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Cauda equina syndrome — MCCQE Part 1 MCQ

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EasyBack PainCauda equina syndromeMCCQE Part 1

A 47-year-old man has acute low back pain, bilateral sciatica, saddle anaesthesia and new urinary retention. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: AArrange emergency MRI and spine surgery consultation

Arrange emergency MRI and spine surgery consultation is the single best answer because the age, timing, examination findings and investigations in the vignette fit Cauda equina syndrome better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian spine surgery guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian spine surgery guidance