Rosh Emergency Medicine Practice Test

In a patient with back pain, leg pain, and decreased rectal tone, what should be prioritized in management?

1. Immediate physical therapy

2. Neuroimaging with MRI

3. Consultation for pain management

4. Corticosteroid management

The correct answer is: Neuroimaging with MRI

In a patient presenting with back pain, leg pain, and decreased rectal tone, prioritizing neuroimaging with MRI is essential. This combination of symptoms raises significant concern for possible cauda equina syndrome or other serious spinal conditions that may require urgent intervention. The acute loss of rectal tone indicates that there may be compression of the cauda equina, which can lead to permanent neurological deficits if not addressed promptly. MRI is the preferred imaging modality for assessing such scenarios because it provides detailed information about the spinal cord and surrounding structures, enabling identification of any masses, herniated discs, or other abnormalities that could be contributing to the neurological symptoms. Addressing this urgent need for imaging helps to clarify the diagnosis and determine the necessary treatment options, which may include surgical intervention if there is evidence of significant compression. While other modalities such as physical therapy, pain management consultations, and corticosteroid management may be beneficial in managing pain and improving function, they do not address the underlying potential neurological emergency that requires immediate attention.