An 81-year-old female was admitted to the hospital for a

An 81-year-old female was admitted to the hospital for a total knee arthroplasty. After the surgical procedure she had no postoperative complications and a successful recovery. Two years later, while living independently at home, she began to experience chronic, daily pain in the knee and joint. To control the pain, she would take acetaminophen every several hours as directed. She finally presented to her orthopedic surgeon after a 2-month history of the pain. She could not recall any injury or change in activity that may have initiated the pain. Physical examination of the knee and joint demonstrated moderate swelling and mild erythema of the artificial joint. She experienced increased pain with weight bearing and passive range of motion. A new x-ray revealed no acute fractures or deformities but did reveal a small effusion, indicating the need for an arthro-centesis. Joint fluid revealed no crystals, 110,000 white blood cells, and 25,000 red blood cells. Questions 1. Describe the proper interpretation for the Gram stain depicted in Figure 13-7. 2. What additional laboratory tests would assist in the diagnosis of the patient’s condition? 3. Review the laboratory tests in the following table: Laboratory Test WBC (white blood cells) RBC (red blood cells) Hgb (hemoglobin) Hot (hematocrit) MCV (mean cell volume) MCH (mean cell hemoglobin) MCHC (mean corpuscular hemoglobin concentration) Patient Results Normal Range 16 5-10 × 10°/L 4.3 4-5 × 1012L 13.5 12-16 0.40 0.36-0.46 L/L 94 80-100 fL 31 26-34 pg 33 30%-37% Laboratory Test Platelets Patient Results Normal Range 156 150-400 x 10°/L Neutrophils 85 25%-60% Lymphocytes 12 20%-50% ESR (erythrocyte sedimenta- 72 0-15 mm/h tion rate) CRP (C-reactive protein) 15.5 <1 mg/dL Identify the abnormal results. What is the possible diagnosis based on the patient's history and laboratory results? 4. What follow-up treatment would be indicated in this case?

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