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th th th th th


please be back

lol ! ray33.
How are ya ?
You want me back or you want my question back ? lol !!




OK, a gift for you !
see below:




























































































































































































































































































































101.
A 72-year-old man has a 10-year history of end-stage renal disease and requires hemodialysis three times weekly. The dialysate is administered through an arteriovenous polytetrafluoroethylene graft in his left forearm. About 1 week ago, he developed fever. Three sets of blood cultures drawn during his dialysis session were positive for methicillin-resistant Staphylococcus aureus. The patient is hospitalized, and intravenous vancomycin and gentamicin are begun.

Three days after therapy is started, he develops back pain. On physical examination, he is afebrile and has no neurologic deficits. MRI of the spine shows evidence of osteomyelitis involving vertebral bodies T10 and T11, diskitis, and a small epidural collection without impingement on the spinal cord.

Which of the following is the most appropriate management at this time?

A Monitor the patient's neurologic status while on antimicrobial therapy
B Perform CT-guided aspiration of the epidural collection
C Refer for immediate laminectomy to drain the epidural collection
D Place a lumbar drain
E. Closely observe clinically

can i answer this question........... !!!
or is it only for ray33.................. ??

lol !
yes, try boss !

this is a good question...
but is beyond the scope of step 3....my opinion only!
BUT I ENJOYED THE PROCESS OF PICKING MY ANSWER....as you see........lol...

so the story is that the AV fistula get infected..most commoN bug is Staph aureu...
bactermia evelops and leads to complications like osteomyelitis, diskitis and epidural abcess formation.......hmm!

now theY tell me that pt does not have any focal neurological deficit...ie, secondary to spinal cord compression or due to individual spinal nerve root compression...
but there is some collection of fluid in th epidural space...

next best step would be... B !!
if he had sxs of SC compression than ... C...would have been the right answer then!



Correct Answer:::::::::::::: *B*.

thanks for your participation, boss, but,
How do you know that this Q is beyond the socpe of Step 3 ?
Do you wirte Qs for step 3 or do you teach for step 3 or did you take step 3 many times ???
lol !! Just kidding...please do not KILL me, "I already died in her arms yesternight"...

Think about it what I said !

TH...i do not understand a word of what you are saying?????
how can i think about it !!!!
let me put you on the spot here......why do you have something against ppl who take step3 abunch of times??????.......lol....

this q is appropriate for Infectious Dz, IM or maybe Anethesia/Pain boards!

ok, let me ask you the question straight forward:

How do you know which Q is beyond the scope of step 3 ?
Please, genuine answer please, no guessing !!

ray33,
what is your answer to this question ?
or you are gone for the day !!

TH.. Since u have put this question, I need to answer
I think its A.
B. not done for therapeutic reasons
C. Small epidural not compressing; avoid invasive surgery in 72 yr.
D. Lumbar drain will drain CSF from subarachnoid space
E. Can be. its very similiar to A

whats the answer captain