Professional Documents
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Overview
Mrs. Johnson is a 73 y.o. female who presents to your office with right shoulder pain. Her and
her husband just moved to the area a few months ago, and you have only seen her once for a
sinus infection. Today she states that she is having increasing right shoulder pain over the past
couple of weeks. She explains that her shoulders have “always bothered” her because she
worked in a factory moving boxes for years. She states that she uses naproxen, “prescription
strength” and that usually does the trick when her arthritis flares up, but she is out and would like
a refill.
On exam, you note that her right shoulder is tender to palpate, and she has limited motion. She
smells of BenGay but otherwise, she seems healthy. The area is edematous and when asked she
does agree that her arm seems swollen. She denies any falls but remembers that she lost her
balance and fell backward into her recliner a few days ago “kind of hard” but she caught herself
when she grabbed for the coffee table. Otherwise, she does not recall any injuries. You decide to
send Mrs. Johnson for an x-ray and she is in the waiting room until you get the results back.
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Questions to answer
1. What is in your differential diagnosis (top 3 minimum) as you think through this case?
It is not always the case that shoulder pain should emanicipate from the shoulder. The author
therefore in this case would order a differential diagnosis on the electrocardiogram(ECG), and
another diagnosis on cardiac enzymes and also a diagnosis on the suspected gall blander disease
to ensure that the patients patient does not risk her life. These diagnosis are important sice the
pain may be related to non-musculoskeletal issue, thus there is not need to order anything else.
2.
What else would you like to ask Mrs. Johnson relating to how she may have been injured?
The author would like to know for how long Mrs Johson has been with the injury. This will helo
3.
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There are at least two areas of concern on this x-ray—one is a pathological fx of her humerus.
Research pathological fractures; review the physiology of the musculoskeletal system and
A break in the bone that is caused by an underlying disease is a pathological fracture. The body
bones, tendons, muscle, joints and the cartilage made up the musculoskeletal system where its
4.
After focusing on the pathophysiology of the fractured bone, discuss what other disorder you
The other disorder is the osteomalacia where the bones are are softened a condition that is caused
by lack of vitamin thus making the body not to aborb calcium which is vey vital for the health of
the bones.
5.
What would be your primary choice for an underlying diagnosis for Mrs. Johnson, and why?
The author would prefer performaning a CT scan on Mrs Johnson as it will enable in
6.
What past pertinent information related to a pathological fracture and your second suspected
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The fact that Mrs Johnson had a fall in the past while in her place of work is enough information
to relate to a pathological fracture. The author thus would like to ask Mrs Johnson the nature of
her fall and whether the coffee table in which she held herself onto had any contact with her.
This will help in ruling out cases of more severe injuries due to her fall.
7.
Are there any additional tests, radiological studies, etc. that you would order for Mrs. Johnson?
Yes. The author would like to subject mrs Jonson to more tests to fully understand what she is
suffering from. A CT scan would be very much necessary as it will bring out all the internal
details regarding her health. The author would also like mrs Johnson to go through a series of lab
tests. Finally, the author would like to refer mrs Johnson to medical laboratory that will carry the
pathologic fracture is a broken bone that’s caused by a disease. This is due to weakness in
What can cause a pathological fracture? The pathological conditions that can cause
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Based on the history provided in the first paragraph, what other musculoskeletal problem
do you suspect? What is the pathophysiology for this? In this picture one will have to rule
out malignancy and once that is ruled out then it is invariably osteoporosis. Osteoporosis
osteoclasts during life and replaced by new bone created by osteoblasts. The process is
undersupply of osteoblasts relative to the need for cavity repair (Manolagas, 2020)
What are things that can be done to promote healing of a pathological fracture?
usually occurs automatically (Morrison, 2017). In order for this process to take place, the
bones most be lined up, this process is known as reducing the fracture. Applying plaster
casts or plastic functional braces helps keep the bone positioned during healing (2020). In
promotes healing.
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