Low back pain radiating to the thighs? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 557 Times in 318 Posts
Reputation: 567
Rheumatology/Orthopedics Low back pain radiating to the thighs?

A 72-year-old woman presents to her physician with worsening low back pain that radiates over her anterior thighs. The pain has affected her for nearly 3 years; it occurs during walking and prolonged standing and is relieved by rest and sitting. The patient also says that she has begun to experience a decreased urinary stream. Physical examination is notable for reduced mobility over the lumbar spine; there is no pain elicited with leg raising in the supine position. Posterior tibial and dorsalis pedis pulses are 2+. Ankle reflexes are 1+ bilaterally. Which of the following represents the most likely process responsible for this patient's back pain?

a) conus medullaris syndrome
b) lumbar spinal stenosis
c) lumbosacral disc herniation
d) peripheral vascular disease
e) polymyalgia rheumatica

I would appreciate if you could explain your answer
Reply With Quote Quick reply to this message



  #2  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 790
Threads: 76
Thanked 672 Times in 316 Posts
Reputation: 690
Default

im confused between A and B....

PERIPHERAL VASCULAR DISEASE- decreased urinary stream and reduced mobility in lumbar spine is highly unlikely.

DISC PROLAPSE is unlikely too since straight leg raise does not cause any pain

Polymyalgia rheumatica has diffuse muscle and joint pains seen in association with temporal arteritis


ill choose lumbar canal stenosis.....
__________________

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Matched!!!
Reply With Quote Quick reply to this message
The above post was thanked by:
Casandra (06-07-2012)
  #3  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 557 Times in 318 Posts
Reputation: 567
Default ;)

a and b - I had the same dilemma... that's why I was wondering how are you guys getting to the right answer here
Reply With Quote Quick reply to this message
  #4  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 790
Threads: 76
Thanked 672 Times in 316 Posts
Reputation: 690
Default

i choose B due to.....old age, long history of symptoms, bladder problem and degenerative changes in spine leading to reduced mobility

i googled those two and found many overlapping symptoms....so i cant substantiate my answer......
__________________

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Matched!!!
Reply With Quote Quick reply to this message
  #5  
Old 06-07-2012
USMLE Forums Guru
 
Steps History: Not yet
Posts: 375
Threads: 17
Thanked 131 Times in 81 Posts
Reputation: 147
Default

I don't know A so I will go with B...The other are irrelevant I think...So either A or B
Reply With Quote Quick reply to this message
  #6  
Old 06-07-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 135
Threads: 3
Thanked 73 Times in 48 Posts
Reputation: 83
Default

I choose b) lumbar spinal stenosis.

Because I saw similar presentation during clinicals. The fact that she has pain that occurs during walking/standing and is relieved with rest suggest a blood supply/ishemic problem. She has atherosclerosis which is causing the arterial stenosis leading to these symptoms.
__________________

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
You can't confuse the confused!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
The above post was thanked by:
Casandra (06-07-2012), Doc4Step1 (06-07-2012)
  #7  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 23
Threads: 12
Thanked 4 Times in 3 Posts
Reputation: 14
Default

A 72-year-old woman presents to her physician with worsening low back pain that radiates over her anterior thighs. The pain has affected her for nearly 3 years; it occurs during walking and prolonged standing and is relieved by rest and sitting. The patient also says that she has begun to experience a decreased urinary stream. Physical examination is notable for reduced mobility over the lumbar spine; there is no pain elicited with leg raising in the supine position. Posterior tibial and dorsalis pedis pulses are 2+. Ankle reflexes are 1+ bilaterally. Which of the following represents the most likely process responsible for this patient's back pain?

a) conus medullaris syndrome
b) lumbar spinal stenosis
c) lumbosacral disc herniation
d) peripheral vascular disease
e) polymyalgia rheumatica



answer is spinal stenosis.seen in middle age and elderly,relieved by resting and lyin, urinary retention, does not affect the tract hence no effect on reflex, due to hypertrophy of ligament thus suggetin the reduced motility, also no pain on stretchin leg

A-causes urinary incontinence, ankle reflexes are affected more than knee also there wud be multiple effects bcos it affects nerves
C- there is no pain on stretchin leg this rules out this option since leg stretching wud cause the affected nerve to be pulled and hence cause pain.also multiple effect wud b seen in the areas supplied by the nerve
D- this wud cause calf pain(claudication) and also the pulses of the lower limb are affected
E- is an inflammatory disorder manifestin as pain and stiffness in neck, shoulder and HIP not low back pian
Reply With Quote Quick reply to this message
The above post was thanked by:
Casandra (06-08-2012), Doc4Step1 (06-07-2012)
  #8  
Old 06-08-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 557 Times in 318 Posts
Reputation: 567
Correct Answer correct answer :)

Thank you very much for all your input guys!!! I was stuck btw a) & b), went for a) bc I wasn't sure about the symptoms in b) - I guess I have some reading to do here

The correct answer is b) lumbar spinal stenosis

Here's how they explain it:

Lumbar disc degeneration with enlargement of the facet joints can lead to lumbar spinal stenosis in the aging population. Spinal stenosis is characterized by:
- neurogenic claudication - pain in the buttocks or back that is induced by walking or prolonged standing and relieved by rest. It can mimic vascular claudication symptoms, but the maximal pain is over the anterior thighs as opposed to the legs, as in typical claudication. Patients also have preserved lower extremity pulses without stigmata of peripheral vascular disease. Unlike patients with disc herniation, these patients have pain that is relieved by sitting and have negative leg raises bilaterally. Spinal stenosis can result in focal weakness and potentially alarming signs and should be aggressively imaged to rule out more ominous causes of back pain.

Answer a) is incorrect. Conus medullaris syndrome is a cord compression syndrome that produces perianal numbness and urinary retension with an atonic rectal sphincter, as oppossed to the saddle anesthesia more typically found in the cauda equina syndrome, another cord compression syndrome.
Reply With Quote Quick reply to this message
The above post was thanked by:
alice (10-07-2012)
  #9  
Old 07-27-2012
Dr.Lacune's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 207
Threads: 38
Thanked 115 Times in 45 Posts
Reputation: 125
Default

Lumbar spinal stenosis, is the most common cause of wide variety of spinal compressive lesions, and it's considered the most common cause of cauda equina and conus modularis syndromes. It's not a syndrome itself, but rather a cause that might results in conus modularis syndrome.
__________________
IT IS GETTING INTENSE !!
Reply With Quote Quick reply to this message
The above post was thanked by:
Casandra (07-28-2012)



Reply

Tags
Musculoskeletal-, Nervous-System-, Pathology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
please help me check my PN for back pain chienpolska USMLE Step 2 CS Forum 1 07-15-2012 03:48 PM
Back Pain and Hematuria! tyagee USMLE Step 2 CK Forum 11 04-15-2012 12:20 PM
back pain! salz USMLE Step 1 Forum 2 08-05-2011 03:50 AM
old man with back pain. dr_lizard USMLE Step 1 Forum 7 08-04-2011 07:36 PM
Old man with lower back pain rasheed USMLE Step 1 Classic Clues 0 08-21-2009 11:25 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)