Melh. UW bullet cases 3 MSK Flashcards
Mehl. 16M + soccer tournament yesterday + fever + high WBCs + bone pain + Tc99 bone scan shows uptake in the metaphysis; Dx?
osteomyelitis; uptake in metaphysis, not diaphysis (Ewing).
Mehl. 15F + severe pain of sternoclavicular joint + fever + arthrocentesis yields thick, yellow fluid + gram stain shows gram-negative diplococci; next best step?
culture of the aspirate fluid
“wtf why? You’ve already determined the organism” -> determine sensitivities; but empirically she would receive IM ceftriaxone and oral azithromycin or doxycycline; if septic, do IV therapy
UW. 15 y/o + sickle cell disease + 2 days of fever and severe pain in the left knee. The patient has been hospitalized previously for acute vasoocclusive crises, which generally occur in his arms. Temp. 38.2 C. Physical examination shows marked tenderness and swelling over the proximal tibia. Lab: leukocytosis and an elevated CRP. MRI of the left leg shows marked inflammation of the proximal tibia without joint effusion. Blood culture is obtained. Empiric antibiotic therapy?
CEFTRIAXONE AND CLINDAMYCIN
(solo vanco was wrong answer)
Need to cover S aureus and Salmonela
S aureus - clindamycin
Salmonela - ceftriaxon
clindamycin solo OR vancomycin solo - can cover MRSA, but does not cover salmonela, therefore solo therapy would not be efficient.
UW. 7y/o boy + began 3 days ago parents noticed him limping. He had mild right lower leg pain at that time, but subsequently developed fever, fatigue, and decreased appetite 2 days ago. The patient’s pain is currently 7 on a scale of 0-10 in severity, is nonradiating, and is unrelieved by ibuprofen, heat, or rest. He has no history of trauma and is otherwise healthy. Immunizations are up to date. The patient’s second cousin has sickle cell disease. Temp. 39.4 C, BP 100/70 pulse 138/min, RR 22/min. Examination of the right leg shows bony point tenderness, erythema, and warmth over the proximal tibia. Blood is drawn for culture. Which of the following organisms will most likely be isolated from this patient’s blood?
STAPH. AUREUS
zymejau salmonela. nors second cousin serga sickle cells disease, bet sitas vaikas pats neturi sickle simptomu, todel nereikia traktuoti kad serga. Todel sukelejas = s aureus, be salmonelos
