Mechanical back pain Quiz: Ace Your Exams

Get ready to dominate your medical and nursing exams by using our dynamic quizzes to elevate your knowledge and increase your confidence. Whether you're gearing up for the USMLE®, COMLEX®, or your next in-class assessment, Osmosis quizzes tackle key topics in pathology, diagnostics, and treatment approaches. By honing in on clinical readiness and decision-making, we make sure the knowledge you gain empowers you both in the classroom and in real-world practice. Jump in and supercharge your exam prep!

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A 60-year-old man presents to the primary care clinic with a 4-month history of low back pain. He describes the pain as a dull, aching sensation that worsens with prolonged standing or walking and improves with rest. The pain is localized to his lower back and does not radiate to his legs. There has not been recent trauma or heavy lifting. There is no numbness, tingling, or weakness in his lower extremities, and he has not had bowel or bladder incontinence, fever, or weight loss. He has a history of hypertension and type 2 diabetes, both well-controlled with amlodipine and metformin, respectively. Vitals are within normal limits. The patient has a normal gait but appears uncomfortable when standing upright. There is tenderness to palpation over the lumbar paraspinal muscles and the lumbar spinous processes. Range of motion is limited, especially in lumbar extension and rotation, which reproduces his pain. Neurological examination is unremarkable, with normal strength, sensation, and reflexes in the lower extremities. Straight leg testing is negative bilaterally. An x-ray is performed and shown below. Which of the following is the most likely diagnosis?
 A lateral X-ray of a lumbar spine shows 2 arrows pointing to a bone spur and disc space narrowing between vertebrae, indicating degenerative changes.
Image by Nevit Dilmen, crop and annotation by Mikael Häggström, M.D. Licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license. Reproduced from WikiCommons 

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