Never Bored Review ! 7/3/14

by andygrock • July 3, 2014 • Comments Off

I know Board Review is usually Tuesday…but this one couldn’t wait. Chief Carl’s asked an interesting question during conference. Let’s make his implied knowledge a little more obvious.

A Case

70 yo Male with no related past medical history presents with acute on chronic low back pain. Recently he has noticed it’s worse whenever he is walking downhill or standing for too long and improved when walking uphill or by rest. The pain radiates down both legs. He has no concerning signs or symptoms for cauda equina/epidural abscess/other acute neuro-surgical emergency (we’ll cover these another time

What is the diagnosis?

Spinal Stenosis, AKA neurologic claudication. Think of the vertebrate when someone flexes (or walks uphill, or gets an LP), the posterior space between vertebrate is expanded. Meanwhile, during extension (or walking downhill) the same posterior space is reduced. If you have bone problems leading to nerve compression, making the extra posterior space will help the symptoms.

That Dr. Alsup sure is smart!

By Dr. Andrew Grock and Dr. Sally Bogoch. Inspired by Dr. Carl Alsup.

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th edition

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

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andygrock

Resident Editor In Chief of blog.clinicalmonster.com.
Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
Resident at Kings County Hospital