A 66-Year-Old Man Comes to the Office for Evaluation of Low

question 717

Multiple Choice

A 66-year-old man comes to the office for evaluation of low back pain and difficulty walking for the past several months.  The pain is worse with prolonged standing and is relieved by sitting.  The pain is also less severe with walking uphill than with walking downhill.  Medical history is significant for degenerative joint disease of both knees.  The patient does not use tobacco, alcohol, or drugs.  He takes acetaminophen as needed.  His temperature is 37.2 C (98.9 F) , and blood pressure is 126/76 mm Hg.  His abdomen is soft and nontender.  There is no spinal tenderness to palpation and a straight leg raise elicits no pain.  Reflexes are 2+ in both legs.  There is no Babinski sign.  Dorsalis pedis pulses are full and equal in both feet.  Which of the following is most helpful in diagnosing his current condition?

• A)Ankle brachial index measurement
• B)Doppler ultrasonogram of the lower extremities
• C)MRI of the spine
• D)Electromyography and nerve conduction studies
• E)HLA-B27 levels
• F)Lyme titers
• G)Bone scan

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Definitions:

Adolescence

The transitional stage of physical and psychological development that occurs between childhood and adulthood, marked by puberty and increased independence.

Antipathy

Feelings of dislike or even hatred for another person.

Child Culture

The shared practices, beliefs, and activities among children that are passed down and evolve independently from adult culture, influencing social development and identity.

Empathy

The ability to understand the emotions and concerns of another person, especially when they differ from one’s own.