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 BACK PAIN  



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Author17 Posts
  #1

A 67 Y.O MAN IS BROUGHT TO EMG DEP. 4HR LATER AFTER ONSET OF SEVERE MID LUMBAR BACK PAIN. HE IS ANXIOUS, PALE AND DIAPHORETIC. VITAL SIGNSD ARE T=37 BP=105/65PULSE 120
EXAMINATION SHOWS NO ABNORMALTIS. X RAY = LUMBAR SPINE SHOW DEGENERATIVE DISC DISEASE WITH CALCIFICAION ANTERIOR TO VERTEBRAL BODIES. WHICH IS THE DX???

A)AORTOILIAC OCCLUSION
B)HERNIATED NUCLEOUS PULPOSUS
C)LUMBAR STRAIN
D)LUMBAR DISCITIS
E)PYELONEPHRITIS
F)RUPTURE ANEURYSM
G)SPINAL STENOSIS




  #2

A...


  #3

BUT THE X RAY FINDINGS DOESN'T TELLS YOU IT IS DEGENERATIVE BACK PAIN, OR THAT IS NOT A CLUE???
I GUESS THAT THE LACK OF NEURO FINDINGS R/O HNP AND LUMBAR STENOSIS.


  #4

I know i was also confused with this Q (i know the source :wink: ) tough one for me too :cry: :roll:


  #5

wouldn't occlusion present with higher than normal pressure above? and lower below?? also numbness in the extremities, decreased pulses, cold skin etc.
Calcifications at LS level can suggest Athero Disease in lower vessels. But not all the time.
With such findings and vitals I'd say the doc missed belley full of blood from ruptured aneurism.
So not carring for the source of the q...
I say..
F


  #6

How and why do u say rupture anuresym ??? :roll:


  #7

Low BP and periferal vasoconstriction (paleness) , sympathetic overdrive( HR 120, low BP+fairly normal pulse pressure, diaphresis, anxiety), evidence of atherosclerosis (clacifications anterior to spine) stabbing back pain. All point to possibility of aneurism. At least in my humble opinion.


  #8

YES, ASMI THAT'S THE SOURCE. DON'T HAVE THE ANSWERS
THANKS YOU GUYS FOR THE DISCUSSION. 8)


  #9

thanks mdwannabe...you are awesome ..


  #10

we still don't know if I am right?


  #11

I think u r right Mdwannabe .Since the Q mentions acute condition


  #12

Hi bronco can you pls tell me the source if you dont mnid.The ques are really good and tricky.


  #13

I would like to know the source of this Q too.


  #14

NBME SELF ASSESMENT ( CLINICAL ). IT IS A GOOD SOURCE , BUT NO FEED BACK :x


  #15

Thanks bronco


  #16

what is the relation of COPD to rupture abd aneurysm :roll: ?

They say 3 factors for rupture:

size (> 6 cm) , HTN and COPD .


  #17

possibly due to the fact that some COPD is caused by alfa-1-antitrypsin def. So as the alveoli are eaten by uncontrolled elastase activity, the same is going on the aortic wall, making it thinner, and make it prone to baloone out.
May be?





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