dr_jojo
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A 67-year-old man is brought to the emergency department 4 hours after the onset of severe midlumbar back pain. He is anxious, pale, and diaphoretic. His temperature is 37.1 C (98.8 F), blood pressure is 105/65 mm Hg, and pulse is 120/min. Examination shows no other abnormalities. X-ray films of the lumbar spine show degenerative disc disease with calcifications anterior to the vertebral bodies. Which of the following is the most likely diagnosis?
A
) Aortoiliac occlusion
B
) Herniated nucleus pulposus
C
) Lumbar discitis
D
) Lumbar strain
E
) Pyelonephritis
F
) Ruptured aortic aneurysm
G
) Spinal stenosis
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| doc_clotaire
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G ) Spinal stenosis
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| Dr_kholioo
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why ?
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| 92306
Forum Senior
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F ) Ruptured aortic aneurysm
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| dr_jojo
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I will go for F
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| dr in trouble
Forum Guru
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It looks like ruptured aortic aneurysm.
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| klimt
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can anyone explain this q? if it's ruptured Ao aneurysm, why is there degenerative disc disease with calcifications?
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| usmle12
Forum Senior
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yup most probably aortic aneurysm rupture cz its real acute presentaion and midlumbar pain....as compared to typical lower lumbar...so ithink its aortic rupture
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| webjeee
Forum Guru
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Posts: 350
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calcifications anterior to the vertebral bodies
please concentrate on ANTERIOR!
that's probably not calcified pulpus, otherwise really rare. normally, herniation is posterior of vertebrate. sometimes, disc herniation will cause the imbalance of the spine, then overstretch of these ligaments, then injury, then soft tissue calcification, spur.
anterior spur may pierce the vessels, who knows
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| vradojc1
Forum Elite
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Posts: 309
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Same case in surgery section:
http://www.prep4usmle.com/forum/thread/53177
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| fongch
Forum Elite
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Posts: 316
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It's F
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| ram3
Forum Guru
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In ruptured aortic dissection there would be hypotension here there is not so the answer is spinal stenosis big time
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| cirus
Forum Guru
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I don't believe that spinal stenosis is right due to the sudden onset of the presentation & the abscence of focal neurological signs, this article confirms my point of view
What Are the Symptoms of Spinal Stenosis?
The space within the spinal canal may narrow without producing any symptoms. However, if narrowing places pressure on the spinal cord, cauda equina, or nerve roots, there may be a slow onset and progression of symptoms. The neck or back may or may not hurt. More often, people experience numbness, weakness, cramping, or general pain in the arms or legs. If the narrowed space within the spine is pushing on a nerve root, people may feel pain radiating down the leg (sciatica). Sitting or flexing the lower back should relieve symptoms. (The flexed position "opens up" the spinal column, enlarging the spaces between vertebrae at the back of the spine.) Flexing exercises are often advised, along with stretching and strengthening exercises.
People with more severe stenosis may have problems with bowel and bladder function and foot disorders. For example, cauda equina syndrome is a severe, and very rare, form of spinal stenosis. It occurs due to compression of the cauda equina, and symptoms may include loss of control of the bowel, bladder, or sexual function and/or pain, weakness, or loss of feeling in one or both legs. Cauda equina syndrome is a serious condition requiring urgent medical attention.
anyone thought about lumbar discitis??
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| cirus
Forum Guru
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i think the ans is F
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| sailing boat
Forum Elite
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please can u explain this again, i think i am not getting a word of it,why re there calcifications seen
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| krsna
Forum Senior
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i too think its F. the calcifications are probably in the abd aorta running anterior to the vertebral column...
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| The_King
Forum Newbie
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see this
http://rheumatology.oxfordjournals.org/cgi/conten...
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| prathapdoctor
Forum Elite
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i think its rupture of aortic aneurysm. there are calcifications anterior to lumbar vertebrae suggesting calcified aorta which is prone to rupture.
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| smal
Forum Guru
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B......
biggest clue-degenerative disease of disc
secondly-chronic prolapsed disc can lead to calcification and hence the appearence.
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| yasmeen
Forum Guru
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F calcification anterior to vertebrae is calcified atherosclerotic aortic plaque . diaphorsis hypotension lumbar pain and low blood pressure all favours FFFFFFFFFFF
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| Justice
Forum Fanatic
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Posts: 2,324
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(F)
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