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A 65-Year-Old Man Comes to the Office Due to a Foot

question 298

Multiple Choice

A 65-year-old man comes to the office due to a foot ulcer. The ulcer began 2 weeks ago, a few days after he scrubbed a callus off the bottom of his left foot. The patient tried over-the-counter antibiotic creams, but the ulcer gradually enlarged and started draining a foul discharge. The foot is not painful and he has had no fever. The patient has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. His diabetes has been poorly controlled by oral medications, and he has refused to take insulin. The patient is a retired veteran and does not use tobacco, alcohol, or illicit drugs. Temperature is 37.2 C (99 F) , blood pressure is 130/86 mm Hg, and pulse is 80/min. BMI is 32 kg/m². Examination of the left foot shows a 2×2 cm plantar ulcer with a necrotic base. No surrounding erythema or induration is present, and metal probing does not contact bone. Lower extremity pulses are diminished but palpable. Sensation to light touch and vibration is reduced, and ankle reflexes are absent bilaterally. Leukocyte count is 13,000 cells/mm³ and erythrocyte sedimentation rate is 95 mm/hr. Blood cultures and wound swab cultures are obtained.
Which of the following is most helpful for ruling out bone infection in this patient?

Definitions:

Equilibrium

A state where market supply and demand balance each other, and as a result, prices become stable.

Excise Tax

A tax charged on specific goods and services, such as tobacco, alcohol, and gasoline, usually intended to discourage their use or generate revenue.

Revenue Generated

The total amount of money received by a company from its sales of goods or services, before any expenses are subtracted.

Deadweight Loss

A decline in economic productivity that happens when a good or service does not reach or cannot reach its equilibrium.