{ Thieves Market 2013 J. Scott Neumeister MD Associate
Professor, General Internal Medicine The Nebraska Medical
Center
Slide 2
Back Pain Back Pain A 48 year old male presents with a 3 month
history of low back pain.
Slide 3
His pain started 3 months ago after getting jarred while on a
roller coaster ride. He has been taking Tramadol and seeing a
Chiropractor without any relief. The pain is worsening and he now
has trouble walking.
Slide 4
He has not been able to work at his job as electrical
contractor for this time period. He has been bruising easily on his
arms and legs without defined trauma. He notes his legs have been
swollen. Furosemide has not helped reduce the swelling. He has
noticed some difficulty passing his urine with rare
incontinence.
Slide 5
Married. 3 kids. Electrician. No Tobacco. Rare ETOH. No drugs.
PGM had breast cancer Tramadol, Furosemide No allergies
Appendectomy years ago.
Slide 6
98.7 88 16 122/60 Takes 3 people to stand him up strength,
reflexes, sensations intact proprioception normal painful with any
movement Back tender along vertebrae diffusely Bruising on arms and
legs, no other skin abnormalities Edema legs symmetric, below knees
Prostate normal No lymphadenopathy
Slide 7
14.2 11.7 179 141 105 19 108 41 3.4 27 0.9 9.5 AST/ALT normal
AP 217 Bili 1.3 TSP 4.9 Alb 2.9 B12 normal TSH normal
Slide 8
Slide 9
T5, T7 L5 compression fractures. Some new, some old, some new
on old
Slide 10
UA normal (no protein) Sed rate 2 SPEP normal Immunofixation
normal Bone Marrow Bx normal
Slide 11
Vitamin D 60 PTH 30 (normal) PTHrp negative Heavy metal screen
normal Dexa T score -2.8 Z score -2.8
