MUSCULOSKELETAL BLOCK CASE 1 A 68 years old woman presents to your office complaining of aching lower back pain.

She was menopause 15 years ago. Upon directed history, she tells you that she feels that she is getting shorter and you note that she has a slight hunchback. An x-ray of her spine reveals a compression fracture of the L4 vertebra. 1. 2. 3. 4. 5. CASE 2 A 67 years old woman presents to your clinic complaining of stiffness and pain in her left knee. Upon further questioning, she tells you that the pain becomes worse later in the day after she has been walking around. Physical exam reveals a swollen, tender left knee with joint effusion. You also notice bony nodules on her DIP and PIP joints. She was diagnosed to have osteoarthritis 1. 2. 3. 4. 5. CASE 3 A 74 years old man presents to your clinic complaining of bone pain in his left thigh. He also reports that he has developed bilateral hearing loss. Directed questioning reveals that he has noticed an increase in his hat size. Lab results demonstrate an increased serum ALP and an x-ray of his left thigh shows mixed thickening and lucency of the bone. You worry that this patients condition may put him at risk for osteosarcoma and high output cardiac failure. 1. 2. 3. 4. State your provisional diagnosis State briefly the pathogenesis of this disease State how this disease may leads to high output cardiac failure Explain briefly the pathophysiology of bilateral hearing loss in this patient Define osteoarthritis State the pathogenesis of osteoarthritis State 2 differences between osteoarthritis and rheumatoid arthritis Name the signs bony nodules on her DIP joint and bony nodules on her PIP joint State 1 pharmacological treatment in this patient and 1 surgical treatment in this patient State your provisional diagnosis Classify the disease you stated above, list 2 causes under each classification State the pathophysiology of compression fracture of L4 vertebra related to your diagnosis State 3 pathological findings in this patient State 4 treatment for this patient

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CASE 4 A 19 years old boy presents to the emergency department complaining of right lower thigh pain following a minor fall. An x-ray of his right thigh reveals a fracture in a stalk of bone growth protruding from the end of his femur. Although you believe the growth to be benign and due to an autosomal dominant trait, you obtain a bone biopsy to rule out malignancy. 1. 2. 3. 4. CASE 5 A 4 months old baby boy is brought to the emergency department by his adoptive parents, because their baby has been fussy and seem to cry whenever his left arm is touched. On physical exam, you noticed hypoactivity of the left arm. X-ray of the left arm reveals multiple fractures. You decide to order multiple radiographs of the skull, chest and all extremities looking for evidence of other fractures. On closer physical exam, you do not see any abnormal bruising of the trunk, back or buttocks. You then notice the child has blue sclera. 1. 2. 3. 4. CASE 6 A 38 years old woman presents to your office complaining of chronically swollen finger joints over the past 6 months. She tells you that the swelling and pain are usually most severe in the morning, but do resolve within a couple of hours. Physical exam reveals swelling of the PIP and MCP joints of both hands, ulnar deviation of the fingers, the swan-neck deformitiy and subcutaneous nodules over both of her elbows. Lab result reveals the presence of specific IgM antibody against the Fc fragment of IgG 1. 2. 3. 4. 5. CASE 7 A 15 years old boy presents to the emergency department with suspected fractures of the left tibia and fibula following a fall. He tells you that he has broken several bones in the past and his mother has a bone disease. Physical exam reveals a slight hearing loss, facial asymmetry and hepatosplenomegaly. Lab test demonstrate anaemia and x-ray of his left leg shows fracture of both tibia and fibula as well as an Erlenmeyer flask deformity. 1. 2. 3. State your diagnosis Briefly explain why this patient develops anaemia Explain how this patient develops hearing loss and facial asymmetry State your provisional diagnosis State the pathogenesis of the disease you stated above What do you mean by swan-neck deformity? explain with the aid of diagram State 2 treatment in this patient and briefly describe how this treatment would help the patient List and explain 4 theories of autoimmunity State how fracture is classify in this patient State your diagnosis Classify the disease you stated above Explain how this patient develops blue sclera State your diagnosis based on radiological findings Explain briefly the pathophysiology of right lower thigh pain following a minor fall Based on autosomal dominant trait, state you genetic diagnosis List 2 gross pathological findings in this patient

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CASE 8 A 13 years old boy presents to your office complaining of pain and swelling in his left knee. He denies any trauma to the knee and has no fever to suggest an infectious process. Lab tests reveal an increased serum alkaline phosphate and an x-ray of the knee shows a mass with a sunburst growth pattern and a periosteal elevation by the mass and he was diagnosed to have osteosarcoma 1. 2. 3. 4. CASE 9 A 22 years old man presents to your office complaining of lower back pain and stiffness. On further history, you discover that he occasionally has stiffness of his left knee as well. Physical exam reveals pain and limited range of motion of sacroiliac spine. When an x-ray of the spine demonstrates a characteristic bamboo spine, you begin to suspect that this patient is probably an HLA-B27 positive individual. 1. 2. 3. CASE 10 A 5 years old boy is brought to your office by his parents, who are concerned about skeletal deformities. Physical exam reveals a short boy with protrusion of the sternum, thinning of the occipital and parietal bones result in squared appearance of the head and the rachitic rosary. His parents tell you that he is well nourished, plays outside a lot and has had no prior medical problems. He was diagnose to have rickets 1. 2. 3. 4. CASE 11 A 6 years old boy presents to your office complaining of severe muscle weakness, especially of his thigh. The boys parents tell you that his maternal uncle died of a muscle disease during adolescence. Physical exam reveals enlarged calves and decreased strength in the proximal muscles of the lower extremities. When you ask the boy to rise from a crouching position, he uses his arms to assist himself. Lab tests demonstrate increased serum creatine kinase levels. 1. 2. 3. 4. 5. State your diagnosis State the pathogenesis of the disease you stated above State the pathophysiology of increasing creatinie kinase levels in this patient State the term he uses his arms to assist himself to rise from crouching position Explain why this patient have enlarge calves Explain briefly the regulation of calcium in this patient State 3 likely causes of rickets in this patient What is rachitic rosary? State the treatment in this patient State 3 differential diagnosis in this patient Explain what do you mean by Reiters syndrome State the causative organism in Reiters syndrome State 4 risk factors of developing osteosarcoma State the radiological term of elevation of periosteal by the mass Define and state steps involve in carcinogenesis State 2 gross pathological findings and 2 histopathological findings in this patient

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