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* Question micro
 #846661  
  mohammedyousifrer - 12/30/17 05:06
 
  A 68-year-old woman with end-stage renal disease receiving intermittent hemodialysis comes to the office due to back pain. She says that she may have "pulled a muscle" while getting out of her car a week ago; since then she has had progressively worsening back pain. She has no leg numbness or weakness but reports malaise and fatigue. The patient also has hypertension and type 2 diabetes mellitus and was treated several weeks ago for staphylococcal bacteremia associated with the dialysis catheter. Her temperature is 38 C (100.4 F). On examination, she has tenderness over the upper lumbar vertebrae without overlying skin changes. The straight leg raise test is negative. Which of the following is the best next step in management of this patient?
A. Analgesics and close follow-up
B. CT myelogram
C. Lumbar puncture
D. MRI of the spine
E. Serum protein electrophoresis
 
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* Re:Question micro
#3356308
  halux - 12/30/17 09:54
 
  D. MRI of the spine

Keys:
-end-stage renal disease
-treated several weeks ago for staphylococcal bacteremia associated with the dialysis catheter
-lumbar vertebrae/ back pain
-fever

Dx: Vertebral Osteomyelitis
She has hematogenous spread bacteremia
Adult vertebra is highly vascularize
 
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* Re:Question micro
#3356320
  mohammedyousifrer - 12/30/17 12:43
 
  @halux
yes
 
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