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Old 10-21-2011
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Rheumatology/Orthopedics Severe Back Pain and Radiolucency!

A 56-year-old white woman comes to the office because of severe back pain and mild hip pain for the past 48 hours. The pain began when she bent over to pick up her cat. She has also noted significant fatigue and malaise over the past few months. She does not complain of any neurologic dysfunction. She denies any history of trauma and has no other significant medical illnesses. Her vital signs are within normal limits. Physical examination is benign with the exception of extreme tenderness to palpation in the mid-lumbar spine and an inability to flex and extend her back because of pain. Radiographs of the lumbar spine and pelvis show a compression fracture of her L3 vertebra. There are also several areas of radiolucency in her pelvis and proximal femur. Which of the following is the most appropriate next step in management?

A. Admit the patient to the hospital for further workup and pain management of her L3 fracture
B. Await the radiologist’s report on the patient’s radiographs until tomorrow when you will call the patient with her results
C. Discharge the patient from the office after prescribing muscle relaxants and narcotics for her back pain
D. Discharge the patient from the office with a back brace to help her with her back pain
E. Obtain an MRI of the patient’s spine immediately
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noor84 (10-31-2011)

Old 10-22-2011
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osteoporosis D ??
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Old 10-23-2011
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Default Answer

The correct answer is A. Multiple lytic lesions on radiographic examination is highly suggestive of multiple myeloma, a plasma cell disorder that commonly occurs between the ages of 50 to 80 years. A skeletal radiographic survey is indicated to look for other sites of involvement that may be at risk for pathologic fracture. This patient will need to be evaluated by a hematologist/oncologist and should also have a serum calcium level sent immediately to the laboratory because these patients may often have significant hypercalcemia.
This patient should not be allowed to go home as she is at significant risk for other pathologic fractures and hypercalcemia; thus, choices B, C, and D are incorrect and may result in significant morbidity and mortality.
An MRI (choice E) would be more helpful if the patient was having neurologic symptoms as a result of her fracture, and could be done the hospital.
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Old 10-31-2011
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Default ....

I agree with answer A.

I feel with this compression fracture, it is just not a strain.

With the radiolucency , we need to investigate


maybe bone scan
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Rheumatology-, Step-3-Questions

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