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A 25-year-old white male, who is an IV drug abuser, presents with fever, malaise and pain in his right lower leg for the past 1 week. Fever is high grade and is associated with rigors and chills. Pain is 7/10 in severity, does not radiate and is not relieved by ibuprofen, heat or by rest. Knee movements do not have any effect on the pain. He has no history of trauma. His vitals are, PR: 90/min; BP: 116/78mm Hg; Temperature: 39.6C(103F). Examination of his right leg shows bony point tenderness, redness and diffuse swelling below his knee. Range of motion in his knee is normal and there is no effusion present. There is no lymphadenopathy and the rest of the systemic examination is unremarkable. Which of the following is the most appropriate diagnostic technique in this patient?
A. Plain X-ray films of the knee and leg
B. Technetium scan
C. CT scan of the leg
D. MRI of the leg
E. Duplex scan of the right lower extremity
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This patient is most likely suffering from acute osteomyelitis. History of IV drug abuse, high-grade fever, and bony point tenderness in an IV drug abuser is always osteomyelitis until proven otherwise. Patients should receive antibiotics immediately after obtaining the blood cultures. Three phase technetium scan is the test of choice for acute osteomyelitis and it is very sensitive. Plain x-ray films are usually normal in first two to 3 weeks of acute osteomyelitis and therefore are not very sensitive. MRI is usually performed for suspected osteomyelitis of the ˜spine™ and some times foot.
CT scan is not very sensitive in detecting osteomyelitis.
Duplex scan is usually performed when deep venous thrombosis (DVT) is suspected. DVT is a possibility with the above presentation but it is lower on the list because of the above reasons. However, if the Technetium scan and blood cultures turn out to be negative, a duplex should be considered to rule out a DVT.
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if u see in kaplan and listen Fischers we can conclude like this
1st step is xray (periosteal elevation), 2nd is MRI, 3rd is biopsy.
When do you choose bone scan? If you cant do MRI (metal, pacemaker, hearing
tubes, etc). After bx you can make dx: S.aureaus (nafcillin), MRSA (vanco,
linezolid), E.coli (quinolones for bones) and then f/u ESR. When do you choose
culture or sinus drainage? Never!
so y UW is giving the ans scan?
and should we follow the UW or Fischers?
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is bone scan the same as CT scan?
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no pamela they r not the same
lol back to my cook
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i think the most spesific test is bone scan NOT CT scan.
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hey ,zak .what are u cooking?lol
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lol something very light..no timew for complicated dishes looool
boil macarni and make macaroni salad...i love it and it is time saving
lol
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kaplan says not to fall for xray option as it will not show anything for couple of weeks instead do BONESCAN nad start on antibiotics.
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exatly the4 same here ,boiled pasta ,vegtable+salmon(not salmonella)lol
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