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  #1  
Old 07-10-2011
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Rheumatology/Orthopedics Backache with palpable step-off!

A 12-yr-old is brought to your office by his mother because of several months history of back ache. He also experienced bed wetting recently. He tried acetaminophen for pain relief. His past medical history is insignificant. Does not drink or smoke. Temp=36.7, bp=110/65. Pulse=80, rr=16. Physical exam reveals palpable step off at the lumbosacral area. Straight leg raising test is negative. Perianal sensation by pin prick is decreased. Anal reflex is normal. What is the diagnosis?
1) multiple myeloma
2) epidural abcess
3) herniated disc
4) osteoporosis
5) spondylolisthesis
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  #2  
Old 07-10-2011
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epidural abscess
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Old 07-10-2011
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I think answer here is 5.spondylolisthesis....step off at lumbosacral area, radiculopathy signs
option 2 should have fever, since its since several months should have history of serious infection...option 1 and 4 does not fit this age group and given scenario.
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  #4  
Old 07-10-2011
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Default spondylolisthesis

spondylolisthesis is a developmental disorder characterized by forward slip of the vertebra usually l5 over s1. such a displacement results in chronic back ache and is significant, neurologic dysfunction. the area of the vertebral displacement is palpable as a step off sign clinically. for epidural abscess you should have fever and a source of infection.
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cool_atomic (07-10-2011), docmd11 (07-11-2011), USMLE-Syndrome (07-10-2011)
  #5  
Old 07-11-2011
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Correct Answer

5) spondylolisthesis.

Step off sign..
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  #6  
Old 07-11-2011
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Answer is 5 Spondylolisthesis
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