A 64-Year-Old Man with a History of Type 2 Diabetes

question 7

Multiple Choice

A 64-year-old man with a history of type 2 diabetes mellitus comes to the physician with 3 weeks of left foot pain.  He reports recent difficulty with ambulation that requires a cane.  He has no fevers, chills, nausea, vomiting, malaise, or fatigue.  The patient has a history of hypertension and poorly controlled diabetes mellitus complicated by mild renal disease and neuropathy.  His current medications include insulin, lisinopril, metoprolol, and gabapentin.
His temperature is 37.1 C (98.8 F) , blood pressure is 124/84 mm Hg, pulse is 90/min, and respirations are 18/min.  Examination of the lower extremities shows decreased sensation to fine touch bilaterally extending to the knees.  There is a 2x2 cm ulcerated lesion at the base of the left first metatarsal.  The borders are clean without erythema.  There is scant and foul-smelling purulent drainage at the base with poor granulation tissue and visualized bone.
An x-ray of the foot reveals cortical erosion with elevated periosteum.
Which of the following is the best next step in management of this patient?

• A)Check wound swab cultures
• B)Order bone biopsy with localized debridement
• C)Order MRI
• D)Order triple-phase bone scan
• E)Start empiric antimicrobial therapy

---

Definitions:

Receivable Turnover

A financial metric that measures how quickly a company collects payments from its customers by comparing sales to accounts receivable.

Inventory Turnover

A ratio showing how many times a company's inventory is sold and replaced over a particular period, indicating the efficiency of inventory management.

Current Ratio

A liquidity measure that indicates a company's ability to pay short-term obligations with its current assets.

Working Capital

A financial metric representing the difference between a company's current assets and current liabilities, indicating its short-term liquidity.