NEET 2014 SPM MCQ

1. All are Zoonosis except

a. Plague

b. HIV

c. JE

d. TB

2. Demarcation line in iceberg disease is between:

a. Symptomatic and asymptomatic cases

b. Diagnosed and undiagnosed cases

c. Apparent and in-apparent cases

d. Case and carriers

3. Isolation not useful for all except:

a. Mumps

b. Measles

c. Hepatitis A

d. Pneumonic plague

4. All of the following indicators are included in physical quality of life index (PQLI) except:

a. Infant mortality rate

b. Literacy rate

c. Per capita income

d. Life expectancy at age one

5. Which of the following vaccine is not included in EPI, schedule :

a. Tetanus Toxid

b. DPT

c. MMR

d. DT

6. Several studies have shown that 85% of cases of lung cancer are due to cigarette smoking. It is a measure of

a. Incidence rate

b. Relative risk

c. Attributable risk

d. Absolute risk

7. About herd immunity, all are true except

a. Depends on clinical and subclinical cases

b. Influenced by immunization.

c. Depends on the presence of alternative host.

d. Herd immunity is constant.

8. All the statements are true about standardization:

a. Standardization allows comparison to be made between two different populatins

b. The national population is always taken as the standard population

c. For Direct standardization, age specific rates of the study population are applied to that of the standard population

d. For indirect standardization age specific rates of the standard population are applied to the study population

9. 'Endemic Disease' means that a disease :

a. Occurs clearly in excess of normal expectancy

b. Is constantly present in a given population group

c. Exhibits seasonal pattern

d. Is prevalent among animals

10. All of the following are true about the Herd Immunity for infectious diseases except :

a. It refers to group protection beyond what is afforded by the protection of immunized individuals

b. It is likely to be more for infections that do not have a sub-clinical phase

c. It is affected by the presence and distribution of alternative animal hosts

d. In the case of tetanus it does not protect the individual

11. Which one of the following is a good index of the severity of an acute disease ?

a. Cause specific death rate

b. Case fatality rate

c. Standardized mortality ratio

d. Five year survival

12. A study began in 1970 with a group of 5000 adults in Delhi who were asked about their alcohol consumption. The occurrence of cancer was studied in this group between 1990-1995. This is an example of :

a. Cross-sectional study

b. Retrospective cohort study

c. Concurrent cohort study

d. Case-control study

13. All of the following are used as proxy measure for incubation period except:

a. Latent period

b. Period of communicability

c. Serial interval

d. Generation time

Answers –

1. b

2. c.

3. d.

4. c.

 5. c.

6. c.

7. d

8. b.

9. b.

10. b

11. b.

12. c.

13. b.

NEET 2014 MCQs in Radiology

1. Regarding the imaging modalities of the chest:
(a) High resolution computed tomography (HRCT) uses a slice thickness
of 4–6 mm to identify mass lesions in the lung.
(b) Spiral CT ensures that no portion of the chest is missed due to variable
inspiratory effort.
(c) MRI shows excellent detail of the lung anatomy.
(d) Bronchography is the technique of choice to visualize the bronchial
tree
(e) CT pulmonary angiography (CTPA) is performed using catheters
placed in a femoral vein.
2. Regarding the development of the lung:
(a) The tracheobronchial groove appears on the ventral aspect of the
caudal end of the pharynx.
(b) The primary bronchial buds develop from the tracheobronchial
diverticulum.
(c) The epithelium lining the alveoli is the same before and after birth.
(d) A persistent tracheo-oesophageal fistula (TOF) is commonly associated
with an atresia of the duodenum.
(e) Uni-lateral pulmonary hypoplasia is usually due to a congenital
diaphragmatic hernia.
1.
(a) False – HRCT uses 1–2 mm slice thickness and a high resolution computer
algorithm to show fine detail of the lung parenchyma, pleura and
tracheobronchial tree. It is not used to delineate masses in the lung.
(b) True
(c) False – currently MRI is a poor technique for showing lung detail. It allows
visualisation of the chest wall, heart, mediastinal and hilar structures.
(d) False – this invasive technique has largely been superseded by HRCT.
(e) False – CTPA is performed to diagnose major pulmonary emboli using a
cannula placed in any peripheral vein and is relatively non-invasive compared
to conventional pulmonary angiography.
2.
(a) True
(b) True – the bronchial buds differentiate into bronchi in each lung.
(c) False – during embryonic life the alveoli is lined by cuboidal epithelium that
lines the rest of the respiratory tract. When respiration commences at birth the
transfer to the flattened pavement epithelium of the alveoli is accomplished.
(d) False – TOF indicates the close developmental relationship between the foregut
and the respiratory passages. It is usually associated with an atresia of the
oesophagus and the fistula is situated below the atretic segment.
(e) True
Ref -Companion to Applied Radiological Anatomy by Arockia Doss (Author), Matthew J. Bull (Author), Alan Sprigg (Author), Paul D. Griffiths (Author)

Factors That Can Lead to False Diagnoses

Physician-specific Problems
Insufficient History and Clinical Examination. A diagnostic
accuracy of 70% is reached through meticulous history-
taking and examination; misleading results are
rare ( 5%). Laboratory analyses and imaging studies
alone achieve a guarantee of only 30% and misleading
results occur in 10% of these cases. Insufficient history
and examination due to lack of time, lack of knowledge,
or lack of communication can therefore never be compensated
by further investigation.
Disregarding the Prevalence of Clinical Pictures. It is
dangerous to compare a present patient with a recent,
rare and interesting case from personal experience, perhaps
out of fear of not recognizing a rare disease.
“Common diseases are common, and rare diseases
are rare.” Our diagnostic efforts must therefore concentrate
primarily on the most probable diseases.
The simplest explanation is often the best one, and one
should try to assign the complaints and medical findings
of a patient to a single clinical picture. The situation
can be more complex in elderly patients.
Unavailable or Inadequate Knowledge. Current knowledge
can become obsolete or false within a few years.
Constant postgraduate training is required (case examination,
journals, books, continuing medical education,
internet).
Physician’s Characteristics. A physician needs an
enormous amount of self-criticism in order not to run
the risk of overestimation of his/her own capabilities.
Professional and personal contact among colleagues on
a regular basis (quality circle meeting) is essential.
Insufficient Judgement. This is an expression of inadequate
logical and structural procedures from the time of
medical findings to the diagnosis (logical thinking).
Failure to distinguish between medical findings and interpretation,
or unknowingly neglecting new results
which do not fit the diagnosis (preconceived notion), are
common mistakes.
A negative echocardiograph finding, for example,
must not lead to the rejection of a diagnosis of bacterial
endocarditis as suggested by a classic history and clinical
findings (according to the Duke criteria). This would
mean the omission of conclusive diagnostic procedures,
such as blood cultures, and empirical therapy possibilities.
Preexisting secondary diseases may obscure symptoms
of an otherwise classic diagnosis, e. g., angina pectoris
as the chief symptom of coronary heart disease is
frequently absent in a diabetic person.
Possible Errors of a Technical Nature. The great number
of available laboratory tests and technical examinations
means that it is necessary that the physician interpreting
the results in the clinical context be up to date on
their diagnostic significance.
Furthermore, the assumed prevalence of a disease is
always considered when assessing test results (pretest
probability). Whereas a slightly elevated serum alkaline
phosphatase level in a patient with lymphoma may indicate
liver involvement, the same value in a screened
asymptomatic patient is in all likelihood a false-positive.
Patient-specific Problems
Incorrect, Biased or Inaccurate Statements (made consciously
or unconsciously). These statements are based
upon forgetfulness, anxiety (e. g., fear of a serious disease
and the corresponding report from the doctor), or
fear of consequences in regard to official matters such as
suitability for military service, ability to drive a motor
vehicle, liability, etc. They may also occur in cases involving
addicts (alcohol, nicotine, analgesics, illicit
drugs), statements of sexual orientation, and consequences
pursuant to insurance laws. Another rare
phenomenon which can lead to false diagnosis is Münchausen
syndrome. The syndrome was named after the
tale of Baron von Münchausen. Such patients feign more
or less plausible, self-induced symptoms and repeatedly
present to physicians and hospitals to secure numerous
diagnostic tests and therapeutic interventions.
Preconceptions. These are conditioned from prior medical
findings and from reading popular medical journals.
They are frequently observed in patients with a smattering
of medical knowledge, and satisfy the need of
causality.
Inappropriate Behavior. This is characterized by a lack of
cooperation, excessive demands, and fear of disease.
Dissimulation for Various Reasons. There are many reasons
for this condition.
Masking of Symptoms and Findings of a Disease. Typical
examples of masking of symptoms are painless acute
abdomen in schizophrenic patients or in relation to
medications which are being taken, e. g., by drug addicts.

Dietary deficiencies and psychiatric symptoms

Which of the following vitamin deficiencies is most likely to lead to a triad of
gastrointestinal disturbance, dermatological symptoms and a heterogeneous
constellation of psychiatric symptoms?
A. Niacin
B. Vitamin A
C. Vitamin B1
D. Vitamin C

E. Vitamin D
Answer
A Nicotinic acid, or niacin, deficiency (A) is also known as pellagra.
It classically manifests with gastrointestinal symptoms, such as
diarrhoea, anorexia and gastritis. The dermatological manifestations
include symmetrical, bilateral bullous lesions in sun-exposed areas.
The psychiatric symptoms initially manifest as apathy, depression, or
irritability. However, in later stages there are more florid symptoms
resembling delirium, psychosis or a Korsakoff-like presentation. If
identified, treatment with nicotinic acid usually leads to prompt and
dramatic improvements in mental state. Vitamin A deficiency (B)
is associated with night-blindness, dry skin and hair and anaemia.
Thiamine, or vitamin B1 deficiency (C) is known as beriberi. The classical
symptoms of this disorder are neuropathy and heart failure. Acute
depletion of thiamine, as seen in alcohol dependence, leads to Wernicke’s
encephalopathy. Vitamin C deficiency (D) leads to scurvy, characterized
by anorexia, diarrhoea, irritability, anaemia, gingival haemorrhage, poor
wound healing, leg pain and swelling over the long bones. Vitamin D
deficiency (E) leads to rickets in children and osteomalacia in adults.
There is now growing evidence of some link with vitamin D to cognitive
functioning. There are speculations about its role in seasonal affective
disorder whereby patients have normal mental function during the year
but during a particular season, e.g. winter, will display a mood disorder
such as depression year after year during that season.

Autoimmune disorders and psychiatry

A 34-year-old woman presents to accident and emergency claiming that the
devil has returned to earth and is hunting her through her neighbours, who are
recording her every movement. The psychiatric assessment shows florid delusions
and auditory hallucinations. She has no past psychiatric history. Her husband tells
you that she was fine up until 2 weeks ago. Her hands have also been shaking
and she has complained that the devil has been torturing her muscles. She has
widespread lymphadenopathy and an enlarged spleen. An unusual rash is present
across her cheeks and nose, which she says is the brand of the devil. What is the
most likely diagnosis?
A. Behçet’s disease
B. CREST syndrome
C. Graves’ disease
D. Systemic lupus erythematosus (SLE)
E. Wegener’s granulomatosis
Answer
D SLE (D) is an autoimmune connective tissue disorder that may affect any
organ in the body. It commonly presents in women (9:1 female to male
ratio), usually in the third or fourth decades. Neuropsychiatric symptoms
may occur at the beginning of the natural course of the disorder,
without any seeming involvement of other organ systems. Unexplained
psychotic symptoms, which may closely resemble schizophrenia, may
occur, as may a dementia-like illness or affective disorders. This woman
is also displaying neurological signs, making a diagnosis of a functional
psychiatric disorder unlikely. The presence of Parkinsonism, widespread
muscle pain, lymphadenopathy and splenomegaly are all consistent
with the diagnosis. The ‘malar rash’, which is highly indicative of SLE,
is present in this woman but its absence does not negate the diagnosis.
Behçet’s disease (A) is an autoimmune disorder characterized by recurrent
mouth ulcers, genital ulcers and uveitis. Neurological or psychiatric
symptoms are uncommon and usually a late presentation. It also tends
to present in the third or fourth decades, but tends to be more common
in men. The CREST syndrome (B) is a form of systemic scleroderma
characterized by the following five cardinal features from which the
acronym is derived: calcinosis, in which there is calcium deposits in
the soft tissue, usually under the skin; Raynaud’s phenomenon, in
which there is bilateral cyanosis of the hands in response to cold or
stress; oesophageal atresia, which presents with symptoms of gastrooesophageal
reflux; sclerodactyly, in which there is thickening of the
skin of the hands and feet, taking on a ‘shiny’ appearance; finally,
telangiectasia, which are lesions caused by dilated blood vessels and
usually present on the face or hands. Psychiatric complications have been
little studied in this disorder, although depression certainly does occur.
Graves’ disease (C) is an autoimmune thyroiditis, which incidentally
may occur co-morbidly with SLE, although the greatest association is
with rheumatoid arthritis. The characteristic symptoms include those of
hyperthyroidism, which in psychiatric terms may resemble an anxiety
disorder, with tachycardia and palpitations. There may be unexplained
weight loss. Systemic symptoms, such as malaise, are also common, as is
exophthalmos and pretibial myxoedema (‘orange peel’ skin on the shin).
The psychiatric symptoms tend to either resemble an anxiety disorder,
or other affective symptoms. Like SLE, women are more commonly
affected, and usually in their 20s or 30s. Wegener’s granulomatosis (E)
is an autoimmune vasculitis that typically affects the lungs, kidneys and
nervous system. It affects males slightly more often with a slightly later
peak of incidence (fourth and fifth decades). The typical presentations are
with dyspnoea, cough, haemoptysis, nasal ulceration, sinusitis, systemic
symptoms, haematuria, and neurological symptoms – typically peripheral
neuropathy but sometimes strokes and seizures. Psychiatric complications
have not typically been described except in case reports.

NEET 2014 Practice Paper

http://www.medpgthrissur.org/portal/Pages/SubscriberRegistration.aspx

1. A 21-year-old footballer presents to A&E
with a stabbing pain above his right knee
joint. He states the pain came on suddenly
while he was sprinting. On examination he
is unable to extend the leg and he walks
with a limp. There is suprapatellar swelling
and an absent knee jerk. What is the likely
diagnosis?
A Fracture of patella
B Injury to posterior cruciate ligament
C Tear of adductor magnus muscle
D Tear of biceps femoris muscle
E Tear of quadriceps tendon
2. During strenuous exercise, what else
occurs besides tachycardia?
A Rise in Paco2
B Increased stroke volume
C Rise in mixed venous blood O2 saturation
D No change to blood pressure
E Increased renal blood flow
3. A patient is found to have
thrombophlebitis migrans. What other
condition must be considered?
A Venous insufficiency
B Diabetes mellitus
C Bronchial carcinoma
D Lyme disease
E Beckwith–Wiedemann syndrome
1E: Tear of quadriceps tendon
A 21-year-old male has sustained an injury of sudden onset, associated with swelling and an
inability to extend at the knee joint and an absent knee reflex. This is consistent with an injury
to the quadriceps group of muscles that lie in the anterior compartment of the thigh and act as
the principal extensors of the knee joint. The mechanism of injury is inconsistent with a fractured
patella.
2B: Increased stroke volume
During strenuous exercise there is an increase in heart rate, stroke volume and cardiac output.
Remember cardiac output is a function of heart rate and stroke volume. During exercise, there is
an increase in respiratory rate (hyperventilation) which will lead to a reduction in Paco2. During
exercise the oxygen demand of skeletal muscle rises, therefore leading to a reduction in mixed
venous blood oxygen concentration. Renal blood flow is autoregulated, so renal blood flow is
preserved and will tend to remain the same. Mean arterial blood pressure is a function of cardiac
output and total peripheral resistance and will increase with exercise, mainly as a result of the
increase in cardiac output that occurs.
3C: Bronchial carcinoma
Thrombophlebitis migrans (or migratory thrombophlebitis) is a condition that results in recurrent
episodes of venous inflammation (phlebitis) associated with thrombosis, that occurs in different
locations (migratory). It is generally caused by inflammatory, or malignant, conditions where
the patient is tipped into a hypercoagulable state. When associated with malignant conditions
it is known as Trousseau’s syndrome and is generally associated with visceral malignancies
(adenocarcinomas), such as gastric, pancreatic, bronchial carcinomas. It is a non-metastatic (or
paraneoplastic) effect of malignancy and is related to factors secreted by tumours.

OSTEOMYELITIS

DESCRIPTION
Osteomyelitis (OM): Infection of bone with ongoing inflammatory destruction
Usually bacterial, but fungal OM does occur
Could be acute or chronic
ETIOLOGY
Hematogenous OM:
Primarily in children, elderly, IV drug abuse (IVDA) patients
Seeding of bacteria to bone from remote site of infection via bloodstream
Children have acute OM and adults subacute or chronic.
Hematogenous OM of long bones rarely occurs in adults.
Most children with acute hematogenous OM have no preceding illness.
1/3 have history of trauma to affected area.
Staphylococcus aureus is most common cause of OM in all ages.
Neonates: S. aureus, Enterobacteriaceae, group A and B streptococci, and Escherichia coli
Children: S. aureus, group A streptococci, Haemophilus influenzae, Enterobacteriaceae
Salmonella: Common in sickle cell disease
Adults: S. aureus, Enterobacteriaceae, Pseudomonas, gram-negative rods, Staphylococcus epidermidis, gram-positive anaerobes, especially Peptostreptococcus
Illicit drug users: Candida, Pseudomonas, Serratia marcescens
Prolonged neutropenia: Candida, Aspergillus, Rhizopus, Blastomyces, coccidioidomycosis
Hematogenous vertebral OM:
Uncommon
Most prevalent in adults >45
Involves the disk and vertebra above and below
Often in setting of long-term urinary catheter placement, IVDA, cancer, hemodialysis, or diabetes
IVDA: OM of pubic symphysis, sternoclavicular, and sacroiliac (S-I) joints
Lumbar vertebrae most common, followed by thoracic, then cervical
Posterior extension leads to epidural/subdural abscess or meningitis.
Anterior extension may lead to paravertebral, retropharyngeal, mediastinal, subphrenic, retroperitoneal, or psoas abscess.
Direct or contiguous OM:
Organism(s) directly seeded in bone due to trauma, especially following open fractures:
Spread from adjacent site of infection or from surgery
More common in adults and adolescents
S. aureus, Enterobacteriaceae, Pseudomonas
Normal vascularity:
S. aureus and S. epidermidis, gram-negative bacilli, and anaerobic organisms
Vascular insufficiency/diabetes:
Small bones of feet are common sites.
Infection resulting from minor trauma, infected nail beds, cellulitis, or skin ulceration
Polymicrobial, including anaerobes
Puncture wound through tennis shoe: S. aureus, Pseudomonas
Clavicular OM can occur as complication of subclavian vein catheterization.
Chronic OM:
Osteomyelitis that persists or recurs
Distinguishing characteristic is necrotic bone (sequestrum) that must be debrided.
S. epidermidis, S. aureus, Pseudomonas aeruginosa, Serratia marcescens, and E. coli

DIAGNOSIS

SIGNS AND SYMPTOMS
Vary with duration of disease
History
Mainly nonspecific symptoms
Pain: Localized, deep, dull, and throbbing; occurs with and without movement
Fever and chills; may be absent in chronic OM
Malaise, nausea, vomiting
Reluctance to use extremity
Nonhealing ulcers despite proper therapy
Consider OM as a cause of fracture nonunion
Predisposing factors: DM, vasculopathy, IVDA, invasive procedures, trauma
Physical Exam
Tenderness to palpation, warmth, erythema, edema, decreased range of motion
Drainage of sinus tract
Deep ulcers and palpable bone (+ “probe to bone” test has very high positive predictive value)
If ulcer size >2 cm2 and >3 mm in depth, bone involvement is likely.
ESSENTIAL WORKUP
CBC
ESR and C-reactive protein
Radiographs
Blood and wound cultures and sensitivities
DIAGNOSTIC TESTS & INTERPRETATION
Lab
CBC; WBC may be elevated but often normal
ESR; elevated in >90% of cases
C-reactive protein (usually elevated)
Blood cultures (positive in ~50% of cases)
Imaging
Plays a central role in evaluation
Start with plain films; other tests often required
Radiographs:
May be normal for the 1st 2–3 wk of symptoms
Earliest finding is periosteal elevation, followed by cortical erosions, then new bone formation.
40–50% of focal bone loss needed to detect lucency on radiograph; fewer than 1/3 of cases have diagnostic findings at 10 days
Obtain CXR if TB suspected
MRI:
Best modality to obtain detailed anatomy and extension of soft-tissue and bone narrow involvement
Sensitivity and specificity of ~90%
Reveals bone edema, cortical destruction, periosteal reaction, joint surface damage, and soft-tissue involvement before x-rays
Effective in early detection (3–5 days from onset of infection)
Test of choice to identify vertebral OM and OM in diabetic foot ulcers
Occasional false-positive results in trauma, previous surgical procedures, or neuropathic joint disease
Negative study after 1 wk of symptoms rules out acute OM
CT:
Modality of choice when MRI can’t be done
Reveals bone edema, cortical destruction, periosteal reaction, small foci of gas or foreign bodies, joint surface damage, and soft-tissue involvement when plain films not helpful
Useful in OM of vertebrae, sternum, calcaneus, pelvic bones
Useful to surgeons in guiding debridement and biopsy
Bone scan:
Technetium99m methylene diphosphonate (99mTc-MDP)
Measures increase in bone metabolic activity
~95% sensitive but less specific than MRI
Bone scan abnormal after 2–3 days of symptoms
False-positive may occur in trauma, surgery, chronic soft-tissue infection, tumor
High radiation burden, useful if suspect multifocal disease
Leukocyte scintigraphy:
Indium111-labeled WBCs
More specific but less sensitive than bone scan
Difficult to distinguish bone inflammation from soft-tissue inflammation (ie, cellulitis, tumors, inflammatory arthritis)
US:
An emerging modality for OM especially in children
Periosteal elevation or thickening, fluid collections adjacent to bone often seen
May show findings of OM days prior to plain films
Useful in guiding biopsy
Diagnostic Procedures/Surgery
Gold standard for diagnosis is bone biopsy with histology and tissue Gram stains, including culture and sensitivities.
Needle aspiration has lower sensitivity than open biopsy.
Culture of sinus or drainage from wound can be misleading; correlates well with S. aureus, but not as reliable for other organisms.
Pediatric Considerations
70–85% of children have fever higher than 38.5°C.
Neonates are commonly afebrile.
Only ~1 in 3 of children will have leukocytosis.
Blood cultures positive in ~50%
US
DIFFERENTIAL DIAGNOSIS
Cellulitis
Paronychia/felon
Bursitis, toxic synovitis, septic arthritis
Extremity fracture
Bone infarction in sickle cell patients
Acute leukemia, malignant bone tumors
Mechanical back pain
Spinal epidural abscess
Brucellosis, especially in S-I joint
TB, more common in thoracic spine (Pott disease)

TREATMENT

INITIAL STABILIZATION/THERAPY
Emergent stabilization if septic or if neurologic deficits from spine involvement
ED TREATMENT/PROCEDURES
Empiric antibiotic treatment in ED
Cultures should guide subsequent antibiotic regimen.
Antibiotics: Depend on patient’s age and organism (see Medications section)
Orthopedic and infectious disease consultation
Surgical intervention may be needed to optimize treatment (eg, infected fracture or hardware, bone necrosis).
Parenteral antibiotic treatment for 4–6 wk
MEDICATION
Newborn–4 mo: Penicillinase-resistant synthetic penicillin (eg, nafcillin: 37 mg/kg IV q6h) plus a 3rd-generation cephalosporin (eg, ceftriaxone: 50–75 mg/kg/d IV); if suspect methicillin-resistant S. aureus (MRSA) then vancomycin (40–60 mg/kg IV q6h) plus a 3rd-generation cephalosporin. (Note: Doses are based on age >28 days)
Children (>4 mo): Penicillinase-resistant synthetic penicillin (eg, nafcillin: 37 mg/kg IV q6h to max. 8–12 g/d). If suspect MRSA, then vancomycin (40–60 mg/kg IV q6h to max. 2–4 g/d). Add 3rd-generation cephalosporin if suspicion for gram-negative rods, or presence on Gram stain noted (eg, ceftriaxone: 50–75 mg/kg IV per day to max. 2–4 g/d)
Adult: Penicillinase-resistant synthetic penicillin (eg, nafcillin: 2 g IV q4h); if suspect MRSA, vancomycin (15 mg/kg IV q12h)
Sickle cell anemia with OM: Ciprofloxacin 400 mg IV q12h, or levofloxacin 750 mg IV q24h (not in children); alternative: 3rd-generation cephalosporin
Post–nail puncture through tennis shoe: Ciprofloxacin 750 mg PO b.i.d. or levofloxacin 750 mg PO q24h; alternative: Ceftazidime 2 g IV q8h
Involving orthopedic prosthesis or hardware: Add rifampin (10 mg/kg/d PO/IV to maximum of 600 mg/d) to regimen for S. aureus. Hardware removal generally required.
Post-traumatic OM: Vancomycin and ceftazidime
If vancomycin-resistant enterococcus present: Linezolid 600 mg IV q12h × 6 wk
Pediatric Considerations
Children with hematogenous OM may undergo short-course IV antibiotics and then be changed to oral for additional 1–2 mo.

FOLLOW-UP

DISPOSITION
Admission Criteria
Patients with acute OM should be admitted.
Patients with chronic osteomyelitis usually require admission for surgical procedures, debridement, and obtaining bone cultures and histology.
Discharge Criteria
Subacute or chronic OM patients may be considered for outpatient management if home IV antibiotics arranged, bone specimens obtained, and necrotic bone debrided.
Cases refractory to debridement and antibiotics benefit from hyperbaric oxygen as an adjunct to standard treatment.
~2/3 of these cases will demonstrate benefit.
PEARLS AND PITFALLS
WBC may be normal in many cases.
Radiographs may be normal in the 1st 2–3 wk of symptoms.
Wound cultures are low yield in guiding antibiotic therapy.
Ref-(Thanks to)

Rosen & Barkin’s 5-Minute Emergency Medicine Consult

by Jeffrey J. Schaider, Roger M. Barkin, Stephen R. Hayden, Richard E. Wolfe, Adam Z. Barkin, Philip Shayne, and Peter Rosen

4th edition published by Wolters Kluwer

 This article is meant exclusively as a learning resource to MBBS students. My sincere thanks to the author & Publisher.There is no commercial interest involved.Purpose is to familiarize the students to such good publications