Master the board step 3

Master the Boards: USMLE Step 3
Syringomyelia
Cord Compression
Metastatic cancer presses on the cord, resulting in pain and tenderness of the
spine. Lumbosacral strain does not give tenderness of the spine itself.
Scan with an MRI. Biopsy is the most accurate test if the diagnosis is not clear
from the history.
The most effective therapy depends on the cause. The most urgent step in cases
of cord compression is to give steroids to decrease swelling.
Spinal Epidural Abscess
A spinal epidural abscess presents with back pain with tenderness and fever.
Scan the spine with MRI. Give antibiotics against Staphylococcus, such as oxacillin
or nafcillin. Large accumulations require surgical decompression.
Spinal Stenosis
This condition presents with leg pain on walking and can look like peripheral arterial
disease. The pulses will be intact, and the pain is worse upon walking downhill,
when the patient is leaning backward, but improved when walking uphill.
Diagnose with an MRI. Treat with surgical decompression.
Anterior Spinal Artery Infarction
All sensation is lost except position and vibratory sense, which travel down the
posterior column. There is no specific therapy.
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