questions about diverticulitis and sickle cell

[uclabruins47]

i have some problems with the initial diagnosis of new onset acute diverticulitis. i have encountered questions that says to use CT and other questions that says to use x-ray.. i know for x-ray you use it to detect perforation and what not. but which one is it really?

and for sickle cell... i first learned that most common cause of osteo is salmonella, and then i read that even in sickler's its still staph, and then again i read another source that said "whoever said it's staph is wrong and it's still salmonella" so now im confused up the wazoo.

I'd like to know what answer to choose on the test. Thanks!

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[ntubebate]

i have some problems with the initial diagnosis of new onset acute diverticulitis. i have encountered questions that says to use CT and other questions that says to use x-ray.. i know for x-ray you use it to detect perforation and what not. but which one is it really?

CT w/ IV Contrast

 

[gutonc]

i have some problems with the initial diagnosis of new onset acute diverticulitis. i have encountered questions that says to use CT and other questions that says to use x-ray.. i know for x-ray you use it to detect perforation and what not. but which one is it really?

and for sickle cell... i first learned that most common cause of osteo is salmonella, and then i read that even in sickler's its still staph, and then again i read another source that said "whoever said it's staph is wrong and it's still salmonella" so now im confused up the wazoo.

I'd like to know what answer to choose on the test. Thanks!

I assume you meant to say that you'd like to know which answer is correct in the setting of a patient presenting with either acute diverticulitis or SC osteo, not for the test.

In any event, it depends on what you're talking about. To quickly diagnose perforation in the setting of diverticulitis, AXR is the way to go. To diagnose acute diverticulitis itself, w/o perf CT w/ IV/PO contrast is it.

As to the HbSC question, having trained in a place w/ a sickle cell population that rivaled the size of it's hypertensive/diabetic population, I've had lots of experience here (and a Sub-I ID attending who studies sepsis in sicklers). The correct answer is: staph is the most common cause of osteo, regardless of coexisting pathology. Salmonella causes osteo in sicklers way more than in any other population but the bulk of cases will still be staph.

If the question (on exams or on rounds) is every, "what bug causes horrible infection X?", you'll be correct more often than not if your answer is Staph spp. It's like the 80/20 rule. If somebody asks you what percent of X is/causes/results in Y, 80 or 20 will be at least close to the correct answer in the vast majority of cases (you shouldn't get crap for answering 20% when the answer is 15% or 80% when it's really 85%...if you do, it's time to leave Duke).

BE (Now PE)