A 58-year-old woman with a 20-year history of type 2 diabetes mellitus, complicated by peripheral neuropathy and recurrent foot ulcers, presents to an urgent care facility. She reports increasing purulent discharge and localized swelling from a chronic ulcer on her right heel over the past three weeks. She denies systemic fevers or chills but notes a general feeling of malaise. Physical examination reveals a deep, foul-smelling ulcer measuring 3 cm x 2 cm, with surrounding erythema, induration, and tenderness upon palpation. The probe-to-bone test is positive. Given this clinical presentation, what is the most appropriate initial diagnostic imaging study and the subsequent definitive management strategy?

A 58-year-old man with a long-standing history of poorly controlled type 2 diabetes mellitus presents to the Emergency Department with a 10-day history of progressively worsening mid-thoracic back pain, low-grade fevers, and generalized malaise. He reports a recent hospitalization 5 months ago for bacteremia secondary to a chronic left plantar diabetic ulcer, which was identified as methicillin-resistant Staphylococcus aureus (MRSA). He denies any recent trauma, urinary retention, bowel dysfunction, or lower extremity weakness. On examination, his temperature is 38.80C, blood pressure 145/88 mm Hg, pulse 95/min, and respiratory rate 16/min. Oxygen saturation is 97% on room air. He exhibits exquisite point tenderness over the T8-T9 vertebral spinous processes with associated paravertebral muscle spasm but no overlying erythema or swelling. Neurological examination of the lower extremities is unremarkable. His left foot shows evidence of a healed plantar ulcer with surrounding callous formation. Given these findings, what is the most appropriate next step for definitive diagnosis and subsequent initial management?

A 38-year-old woman presents to an urgent care center with a 3-week history of progressively worsening low back pain. The pain is described as dull and constant, localized to a single vertebral segment, and is exacerbated by movement. She reports a history of intravenous substance use. She denies any recent trauma or falls. Her temperature is 37.8°C (100.0°F), blood pressure is 125/80 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 98% on room air. On physical examination, there is marked point tenderness and slight warmth to palpation over the L4-L5 vertebral bodies. Neurological examination reveals no focal deficits. Laboratory workup is initiated. Which of the following represents the most likely diagnosis and the appropriate initial management step?

A 62-year-old man with a long-standing history of type 2 diabetes mellitus, poorly controlled (last HbA1C 9.2%), presents to an outpatient clinic with a 6-week history of intermittent low-grade fevers and persistent discomfort in his right foot. He reports a superficial wound on his plantar foot that has been present for several months and has not healed despite various topical treatments. His vital signs today are: temperature 37.9°C (100.2°F), heart rate 88 bpm, respiratory rate 14 breaths/min, and blood pressure 142/88 mmHg. Physical examination reveals an indurated, non-erythematous plantar ulcer, approximately 3 cm in diameter, over the head of the first metatarsal, with a palpable probe-to-bone sensation. There is no surrounding fluctuance. Peripheral pulses are diminished bilaterally, and he has reduced sensation to light touch and pinprick in a stocking-glove distribution. Radiographs of the right foot show periosteal reaction and patchy lucencies in the distal metatarsal. Given these findings, what is the most likely diagnosis and the critical next step in his initial management?

A 45-year-old woman with a history of intravenous drug use and chronic hepatitis C presents to her primary care provider with insidious onset of worsening mid-back pain over the past week, accompanied by chills and subjective fevers. She reports no recent trauma but recalls a superficial skin infection on her arm about a month ago that resolved spontaneously. Her vital signs include a temperature of 38.8°C, blood pressure of 130/75 mmHg, heart rate of 115 beats/min, respiratory rate of 16 breaths/min, and oxygen saturation of 97% on room air. Physical examination reveals marked tenderness to palpation over the T7-T9 vertebral spinous processes, with mild paravertebral muscle spasm. Neurological examination is non-focal, with intact motor strength, sensation, and reflexes in all extremities. Given these findings, what is the most appropriate diagnostic workup and initial therapeutic approach?