osteomyelitis

Question 1

Male patient presented with his left knee swelling and redness with history of the tibial fracture and internal fixation.
..
Q1.Investigation?

Answer 1

Aspiration and send for C&S / Gram Stain

Question 2

Q2: What you look for in aspirated fluid? what tests will you do?

Answer 2

Viscosity and
turbidity and
color
WBCs
PMNs
Crystals
/ Gram Stain, Crystal , Chemical analysis and C&S

Question 3

You are given a pathological report showing proteins, cocci, and PMN.
Q3.Diagnosis?
Q4: What do you think the cause is?
Q5.Common organism?

Answer 3

3 . Chronic OstMyelitits
4 . Implant
5 . S. Aureus

Question 4

Q6:How is pus formed (pathogenesis)?

Answer 4

after microbial invasion – > inflammation with vascular congestion this will cause exudation and infiltration with PMNs

Question 5

Q7: Why pus burst through the bone?

Answer 5

Pus bursts through the bone due to an increase in intraosseous pressure secondary to tissue breakdown. This pressure increase leads to the formation of a cloacal opening in the involucrum, which subsequently breaks down.

Question 6

Q8: Why SCC developed? Sequence of events?

Answer 6

Due to chronic irritation to tissue – > Metaplasia – > dysplasia and cancer formation.

Question 7

Q9.Name of protein deposit in OM?

Answer 7

AA Amyloid

Question 8

Q10.Specific pathological name for pus around the screw or implanted plate?

Answer 8

Biofilm

Question 9

Q11.Define sequestrum & involucrum?

Answer 9

S; Dead bone tissue separated from normal tissue of bone
I; sheath of new bones that surround sequestrum

Question 10

Q12:Type of crystals in gout & pseudogout?

Answer 10

Ps; Calcium pyrophosphate
G; Urate Crystals

Question 11

Q14: Why amyloid can’t be removed from the body?

Answer 11

Large molecules and no enzymes to break it down and degrade it.

Question 12

You are given a pathological report showing proteins, cocci, and PMN.
Q.From report what’s your Dx?

Answer 12

Bacterial Infection which is OM and not Septic arthritis as we cannot apply Kochers criteria (WBCs-Temp-NonWt Bearing)

Question 13

What will do you for this pt?
Osteomyelitis

Answer 13

Remove implant and give Abx

Question 14

How to prevent it before surgery?

Answer 14

Abx - Good preparation – Avoid long starvation – Aseptic technique – Laminar flow

Question 15

What’s the cause of inf. Of this pt?

Answer 15

As this pt on steroids for RA – > suppression of immunity