A 74-Year-Old Man Comes to Urgent Care Due to Persistent

A 74-year-old man comes to urgent care due to persistent back pain at L1 to L4 spinal levels.  The patient's symptoms started suddenly while he was having breakfast yesterday.  The pain is constant, deep, and dull.  He reports no trauma or having had similar pain previously.  The symptoms do not change with climbing stairs or lumbar flexion/extension activities.  The patient had difficulty falling asleep last night because of increased pain in his lower back.  Medical history is significant for hypertension.  The patient has a 40 pack-year smoking history, but he does not use alcohol.  Medications include amlodipine and enalapril.  He is afebrile; blood pressure is 140/90 mm Hg and pulse is 88/min.  BMI is 27 kg/m².  Physical examination shows normal range of motion of the spine without point tenderness.  Straight leg raise test is normal.  The abdomen is soft.  Mild tenderness is present with deep palpation from the epigastric to supraumbilical regions.  Bowel sounds are normal.  Femoral, popliteal, and pedal pulses are symmetric.  Erythrocyte sedimentation rate is normal.  X-ray of the spine reveals no vertebral abnormalities, but prevertebral calcifications are present.  Which of the following is the best next step in management of this patient?

A) CT scan of the abdomen
B) Ibuprofen and clinical follow-up in 2 weeks
C) MRI of the spine
D) Serum amylase and lipase
E) Serum protein electrophoresis

Correct Answer:

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