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Infection, Pharmacology & VTE MCQs

Practice Set 11 of 68

This practice set contains high-yield board review questions covering key concepts in Infection, Pharmacology & VTE. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 201

Topic: Infection, Pharmacology & VTE
Following severe musculoskeletal trauma, prophylactic anticoagulation is routinely employed to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). Based on recent large randomized clinical trials (e.g., PREVENT-CLOT) evaluating venous thromboembolism prophylaxis in major orthopedic trauma patients, which statement is true?
. Aspirin is significantly less effective than low-molecular-weight heparin (LMWH) in preventing fatal PE.
. Aspirin is noninferior to LMWH for the prevention of symptomatic deep-vein thrombosis and pulmonary embolism.
. Unfractionated heparin offers superior DVT protection compared to LMWH.
. Mechanical prophylaxis alone is sufficient for lower extremity trauma requiring immobilization.
. Direct oral anticoagulants (DOACs) are contraindicated in all major trauma patients for 6 weeks.

Correct Answer & Explanation

. Aspirin is noninferior to LMWH for the prevention of symptomatic deep-vein thrombosis and pulmonary embolism.

Explanation

Recent trials, such as PREVENT-CLOT, have demonstrated that aspirin is noninferior to low-molecular-weight heparin (LMWH) in preventing death and nonfatal pulmonary embolism in patients with major extremity trauma.

Question 202

Topic: Infection, Pharmacology & VTE

A 65-year-old right-hand dominant woman presents with severe, persistent pain in her left index finger PIP joint due to erosive osteoarthritis. She has a 35-degree fixed flexion contracture and significant lateral deviation, making it difficult to hold objects and perform daily tasks. She has undergone 9 months of non-operative treatment, including NSAIDs, corticosteroid injections, and extensive hand therapy, with no significant improvement. Radiographs show advanced joint space narrowing, subchondral collapse, and large osteophytes. Which of the following is the most appropriate indication for surgical intervention in this patient?

. Mild to moderate pain responsive to NSAIDs.
. Early disease with preserved range of motion.
. Acute inflammatory flares without significant deformity.
. Significant loss of function and fixed deformity refractory to conservative management.
. Patient preference to avoid surgery despite severe symptoms.

Correct Answer & Explanation

. Significant loss of function and fixed deformity refractory to conservative management.

Explanation

Correct Answer: DThe case content's 'Operative Indications' section clearly states that surgical intervention is considered when non-operative measures fail to provide adequate relief from pain, or when significant functional impairment or deformity develops. Specific indications include 'Persistent severe pain: Localized to the PIP joint, refractory to conservative management' and 'Significant loss of function: Inability to perform activities of daily living (ADLs) or occupational tasks due to stiffness, weakness, or pain' and 'Fixed deformity: Such as a significant flexion contracture (>30 degrees), lateral deviation, or rotational deformity that impairs function and cannot be corrected by therapy.' This patient's presentation of severe, persistent pain, 35-degree fixed flexion contracture, significant lateral deviation, and failure of 9 months of conservative treatment perfectly aligns with these operative indications.Incorrect Options:A, B, C:These describe scenarios that fall under 'Non-Operative Indications' in the case content, where initial management focuses on pain control, reduction of inflammation, and preservation of function, without immediate need for surgery.E:While patient preference is a factor, if a patient with severe symptoms and failed conservative treatment still wishes to avoid surgery, it would be a contraindication to surgery based on their choice, not an indication for surgery. The question asks for an indication for surgical intervention.

Question 203

Topic: Infection, Pharmacology & VTE

A 52-year-old painter presents with mild to moderate pain at the base of his dominant thumb, exacerbated by fine brushwork. Radiographs show Eaton-Littler Stage II changes. He has tried NSAIDs with some relief. Which of the following non-operative interventions is most appropriate as the next step in his management, specifically targeting joint stabilization and pain reduction during activity?

. Immediate referral for trapeziectomy with LRTI.
. A course of oral corticosteroids.
. Intra-articular corticosteroid injection into the CMC joint.
. Prescription of a thumb spica splint for activity and night use.
. Referral for CMC joint arthrodesis.

Correct Answer & Explanation

. Prescription of a thumb spica splint for activity and night use.

Explanation

Correct Answer: DThe patient presents with mild to moderate pain and Eaton-Littler Stage II changes, indicating early to moderate disease. The case states that non-operative management is first-line for such patients. Among the non-operative options, "Orthotics/Splinting: Custom or off-the-shelf splints (e.g., thumb spica splints) to immobilize or support the joint, reducing pain and stabilizing subluxation. Nighttime splinting is common." This directly addresses joint stabilization and pain reduction during activity, which is crucial for a painter.Option A and E (surgical interventions) are premature given the mild-to-moderate symptoms and Stage II disease. Option B (oral corticosteroids) is not a standard long-term management for chronic OA. Option C (intra-articular corticosteroid injection) can provide temporary pain relief but does not offer continuous joint stabilization during activity as effectively as a splint, and repeated injections carry risks.

Question 204

Topic: Infection, Pharmacology & VTE

A 45-year-old male presents with a 3-day history of pain, swelling, and redness over the dorsum of his hand following a fight. He has a small, punctate wound over the third MCP joint. X-rays show no fracture or foreign body. Examination reveals significant swelling, warmth, and exquisite pain with any movement of the third MCP joint. Which of the following is the most appropriate next step in management?

. A. Prescribe oral clindamycin and discharge with instructions for warm soaks.
. B. Admit for intravenous broad-spectrum antibiotics and emergent surgical irrigation and debridement.
. C. Perform an aspiration of the MCP joint for Gram stain and culture.
. D. Order an MRI to evaluate for soft tissue involvement prior to any intervention.
. E. Splint the hand and review in clinic in 24 hours to monitor for improvement.

Correct Answer & Explanation

. B. Admit for intravenous broad-spectrum antibiotics and emergent surgical irrigation and debridement.

Explanation

Correct Answer: BThe correct answer is B because the patient's presentation, including a punctate wound over an MCP joint and signs of significant inflammation with exquisite pain on movement, is highly suggestive of septic arthritis of the MCP joint, a serious complication of fight bites. Given the delayed presentation and severe symptoms, emergent surgical irrigation and debridement of the joint, combined with intravenous broad-spectrum antibiotics, is the standard of care. Oral antibiotics (A) are insufficient. While joint aspiration (C) can confirm the diagnosis, it should not delay definitive surgical management once septic arthritis is clinically suspected. An MRI (D) may provide further detail but is not necessary before proceeding with emergent surgical exploration for a clear clinical picture of septic arthritis. Delaying definitive treatment (E) can lead to rapid joint destruction.

Question 205

Topic: Infection, Pharmacology & VTE

Which antibiotic regimen is considered first-line empiric therapy for a human bite infection involving the hand, pending culture results?

. A. Ciprofloxacin and Rifampin
. B. Amoxicillin-clavulanate (Augmentin)
. C. Doxycycline and Metronidazole
. D. Cephalexin (Keflex) alone
. E. Vancomycin and Gentamicin

Correct Answer & Explanation

. B. Amoxicillin-clavulanate (Augmentin)

Explanation

Correct Answer: BThe correct answer is B because Amoxicillin-clavulanate (Augmentin) is widely considered the first-line empiric antibiotic for human bite infections. It provides excellent coverage against common oral flora, including Staphylococcus (non-MRSA), Streptococcus species, anaerobes, and notably, Eikenella corrodens. Ciprofloxacin and Rifampin (A) lack adequate anaerobic coverage. Doxycycline (C) has activity against some oral flora, but Metronidazole alone does not cover aerobic organisms like Staphylococci/Streptococci. Cephalexin (D) has good Gram-positive coverage but lacks activity against anaerobes and Eikenella. Vancomycin and Gentamicin (E) are typically reserved for more severe, resistant, or nosocomial infections, with Vancomycin targeting MRSA and Gentamicin providing Gram-negative coverage, but this combination is not optimal for initial empiric human bite coverage.

Question 206

Topic: Infection, Pharmacology & VTE

Which of the following is an absolute indication for surgical exploration and debridement of a human bite wound to the hand?

. A. A small, superficial laceration less than 1 cm without joint involvement.
. B. Presentation within 6 hours of injury with minimal surrounding inflammation.
. C. Any wound penetrating the joint capsule, tendon sheath, or involving bone.
. D. A patient with well-controlled diabetes mellitus.
. E. Mild swelling and tenderness responsive to oral antibiotics.

Correct Answer & Explanation

. C. Any wound penetrating the joint capsule, tendon sheath, or involving bone.

Explanation

Correct Answer: CThe correct answer is C because any human bite wound that is suspected or confirmed to penetrate the joint capsule, a tendon sheath, or directly involve bone is an absolute indication for emergent surgical exploration and debridement. These injuries carry a high risk of developing severe infections like septic arthritis, tenosynovitis, or osteomyelitis. Superficial lacerations (A) or early presentations without deep involvement (B) might sometimes be managed non-operatively, but caution is paramount. Diabetes (D) increases risk but doesn't, by itself, mandate surgery without deep involvement. Response to oral antibiotics (E) suggests a less severe infection, but deep involvement would still warrant surgical management.

Question 207

Topic: Infection, Pharmacology & VTE

A 28-year-old male presents with a severe human bite wound to the hand. He has a documented anaphylactic allergy to penicillin. Which of the following antibiotic regimens is most appropriate to cover Eikenella corrodens and other oral flora?

. Clindamycin alone
. Cephalexin alone
. Ciprofloxacin and clindamycin
. Erythromycin alone
. Vancomycin alone

Correct Answer & Explanation

. Ciprofloxacin and clindamycin

Explanation

Eikenella corrodens is a Gram-negative rod highly resistant to clindamycin, first-generation cephalosporins, and macrolides. In penicillin-allergic patients, a fluoroquinolone (like ciprofloxacin) combined with clindamycin or metronidazole provides optimal coverage.

Question 208

Topic: Infection, Pharmacology & VTE

Which of the following best explains why human clenched-fist injuries frequently result in delayed presentation of septic arthritis that is difficult to visually assess upon initial emergency department evaluation?

. The wound is typically visible directly over the MCP joint when the fingers are fully extended.
. The extensor tendon laceration lies distal to the skin laceration when the hand is assessed in extension.
. The skin laceration overlies the joint capsule defect regardless of the finger's position during assessment.
. The extensor tendon laceration and capsular defect retract proximally relative to the skin when the finger is extended.
. The joint capsule remains intact due to the thick protection of the superficial sagittal bands.

Correct Answer & Explanation

. The extensor tendon laceration and capsular defect retract proximally relative to the skin when the finger is extended.

Explanation

Clenched-fist injuries occur with the MCP joints in marked flexion, driving the tooth through the skin, extensor tendon, and joint capsule. When the fingers are subsequently extended, the lacerated extensor tendon and capsular defect retract proximally, sealing the bacterial inoculum deep within the joint.

Question 209

Topic: Infection, Pharmacology & VTE

A 68-year-old female presents with acute right groin pain radiating to the medial thigh, associated with a tender, irreducible mass. She has a history of multiple prior abdominal surgeries. Imaging suggests a Richter hernia in a femoral location. As an orthopedic surgeon, what is a crucial aspect of the initial management plan you would emphasize for this patient, considering her immediate risk?

. Immediate physical therapy consultation for groin strain
. Trial of manual reduction with sedation and Trendelenburg position
. Urgent general surgery consultation for surgical exploration
. Prescription of NSAIDs and rest for presumed adductor tendinopathy
. MRI of the hip to rule out avascular necrosis

Correct Answer & Explanation

. Urgent general surgery consultation for surgical exploration

Explanation

Correct Answer: CFor a suspected Richter hernia, especially one that is tender and irreducible, urgent general surgery consultation for surgical exploration is paramount. Richter hernias carry a very high risk of strangulation and bowel necrosis, making them a surgical emergency. Delay can lead to catastrophic consequences like bowel perforation, peritonitis, and sepsis. Physical therapy, NSAIDs, and MRI of the hip are appropriate for orthopedic conditions but would be dangerously delayed and incorrect for an acute surgical emergency like an incarcerated hernia. While manual reduction can be attempted forsomeincarcerated hernias, it is often difficult and potentially harmful (e.g., reduction en masse) in a suspected Richter hernia, especially with signs of ischemia or tenderness, and should only be considered under specific circumstances and surgical readiness.

Question 210

Topic: Infection, Pharmacology & VTE

Post-operatively, a patient who underwent reduction and repair of a Richter hernia should be monitored closely for which of the following complications specific to ischemic bowel?

. Deep vein thrombosis (DVT)
. Wound infection
. Perforation of the reduced, previously ischemic bowel segment
. Urinary retention
. Pulmonary embolism

Correct Answer & Explanation

. Perforation of the reduced, previously ischemic bowel segment

Explanation

Correct Answer: CPerforation of the reduced, previously ischemic bowel segment (known as 'reperfusion injury' or 'retained ischemic segment' complications) is a critical post-operative concern after Richter hernia repair, especially if the viability of the bowel was questionable or borderline during surgery. Even if the segment appears viable at the time of reduction, ongoing ischemia can lead to delayed necrosis and perforation. All other options (DVT, wound infection, urinary retention, PE) are general post-operative complications, but delayed perforation due to a compromised bowel segment is highly specific and dangerous after ischemic bowel events.

Question 211

Topic: Infection, Pharmacology & VTE

The patient's proximal tibial diaphyseal fracture exhibits significant apex anterior (procurvatum) and apex lateral (valgus) angulation.

Which of the following anatomical structures is primarily responsible for the apex anterior (procurvatum) deformity observed in proximal third tibial fractures?

. Gastrocnemius muscle
. Soleus muscle
. Extensor mechanism (quadriceps via patellar tendon)
. Pes anserinus
. Iliotibial band

Correct Answer & Explanation

. Extensor mechanism (quadriceps via patellar tendon)

Explanation

Correct Answer: CThe case specifically addresses the deforming forces in proximal third tibial fractures: 'This specific deformity pattern is classic for proximal third tibial fractures and is driven by the unopposed pull of the extensor mechanism (quadriceps via the patellar tendon) on the proximal fragment, drawing it into extension, while the pes anserinus and iliotibial band exert variable varus/valgus and rotational forces.' The extensor mechanism, primarily through the patellar tendon, pulls the proximal fragment anteriorly, creating the apex anterior (procurvatum) deformity. The other options are either not the primary deforming force for procurvatum or contribute more to other deformities (e.g., pes anserinus and iliotibial band for varus/valgus).

Question 212

Topic: Infection, Pharmacology & VTE

An 82-year-old female presents after a fall with a shortened, externally rotated lower extremity. X-rays reveal a displaced femoral neck fracture. She has a history of atrial fibrillation on warfarin. Which of the following is the most appropriate initial management strategy regarding her anticoagulation?

. Continue warfarin and proceed with surgery as planned.
. Reverse warfarin immediately with Factor Xa inhibitor reversal agent and proceed with surgery within 6 hours.
. Hold warfarin, allow INR to normalize spontaneously, and delay surgery.
. Reverse warfarin with Vitamin K and Prothrombin Complex Concentrate (PCC), and proceed with surgery once INR is acceptable.
. Start bridging therapy with unfractionated heparin and proceed with surgery after 24 hours.

Correct Answer & Explanation

. Reverse warfarin with Vitamin K and Prothrombin Complex Concentrate (PCC), and proceed with surgery once INR is acceptable.

Explanation

Correct Answer: DFor displaced femoral neck fractures in elderly patients, surgical intervention is typically recommended within 24-48 hours. Patients on warfarin require rapid reversal of anticoagulation to minimize perioperative bleeding risks. The most effective and rapid reversal for significant bleeding risk is a combination of Vitamin K (for sustained effect) and Prothrombin Complex Concentrate (PCC) for immediate effect, allowing surgery once the INR is acceptable (typically <1.5). Factor Xa inhibitor reversal agents are for direct oral anticoagulants, not warfarin. Holding warfarin without rapid reversal delays surgery unnecessarily and increases DVT risk. Bridging therapy with heparin is not appropriate prior to emergency surgery for hip fracture due to bleeding risk.

Question 213

Topic: Infection, Pharmacology & VTE

A 48-year-old female presents after a motor vehicle accident with a comminuted fracture of the distal tibia extending into the ankle joint (pilon fracture). There is significant soft tissue swelling and blistering. What is the primary goal of immediate non-operative management?

. Achieve anatomical reduction and maintain it with external splinting.
. Aggressive pain control and early mobilization.
. Reduction of soft tissue swelling to prepare for definitive surgery.
. Prevention of deep vein thrombosis (DVT).
. Immediate weight-bearing to promote bone healing.

Correct Answer & Explanation

. Reduction of soft tissue swelling to prepare for definitive surgery.

Explanation

Correct Answer: CPilon fractures are challenging due to their articular involvement and often severe soft tissue injury. Significant soft tissue swelling and blistering indicate a compromised soft tissue envelope that is not ready for definitive surgical intervention. The primary goal of immediate non-operative management (often with a spanning external fixator for provisional stability) is to allow the soft tissues to recover, reduce swelling, and improve the skin condition. This 'waiting game' is crucial to minimize the high risk of wound complications (dehiscence, infection) associated with early surgery on inflamed tissues. Anatomical reduction is the ultimate goal, but it must be achieved when the soft tissues allow. Early weight-bearing is contraindicated. DVT prophylaxis is important but not the primary goal of local fracture management in this context.

Question 214

Topic: Infection, Pharmacology & VTE

A 40-year-old farmer sustains a severe open tibia fracture heavily contaminated with soil and manure. According to current guidelines, what is the most appropriate initial intravenous antibiotic regimen?

. Cefazolin alone
. Cefazolin and gentamicin
. Cefazolin and clindamycin
. Ceftriaxone and vancomycin
. Cefazolin, gentamicin, and penicillin

Correct Answer & Explanation

. Cefazolin, gentamicin, and penicillin

Explanation

Farm injuries or wounds heavily contaminated with soil have a high risk of clostridial infection. The addition of high-dose penicillin is recommended alongside a first-generation cephalosporin and an aminoglycoside.

Question 215

Topic: Infection, Pharmacology & VTE

A 6-year-old boy is brought to the clinic with an acute onset of right hip pain and a limp. He had a brief upper respiratory infection two weeks prior. He is afebrile, and his WBC, ESR, and CRP are within normal limits. Ultrasound demonstrates a small joint effusion. What is the most appropriate initial management?

. Immediate hip aspiration in the operating room
. Intravenous administration of broad-spectrum antibiotics
. Urgent MRI of the bilateral hips with contrast
. Nonsteroidal anti-inflammatory drugs and observation
. Application of a hip spica cast

Correct Answer & Explanation

. Nonsteroidal anti-inflammatory drugs and observation

Explanation

This presentation is highly characteristic of transient synovitis of the hip, a benign, self-limiting condition often following a viral illness. Because his inflammatory markers are normal (Kocher criteria negative), septic arthritis is unlikely, and NSAIDs with observation is the standard of care.

Question 216

Topic: Infection, Pharmacology & VTE

A 50-year-old patient, 5 months post-operative from an open Achilles tendon repair, is struggling with return to sport. He has full range of motion but complains of persistent weakness in push-off and inability to perform a single-leg heel raise more than 5 times. His calf girth is noticeably smaller on the affected side. Based on the potential complications and rehabilitation principles, what is the most likely underlying issue and the recommended next step in his rehabilitation?

. Sural nerve injury, requiring surgical exploration and neurolysis.
. Adhesions and stiffness, requiring manipulation under anesthesia.
. Tendon lengthening/weakness due to insufficient strengthening, requiring aggressive eccentric calf strengthening and potentially revision surgery if conservative measures fail.
. Rerupture, necessitating immediate re-evaluation with MRI and revision surgery.
. Deep vein thrombosis, requiring anticoagulation and cessation of activity.

Correct Answer & Explanation

. Tendon lengthening/weakness due to insufficient strengthening, requiring aggressive eccentric calf strengthening and potentially revision surgery if conservative measures fail.

Explanation

Correct Answer: CThe patient's symptoms of persistent weakness in push-off, inability to perform a single-leg heel raise (a key return-to-sport criterion), and reduced calf girth 5 months post-op are classic signs of "Tendon Lengthening/Weakness" as described in the complications section. The management for this is "Often managed conservatively with strengthening exercises. Revision surgery with shortening or augmentation may be considered in severe cases causing significant functional impairment." The rehabilitation section also emphasizes "Eccentric calf strengthening (e.g., calf raises over a step)" as crucial for tendon remodeling and strengthening in later phases.Option A is incorrect; sural nerve injury typically presents with sensory deficits (numbness, paresthesias), not primary weakness or calf atrophy. Option B is incorrect; while adhesions can cause stiffness, the patient has full ROM, making stiffness less likely the primary issue. Option D is incorrect; while rerupture is a possibility, the description of persistent weakness and inability to perform heel raises, along with calf atrophy, points more towards a lengthened or weak repair rather than an acute rerupture, which would likely present with a sudden event and palpable gap. Option E is incorrect; DVT symptoms are typically swelling, pain, and warmth, not persistent weakness in push-off or calf atrophy.

Question 217

Topic: Infection, Pharmacology & VTE

A 60-year-old male with a history of traumatic brain injury (TBI) undergoes open reduction and internal fixation of a complex posterior hip dislocation with an acetabular fracture. Given his risk factors, which of the following prophylactic measures is most effective in preventing heterotopic ossification (HO)?

. High-dose systemic corticosteroids for 6 weeks post-operatively.
. Routine use of low molecular weight heparin (LMWH).
. Indomethacin (NSAID) or single-dose post-operative radiation.
. Early, aggressive passive range of motion exercises beyond protective limits.
. Strict immobilization of the hip for 3 months.

Correct Answer & Explanation

. Indomethacin (NSAID) or single-dose post-operative radiation.

Explanation

Correct Answer: CThe case states, "Heterotopic Ossification (HO): ...Patients undergoing open reduction, especially those with associated head injuries, are at higher risk for HO. Prophylaxis with non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (e.g., 25 mg TID for 3-6 weeks) or a single dose of post-operative radiation (700-800 cGy) has been shown to be effective in preventing symptomatic HO." A history of TBI is a well-known risk factor for HO. LMWH is for DVT prophylaxis, not HO. Aggressive ROM or strict immobilization are not primary HO prophylaxis methods and can be detrimental.

Question 218

Topic: Infection, Pharmacology & VTE

A 58-year-old male with a 20-year history of poorly controlled type 2 diabetes mellitus presents to the emergency department with a 3-week history of progressive swelling, erythema, and warmth of his right foot. He denies any specific trauma but reports a dull ache. On examination, his foot appears as shown in the image. He has absent vibratory sensation and diminished protective sensation. His white blood cell count is normal, and ESR/CRP are mildly elevated. The elevation test shows persistent erythema after 10 minutes.

. Immediate surgical debridement and bone biopsy.
. Initiation of broad-spectrum intravenous antibiotics.
. Magnetic Resonance Imaging (MRI) of the foot with and without contrast.
. Repeat plain radiographs in 2 weeks to assess for bony changes.
. Application of a total contact cast (TCC) and strict non-weight-bearing.

Correct Answer & Explanation

. Magnetic Resonance Imaging (MRI) of the foot with and without contrast.

Explanation

Correct Answer: CThe clinical presentation of warmth, erythema, and edema is common to both acute Charcot neuroarthropathy (Eichenholtz Stage 0/I) and osteomyelitis. The elevation test, which shows persistent erythema after 10 minutes, is a useful clinical adjunct that suggests an infectious process rather than acute Charcot, where erythema typically resolves with elevation. Given the suspicion for osteomyelitis, advanced imaging is required for definitive differentiation. Magnetic Resonance Imaging (MRI) with and without contrast is considered the gold standard. Charcot typically demonstrates primary joint-based marrow edema, while osteomyelitis shows contiguous bone marrow edema adjacent to a soft tissue ulceration or sinus tract. Surgical debridement and antibiotics (Options A and B) would be premature without a definitive diagnosis. Waiting for plain radiographic changes (Option D) would delay diagnosis and appropriate treatment, as early Charcot (Stage 0) has normal radiographs and osteomyelitis may not show changes for weeks. Application of a TCC (Option E) is appropriate for acute Charcot but contraindicated if active infection is present, highlighting the critical need for accurate diagnosis.

Question 219

Topic: Infection, Pharmacology & VTE

A 40-year-old male with a history of cervical syringomyelia presents with massive swelling, crepitus, and instability of his right shoulder without significant pain. Radiographs demonstrate severe destruction of the humeral head and glenoid with multiple loose bodies. What is the most likely diagnosis?

. Septic arthritis
. Avascular necrosis
. Neuropathic (Charcot) arthropathy
. Milwaukee shoulder syndrome
. Synovial chondromatosis

Correct Answer & Explanation

. Neuropathic (Charcot) arthropathy

Explanation

Neuropathic (Charcot) arthropathy in the upper extremity is most commonly associated with cervical syringomyelia. It presents with rapid, painless joint destruction, massive swelling, and extensive osseous fragmentation.

Question 220

Topic: Infection, Pharmacology & VTE

A 60-year-old diabetic female presents with a swollen, erythematous midfoot and an overlying plantar ulcer. Radiographs show destruction of the naviculocuneiform joint. Which of the following MRI findings most strongly suggests superimposed osteomyelitis rather than acute Charcot arthropathy alone?

. Subchondral bone marrow edema
. Diffuse joint effusion
. Disappearance of normal subchondral cysts (ghost sign)
. Replacement of subcutaneous fat with fluid signal
. Confluent bone marrow edema involving both the subchondral and diaphyseal regions with adjacent soft tissue ulceration tracking to bone

Correct Answer & Explanation

. Confluent bone marrow edema involving both the subchondral and diaphyseal regions with adjacent soft tissue ulceration tracking to bone

Explanation

While both acute Charcot and osteomyelitis display marrow edema, osteomyelitis typically demonstrates diffuse, confluent marrow edema extending away from the joint into the diaphysis, often contiguous with an overlying ulcer or sinus tract.

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