a qBook question..

[nuclearrabbit77]

there's this question that asks about a 12y.o. sickle cell patient with acute osteomyelitis.
the answer choices:
-group B strep
-h. influenza
-m. tuberculosis
-p. aeruginosa
-s. aureus

the answer said p. aeruginosa, which i agree can be present in sickle cell patients, including salmonella...
but isn't staph aureus still going to be the most likely, regardless?

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[Plinko]

I don't know which question you are referring to, but based on the information you gave I would have to say that Staph A (since Salmonella was not an answer choice) would be the right answer. To get p. aeruginos as an answer you would have to be given a gram stain, in order to rule out staph. Even with the stain you still couldnot rule out Salmonella, but this was not an answer choice.

I have noticed that the qBook can give some questionable answers from time to time. Of course, if the patient in question was in the burn unit, or had CF, or a gram stain was given, etc. this would change things a bit, and I could see how p. aeruginosa might be the answer choice. But without such a factor, I would have to say that you are right and Kaplan is wrong. Here's a link from the Harvard Teaching Database that supports my point.


http://brighamrad.harvard.edu/Cases/bwh/hcache/81/full.html

 

[nuclearrabbit77]

thanks plinko. the question is #39 micro/immuno test #2

 

[nuclearrabbit77]

i couldn't find anything on that link that mentions specific organisms though....

 

[VALSALVA]

I just did that question 20 minutes ago. I picked S. aureus too. I hate q-book/bank sometimes because now I'm not sure which one I'd pick if faced with the same question on the real exam! What to do?

 

[nuclearrabbit77]

i'd go with s. aureus for that specific question.

 

[BrooklynDO]

everything ive ever learned leads me to believe : S aureus mc, even with sickle, just that salmonella is MORE common than usual in sicklers. even if given S aureus and Sal in the same question, id say s aureus... but Ive never had to see those choices together

 

[Plinko]

nuclearrabbit77

It's in the discussion section......"Abnormal tracer accumulation secondary to osteomyelitis may be difficult to distinguish from infarction on bone scan. Sickle cell disease carries an increased incidence of bone infection, most commonly from staphylococcus or salmonella."

I'm not sure if you are a DO or MD student, but on the COMLEX they generally seem to not have as many close calls between answer choices as they do in qBank and qBook. At least I didn't encounter any such problems on the 100 question sample exam from the 2002 COMLEX. For the USMLE though I couldn't say. I hope they don't.

 

[Idiopathic]

Salmonella would be the number one choice here if it were given. The only thing I could think of is if there were chronic transfusions??? I know drug users can get pseudomonas osteomyelitis, but I think it is very rare. More than likely it is an error.

 

[BrooklynDO]

Idio: so you think salmonella is more common is a sickler than A aureus?
from what I read, S aureus is still number one is all pt.

 

[Idiopathic]

Not in sicklers...if they get osteomyelitis, it is due to salmonella, most common. All others Staph (IV drug users get pseudomonas from licking their needles, I think).