75-year-old man is brought to the emergency department with severe back pain that began 3 weeks ago. The
pain has been significantly worse for the last 12 hours. This morning, the patient also noticed difficulty walking and
urinating. He has a history of advanced prostate cancer initially treated with local radiation therapy. Temperature
is 37 C (98.6 F), blood pressure is 122/83 mm Hg, and pulse is 104/min. The patient appears uncomfortable. He
has point tenderness over the midline spine near T10 and T11. Upper extremity strength and reflexes are normal.
Muscle strength in the lower extremities is 3/5 and deep-tendon reflexes are 3+ bilaterally. Bilateral plantar
reflexes are upgoing. Straight urinary catheterization produces 800 ml of urine. Which of the following is the best
initial step in management of this patient?
- O A. Analgesics, alpha blocker, and baclofen
- 0 B. Intravenous glucocorticoids
- 0 C. Radiation to the spine
- 0 D. Radionuclide bone scan
- 0 E. Skeletal survey
0 voters