Thank you everyone for answering todays #USMLE question! The correct answer is D. In a patient who has a history of IV drug use, low back pain, and fever, a spinal epidural abscess is on the differential diagnosis, and an imaging study is needed to visualize the soft tissues surrounding the spine. An MRI scan is the preferred test, because it is positive early in the course of the infection and provides the best image of the inflammatory changes. CT scanning with contrast is an acceptable alternative. The great majority of patients who have back pain alone improve rapidly and do not require imaging. The following are indications for further imaging of the spine: progressive neurologic findings, constitutional symptoms, history of malignancy, age less than or equal to 18 years or more than or equal to 50 years, infectious risks like injection drug use, immunosuppression, indwelling urinary catheters, prolonged steriod use, and osteoporosis. These are known as red flag signs.
Posted on: Fri, 02 May 2014 18:30:10 +0000
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