#january2020mccqe1
A 64-year-old woman is hospitalized because of a nonpainful draining ulcer on the plantar aspect of the left foot. She has a 10-year history of type 2 diabetes mellitus. The ulcer is chronic and nonhealing but over the past 3 days has begun draining foul-smelling material. Yesterday, the patient developed fever, and the area around the ulcer became erythematous. Medications include metformin and pioglitazone.
On physical examination, she does not appear ill. Temperature is 38.3°C (101.0°F); other vital signs are normal. A 3-cm by 2-cm deep plantar ulcer that is draining a purulent green exudate is present at the base of the fourth metatarsal. The entire foot is warm, erythematous, and edematous. Pulses in the foot are palpable. No bone is visible or detected with a metal probe. A plain radiograph of the foot shows only soft tissue swelling.
Which of the following imaging studies of the foot should be performed next?
(A) CT scan
(B) Indium-labeled leukocyte scan
(C) MRI
(D) Triple-phase technetium bone scan
A 64-year-old woman is hospitalized because of a nonpainful draining ulcer on the plantar aspect of the left foot. She has a 10-year history of type 2 diabetes mellitus. The ulcer is chronic and nonhealing but over the past 3 days has begun draining foul-smelling material. Yesterday, the patient developed fever, and the area around the ulcer became erythematous. Medications include metformin and pioglitazone.
On physical examination, she does not appear ill. Temperature is 38.3°C (101.0°F); other vital signs are normal. A 3-cm by 2-cm deep plantar ulcer that is draining a purulent green exudate is present at the base of the fourth metatarsal. The entire foot is warm, erythematous, and edematous. Pulses in the foot are palpable. No bone is visible or detected with a metal probe. A plain radiograph of the foot shows only soft tissue swelling.
Which of the following imaging studies of the foot should be performed next?
(A) CT scan
(B) Indium-labeled leukocyte scan
(C) MRI
(D) Triple-phase technetium bone scan
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