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A 60-Year-Old Woman Comes to the Emergency Department for Acute

question 28

Multiple Choice

A 60-year-old woman comes to the emergency department for acute onset of low back pain radiating down her left leg after lifting heavy boxes at home. She denies any muscle weakness and has no problems with bowel or bladder function. She states that her back pain worsens with coughing or bearing down. Her past medical history is significant for type 2 diabetes mellitus and hypertension. She recently received a flu shot which made her experience mild flu-like symptoms. She has smoked two packs of cigarettes daily for many years, but denies alcohol use.
Her temperature is 37 C (98.6 F) , blood pressure is 140/90 mm Hg, and pulse is 90/min and regular. Neurological examination reveals 5/5 muscle strength in all four extremities with 2+ reflexes. Straight leg raise sign is positive on the left. Sensory examination reveals reduced pinprick and temperature sensation along the posterolateral region of the left leg.
Basic metabolic panel is normal. Plain radiograph of the lumbar spine shows only degenerative changes.
Which of the following is the most appropriate next step in management?

Definitions:

Counterconditioning

A behavior therapy technique where an unwanted behavior or response is replaced with a more desirable one by associating the behavior with a positive action or feeling.

Conditioned Fear

A learned response to a previously neutral stimulus that has been repeatedly paired with an aversive stimulus, leading to fear responses when the neutral stimulus is presented alone.

Furry

A subculture interested in anthropomorphic animal characters with human personalities and characteristics.

Puzzle Boxes

A method used in animal learning experiments where an animal must solve a problem or manipulate mechanisms to escape or obtain a reward.