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 68-year-old man presents to the clinic with two days of acute lower back pain. He describes the pain as a constant, dull ache that has progressively worsened, and now radiates to both legs. The pain intensifies with movement and is unrelieved by over-the-counter pain medications. He denies any recent trauma or overexertion. He has also had 2-3 episodes of urinary incontinence and one episode of bowel incontinence over the past 24 hours. The patient is under active treatment for recently diagnosed prostate cancer. Temperature is 37°C (98.6°F), pulse is 94/min, respirations are 16/min, and blood pressure is 146/94 mmHg. The patient appears uncomfortable and has difficulty standing up straight. There is localized tenderness over the lumbar spine but no obvious deformity. Neurological examination reveals 5/5 strength in the bilateral upper and lower extremities and mild sensory loss in the perineum. There is decreased rectal tone on digital rectal examination. Which of the following is the best next step in management?

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Lumbar spine X-ray

Muscle relaxants and 24-hour bed rest

Magnetic resonance imaging (MRI) of the lumbar spine

Nonsteroidal anti-inflammatory drugs (NSAIDs) and referral to physical therapy

Oxycodone for 1 week with outpatient follow-up