Kaplan QBook IM Test One Q3 Lumbar Disc Herniation

[StrangerX]

Kaplan QBook Step 2 CK 5th edition IM Test 1 Question 3

If a patient has an acute flare-up of back pain which appears as lumbar disc herniation (sciatica with unilateral absent achilles reflex and positive straight leg raise) why would one not want to do an MRI AND instead resort to NSAIDs and bedrest? Step Up to Medicine indicates on page 455 that if one has nerve root compression, that an MRI should be ordered. A bit confused on this one.

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[AndyRSC]

An MRI is time-consuming and expensive, and many of us are normally walking around with disc disease. The diagnosis here is clinical, and the majority of cases will improve without surgical involvement, with NSAIDs and rest alone.

There's a UWorld question on this as well. Make sure you go conservative on this unless cauda equina syndrome or another serious neurological deficit is present, or you suspect epidural abscess, etc.

 

[futuredoctor10]

An MRI is time-consuming and expensive, and many of us are normally walking around with disc disease. The diagnosis here is clinical, and the majority of cases will improve without surgical involvement, with NSAIDs and rest alone.

There's a UWorld question on this as well. Make sure you go conservative on this unless cauda equina syndrome or another serious neurological deficit is present, or you suspect epidural abscess, etc.

And if the person had acute back pain, was sent home with NSAIDs and rest, and after 6 weeks is still not feeling better > then you want to work up further and get the MRI.

 

[StrangerX]

An MRI is time-consuming and expensive, and many of us are normally walking around with disc disease. The diagnosis here is clinical, and the majority of cases will improve without surgical involvement, with NSAIDs and rest alone.

There's a UWorld question on this as well. Make sure you go conservative on this unless cauda equina syndrome or another serious neurological deficit is present, or you suspect epidural abscess, etc.

Right I understand the issue with conservative management and cauda equina syndrome but my issue here is that the person was missing a unilateral reflex, possibly acutely. I would think that this would be suspicious and warrant a work-up. I would have been inclined to do the NSAID and rest alone route had the person been missing the reflexes bilaterally. Why isn't a unilateral absent reflex suspicious?