Osteomyelitis - Case Discussion And Questions

Osteomyelitis in adults almost always presents in a patient with diabetes, peripheral arterial disease, or both with an ulcer or soft tissue infection. You can also think about osteomyelitis in patients with direct trauma and a history of orthopedic surgery , but the case with diabetes and peripheral vascular disease is more likely to show up on exam.

Diagnostic Testing:

• Best initial test : Plain X ray
• Best second test ( if X ray is negative and there is clinical suspicion) : MRI
• Most accurate test: bone biopsy and culture

The patient losses almost 50 % of the bone calcium before the x ray becomes abnormal. Although it may take up to 2 weeks for osteomyelitis to become severe enough to show on X ray , the X ray is still the best test. 

Question: 

Which of the following is the earliest finding of osteomyelitis on X ray?

A. Periosteal elevation

B. Involucrum

C. Sequestrum

D. Punched out lesions

E. Fracture

Managing A Case Of Dog Bite

A 50-year-old man is brought to you in ED after being bitten by a stray dog. The bite was unprovoked and is on the abdomen. The patient has no other health history of note and has not taken antibiotics for over a year. You irrigate the wound and are deciding about closure. There is a 3-cm laceration on the abdomen.

All of the following are true about dog bites EXCEPT:

A) They tend to be primarily crush-type injuries.
B) In general, the infection rate is similar to a laceration from any other mechanism (e.g., knife cut),
except on the hands and feet.
C) A common organism in infected dog bites is Staphylococcus aureus.
D) Primary closure of dog bite wounds is an acceptable
option (except perhaps on the hands and feet).
E) They always require antibiotics.

Answer And Discussion

A Patient on Anti Tuberculous Therapy Presents With Seizures

A 45 year old woman is brought to the emergency department with seizures. Her daughter informed the doctor that she has been on antituberculosis therapy for last 2 months, There was no previous history of seizures or epilepsy.
The best therapy for seizures secondary to isoniazid ingestion is:

A) Lorazepam.
B) Phenytoin.
C) Pyridoxine.
D) Thiamine.
E) Phenobarbital.

Answer And Discussion

A Case Of Gynecomastia

A 60-year-old alcoholic man, currently being treated for gastritis, presents to the office with painful breasts that appear enlarged. The most likely cause is

A) Breast cancer
B) Excessive calcium carbonate ingestion
C) Omeprazole use
D) Trauma
E) Prolactinoma

Answer And Discussion:
The answer is C. (Omeprazole use)

Gynecomastia is a condition characterized by enlargement of the breasts in men. It occurs when there is hypertrophy of breast tissue beneath the areola. In young adolescents, it is a natural response to the body’s hormones. During this time, the breast may be tender. Patients and their parents should be reassured this is a natural response and will eventually resolve (usually within 3 years).

Screening For Prostate Cancer

A 60-year-old man presents to your office inquiring about prostate cancer screening. Choose the correct statement:

A) PSA is the gold standard test for prostate cancer screening.
B) PSA should be checked annually starting at 50 years of age to screen for prostate cancer.
C) PSA can produce false-positive results, which can be associated with negative psychological effects.
D) Men who have false-positive test are less likely to have additional testing.
E) The USPSTF recommends PSA testing to screen for prostate cancer at age 60.

Answer And Discussion:

Cerebral Palsy

An 18 month old child attends the child development center for a thorough assessment with suspected diagnosis of cerebral palsy. Which of the following clinical features would be most likely to suggest an alternative diagnosis?
Select ONE answer Only

A. Dystonia
B. Family history of cerebral palsy
C. Hyperkinesia
D. Prematurity
E. Spasticity

Correct Answer is option B:  Family history of cerebral palsy

Cerebral Palsy:

Cerebral Palsy is a descriptive term which has been defined as a group of permanent disorders of movement and posture causing activity limitation that are attributed to non progressive disturbances that occurred in the developing fetal or infant brain.