A 34-Year-Old Man Comes to the Office Due to Low

question 900

Multiple Choice

A 34-year-old man comes to the office due to low back pain and tightness for the past 3 months.  The pain is dull, has an aching quality, and has become progressively worse.  It is worse late at night and in the early morning hours but improves gradually during the day as he moves around.  The patient has had no recent injury.  Medical history is unremarkable.  He lives with his wife and does not use tobacco, alcohol, or recreational drugs.  Temperature is 36.1 C (97 F) , blood pressure is 120/76 mm Hg, and pulse is 80/min.  Examination shows no tenderness over the lumbar spine or lower extremity weakness.  Straight-leg raising test is negative.  Which of the following most likely accounts for this patient's symptoms?

• A)Decreased bone mineralization
• B)Inflammation at ligamentous insertions
• C)Ligamentous sprain
• D)Lumbar disc degeneration
• E)Lumbar spinal stenosis

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