Infection, Pharmacology & VTE MCQs

According to the Cierny-Mader classification of adult osteomyelitis, what specifically defines a Type B host?

A 9-year-old boy with a history of recurrent skin boils presents with femur osteomyelitis and a concurrent deep vein thrombosis in the adjacent femoral vein. Which virulence factor is most responsible for this specific hypervirulent presentation?

An 18-month-old boy presents with a 2-day history of right knee swelling and refusal to bear weight. He is afebrile with a WBC count of 11,000/mcL, ESR of 35 mm/hr, and CRP of 2.5 mg/dL. Knee aspiration yields purulent fluid, but standard culture plates show no growth at 72 hours. A PCR test of the synovial fluid returns positive. What is the most likely pathogen and appropriate antibiotic therapy?

A 7-year-old boy presents with a 3-day history of fever, malaise, and severe pain in his right distal femur. He refuses to bear weight. Laboratory tests show elevated CRP and ESR. In acute hematogenous pyogenic osteomyelitis in children, what is the most common anatomic location for the initial nidus of infection?

A 24-year-old female presents with anterior chest wall pain, palmoplantar pustulosis, and severe acne. Radiographs of the sternoclavicular joint reveal hyperostosis and osteitis. Which of the following is the most appropriate initial pharmacological treatment for her osteoarticular symptoms?

A 9-year-old girl presents with recurrent episodes of multifocal bone pain and swelling, primarily affecting the clavicle and distal tibia. Laboratory tests show a mildly elevated ESR but normal WBC count. Blood cultures are negative, and a bone biopsy reveals sterile chronic inflammation. She also has palmoplantar pustulosis. What is the most appropriate initial pharmacological treatment?

In the surgical management of chronic bacterial osteomyelitis of the tibia, the surgeon identifies a segment of necrotic cortical bone that has become separated from the surrounding living bone. What is the correct anatomical term for this necrotic bone segment?

A 14-year-old boy reports nocturnal thigh pain that is completely relieved by ibuprofen. Imaging shows a 7 mm radiolucent nidus surrounded by reactive sclerosis in the proximal femur cortex. Which inflammatory mediator is characteristically secreted in high levels by this lesion?

A 9-year-old boy is evaluated for a mass around his ankle. Which of the following is NOT a typical presenting symptom or sign of Dysplasia Epiphysealis Hemimelica (DEH)?

A 58-year-old male with poorly controlled diabetes mellitus presents with a swollen, erythematous, and warm right foot. Radiographs reveal generalized osteopenia and joint subluxation at the midfoot. Which of the following MRI findings is most specific for diagnosing osteomyelitis over acute Charcot neuroarthropathy in this patient?

A 55-year-old male with long-standing diabetes presents with a non-healing neuropathic plantar ulcer beneath the first metatarsal head. He has bounding pedal pulses and profound peripheral sensory neuropathy. Which of the following is considered an absolute contraindication to treating this ulcer with a Total Contact Cast (TCC)?

A 4-year-old girl is brought to the emergency department refusing to bear weight on her right leg. She has a temperature of 38.8°C, an ESR of 55 mm/hr, and a serum WBC of 14,000 cells/mm3. According to the classic Kocher criteria, what is the probability that this child has septic arthritis of the hip?

A 2-year-old girl presents with a fever of 39 C, refusal to bear weight, an ESR of 55 mm/hr, and a WBC count of 14,000. Hip aspiration yields purulent fluid with a negative Gram stain. What is the most sensitive method to identify the most common atypical bacterial pathogen in this age group?

A 45-year-old male presents with an acutely swollen, red, and painful knee. Aspiration yields turbid fluid. Synovial fluid analysis confirms the diagnosis of gout. Which of the following describes the characteristic microscopic findings under polarized light?

A 4-year-old boy refuses to bear weight on his right leg. His temperature is 38.8°C, WBC is 13,500/mm3, and ESR is 45 mm/hr. An ultrasound of the right hip demonstrates a significant joint effusion. What is the most appropriate next step in management?

A 55-year-old male presents with an acute gout flare in his first metatarsophalangeal joint. He has a history of a recent severe upper gastrointestinal bleed and end-stage renal disease on dialysis. Which of the following is the most appropriate acute pharmacologic treatment?

A 2-year-old, fully immunized child is brought to the emergency department with a 2-day history of fever, refusal to walk, and left hip pain. Joint aspiration yields purulent fluid with a WBC count of 85,000/mm3. What is the most common causative organism overall for this condition?

A 68-year-old male presents with a painful, swollen great toe. Radiographs demonstrate punched-out periarticular erosions with overhanging edges.

Synovial fluid analysis of the affected joint is most likely to reveal which of the following?