USMLE Forum Archives - USMLE Step 3 - Osteomilitis?
Osteomilitis?
zkadhem - 08-05-09 08:59
A 56-year-old Caucasian man comes to the emergency room with complaints of fever,
pain, and swelling around the right lower leg for the last five days. His symptoms are
getting worse, and he has been having difficulty weight bearing and ambulating for the
last two days. He has a past medical history of coronary artery disease, ischemic
cardiomyopathy with an ejection fraction of 25%, pacemaker implantation for sick sinus
syndrome, and insulin dependent diabetes mellitus with diabetic neuropathy. He is an exsmoker and quit smoking 12 years ago. He is a manager at a local restaurant. On
examination, his temperature is 38.9 C (101 F), heart rate is 86/minute, blood pressure is 132/76 mmHg, and respiratory rate is 16/minute. There is significant swelling and
erythema around the right lower leg. Lower extremity ultrasound is negative for deep
vein thrombosis. A plain radiograph of the lower extremity is also negative for any acute
pathology. You send the blood cultures and start him on appropriate antibiotics. What is
the next most appropriate step in the management of this patient?
zkadhem - 08-05-09 08:59
A 56-year-old Caucasian man comes to the emergency room with complaints of fever,
pain, and swelling around the right lower leg for the last five days. His symptoms are
getting worse, and he has been having difficulty weight bearing and ambulating for the
last two days. He has a past medical history of coronary artery disease, ischemic
cardiomyopathy with an ejection fraction of 25%, pacemaker implantation for sick sinus
syndrome, and insulin dependent diabetes mellitus with diabetic neuropathy. He is an exsmoker and quit smoking 12 years ago. He is a manager at a local restaurant. On
examination, his temperature is 38.9 C (101 F), heart rate is 86/minute, blood pressure is 132/76 mmHg, and respiratory rate is 16/minute. There is significant swelling and
erythema around the right lower leg. Lower extremity ultrasound is negative for deep
vein thrombosis. A plain radiograph of the lower extremity is also negative for any acute
pathology. You send the blood cultures and start him on appropriate antibiotics. What is
the next most appropriate step in the management of this patient?
The correct answer and explanation will be available after you answer.
Page 1
#4
Re: Osteomilitis?
zkadhem - 08-05-09 17:06 Hopefully this mcq will teach us how to pay attention.I was trapped just like you, friends.
We need to open our eyes and minds when we answer~
thx.
#7
Re: Osteomilitis? smyomer - 08-11-09 22:44 this Q is some what tricky because in the book ,if the x ray negative do MRI it more specific than scan .
#20
Re: Osteomilitis? babbu5508 - 09-30-10 14:16 My answer is: a.
Obtain a MRI scan of the lower extremity to confirm the diagnosis...the best single test for bone as well as soft tissues...
#29
Re: Osteomilitis? sudha2015 - 12-25-10 17:47 My answer is: b.
in bonescan we can easily c d pathology
Page 1