QuestionSBA
QuestionChoice
You may wish to give an NSAID with gastric protection if you suspected this back pain was mechanical. However, this patient has some red flags, like saddle anesthesia and bowel disturbance and therefore this would not be the most appropriate action.
10007671
b
Ibuprofen and omeprazole
QuestionChoice
It may be appropriate to look at inflammatory markers if you suspect an inflammatory cause of back pain such as ankylosing spondylitis. This would present as back pain with early morning stiffness, peripheral enthesitis or arthritis and tenderness of the sacroiliac joints. It would not cause saddle anesthesia or bowel disturbance.
10007672
c
Measure ESR and CRP
QuestionChoice
You wish to do an X-ray of the spine if you suspect a vertebral fracture. This would be more likely if there was a history of trauma, such as involvement in a road traffic collision. However, the clinical picture here is more likely to be cauda equina syndrome, and therefore a full spine MRI is the best investigation.
10007673
d
Spinal X-ray
QuestionChoice
This patient is presenting with the clinical features of cauda equina syndrome. Back pain associated with saddle anaesthesia (inability to feel toilet paper when wiping), and bladder or bowel disturbance (constipation or incontinence). Patients with these symptoms should receive a full spine MRI. If evidence of cauda equina is found, surgical decompression of the spine should be performed where appropriate within 48 hours of presentation.
10007670
a
Whole spine MRI
QuestionChoice
This acute nature of this patient's pain and neurological changes makes a diagnosis of cauda equina more likely than multiple myeloma. Therefore, a myeloma screen would not be the best investigation for this patient.
10007674
e
Myeloma screen
Concept
Chapter
2693
4618
Cauda equina
Topic
145
Orthopaedics
14081
A 62-year-old female presents to the GP with lower back pain that began 11 hours ago. On further questioning, she tells you she cannot feel the toilet paper when wiping. She has not opened her bowels or urinated since yesterday afternoon.

Which of the following is the next best step?
a