A 60-year-old male—newly diagnosed Type II diabetic complains of unremitting and increasingly severe low back pain for the past 48 hours. He has been unable to find a comfortable position, that is, whether he is sitting, standing, flexed at the hips supine or on his side. There is radiation down the left lateral thigh. He denies urinary symptoms of any sort. His vital signs are normal except for a temperature of 100.8 F. Examination shows no abdominal mass or tenderness, and there is no costo-vertebral angle or other back tenderness. There is no saddle numbness or sensory loss. Deep tendon reflexes of the lower extremities are brisk and symmetrical. Straight-leg-raising test is unworkable due to the patient writhing in pain when in the supine position. Complete blood count (CBC) shows a leukocytosis of 18,000 with 80 neutrophils and a slight shift toward immature forms. The urinalysis is unremarkable. Which of the following is the most important next step in evaluating this patient? (A) 100 mg meperidine intravenously for empiric evaluation of his response (B) Urology consultation for a possible obstructing urolith accounting for normal urinalysis (C) Computed tomography (CT) of the lumbo-sacral spine (D) Stat blood cultures to be drawn (E) Start intravenous levofloxacin
Posted on: Fri, 07 Mar 2014 09:00:46 +0000
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