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  #1  
Old 08-17-2013
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Wink Elderly Low Back Pain

70 yr old male with history of low back pain since 6 months with 5 kg weight loss. Pain has progressively worsened and increases on coughing.
On exam - no neurologic deficits.
what is most appropriate next step?
a. Xray
b. MRI
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Old 08-17-2013
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Was thinking about this yesterday.

My usual answer would be MRI but MTB says the "best initial" is X-ray
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Old 08-17-2013
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Quote:
Originally Posted by Renaissance View Post
Was thinking about this yesterday.

My usual answer would be MRI but MTB says the "best initial" is X-ray
but does "appropriate" equal "initial"?
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Old 08-17-2013
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most apt 'next step'...initial or best?
i think it should be mri...

Last edited by drsrb; 08-17-2013 at 07:11 AM.
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Old 08-17-2013
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was just doing kln qbank...there was a question about most apt next step..the answer was given acc to the initial step not the best..
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Old 08-17-2013
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According to me, and i think MTB concurs on this, the most appropriate step for this question would be an xray, because if you can locate osteolytic or blastic lesions on an xray you won't need to put the patient through an MRI (costly etc), but you can go straight straight to abdomen & pelvis CT for other metastases and primary.
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Old 08-17-2013
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Most appropriate step = Best initial step, in my book.
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Old 08-17-2013
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You do an X-ray to rule out lyric lesions and fractures (compression fractures)

If negative, Then you do an MRI to be sure there isn't any cord compression
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Old 08-17-2013
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yess i agree the ans must be Xray as MTB also says.
but the ans given was MRI and i m sure its wrong.
sticking to the concept of best initial -> Xray
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