NBME Form2, 42-y woman,IVD,

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NBME Form2, 42-y woman,IVD,

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8 Posts

nida
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01/17/07 - 05:52 AM

A 42-year-old woman comes to the physician because of increasing low back pain for 2 days. She is a daily intravenous drug user. She has a history of pyelonephritis, abscesses at injection sites, and pelvic inflammatory disease. Her temperature is 39 C (102.2 F), blood pressure is 130/70 mm Hg, pulse is 84/min, and respirations are 20/min. Examination shows warm, dry skin, a supple neck, and no jugular venous distention. There is tenderness over L4. Pelvic examination shows mild erythema around the cervical os and scant discharge; there is no adnexal or cervical motion tenderness. Her hematocrit is 30%, leukocyte count is 10,600/mm3, and serum glucose level is 110 mg/dL. Urinalysis is within normal limits. Which of the following is the most appropriate next step in management?

A) Echocardiography

B) Renal ultrasonography

C) MRI of the back

D) Colposcopy

E) Laparoscopy

prathapdoctor
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Topics: 12
Posts: 406

01/17/07 - 11:15 AM

i have gone for MRI of the back in the exam,i think thats the right choice.

drashishmahajan
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Topics: 6
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01/17/07 - 12:27 PM

i guess this is disseminated gonorrhoea infection with cervicitis in which Wbc count stays normal wid mild redness n discharge.. MRI ll tell if tenosynovitis or abscess is there...

raghavesh_p
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03/30/07 - 11:49 PM

even me too for MRI

Justice
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03/31/07 - 05:38 PM

Yes, I go with (C), but let's answer another Q:
when you give a referral to MRI, you virtually transfer Pt to the nuc radiology dept. From my experience I know that it is quite uneasy to get an appt for the same day, or even within a week... Usually it takes 7-10 days to have the test done + 1 day to have a reading. Considering this, can this be the most appropriate next step in management, timewise?

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new_n_lost
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03/31/07 - 05:40 PM

Justice wrote:
Yes, I go with (C), but let's answer another Q:
when you give a referral to MRI, you virtually transfer Pt to the nuc radiology dept. From my experience I know that it is quite uneasy to get an appt for the same day, or even within a week... Usually it takes 7-10 days to have the test done + 1 day to have a reading. Considering this, can this be the most appropriate next step in management, timewise?

B) Renal ultrasonography ????

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Justice
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03/31/07 - 06:06 PM

RE: B) Renal ultrasonography ????

With normal urinalysis, I am a bit doubtful about USG

Edited by Justice on 04/01/07 - 08:12 AM

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damngood
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03/31/07 - 09:58 PM

tenderness on the spine L4 indiacates osteomyelitis of spine
soo MRI wud be the best option as thats the only one that detects it

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