WBR280

Author	PageAuthor::Gerald Chi (Reviewed by Serge Korjian)
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Microbiology, MainCategory::Pharmacology
Sub Category	SubCategory::Head and Neck, SubCategory::Hematology, 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 MRSA 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: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Salmonella, WBRKeyword::Osteomyelitis, WBRKeyword::Antibiotics, WBRKeyword::Thalassemia, WBRKeyword::Sickle cell disease
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::