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Pyogenic Infection (osteomyelities)

CASE-1

A 11 years old boy develops a mild fever and pain in the upper
arm, X-ray shows a lytic lesion in the humerus with periosteal
elevation. Patient is taken to surgery, lesion is debrided, pus
removed and sent to the laboratory for investigation.

Q.1. Describe the gram stain morphology.

Q.2. Identify the media and comment on the growth.

Q.3. What is coagulase test.

Q.4. Identify the causative organisms.

Q.5. What is MRSA ? What is the mechanism of penicillin

resistance.

Q.6. Mention the other organisms causing osteomylitis.

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URINARY TRACT INFECTION

CASE-2

A 30 years old female comes to the out patient deparment

complaining of burining micturition.A mistream urine specimen
collected aseptically is subjected to culture and biochemical
reactions are put up.

Q.1. Identify the medium and comment on the growth.

Q.2. Interpret the biochemical reactions.

Q.3. Mention the other bacteria causing U.T.I.

Q.4. What is the Significant bacteriuria?

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ENTERIC FEVER-BACTERIOLOGICAL
DIAGNOSIS
Case-3

Blood culture is done for a patient suffering from fever for 5 days
duration and sub culture is done on solid media.

Q.1. What is PUO ? Mention its causes.

Q.2. How is blood collected for culture ?

Q.3. Identify the media and comment on the growth.

Q.4. Interpret the biochemical reactions.

Q.5. Mention the other specimens sent to the laboratory in a

case of Enteric fever
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ENTERIC FEVER-SEROLOGICAL
DIAGNOSIS

Case-4

A serological test is put up for a patient suffering from fever for

10 days duration.

Q.1. Identify the test and give your interpretation.

Q.2. What is the diagnostic titre ?

Q.3. How do you interpret widal test

Q.4. What is basal titre ?

Q.5. How would you investigate a carrier ?

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BACILLARY DYSENTERY

Case-5
A 20 Year old male complains of colicky abdominal pain and frequent small
stools with blood and mucus.The stool is subjected to culture and biochemical
reactions are put up.

Q.1. Identify the medium and comment on the growth.

Q.2. Interpret the biochemical reactions.

Q.3. Mention the organisms that cause

a) Dysentery
b) Diarrhea

Q.4. Difference between bacillary dysentery and amoebic dysentery

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CHOLERA
Case-6
A 18 Year old male is brought to the Emergency room with a history of profuse
watery diarrhea. On examination, he shows signs of severe dehydration. The
stool sample is subjected to culture and biochemical reactions are put up.

Q.1. Identify the medium and comment on the growth.

Q.2. Interpret the biochemical reactions.

Q.3 How do you confirm the diagnosis

Q.4. How do you differenciate between eltor and classical vibrio biotypes

Q.5. What is the pathogenesis of this organism ?

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FUNGAL VAGINITIS

Case-7

A 30 years old female, comes to the out patient department

complaining of curdy white discharge per vagina associated with
intense pruritis. A high vaginal swab collected with aseptic
precautions is subjected to culture and a smear made is stained by
Gram's technique.

Q.1. Describe morphology on Gram's stained smear.

Q.2. Identify the medium and comment of the growth.

Q.3. Identify the causative organism.

Q.4. Mention the various lesions caused by this fungus.

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PULMONARY ASPERGILLOSIS

Case-8

A 60 Year old male on immunosuppressive therapy is brought to the

medical out patient department with a history of productive cough
1month duration. The sputum is subjected to culture a lactophenol
cotton blue mount is made from the growth.

Q.1. Describe the microscopy of lactophenol cotton blue mount

Q.2. Identify the medium and comment on the growth

Q.3 Identify the causative agent.

`

Q.4. What are the other infections caused by this fungus?

Q.5. Mention the other fungi causing opportunistic mycosis ?

RHINOCEREBRAL ZYGOMYCOSIS
Case-9
A 50 Year old immuno compromised male patient complains of facial pain,
headache, and lethargy. On examination brownish blood stain nasal discharge
is seen from the left side with a black Escher from the
palate. The nasal discharge and the biopsy from the turbinate are subjected
to fungal culture and a
lacto phenol cotton blue mount is made from the growth.

Q.1. Describe the microscopy of lactophenol cotton blue mount

Q.2. Identify the medium and comment on the growth

Q.3 Identify the causative agent.

Q.4. Mention the various factors that predispose to Rhinocerebral

zygomycosis
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RABIES
Case-10
A 10 years old boy was bitten by a dog and presented to emergency
department with laceration on leg. The would was treated with povidone
iodine and left opened to be healed. Anti rabies vaccination
was started immediately. The dog died two days later. Impression smear of
the dogs brain was made
and stained appropriately.

Q.1. Describe what you see in the smear and identify the stain used.

Q.2. What is Ante-mortem diagnosis of Rabies

Q.3. what is the immunization schedule followed in India ?

Q.4. How do classify the wounds caused by dog bite ?

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RHINOCEREBRAL ZYGOMYCOSIS
Case-11
A 25 Year old male presents to the medical out patient with a history of jaundice of
the 1 month duration. Blood collected is subjected to electron microscopy and
serological testing.

Q.1. Identify the particles seen in the Electron microscope.

Q.2. Briefly explain serological markers

Q.3 Enumerate the other Hepatitis viruses and their modes of transmission.

Q.4. Mention the complications of serum Hepatitis..

Q.5. Prophylaxis of hepatitis-B infection.

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AIDS
Case-12
A truck driver presented to OPD with a history of weight loss and decrease
appetite and mild fever for a duration of one month. On investigation he was
found to be HIV+Ve. He is referred to the laboratory for a confirmatory test.

Q.1. Describe the morphology of HIV.

Q.2. Identify the serological tests put up and give your interpretation.

Q.3 What are the mechanisms involved in Immunodeficency?

Q.4. What is the window period in the lab diagnosis of HIV infection
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Q.5. Mention the different strategies for diagnosis

Q.6. How do you monitor the progress of disease

Q.7. Opportunistic infection in HIV

Q.8. Post exposure prophylaxis ?

AETCOM
Scenario 1

Ladies 20 years admitted for fever and breathlessness jumps from 4th floor
the hospital and dies it was revealed that she was recently diagnosed to be
HIV reactive and retro positive labels where put on the case files and bed
family members had to come to know about HIV status when they had
inquired with a junior resident about retro positive label. They became
stressed out and shouted at the patient except mother all other family
members has stopped visiting her then onwards.

Scenario 2

A 33-year-old man is admitted to the emergency ward with multiple Limb

fractures. With ongoing medical treatment his vitals are stabilized, he is
conscious and oriented. Emergency surgery is planned. His relative comes to
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the laboratory to collect the investigation reports, he isis given all reports
except HIV results. He is Suspicious and is specifically askingif the
laboratory is not issuing only HIV report because it is reactive. Technician
gets a call from the ward asking for the HIV report immediately over the
phone, as the patient is being shifted to the operating room.

Case scenario 3

Sequestrum from a chronic osteomyelitis case was debrided and sent for
culture and sensitivity. The sample was rejected by the laboratory
mentioning that it was received in formalin, hence unsuitable for culture.
There is no more sample available for culture now.

Case scenario 4

A critically ill 5 year old child’s CSF report is awaited for 3 days. On enquiry
laboratory says it did not receive the sample. On further probing, it was
found that the nursing staff had kept the small bottle with the sample in his
pocket and mistakenly taken it outside the hospital & had dropped it
somewhere, and did not submit it to the laboratory for testing. Now the baby
needs to undergo lumbar puncture again, results may not be the same as
antibiotics are given & need to wait for some more days for the culture
report.

CASE-1

A 11 years old boy develops a mild fever and pain in the upper
arm, X-ray shows a lytic lesion in the humerus with periosteal
elevation. Patient is taken to surgery, lesion is debrided, pus
removed and sent to the laboratory for investigation.

Q.1. Describe the gram stain morphology.

`

Q.2. Identify the media and comment on the growth.

Q.3. What is coagulase test.

Q.4. Identify the causative organisms.

Q.5. What is MRSA ? What is the mechanism of penicillin

resistance.

Q.6. Mention the other organisms causing osteomylitis.

CASE-2

A 30 years old female comes to the out patient deparment

complaining of burining micturition.A mistream urine specimen
collected aseptically is subjected to culture and biochemical
reactions are put up.
`

Q.1. Identify the medium and comment on the growth.

Q.2. Interpret the biochemical reactions.

Q.3. Mention the other bacteria causing U.T.I.

Q.4. What is the Significant bacteriuria?

Case-3

Blood culture is done for a patient suffering from fever for 5 days
duration and sub culture is done on solid media.

Q.1. What is PUO ? Mention its causes.

`

Q.2. How is blood collected for culture ?

Q.3. Identify the media and comment on the growth.

Q.4. Interpret the biochemical reactions.

Q.5. Mention the other specimens sent to the laboratory in a

case of Enteric fever

Case-4

A serological test is put up for a patient suffering from fever for

10 days duration.

Q.1. Identify the test and give your interpretation.

`

Q.2. What is the diagnostic titre ?

Q.3. How do you interpret widal test

Q.4. What is basal titre ?

Q.5. How would you investigate a carrier ?

Case-5
A 20 Year old male complains of colicky abdominal pain and frequent small
stools with blood and mucus.The stool is subjected to culture and biochemical
reactions are put up.
`

Q.1. Identify the medium and comment on the growth.

Q.2. Interpret the biochemical reactions.

Q.3. Mention the organisms that cause

a) Dysentery
b) Diarrhea

Q.4. Difference between bacillary dysentery and amoebic dysentery

Case-6
`

A 18 Year old male is brought to the Emergency room with a history of profuse
watery diarrhea. On examination, he shows signs of severe dehydration. The
stool sample is subjected to culture and biochemical reactions are put up.

Q.1. Identify the medium and comment on the growth.

Q.2. Interpret the biochemical reactions.

Q.3 How do you confirm the diagnosis

Q.4. How do you differenciate between eltor and classical vibrio biotypes

Q.5. What is the pathogenesis of this organism ?

Case-7
`

A 30 years old female, comes to the out patient department

complaining of curdy white discharge per vagina associated with
intense pruritis. A high vaginal swab collected with aseptic
precautions is subjected to culture and a smear made is stained by
Gram's technique.

Q.1. Describe morphology on Gram's stained smear.

Q.2. Identify the medium and comment of the growth.

Q.3. Identify the causative organism.

Q.4. Mention the various lesions caused by this fungus.

`

Case-8

A 60 Year old male on immunosuppressive therapy is brought to the

medical out patient department with a history of productive cough
1month duration. The sputum is subjected to culture a lactophenol
cotton blue mount is made from the growth.

Q.1. Describe the microscopy of lactophenol cotton blue mount

Q.2. Identify the medium and comment on the growth

Q.3 Identify the causative agent.

Q.4. What are the other infections caused by this fungus?

Q.5. Mention the other fungi causing opportunistic mycosis ?

`

Case-9
A 50 Year old immuno compromised male patient complains of facial pain,
headache, and lethargy. On examination brownish blood stain nasal discharge
is seen from the left side with a black Escher from the
palate. The nasal discharge and the biopsy from the turbinate are subjected
to fungal culture and a
lacto phenol cotton blue mount is made from the growth.

Q.1. Describe the microscopy of lactophenol cotton blue mount

Q.2. Identify the medium and comment on the growth

Q.3 Identify the causative agent.

Q.4. Mention the various factors that predispose to Rhinocerebral

zygomycosis
`

Case-10
A 10 years old boy was bitten by a dog and presented to emergency
department with laceration on leg. The would was treated with povidone
iodine and left opened to be healed. Anti rabies vaccination
was started immediately. The dog died two days later. Impression smear of
the dogs brain was made
and stained appropriately.

Q.1. Describe what you see in the smear and identify the stain used.

Q.2. What is Ante-mortem diagnosis of Rabies

Q.3. what is the immunization schedule followed in India ?

Q.4. How do classify the wounds caused by dog bite ?

`

Case-11
A 25 Year old male presents to the medical out patient with a history of jaundice of
the 1 month duration. Blood collected is subjected to electron microscopy and
serological testing.

Q.1. Identify the particles seen in the Electron microscope.

Q.2. Briefly explain serological markers

Q.3 Enumerate the other Hepatitis viruses and their modes of transmission.

Q.4. Mention the complications of serum Hepatitis..

Q.5. Prophylaxis of hepatitis-B infection.

`

Case-12
A truck driver presented to OPD with a history of weight loss and decrease
appetite and mild fever for a duration of one month. On investigation he was
found to be HIV+Ve. He is referred to the laboratory for a confirmatory test.

Q.1. Describe the morphology of HIV.

Q.2. Identify the serological tests put up and give your interpretation.

Q.3 What are the mechanisms involved in Immunodeficency?

Q.4. What is the window period in the lab diagnosis of HIV infection

Q.5. Mention the different strategies for diagnosis

Q.6. How do you monitor the progress of disease

Q.7. Opportunistic infection in HIV

Q.8. Post exposure prophylaxis ?

`