A 66-Year-Old Man Comes to the Emergency Department with Progressive

question 454

Multiple Choice

A 66-year-old man comes to the emergency department with progressive lower back pain, urinary incontinence, and decreased appetite for the past 2 days.  He was recently diagnosed with L4-L5 disc herniation and received an epidural injection for radicular pain 2 weeks ago.  His other medical problems include type 2 diabetes mellitus and hypertension.  Temperature is 38.3 C (100.9 F) , blood pressure is 136/88 mm Hg, pulse is 96/min, and respirations are 14/min.  The patient is alert and oriented.  Physical examination shows poor dentition, tenderness on palpation of the lumbar spine, and absent deep-tendon reflexes in both lower extremities.  Rectal examination shows decreased rectal sphincter tone and an enlarged, smooth prostate.  Laboratory results are as follows: Which of the following is the most appropriate next step in management of this patient?

• A)Intravenous glucocorticoids
• B)Lumbar puncture
• C)Magnetic resonance imaging of the spine
• D)Serum prostate-specific antigen and bone scan
• E)Tagged white blood cell scan

---

Definitions:

Wasting Resources

The inefficient or unnecessary use of materials, time, or energy, resulting in lost potential.

Avoiding Work

An employee’s deliberate attempt to evade tasks or responsibilities assigned as part of their job.

Cognitive Dissonance

Experienced inconsistency between one’s attitudes and/or between attitudes and behavior.

Perceived Control

An individual's belief in their ability to influence or control events in their life, which can impact their motivation and psychological well-being.