sprint123
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25 year old male presents with right foot pain.He stepped on a nail several days ago.At that time,tetanus shot was givena nd the wound was thoroughly irrigated.Now,on examination he ahs red,swollen,tender wound.Osteomyelitis is suspected.Wat is the most appropriate next step in the diagnosis of this patient?
A.WBC count
B.CT scan
C.Gallium scan
D.Technetium scan
E.X-ray of the right foot
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| Justice
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Either (E) or (C)... Not (D)-used for functional scanning of the heart.
I like C better, and it accumulates specifically in the site of acute inflammation (not selectively though)... Here are some indications to it:
* Detect the source of an infection that is causing a fever
* Detect an abscess or certain infections, especially in the bones.
* Monitor the response to antibiotic treatment.
* Diagnose inflammatory conditions such as pulmonary fibrosis or sarcoidosis.
* Detect certain types of cancer (such as lymphoma). A gallium scan also may be done to determine whether cancer has metastasized to other areas of the body, or to monitor the effectiveness of cancer treatment.
BUT, plain X-ray probably should be taken first.
Any other thoughts?
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| Adam
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X-ray may not help in osteomyelitis during the first days ( i guess till 10-12 days after the infection), i think it will only show the soft tissue oedema...
The first diagnostic test is Technetium scan (D) or MRI (not in the choices),,
WBC, gallium and CT are nonspecific for osteomyelitis.
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| Justice
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Adam wrote:
X-ray may not help in osteomyelitis during the first days ( i guess till 10-12 days after the infection), i think it will only show the soft tissue oedema...
The first diagnostic test is Technetium scan (D) or MRI (not in the choices),,
WBC, gallium and CT are nonspecific for osteomyelitis.
OK, i found the info...
o A 3-phase bone scan with technetium 99m is probably the initial imaging modality of choice.
o In special circumstances, additional information can be obtained from further scanning with leukocytes labeled with gallium 67 and/or indium 111.
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| sprint123
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yOU GOT IT GUYS!!But I have a query!
I remember Dr.Fischer saying that we have to do an X-ray first and if it is positive(sometimes) we could straight away go for a biopsy.......In this case,time duration is not gven specifically....By any chance,X-ray can be the answer??
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| Justice
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sprint123 wrote:
yOU GOT IT GUYS!!But I have a query!
I remember Dr.Fischer saying that we have to do an X-ray first and if it is positive(sometimes) we could straight away go for a biopsy.......In this case,time duration is not gven specifically....By any chance,X-ray can be the answer??
It was my initial answer, and I would like to know the correct one.
Plain x-ray would also help to exclude any foreign body left in the deep tissue...
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| Justice
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I know that it may sound boring, but I again asked MD fellows sitting by myself in my office, and they said that x-ray of the foot is usually the first option. Another thing is that USMLE wants us to think stepwise and moneywise, so we have to consider to start with least expensive test.
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| sprint123
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But the answer givenwas technetium scan!!!I am confused
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| nadiabarati
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sprint 123 I also know what Dr.Fischer told. I'm also confused because it's not the only difference between what he says and what you find in different books!! We know our materials but we get the Qs wrong while we are innocent because we get opposite information! It's not fair, is it?
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| webjeee
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maybe, because the wound was thoroughly irrigated already
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| Justice
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Just an update:
In University of Wisconsin the strategy in suspected OM is:
1. plain x-ray of the foot
2. MRI if (1) did not clarify the situation.
I am worried if what we learn is being used in all US centers, or just something that somebody put in this manual
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