A 63-Year-Old Woman Comes to the Office Due to Back

question 490

Multiple Choice

A 63-year-old woman comes to the office due to back pain.  The patient works as a postal carrier, and the pain started 2 days ago while she was lifting a heavy package on the job.  She has had no lower extremity weakness or sensory symptoms.  The patient was treated for a urinary tract infection a month ago.  She smokes a pack of cigarettes daily.  The patient reports "I am tired of the heavy lifting I've been doing for 30 years."  Temperature is 36.7 C (98.1 F) , blood pressure is 120/76 mm Hg, and pulse is 80/min.  Physical examination shows paravertebral tenderness localized to the L3 level on the right side.  There is no tenderness over the spine.  Lower extremity strength is 5/5, and deep tendon reflexes are 2+ and symmetric.  Babinski sign and straight-leg raising test are negative.  Which of the following is the most likely diagnosis in this patient?

• A)Herniated intravertebral disc
• B)Lumbosacral strain
• C)Malingering
• D)Metastatic cancer
• E)Osteoporotic compression fracture
• F)Spinal epidural abscess

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