05 Oct Discussion: Diagnosis and Management of Musculoske
Discussion: Diagnosis and Management of Musculoskeletal and Neurologic Disorders Musculoskeletal and neurologic disorders can present complications for pediatric patients from infancy to adolescence. These disorders affect patients physically and emotionally and often impact a patient’s ability to participate in or carry out everyday activities. Patients with these disorders frequently need long-term treatment and care requiring extensive patient management and education plans. Musculoskeletal and neurologic disorders present various symptoms because they affect multiple parts of a patient’s body. Consider treatment, management, and education plans for the patients in the following three case studies. Case Study 2: HPI: A 12-year-old girl presents with left knee pain during and after playing soccer. She’s been a member of an elite soccer team for the last 6 years. She has 2 hour practices 3 times a week. Does not recall any injuries. PMH: asthma, eczema MS: Anterior/posterior drawer tests negative; negative ballottement; negative edema/erythema; bony tenderness, slight swelling at the left tibial tubercle. To prepare: Review “Neurologic Disorders” and “Musculoskeletal Disorders” in the Burns et al. text. Review and select one of the three provided case studies. Analyze the patient information. Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments. Consider strategies for educating patients and families on the treatment and management of the musculoskeletal or neurologic disorder. Post an analysis of your assigned case by responding to the following: What additional questions will you ask? Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses). What additional examinations or diagnostic tests, if any will you conduct? What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials. What is your most likely diagnosis and why? How will you treat this child? Provide medication treatment and symptomatic care. Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area. Patient Education, Health Promotion & Anticipatory guidance: Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study. Include any socio-cultural barriers that might impact the treatment and management plans. Health Promotion: What immunizations should this child have had? Based on the child’s age, when is the next well visit? At the next well visit, what are the next set of immunizations? What additional anticipatory guidance should be provided today?
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