Author Question: A 35-year-old woman who has been in recovery from alcoholism for 2 years presents at her primary ... (Read 44 times)

mp14 · **on:** Jun 25, 2018

A 35-year-old woman who has been in recovery from alcoholism for 2 years presents at her primary care physician's office with chronic hip pain.

She reports that as part of her commitment to her recovery, she began exercising regularly about a year earlier. After a month or two, her hip began to hurt when she ran on the treadmill. She stretches, has had a physical trainer check her form to ensure that it is correct, and rests adequately between each workout. Six months ago, the pain began waking her at night, and now it is constant. She is not aware of any injury to her hip and has no other outward symptoms. Which of the following is most likely to be the cause of her pain?
A)
Hematogenous osteomyelitis
B)
Osteomyelitis with vascular insufficiency
C)
Tuberculosis of the bone
D)
Osteonecrosis

Question 2

A 51-year-old male with a history of hypertension has received a kidney transplant.

The client's physician is explaining some of the consequences of the procedure, including the fact that he will need to be on long-term steroid therapy. Which of the following teaching points should the physician emphasize?
A)
One of the risks that these steroids bring is the possibility that part of a bone might die.
B)
Steroids will help your body to not reject your new kidney, but they bring a risk of bone infection.
C)
You're going to have to avoid contact sports because the steroids will make your bones very susceptible to breakage.
D)
If you notice sudden limb pain after taking your steroid pills, it could be an increase in pressure in the compartment around your muscles.

HandsomeMarc · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Ans:
D

Feedback:

The symptoms associated with osteonecrosis are varied and depend on the extent of infarction. Typically, subchondral infarcts cause chronic pain that is initially associated with activity, but that gradually becomes more progressive until it is experienced at rest. Osteonecrosis is a common complicating disorder of Legg-Calv-Perthes disease, slipped capital epiphysis, sickle cell disease, steroid therapy, alcohol abuse, and hip trauma, fracture, or surgery. In adults, hematogenous osteomyelitis is seen most commonly in debilitated patients; in those with a history of chronic skin infections, chronic urinary tract infections, and intravenous drug use; and in those who are immunologically suppressed. Osteomyelitis with vascular insufficiency is characterized by local cellulitis with inflammation and necrosis. Local symptoms of tuberculosis of the bone include pain, immobility, and muscle atrophy; joint swelling, mild fever, and leukocytosis also may occur.

Answer to Question 2

Ans:
A

Feedback:

Osteonecrosis is strongly associated with steroid therapy. Osteomyelitis, decreased bone density, and compartment syndrome are not associated with steroid therapy.