A 75-Year-Old Woman Comes to the Emergency Department Due to a Day

question 835

Multiple Choice

A 75-year-old woman comes to the emergency department due to a day of severe low back pain.  The pain started after she lifted a turkey from the freezer and worsens with standing, walking, and lying on her back.  She had no recent falls, lower extremity weakness, or sensory loss in the legs.  The patient has a history of temporal arteritis, which was diagnosed several months ago and is being treated with prednisone.  She does not use tobacco or alcohol.  Temperature is 36.7 C (98.1 F) , blood pressure is 140/70 mm Hg, pulse is 80/min, and respirations are 16/min.  Physical examination shows midline tenderness to palpation or percussion of the lumbar spine.  Ankle jerk reflexes are absent bilaterally.  Knee reflexes are 2+ in both legs.  Flexor plantar responses are present bilaterally.  Muscle strength is 5/5 in both legs.  Bilateral straight-leg raising test to 90 degrees does not increase the pain.  Which of the following is the most likely diagnosis in this patient?

• A)Facet joint dislocation
• B)Herniated disk
• C)Lumbosacral strain
• D)Spinal stenosis
• E)Vertebral compression fracture

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Definitions:

Sharpe Measure

A method used to evaluate the risk-adjusted return of an investment, comparing the excess return (over a risk-free rate) to the standard deviation of returns.

S&P 500 Index

A stock market index in the United States composed of the market values of 500 major companies listed on either the New York Stock Exchange or NASDAQ.

Time-Weighted Return

A method of calculating investment returns that eliminates the impact of cash flows into and out of the portfolio, focusing solely on the performance of the investments themselves.

Information Ratio

A measure of portfolio returns beyond the returns of a benchmark, divided by the volatility of those returns.