GCA & Osteaprosis

Question 1

A 76 year old female referred for temporal artery biopsy . Presented with headache, scalp tenderness, upper limb stiffness and transient loss of vision in one eye.

Q1. Why biopsy taken?

Answer 1

As it’s the dx test for GCA

Question 2

Q2. Whal’s giant cell arteritis?

Answer 2

It’s granoulomatous inflammation dis that affecting Large and medium arteries mainly branches of ECA with mononocular cell infiltration

Question 3

Q3. What are the histological findings on biopsy?

Answer 3

Granoul inflammation /
inflatration of macrophages /
intimal thickening /
Fibrinoud necrosis

Question 4

Q4.What’s the cause of loss of vision?

Answer 4

Due to affection of ophthalmic artery give the end artery CRA giving blood supply to retina

Question 5

Q5 . Mention simple blood test could be used.

Answer 5

ESR

Question 6

Q6. How is this treated? Mention doses?

Answer 6

Oral Pred 60mg oral / Vision loss  IV methylprednisolone 80mg

Question 7

Q7. Patient came back a year later with a # NOF, what’re the possible risk factors for pathological # in this patient?

Answer 7

Female/ Old age / Post-menopausal / Using Steroids /

Question 8

Q8. Other local pathologies could cause pathological # in elderly mention 4?

Answer 8

Osteomalacia /
Hyperparathyroidism /
1ry or 2ry Malignant Dis /
Pagets Dis

Question 9

Q9. What’s pathology of osteoporosis?

Answer 9

Normal mineralization but less bone density

Question 10

Q10. What are the perioperative concerns and how to address them?

Answer 10

Relapse of GCA and Addisonian Crisis
…..
By Giving 100 mg bolus of Hydro then 200 mg over 24hrs (Pre-OP) then will give double oral dose for 24-48 when pt start oral then pt will take his usual dose

Question 11

Q11: After surgery for # she developed confusion, SOB & petechial rash. Diagnosis?

Answer 11

Fat Embolism

Question 12

Q12. What’s the pathogenesis of FE?

Answer 12

After trauma disrubtion of tissue will lead to fat to enter circulation and goes to pulm circulation

Question 13

Q13. What’s osteoid?

Answer 13

Ptn produced by osteoblast which takes part in formation of bone matrix

Question 14

Q14. What’re the risk factors for Ostcomalacia?

Answer 14

Vit D deficiency /
any cause for hypocalcemia / postmenopausal /
Steroid therapy /
Prolonged immobilization.

Question 15

Q15. What’s protein deposition in this case?

Answer 15

Amyloid AA

Question 16

Q16. Why it couldn’t be removed from the body?

Answer 16

Lack of enzymes that destruct or degrade it and also have large molecular wt ptn

Question 17

Q17. How to do ESR?

Answer 17

Draw the blood to a special tube and leave it for one hour in room temp in vertical position and then measure the distance btw the blood mixture and the sediment

Question 18

Sepsis Servival Guidelines

Answer 18

3hrs bundlemeasure lactate / Blood cultre / Give Abx / Give 30 ml/kg of crystaloids.
..
6h bundle hypotension not responding to fluids and in case of peripheral art hypotension despite volum resus you should measure CVP / O2 sat and measure lactate