quizzER Winners:

David Mishkin           Marjan Siadat           Ryan Phillips             Allison Loynd

Julie Nguyen              Maria Pak                  HVSH CRNAs           Devon Moore

Maria Pak                   Brian Kern                 Richard Gordon        Rob Klever

Last Week’s Question

The answer is c.

Spinal abscesses are most commonly found in immunocompromised patients, IV drug users, and the elderly.Signs and symptoms of epidural abscess usually develop over a week or two and include fever, localized pain, and progressive weakness. An elevated WBC count is also commonly seen. MRI is the most useful diagnostic test. S. aureus is the most common causative organism, followed by gram-negative bacilli and tuberculosis bacillus.

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(a) A lung abscess is a cavitation of lung parenchyma resulting from local suppuration and central necrosis. It is often precipitated by aspiration of oropharyngeal secretions. (b) Inflammatory conditions, including ankylosing spondylitis, may cause back pain. The key findings in this disease include gradual onset of morning stiffness improved with exercise in a patient less than age 40 years. On physical examination, these patients may have limited back flexion, reduced chest expansion, and sacroiliac joint tenderness, all of which are nonspecific. Fever and weakness would not be expected. (d) Back pain may result from vertebral compression fractures. These may be secondary to trauma or may be atraumatic in a patient with osteoporosis. Osteoporotic compression fractures usually involve patients over 70 years or patients with acquired bone weakness (e.g., prolonged steroid use). (e) Metastatic lesions invade the spinal bone marrow, leading to compression of the spinal cord. Most common primary tumors include breast, lung, thyroid, kidney, prostate (BLT with Kosher Pickles), as well as lymphoma and multiple myeloma. Maintain a high level of suspicion for any cancer patient who develops back pain; these patients must be investigated for spinal metastases.

Thank you for everyone who submitted an answer.  Please stay tuned for next week’s quizzER.

quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training.