A 12 year old boy is admitted to the ER with high spiking fever and swelling over the left shin. X ray of the left leg showed erosion and destruction of the tibia.

1. The investigations needed at this point include
  1. MRI Left leg, blood culture, urine culture
  2. MRI left leg, MRI right leg, chest X ray
  3. MRI left leg, bone biopsy and culture
  4. Blood culture, urine culture, sputum culture

Answer: The answer is (c). The condition described is acute Osteomyelitis. An MRI well show the diagnosis clearly. A bone biopsy and culture will identify the organism and will guide treatment.

 

2. Which of the following is not a mechanism for occurrence of Osteomyelitis?

  1. Acute hematogenous
  2. Vascular insufficiency of bone
  3. Infection of orthopaedic devices
  4. Associated with lung infections

Answer: The answer is (d). There are several mechanisms for Osteomyelitis. Acute hematogenous spread is commonly due to S.aureus. Vascular insufficiency of the bone as occurs in diabetes can lead to Osteomyelitis. Orthopedic devices can cause lingering infections.