A 48-Year-Old Man Comes to the Emergency Department Due to a 3-Day

question 242

Multiple Choice

A 48-year-old man comes to the emergency department due to a 3-day history of worsening low back pain.  He had no significant trauma to account for the pain, which started after he drove 12 hours in a day while returning from vacation.  The patient says, "As long as I stay in bed or in a recliner, it's okay, but if I twist, bend over, or stand up too fast the pain is excruciating."  He has tried using a heating pad with no relief.  Medical history is unremarkable, and he takes no medications.  Vital signs are normal.  Examination shows reduced lumbar lordosis and tenderness in the right midlumbar paraspinal area.  Motor strength, reflexes, and sensation in the lower extremities are normal.  With the patient supine and the knee extended, lifting the right leg over 60 degrees elicits achy pain in the posterior thigh.  Which of the following is the most appropriate next step in management?

• A)Erythrocyte sedimentation rate
• B)MRI of the lumbar spine
• C)Strict bed rest
• D)Trial of a nonsteroidal anti-inflammatory drug
• E)X-ray of the lumbar spine

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