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  1. #1
    Kayla99 is offline Newbie 510 points
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    Osteomyelitis???

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    If anyone can help me with this I would be incredibly grateful... Kaplan and USMLE World totally contradict one another when it comes to Osteomyelitis diagnosis.

    Kaplan: MRI better than bone scan.
    USMLE World: Bone scan always first unless suspected Spinal Osteomyelitis.

    I know I may be over analyzing here, but it would be stupid to lose points over something like this... (please don't just guess, I can do that on my own)

    Thanks )

  2. #2
    tralfaz's Avatar
    tralfaz is offline Member 510 points
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    Quote Originally Posted by Kayla99 View Post
    If anyone can help me with this I would be incredibly grateful... Kaplan and USMLE World totally contradict one another when it comes to Osteomyelitis diagnosis.

    Kaplan: MRI better than bone scan.
    USMLE World: Bone scan always first unless suspected Spinal Osteomyelitis.

    I know I may be over analyzing here, but it would be stupid to lose points over something like this... (please don't just guess, I can do that on my own)

    Thanks )
    You are over-analyzing quite a bit for step 1.
    Anyways, NEITHER of the 2 sources you mentioned are truly reliable. I mean, you couldn't really quote either of them as a reference on the wards.

    Osteomyelitis: Bone and Joint Infections: Merck Manual Home Edition
    eMedicine - Osteomyelitis : Article by Randall W King, MD
    MRI for the Diagnosis of Foot Osteomyelitis - Journal Watch (General)
    Pyogenic vertebral osteomyelitis: diagnosis and management.
    Last edited by tralfaz; 07-15-2007 at 07:28 PM.
    Plaque is a figment of the liberal media and the dental industry to scare you into buying useless appliances and pastes. Now, I've read the arguments on both sides, and I haven't found ANY evidence yet to support the need to brush your teeth. Ever.

  3. #3
    sreec is offline Super Moderator 536 points
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    From UptoDate, "Diagnosis of osteomyelitis in adults":

    The diagnostic test of choice for osteomyelitis varies with the clinical setting. In uncomplicated cases of suspected acute osteomyelitis, plain films are fairly specific but insensitive for osteomyelitis. If plain films are negative, a three phase technetium bone scan is the test of choice. Plain films should also be obtained in chronic osteomyelitis to aid in interpreting other studies. In suspected cases of complicated osteomyelitis (eg, complicating a fracture, postoperative state, neuropathy, vasculopathy), the options are a little more varied:
    • A nuclear study may be the test of choice when there is hardware in place, which would seriously degrade the images on MRI or CT. If a nuclear study is chosen, the test of choice would be either an indium scan or a dual tracer examination, combining indium labeled white cells with three phase bone scan (in the hands and feet) or bone marrow scan (in the axial skeleton) [19,20]. Acute infections image better than chronic infections due to the briskness of the inflammatory response.
    • MRI is the test of choice in evaluating the spine for osteomyelitis, since it provides the anatomic detail necessary to rule out potential neurologic complications and abscesses. The diabetic foot ulcer has such a high risk of having underlying osteomyelitis if the ulcer is larger than 2 cm x 2 cm or bone is palpable that further noninvasive testing may not be warranted to rule in osteomyelitis [1]. If neither of these clinical findings is present, an MRI may be useful in evaluating for osteomyelitis and determining the likely extent of debridement [12]. (See "Clinical features and diagnosis of diabetic foot infections", section on Osteomyelitis).
    Like the previous poster said, this won't be tested on Step 1.


  4. #4
    Kayla99 is offline Newbie 510 points
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    thank you for the info ) I don't have access to UpToDate, and that's as reliable as it gets! Just what I needed. Ironically enough, after I posted my question I googled it and there are countless debates over the same thing (MRI vs Bone Scan) I will go with UpToDate.
    I'm actually taking step 2...

  5. #5
    thethom is offline Senior Member 517 points
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    Bone scans can be too sensitive. I prefer MRI.
    M.D. RUSM c/o 2009.
    Step 1: 260/99, Step 2CK: 236/98, Step 3: 244/99.
    Family Medicine Residency 2009-2012, Board Certified.
    Sports Medicine Fellowship 20012-2013, Board Certified.
    Adjunct Professor of Family Medicine, UNC-Chapel Hill School of Medicine.
    Currently in private Primary Care Sports Medicine Practice.

  6. #6
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    drnick07 is offline Senior Member 514 points
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    How about the FIRST exam being an x-ray? Looking for radiolucency or elevation of the cortex. First and Best type questions are huge in Step 2. Know the difference. Know the Gold Standard. That will be the Best test.
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