Infection, Pharmacology & VTE MCQs

A 3-week-old neonate presents with fever, irritability, and decreased movement of the left lower extremity. Imaging demonstrates a hip effusion.

What is the most appropriate empiric intravenous antibiotic regimen after obtaining aspirates?

A 9-year-old girl has had intermittent clavicle and distal tibial pain for 6 months. Inflammatory markers are mildly elevated. Multiple bone biopsies yield no bacterial growth and show chronic non-suppurative inflammation. What is the most appropriate first-line treatment?

A 3-week-old premature neonate presents with asymmetric hip creases, irritability, and decreased spontaneous movement of the right lower extremity. Ultrasound reveals a large right hip effusion.

Following diagnostic aspiration that yields purulent fluid, which of the following empiric antibiotic regimens is most appropriate for this patient?

A 10-year-old girl presents with a 6-month history of intermittent, multifocal bone pain involving the medial clavicle and bilateral proximal tibias. Laboratory studies show a mildly elevated ESR, but multiple bone biopsies show sterile, non-suppurative inflammation. Radiographs reveal mixed lytic and sclerotic metaphyseal lesions. Which of the following is the most appropriate first-line treatment for this condition?

A 4-week-old female is treated for culture-proven septic arthritis of the right hip.

Which unique anatomical factor makes the neonatal hip highly susceptible to permanent avascular necrosis and physeal destruction from this condition?

A 7-year-old boy presents with high fever, chills, and an inability to bear weight on his left leg. Examination reveals severe focal tenderness over the distal femur. Which region of the bone is the initial nidus for bacterial seeding in acute hematogenous osteomyelitis in this age group?

A 6-year-old child with a known history of systemic-onset JIA (Still's disease) suddenly develops a high unremitting fever, hepatosplenomegaly, bleeding gums, and profound lethargy. Laboratory tests show a rapidly dropping platelet count and an exceptionally high serum ferritin level. What is the most likely diagnosis?

A 5-year-old boy is brought to the orthopedic clinic by his parents due to a noticeable deformity around his right knee. Which of the following symptom clusters is most characteristic of Dysplasia Epiphysealis Hemimelica (DEH) at presentation?

Which of the following is the most common presenting symptom complex for a patient with Dysplasia Epiphysealis Hemimelica?

Which of the following constellations of symptoms is most characteristic for a child presenting with Dysplasia Epiphysealis Hemimelica (DEH)?

During a TKA for a severe varus deformity, the medial compartment remains tight in full extension but is well balanced in flexion. Which structure should be incrementally released next to specifically address the tight extension gap?

A 12-year-old boy with systemic juvenile idiopathic arthritis (JIA) presents to the emergency department with acute high fever, hepatosplenomegaly, and altered mental status. Laboratory results show a sudden drop in ESR, thrombocytopenia, and hypofibrinogenemia. What is the most likely diagnosis?

A 4-year-old boy presents with a 2-day history of right hip pain, a limp, and a tactile fever. Which of the following is NOT a parameter included in the classic Kocher criteria used to differentiate septic arthritis from transient synovitis of the pediatric hip?

A 68-year-old male undergoes total knee arthroplasty and develops signs of infection 3 months post-op. Aspiration and biopsy confirm a prosthetic joint infection (PJI) caused by Methicillin-Sensitive Staphylococcus aureus (MSSA). What is the most appropriate management strategy?

A 72-year-old male presents with sudden onset excruciating pain in his right great toe, which is exquisitely tender, swollen, and erythematous. He has a history of hypertension and is on a thiazide diuretic. Serum uric acid level is 9.5 mg/dL. Radiographs show soft tissue swelling but no erosions. He is diagnosed with acute gout. Which of the following is the most appropriate acute management strategy?

A 60-year-old male with a history of open tibia fracture 5 years ago presents with a draining sinus tract and chronic pain at the fracture site. X-rays show sclerosis, cortical thickening, and a cloaca. MRI confirms chronic osteomyelitis with sequestrum formation. Cultures from the draining sinus have repeatedly grown Pseudomonas aeruginosa. After thorough debridement, what is the most appropriate next step in managing the infection and achieving bone union?

A 50-year-old diabetic male develops chronic osteomyelitis in his right tibia following an open fracture 2 years ago. He has a persistent draining sinus tract and imaging shows a large segmental bone defect (6 cm) with surrounding sclerotic bone and sequestrum. What is the most appropriate surgical treatment?

A 55-year-old diabetic male has chronic osteomyelitis of the distal tibia following an open fracture 8 months prior, which was treated with ORIF. He presents with a persistent draining sinus tract, localized pain, and imaging showing cortical destruction and a large sequestrum adjacent to the hardware. What is the most critical surgical step for definitive treatment?

A pregnant patient in her third trimester presents with acute severe L5 radiculopathy due to a large disc extrusion. She has significant motor weakness (4/5) in ankle dorsiflexion. What is the MOST appropriate initial management?

In the management of a staphylococcal periprosthetic joint infection treated with DAIR, rifampin is frequently added to the oral antibiotic regimen after initial intravenous therapy. What is the mechanism of action of rifampin that makes it critical for biofilm-associated infections?