doc_clotaire
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A 35-year-old woman is seen in the emergency department because of the sudden onset of severe low back pain 12 hours earlier. The pain began when she bent over to pick up her 2-year-old child. She has been unable to stay in bed because of the need to care for her child. Low doses of ibuprofen have eased the discomfort slightly. Careful physical examination, including a neurologic
examination, is normal except for evidence of muscle spasm. She believes she has a herniated disc because 2 years ago her father
developed the sudden onset of back pain that required immediate surgery.
1.- Which of the following is the most appropriate first step?
(A) Order CT scan of the lumbar spine
(B) Order MRI of the lumbar spine
(C) Order x-ray films of the lumbar spine
(D) Reassure her and treat with a nonsteroidal anti-inflammatory drug (NSAID)
(E) Request consultation with an orthopedic surgeon
She returns 3 weeks later because of persistent left lower leg pain and a weak left ankle-jerk reflex. In addition to painmanagement,
2.- which of the following is the most appropriate step at this time?
A) AP and lateral x-ray films of the lumbosacral spine
(B) CT scan of the lumbosacral spine
(C) Diskography
(D) MRI of the spine
(E) Observation
END OF SET
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| Justice
Just signed contract
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1. (B)
2. (C)
Hope the birds are killed...
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| dr.wad
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C
D
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| vradojc1
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C
D
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| sprint123
Forum Guru
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I am going to use D as my stone....in both cases
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| doc_clotaire
Forum Guru
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1.- The correct answer is D.
This patient has an acute back syndrome that is most
likely due to lumbosacral muscle sprain or strain. The normal neurologic examination
does not suggest any evidence of a radiculopathy, and therefore a disc herniation is less
likely. The great majority of these injuries improve with NSAID use and bedrest for
approximately three days. Longer periods of bedrest, immobilization, or traction have not
been demonstrated to improve outcomes when compared to three days of bedrest.
A CT scan (choice A), MRI (choice B), x-rays (choice C), and a orthopedic consultation
(choice E) are not indicated at this time as this patient most likely has lumbosacral
muscle sprain or strain and has no evidence of a radiculopathy, infection, or tumor.
2. The correct answer is D.
The symptoms now suggest a radiculopathy because of
the left lower extremity pain, and the weak left ankle-jerk reflex. Therefore, consideration
of a disc bulge or herniation must be considered. The most effective diagnostic imaging
of this region is an MRI of the lumbosacral spine, not an x-ray (choice A), CT scan
(choice B), or diskography (choice C).
Observation (choice E) is inappropriate as she has symptoms of a radiculopathy and
should be further evaluated with an MRI
You killed both of those suckers BIG TIME sprint
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