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A 62-Year-Old Man Comes to the Office After a Week

question 85

Multiple Choice

A 62-year-old man comes to the office after a week of persistent back pain. The patient has had back pain before, but this episode is more disturbing. The pain is limited to his lower back, becomes worse with movement, and persists at night. He has no leg pain or abdominal symptoms. Three weeks ago, the patient was evaluated for fever, urinary frequency, and dysuria. He was found to have an enlarged, nontender prostate with a prostate-specific antigen level of 2.2 ng/mL (normal <4 ng/mL) , and was prescribed a 7-day course of ciprofloxacin. Except for mild malaise, the symptoms have subsided. The patient's medications include vitamin D and daily fiber supplements.
Temperature is 36.7 C (98.1 F) , blood pressure is 120/70 mm Hg, and pulse is 88/min. The patient has limited mobility of his back in all directions due to pain. There is no tenderness on palpation of any of the spinal processes. There is no costovertebral angle tenderness. Gait, perineal sensation, and deep tendon and plantar reflexes are normal. The remainder of the examination is normal.
Which of the following is the best next step in management of this patient?

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Advanced Funds

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Ethical Opinion

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American Bar Association (ABA)

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