#june2020mccqe1
A 75-year-old man has a 2-month history of gradually increasing severe low back pain that is not related to trauma. The patient often feels warm and diaphoretic. He has no urine or stool incontinence. Ten weeks ago, he was discharged from the hospital after a prolonged intensive care unit stay for the treatment of community-acquired pneumonia-associated sepsis. During his stay, he required mechanical ventilation, enteral nutrition, and prolonged central venous access.
On physical examination, temperature is 38.1°C (100.5°F); other vital signs are normal. There is mild tenderness to palpation over the lower back with no definitive point of maximum tenderness. Neurologic examination is normal.
Complete blood count and urinalysis are normal. Erythrocyte sedimentation rate is 90 mm/h. Blood cultures are drawn.
Which of the following is the optimal diagnostic test?
(A) CT scan of the lumbar spine
(B) MRI of the lumbar spine
(C) Plain radiograph of the lumbar spine
(D) Three-phase bone scintigraphy
A 75-year-old man has a 2-month history of gradually increasing severe low back pain that is not related to trauma. The patient often feels warm and diaphoretic. He has no urine or stool incontinence. Ten weeks ago, he was discharged from the hospital after a prolonged intensive care unit stay for the treatment of community-acquired pneumonia-associated sepsis. During his stay, he required mechanical ventilation, enteral nutrition, and prolonged central venous access.
On physical examination, temperature is 38.1°C (100.5°F); other vital signs are normal. There is mild tenderness to palpation over the lower back with no definitive point of maximum tenderness. Neurologic examination is normal.
Complete blood count and urinalysis are normal. Erythrocyte sedimentation rate is 90 mm/h. Blood cultures are drawn.
Which of the following is the optimal diagnostic test?
(A) CT scan of the lumbar spine
(B) MRI of the lumbar spine
(C) Plain radiograph of the lumbar spine
(D) Three-phase bone scintigraphy
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