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|MainCategory=Microbiology, Pharmacology | |MainCategory=Microbiology, Pharmacology | ||
|SubCategory=Head and Neck, Musculoskeletal/Rheumatology | |SubCategory=Head and Neck, Musculoskeletal/Rheumatology | ||
|Prompt=An 8-year-old girl with a history of thalassaemia major presents to the emergency department with low-grade fever, leg pain, and malaise for the past week. Her blood pressure is 110/60 mm Hg, heart rate is 90/min, and temperature is 37.8 ᵒC ( | |Prompt=An 8-year-old girl with a history of thalassaemia major presents to the emergency department with low-grade fever, leg pain, and malaise for the past week. Her blood pressure is 110/60 mm Hg, heart rate is 90/min, and temperature is 37.8 ᵒC (100 ᵒF). On physical examination, her anterior left shin is red, swollen, and tender to palpation. Two sets of blood cultures are positive for gram-negative bacteria and MRI confirms a diagnosis of tibial osteomyelitis. Which of the following antimicrobial agent is the most appropriate initial therapy? | ||
|Explanation=Patients with a history of hemoglobinopathy such as sickle cell disease and thalassemia are prone to have osteomyelitis secondary to Salmonella infection. Other risk factors include transfusions and iron chelation therapies. | |Explanation=Patients with a history of hemoglobinopathy such as sickle cell disease and thalassemia are prone to have osteomyelitis secondary to Salmonella infection. Other risk factors include transfusions and iron chelation therapies. | ||
|AnswerA=Intravenous ciprofloxacin | |AnswerA=Intravenous ciprofloxacin | ||
|AnswerAExp= | |AnswerAExp=Intravenous ciprofloxacin is the drug of choice for Salmonella osteomyelitis | ||
|AnswerB=Intravenous linezolid | |AnswerB=Intravenous linezolid | ||
|AnswerBExp= | |AnswerBExp=Intravenous linezolid may be used as an alternative regimen for MRSA osteomyelitis | ||
|AnswerC=Intravenous nafcillin | |AnswerC=Intravenous nafcillin | ||
|AnswerCExp= | |AnswerCExp=Intravenous nafcillin may be used as a primary regimen for S. aureus osteomyelitis | ||
|AnswerD=Intravenous vancomycin | |AnswerD=Intravenous vancomycin | ||
|AnswerDExp= | |AnswerDExp=Intravenous vancomycin may be used as an alternative regimen for S. aureus osteomyelitis | ||
|AnswerE=Intravenous cefazolin | |AnswerE=Intravenous cefazolin | ||
|AnswerEExp= | |AnswerEExp=Intravenous cefazolin may be used as a primary regimen for S. aureus osteomyelitis | ||
|RightAnswer=A | |RightAnswer=A | ||
|WBRKeyword=Salmonella | |WBRKeyword=Salmonella | ||
|Approved= | |Approved=Yes | ||
}} | }} | ||
Revision as of 14:27, 7 August 2015
| Author | PageAuthor::Gerald Chi |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Microbiology, MainCategory::Pharmacology |
| Sub Category | SubCategory::Head and Neck, SubCategory::Musculoskeletal/Rheumatology |
| Prompt | [[Prompt::An 8-year-old girl with a history of thalassaemia major presents to the emergency department with low-grade fever, leg pain, and malaise for the past week. Her blood pressure is 110/60 mm Hg, heart rate is 90/min, and temperature is 37.8 ᵒC (100 ᵒF). On physical examination, her anterior left shin is red, swollen, and tender to palpation. Two sets of blood cultures are positive for gram-negative bacteria and MRI confirms a diagnosis of tibial osteomyelitis. Which of the following antimicrobial agent is the most appropriate initial therapy?]] |
| Answer A | AnswerA::Intravenous ciprofloxacin |
| Answer A Explanation | AnswerAExp::Intravenous ciprofloxacin is the drug of choice for Salmonella osteomyelitis |
| Answer B | AnswerB::Intravenous linezolid |
| Answer B Explanation | AnswerBExp::Intravenous linezolid may be used as an alternative regimen for MRSA osteomyelitis |
| Answer C | AnswerC::Intravenous nafcillin |
| Answer C Explanation | AnswerCExp::Intravenous nafcillin may be used as a primary regimen for S. aureus osteomyelitis |
| Answer D | AnswerD::Intravenous vancomycin |
| Answer D Explanation | AnswerDExp::Intravenous vancomycin may be used as an alternative regimen for S. aureus osteomyelitis |
| Answer E | AnswerE::Intravenous cefazolin |
| Answer E Explanation | AnswerEExp::Intravenous cefazolin may be used as a primary regimen for S. aureus osteomyelitis |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::Patients with a history of hemoglobinopathy such as sickle cell disease and thalassemia are prone to have osteomyelitis secondary to Salmonella infection. Other risk factors include transfusions and iron chelation therapies. Educational Objective: |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Salmonella |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |