Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 60 year old obese gentleman who presents to the ED with a 5-day history of lower back pain.
HPI: The patient does not recall the exact moment of onset of the pain, but it precipitated quickly (within 1 day). He experienced some mild back pain after moving some furniture about two weeks ago, which subsided within a couple of days. The current pain is sharp in character with radiation to the posterior left leg. Prolonged standing or sitting aggravates the pain. Some improvement of pain in recumbent position. Nothing has seemed to improve his pain. No gait disturbance or difficulty walking. No bowel or bladder dysfunction.
SH: Significant for smoking with a 20-pack-year history.
FMH: No family history of prostate cancer.
ROS: Noncontributory
PE: No tenderness to palpation of lumbar spine. Straight leg test is positive on left side only.
On rectal exam, anal sphincter tone intact; prostate small, symmetric and without nodules.