Q: 66 year old male with past medical history of diabetes mMellitus, sensory and autonomic neuropathy, diabetic nephropathy and peripheral arterial disease is admitted to ICU with septic shock. All of the following features support the diagnosis of osteomyelitis except?
A) Ability to probe to bone
B) Ulcer size larger than 5 cm2
C) 'Sausage toe'
D) Erythrocyte sedimentation rate (ESR) >70 mm/h
E) High initial radiographic suspicion
Answer: B
All of the above choices highly support the diagnosis of osteomyelitis due to uncontrolled diabetes except the choice B. Ulcer size larger than 2 cm2 is sufficient to support the diagnosis of diabetic osteomyelitis in the presence of other features.
The objective of above question is to make the emphasis on cost-effective and clinical diagnosis of diabetic osteomyelitis. Though magnetic resonance imaging (MRI) has high sensitivity and specificity for the diagnosis of osteomyelitis, but if the history and clinical findings 3, 4 are present with highly supportive simple radiographic evidence (choice E), MRI may not be needed.
#infectiousdisease
#physicalexam
References:
1. Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54:e132.
2. Butalia S, Palda VA, Sargeant RJ, et al. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 2008; 299:806.
3. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis 2008; 47:519.
4. Rajbhandari SM, Sutton M, Davies C, et al. 'Sausage toe': a reliable sign of underlying osteomyelitis. Diabet Med 2000; 17:74.
A) Ability to probe to bone
B) Ulcer size larger than 5 cm2
C) 'Sausage toe'
D) Erythrocyte sedimentation rate (ESR) >70 mm/h
E) High initial radiographic suspicion
Answer: B
All of the above choices highly support the diagnosis of osteomyelitis due to uncontrolled diabetes except the choice B. Ulcer size larger than 2 cm2 is sufficient to support the diagnosis of diabetic osteomyelitis in the presence of other features.
The objective of above question is to make the emphasis on cost-effective and clinical diagnosis of diabetic osteomyelitis. Though magnetic resonance imaging (MRI) has high sensitivity and specificity for the diagnosis of osteomyelitis, but if the history and clinical findings 3, 4 are present with highly supportive simple radiographic evidence (choice E), MRI may not be needed.
#infectiousdisease
#physicalexam
References:
1. Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54:e132.
2. Butalia S, Palda VA, Sargeant RJ, et al. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 2008; 299:806.
3. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis 2008; 47:519.
4. Rajbhandari SM, Sutton M, Davies C, et al. 'Sausage toe': a reliable sign of underlying osteomyelitis. Diabet Med 2000; 17:74.
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