Chief complaint: 19-year-old non-ambulatory male with pneumonia.
history: james fenlow, a 19-year old male, is immobile and hospitalized for pneumonia. he has a long history of progressive weakening of his muscles. in the first year of his life, james reached many gross motor skill milestones, such as holding his head up, rolling over, sitting, and standing, at normal times. however, he did not walk until age 16 months, and by age two, started to assume a lordoticposture (an exaggeration of the lumbar curvature of the spine) while standing but not while sitting. over the next several years, he suffered progressive muscle weakness, most notably in the proximal musculature of the arms, pelvis, and legs. by age 9, he required orthotic braces to assist his walking, and by age 11, he was confined to a wheelchair. in his early teen years, james was still able to use eating utensils, write, and type on a keyboard, though these functions have declined over the past year. at 16, he was hospitalized with bronchitis requiring antibiotic treatment, but recovered. throughout the years, james has had no history of muscle pain or spasm, chest pain, or irregular heartbeat. the only medications that he normally takes are calcium and fluoride supplements.
physical examination: on examination, james appeared fatigued and short of breath. breath sounds were reduced. his cough was very weak. heart sounds were normal, with no murmur. bowel sounds were normal. musculoskeletal exam revealed a scoliotic (lateral curvature) deformity of the spine when james sat up. james suffers from a condition called duchenne muscular dystrophy. this is a muscular disease characterized by disturbed ("dys") growth ("trophy") of skeletal and cardiac muscle.
answer the questions below:
1. why did james have a lordotic posture and later go on to develop scoliosis (be sure to define what each of these terms refers to)? be sure to specifically address what muscle group deficits lead to these conditions. what is another abnormal curvature of the spine?
2. for each of the abnormal spinal curvatures listed above identify circumstances in which they are likely to be seen.
3. james is prescribed calcium supplements due to his loss of bone mass. what causes this condition in this patient? speak specifically to the loss of muscular function and how that leads to deficits in other structures at the cellular level.
4. why is james susceptible to repeated lower respiratory tract infections? be sure to identify muscular deficits that contribute, as well as the conditions within the lungs that may exacerbate the situation.