 6 weeks.
5) What advice should the family receive prior to being discharged from the hospital?
6) What is potentially occurring if he returns with severe arm pain and swollen digits with
paresthesia’s? What needs to be done immediately?
Case 3:
While at a crowded local swimming pool, an RN notices a group of people gathering
around someone lying on the ground. Upon arrival at the scene, she notices a young man with a right shoulder deformity. He states, “my shoulder often dislocates while swimming
and diving, can you help me?”
1) Review the shoulder joint anatomy.(SLIDES 58-59)
2) What is the priority assessment of the right limb?
3) Discuss why the shoulder joint is prone to dislocation.(SLIDE 58)
4) Why is it imperative to relocate a dislocated joint as soon as possible?(SLIDE 50)
5) Discuss the set of muscles and tendons that provide support and stability to the shoulder
joint. What is rotator cuff syndrome? And discuss its causes and complications. (SLIDE 59)
Case study 4:
Scenario: Fraenzi, a 57- year-old white woman, works long hours as a secretary.
She has no organized exercise schedule. She is 5’1″ and 110 lbs.
PMHx: – Smoker x30 yrs.
– Alcohol: 3 drinks/day
– Hypothyroidism since 25 yrs. ago
Wrist ? 2 yrs. ago following a fall.
Meds: – Levothyroxine daily
1) Discuss the pathophysiology of osteoporosis. (SLIDE 20-22)
2) Identify her risk factors for developing osteoporosis. (SLIDE 23)
3) Discuss clinical manifestations of osteoporosis. (SLIDE 21)
4) Discuss tests used to diagnose osteoporosis. (SLIDE 20)
5) What interventions can be used to prevent osteoporosis? (SLIDE 24)
5) What plan can be formulated to treat osteoporosis? (SLIDE 25)
Case study 5:
Scenario: A 48-year-old man, Jeremiah, has been overweight for most of his life.
His current weight is 365 lbs, and his height is 6’1″. He does not participate in any
formal exercise program and describes his activity level as low. He is at the clinic
today due to sore knees and hips, which have progressively worsened over the
past 6 months.
PMHx: GERD, ?BP, Type 2 diabetes, Sleep apnea
Meds: Amlodipine, Omeprazole, Metformin
X-rays are done of both knees and hip joints, which reveal moderate
osteoarthritis.
1) Describe the pathophysiology of OA. (SLIDES 2-3)
2) What are the risk factors for OA? (SLIDE 4)
3) Describe the clinical symptoms and signs of OA. (SLIDES 3, 5-6)
4) Discuss common treatments of OA. (SLIDE 6)
Case study 6:
Scenario: A 28-year-old woman, Kya, visits the local outpatient clinic with
increasing joint pain and stiffness in her hands, feet and ankles for the past 3
months. Her symptoms began intermittently about 1 year ago, but they have
now become significantly worse.
Kya also reports fatigue and depressive symptoms that she attributes to having a
stressful job and 3 children.
She finds the mornings particularly difficult with joint pain and stiffness.
Focused Exam of Joints:
– Swollen and red finger joints to both hands
– Bilateral ankle joint swelling and redness
– Tender nodules were also noticed behind her elbows.
1) What condition do you suspect Kya has developed? (SLIDES 7-9, 12)
Explain your reasoning.
2) Discuss the pathophysiology of rheumatoid arthritis. (SLIDE 11)
3) Differentiate between RA and OA. (SLIDE 8)
4) Review the progressive joint symptoms and signs of RA. (SLIDE 12)
5) Briefly discuss the management of RA. (SLIDE 13)
6) What tests can be helpful in diagnosing RA? (SLIDE 9)
Case study 7:
Scenario: A 42-year-old man, Rodney, has developed intense pain in his big toe.
He denies any injury to the area. He is having difficulty wt. bearing on his foot
due to intense pain in his toe.
The RN notes the big toe is swollen, red, and painful to move.
1) What condition is most likely occurring in Rodney? (SLIDE 26)
2) Describe the pathophysiology of this condition. What other conditions can develop with elevated uric acid? (SLIDES 26-27)
3) What are the risk factors for gout? (SLIDE 27)
4) Discuss the treatment for an acute gout flare up. What can be done to
prevent flare ups? (SLIDE 27) s
5) How can gout be diagnosed? (SLIDE 26)
6) What is septic arthritis? How can it present in a similar way to gout? How can
it be differentiated from other forms of joint inflammation? (SLIDE 28)
