Respond to at of your colleagues on different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
respongding to
Wk 8 Discussion – Initial Post – Back Pain
Patient Information
Name: M.L
Age: 42 years
Race: African American.
Sex: Male
CC: I feel pain on my back that radiates to the left leg.
SUBJECTIVE:
HPI: The patient is a 42-year-old male of African American origin who presents to the facility with lower back pain for the past month. The patient reports severe pain that starts in the lower back and radiates to the left leg. He describes the pain as a burning sensation deep in the buttocks. He reports that the left leg feels heavy. He reports that the lower back pain is associated with tingling and numbness in the left leg. He reports that sitting down makes the pain worse. He rates the lower back and leg pain at 7/10. The patient denies headache, fever, nausea, or vomiting. He denies abnormal gait or weakness. The patient has been taking Tylenol OCT without better outcomes.
Current Medication: Tylenol 500 mg twice a day for pain.
Allergies: No known allergies.
PMHx: He reports history of HTN. His last immunization for influenza and tetanus was three months ago. No history of trauma.
Surgical Histoty: No history of surgery.
Family History: Father is alive 76-years with history of type 2 diabetes mellitus and arthritis. Mother is alive 72-years with history of HTN and type 2 diabetes mellitus. Elder brother no known medical history. His two children a daughter 16 years and son 13 years, have no known medical history.
Social History: Patient is married and lives with his wife and two children a son and daughter. He works an accountant in a local bank. He smokes at least one packet of cigarette every day. He denies alcohol, marijuana or illegal drug use. He enjoys swimming and watching movies. He uses seat belts while driving and does not text when driving. He uses smoke detectors at home for safety.
ROS:
General: He denies fever, chills or chest pain. Patient denies fatigue or weight loss.
HEENT: Head; Denies headache, dizziness or pain. Eyes; Denies double vision, blurred vision or discharge. Ears; Denies hearing problems, pain in ears or discharge. Nose: Denies congestion, sneezing or bleeding. Throat; Denies swelling or stiffness.
Skin: No lesion, rash or ulcers.
Respiratory: Denies breathing difficulties, cough or wheezing.
Cardiovascular: Denies chest pain, heart murmur or irregular heartbeats. No edema.
Gastrointestinal: Denies abnormal bowel sounds, constipation, diarrhea, vomiting, nausea or blood in stool. Denies difficulties in bowel movement.
Genitourinary: Patient denies pain urinating, hematuria or increased frequency urinating.
Hematologic: Denies easy bruising, bleeding or blood transfusion.
Musculoskeletal: Patient reports pain on the lower back that radiates to the left leg. He reports that the left leg feels heavy. Denies pain in joints or bone fracture. Reports numbness and tingling on the left leg.
Psychiatry: Denies anxiety, hallucination or depression.
Endocrinologic: Denies heat or cold intolerance. No polyuria or polydipsia.
Allergies: No history of eczema, asthma or hives.
Objective:
General: Patient is a 42-year-old. Patient is oriented x4. He appears in pain when lifting left leg.
Vitals: BP 118/83, P 84, R 16, T 98.4. oral Pulse ox 99%
Head: Normocephalic and symmetric to the body. No frontal or maxillary tenderness. Eyes: Symmetrical, sclera white and conjunctiva pink, no drainage or hemorrhages. Ears: no masses on external ears, no injuries or tenderness. No discharge. CN1 crossly intact. Tympanic membrane pearly grey or bulging. Nose: No bleeding from septum. Nosal mucosa is moist and free from polyps. Throat and Mouth: Membranes moist and pink. Tonsils at pillars, no redness or exudates.
Abdominal: Round and non-distended. Normactive sounds in all quadrants. No abdominal bruits.
Musculoskeletal: Pain on the left leg noted after straight leg test. Numbness and tingling noted on the left leg to the toes. Paresthesia noted in buttock area. No pain in joints noted. A loss of muscle strength on the left leg noted. Normal gait.
Neurologic: CN VII-XI crossly intact. Sciatic nerve pain noted on slump test
Diagnostic Results: The recommended laboratory tests for the patient include CT-scan of the lumbosacral spine to evaluate fracture or disc herniation and MRI to evaluate tumors that can affect the sciatic nerve.
Assessment:
Primary diagnosis: The primary diagnosis for the patient is sciatica which involves the compression of the sciatic nerve that causes pain. The sciatic nerve is important in motor and sensory functions for the hamstrings, calf muscles and the lower leg muscles (Koes et al., 2007). A condition such as inflammation of the sciatic nerve causes compression and pain that radiates to the leg. The patient reports lower back pain that radiates to the left leg which supports the diagnosis for sciatica.
Differential Diagnosis:
1. Epidural abscess: The condition is associated with an infection that affects the skull near the spine. Epidural abscess causes lower back pain that can spread to the legs. The condition causes additional symptoms including fever, weakness, headache, nausea and vomiting. The condition is ruled out based on the reported symptoms (Bond & Manian, 2016).
2. Spinal tumor: This involves a cell proliferation that causes tumor in the spinal cord. The condition is associated with lower back pain and the waist tenderness (Ciftdemir et al., 2016). The condition causes additional symptoms including neurological deficit that require MRI to rule out based on the physical examination findings (Ciftdemir et al., 2016).
3. Piriformis syndrome: This condition involves the inflammation of the piriformis muscle that can affect the sciatic nerve. The condition causes severe pain in the affected leg and additional symptoms including tingling and numbness of the leg. The MRI imaging is important in ruling out the condition (Ro & Edmonds, 2018).
References
Bond, A., & Manian, F. A. (2016). Spinal epidural abscess: A review with special emphasis on earlier diagnosis. BioMed Research International, 2016, 1-6. https://doi.org/10.1155/2016/1614328
Ciftdemir, M., Kaya, M., Selcuk, E., & Yalniz, E. (2016). Tumors of the spine. World Journal of Orthopedics, 7(2), 109. https://doi.org/10.5312/wjo.v7.i2.109
Koes, B. W., Van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313-1317. https://doi.org/10.1136/bmj.39223.428495.be
Ro, T. H., & Edmonds L. (2018). Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843966/
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