EMQs in Clinical Medicine.pdf - Peshawar Medical College

Back pain 115
45 Back pain
A
B
C
D
E
F
Paget’s disease
polymyositis
Scheuermann’s disease
vertebral disc prolapse
osteomyelitis
Reiter’s disease
G
H
I
J
K
myeloma
rheumatoid arthritis
Pott’s disease
spinal stenosis
ankylosing spondylitis
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
1 A 22-year-old man complains of stiffness in the lower back and buttock pain
that is relieved by exercise. He also suffers from bouts of painful red eye. His ESR
is raised. His radiograph shows blurring of the upper vertebral rims of the lumbar
spine.
2 A 60-year-old woman presents with constant backache. Her ESR and serum calcium
are markedly elevated.
3 A 65-year-old man with osteoarthritis complains of back pain worse on walking
along, with aching and heaviness in both legs that force him to stop walking.
Pain is relieved slowly after rest or leaning forward.
4 A 13-year-old girl complains of backache and fatigue. She is worried that she is
becoming increasingly round-shouldered. On examination, she has a smooth
thoracic kyphosis. Her radiograph shows wedge-shaped vertebral bodies in the
thoracic spine.
5 A 35-year-old tourist complains of severe back pain with inability to straighten
up after lifting a suitcase yesterday. He now presents with weakness of his big
toe extension and loss of sensation on the outer side of the calf.
Answers: see page 127.