11-25-2006, 07:14 AM
A 64-year-old African-American male has a long history of coronary artery disease for which he underwent a triple bypass 5 years previously. Approximately 3 years ago he developed difficulty passing urine and was found to have an enlarged prostate. His prostate-specific antigen level was raised, and a biopsy confirmed prostate cancer, which was treated by radiotherapy. The patient also has moderate hypertension and type 2 diabetes mellitus and is on an ACE inhibitor and a diuretic for his hypertension, and metformin for diabetes. Two weeks ago he starts to complain about low back pain but rationalized that it was from back strain caused by working in his yard. However, he has now developed weakness in his legs and problems with urination and consequently presents himself to a local emergency department. Neurologic examination reveals paraparesis with a sensory level below T10 and a distended urinary bladder. There is tenderness over the thoracic spine in that area. Which of the following is the proper next step in diagnosis?
A: Order an emergency computed tomography (CT) myelogram after an intravenous (IV) bolus of steroids
B: Order magnetic resonance imaging with contrast after an IV bolus of steroids
C: Order radiography of the thoracic spine after an IV bolus of steroids
D: Order electromyography (EMG) after an IV bolus of steroids
E: Send for radiation therapy over the lumbar and sacral areas after an IV bolus of steroids
A: Order an emergency computed tomography (CT) myelogram after an intravenous (IV) bolus of steroids
B: Order magnetic resonance imaging with contrast after an IV bolus of steroids
C: Order radiography of the thoracic spine after an IV bolus of steroids
D: Order electromyography (EMG) after an IV bolus of steroids
E: Send for radiation therapy over the lumbar and sacral areas after an IV bolus of steroids