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  #1  
Old 08-12-2012
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Angry Osteomyelitis Dx??

im confused as to whats the best way to dx osteomylitis.

acc to MTB . Most initial test is Xray and then Most accurate is Biopsy.
if Xray negative then do MRI

but UW says , do Bloodcultures and xray ,then proceed with antibiotics.
if xray negative, do bone scan! and if bloodcultures negtive do MRI

also i searched the forums, according to someone KaplanQbank says go strait to MRI!

anyone?
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There is lot of discrepancy between kaplan qbank and UWorld. i would insist go with Uworld .

one more example
kaplan qbank says if patient is a smoker ,screen for bladder cancer via cystoscopy
Uworld says patient is a smoker and has family history of bladder cancer still no need to screen for bladder cancer due to its low incidence .

urrghh

kaplan qbank has actully lowered my scores in uworld
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One more point
Kaplan qbank says if patient came with a single thyroid nodule with TSH normal next step is FNAC and since the radionucleotide scan is outdated

Uworld says do radionucletide scan first ,if cold nodule is found then do FNAC .
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Quote:
Originally Posted by shyangel18 View Post
im confused as to whats the best way to dx osteomylitis.

acc to MTB . Most initial test is Xray and then Most accurate is Biopsy.
if Xray negative then do MRI

but UW says , do Bloodcultures and xray ,then proceed with antibiotics.
if xray negative, do bone scan! and if bloodcultures negtive do MRI

also i searched the forums, according to someone KaplanQbank says go strait to MRI!

anyone?
In case of Acute osteomylitis X ray is useless investigation for Ist 10 days,..It si used to exclude other conditions like trauma, septic arthritis, osteosarcoma or ewings,...So it depends of clinical scenario

In case of osteomylitis Initial investigations are Blood culture and ESR.
Best test is MRI with Bone scan supportive.
Definitive is aspiration and culture
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I agree. All depends on the question. if you very strong suspect osteromyelitis, need not go through x-ray.
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Quote:
Originally Posted by step_enhancer View Post
One more point
Kaplan qbank says if patient came with a single thyroid nodule with TSH normal next step is FNAC and since the radionucleotide scan is outdated

Uworld says do radionucletide scan first ,if cold nodule is found then do FNAC .
yeah true i went thru the same crap, after doing Kaplan Qbank. n im glad i didnt do much of it!
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I think we should also know that...

Vertebral and small bone (metatarsals e.g) Osteomyelitis...best is MRI cos the space is cramped up and to rule out other differentials at those locations

But for Long bones Osteomyelitis...its safe to go straight to Bone Scan

Xray has limited sensitivity for osteomyelitis...
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This may help:
*The best initial step is X-ray , excellent specificity (show periosteal elevation) but lack sensitivity for first 1-2 wks .
If normal X-ray and still suspecious of Osteomyelitis then
*The best next test is MRI (high sensitivity and spacificity ).
Bone scan has same sensitivity of MRI but not spacific , so if Bone scan is abnormal still you need to perform MRI , but if Bone scan is (-ve) then = NO Osteomyelitis .
*The most accurate test is Biopsy.
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Quote:
Originally Posted by step_enhancer View Post
One more point
Kaplan qbank says if patient came with a single thyroid nodule with TSH normal next step is FNAC and since the radionucleotide scan is outdated

Uworld says do radionucletide scan first ,if cold nodule is found then do FNAC .

I would go for FNAC..
I believe in Conrad Fischer..
MTB p 115.
He has not even mentioned of radioactive iodine.

Most common solitary nodule are benign ( adenoma,colloid nodule , cyst) that need FNAC to diagnosis.
Why should one be exposed to Radiation for detecting a benign condition -- Thyroid radiation predispose to Papillary carcinoma...

Thyroid scan is done if FNAC is in conclusive - planning for Biopsy - Lobectomy -

See AAFP guidline..
Thyroid nodule
Next best step.
TFT - N - FNAC
TFT Abn - Thyroid scan - cold nodule - FNAC.

http://www.aafp.org/afp/2003/0201/p559.html
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Id disagree. Any breast lump shud be investigated thoroly watsoever the case be, benign or malignant, no so evrytime we do FNAC we do an US first! Better to do a noninvasive procedure first. N if its inconclusove then proceed with FNAC. Also it depends on the options, mayb the option doesnt have US, in that case Fnac wud be the right answrr and viceversa. So i guess same theory can be applied to thyroid as well.
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Quote:
Originally Posted by shyangel18 View Post
Id disagree. Any breast lump shud be investigated thoroly watsoever the case be, benign or malignant, no so evrytime we do FNAC we do an US first! Better to do a noninvasive procedure first. N if its inconclusove then proceed with FNAC. Also it depends on the options, mayb the option doesnt have US, in that case Fnac wud be the right answrr and viceversa. So i guess same theory can be applied to thyroid as well.
Sorry I don't meant Ultrasound scan..I meant Isotope scan...
Ultrasound scan definity done before FNAC to localize lesion and measure size of nodule..
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