The Case of a 51-year-old Man with Back Pain
Most new third-year medical students can recite the “red flags” of back pain: extremes of age, fever, history of cancer, history of trauma, failure to improve after one month of therapy. Few would fail to consider metastatic disease in a 64-yearold woman with a history of breast cancer and new-onset low back pain, but what about the 51-year-old male without a significant past medical history?
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14-year-old boy with lower back pain stemming from fall
The patient is a 14-year-old boy who presents with low back pain after falling from “a high height” and landing on his feet. Exam is normal except for tenderness in the mid-lumbar region. View the image taken and consider what your diagnosis and next steps would be.
Read MoreClinical Challenge 2
The patient is a 61-year-old male who presents with back pain. The patient’s abdomen is soft. Vitals are stable. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 12-year-old Girl with Back Pain
Urgent message: Back pain in a pediatric patient requires a high index of suspicion. Ominous causes (e.g. cancer, infection), are far more common in the pediatric population. Conversely, mechanical low back pain is far less common, and is a diagnosis of exclusion. Forrest Nguyen, DO Introduction As urgent care physicians, we are responsible for anything that comes through the door. Often, the diagnosis proves to be routine – a viral infection, a sore throat, or …
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December 2009
55-year-old female experienced blow to back from fall
The patient is a 55-year-old female who experienced a blow to the back when she fell while riding a bus. She complains of pain in her neck, shoulder, and back. On examination, you find that her vitals are stable and she has no significant past medical history. View the x-ray taken and consider what your diagnosis and next steps would be.
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80-year-old man suffering lower back pain
The patient is an 80-year-old man who presents with a two-week history of low back pain. He is hemodynamically stable and has a normal neurological exam. His personal medical history reveals hypertension, for which he is being treated. Blood pressure is 140/80, pulse 63. View the x-ray taken and consider what your diagnosis and next steps would be.
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May 2008
The Case of a 71-Year-Old Man with Back Pain
Though it is easy to predict the usual etiology of common complaints, we need to be able to exclude life-threatening causes of symptoms. In law, we are innocent until proven guilty. In medicine, we are required to prove certain diseases are not occurring; we are, in a sense, guilty until proven innocent: A 50-year-old man with chest pain and diaphoresis has an MI until proven otherwise. A 22-year-old woman with lower abdominal pain has an …
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