WBR0858

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Infectious Disease
Prompt	An 11 year-old boy brought to the ED by his mother complaining of progressive severe pain, and swelling in his left foot. The mother said that she used some analgesic medications that were prescribed to him 2 weeks ago for fever after he injured himself during playing, but neither the pain nor the fever subsided. He is a diabetic on insulin, taking no other medications. On examination, the patient is feverish with temperature 39 C (102 F), heart rate 100/min, blood pressure 140/80 mmHg, and respiratory rate of 22/min. Which of the following is the earliest finding you will detect in this patient`s X-ray?
Answer A	Involucrum
Answer A Explanation	Incorrect It is a term used to describe the formation of abnormal new bone in the periosteum , and occurs late in bone infection.
Answer B	Sequestrum
Answer B Explanation	Incorrect It is a term used to describe the formation of abnormal new bone in the periosteum , and occurs late in bone infection
Answer C	Periosteal elevation
Answer C Explanation	Correct The earliest X-ray finding will appear is periosteal elevation
Answer D	Fracture
Answer D Explanation	Incorrect Osteomyelitis doesn’t have association with fracture or fissure of the bone
Answer E	Fissure
Answer E Explanation	Incorrect Osteomyelitis doesn’t have association with fracture or fissure of the bone
Right Answer	C
Explanation	Osteomyelitis is an infection of bone or bone marrow, usually caused by pyogenic bacteria or mycobacteria. It can be usefully subclassifed on the basis of the causative organism, the route, duration and anatomic location of the infection. It usually present with fever, chills, erythema, and swelling over the involved bone. The earliest X-ray finding will appear is periosteal elevation Educational Objective: References:
Approved	No
Keyword	[[WBRKeyword::Osteomyelitis]]
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