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Breast screening test performance — USMLE Step 3 MCQ

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HardPreventive Medicine, Epidemiology, BiostatisticsBreast screening test performanceUSMLE Step 3

A 59-year-old man with diabetes has fever, severe thoracic back pain, rapidly progressive bilateral leg weakness, and urinary retention. MRI shows a posterior epidural abscess compressing the spinal cord. Blood cultures are obtained, and he has no operative contraindication. Which management is most appropriate?

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Correct answer: B — Begin empiric intravenous antibiotics and obtain urgent surgical decompression and drainage

The best answer is “Begin empiric intravenous antibiotics and obtain urgent surgical decompression and drainage”. Spinal epidural infection with cord compression and progressive neurologic deficit is a surgical emergency. Cultures should be obtained promptly when feasible, followed by empiric therapy covering likely organisms and urgent decompression/drainage. Antibiotics alone may be considered in selected neurologically intact patients, but culture delay, percutaneous aspiration alone, glucocorticoids, or outpatient oral therapy risks irreversible paralysis.

Reference: IDSA Guideline: Native Vertebral Osteomyelitis: https://www.idsociety.org/practice-guideline/vertebral-osteomyelitis/