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Refer patient to an orthopedic surgeon
5%
15/277
Switch medication and avoid exercise
63%
175/277
Place permanent urinary catheter
7%
20/277
Perform MRI
12%
32/277
Perform CT scan
9%
24/277
Select Answer to see Preferred Response
This patient is most likely suffering from bilateral achilles tendinopathy secondary to the use of fluoroquinolones for the treatment of his urinary tract infection. Proper treatment includes switching medications and avoiding exercise. Fluoroquinolone antibiotics are often used for the treatment of hospital-acquired pneumonias and recurrent catheter-based infections. Their major side effects include tendinopathy, neuropathy, and QT prolongation. The use of fluoroquinolones is contraindicated in the pediatric population under most circumstances. The first-line management of fluoroquinolone induced tendinopathy includes discontinuation of the medication and the avoidance of exercise in an effort to prevent further injury. Illustration A is an MRI of fluoroquinolone induced achilles tendinopathy and rupture. Incorrect Answers: Answer 1: With no inciting event, this is unlikely to be a surgical issue at this time. Answer 3: Placement of a permanent catheter increases the risk of infection. Answer 4: The patient's history makes it unlikely that a rupture of the achilles tendon has occurred. This would be the proper test to make this diagnosis. Answer 5: A CT scan is not the optimal imaging modality for evaluation of the achilles tendon.
4.6
(15)
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