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a 67 yo man is brought to ED 4hrs after the onset of severe midlumbar back pain.he is anxious pale and diaphoretic.temp.98.8F bp 105/65 pulse 120/min. exam shows no other abnormality.xray film of spine show degenerative disc disease.with calcifications anterior to the vertebral bodies.most likely diagnosis?
a)aortoiliac occlusion
b)herniated nucleus pulposus
c)lumbar discitis
d)lumbar strain
e)pyelonephritis
f)ruptured aortic aneurysm
g)spinal stenosis
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could someone explain what are b and c?
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i think its B
as it was relatively sudden --- sever---with kind of shock take .. high HR and low BP
calcification anterior to vertebral bodies ---ought to be chronic
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thanks sala ----I was stuck with ortho problems in back pain pt now looking back its soo clear
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f)ruptured aortic aneurysm
old age + SUDDEN onset of SEVERE pain + No History of back pain + Tachycardia and hypotension + PALE + Atherosclerosis (calcifications ANTERIOR to the vertebral bodies).
notes:
1.these Sx Tachycardia and hypotension + PALE could be due to PAIN by itself ( reflex) without bleeding.
2.calcifications ANTERIOR to the vertebral bodies= nothing wrong with the bone(vertebra) but with instructures which are in front of the vertebra (atherosclerosis in the vesseles "Aorta" wich pridispose to rupture)
