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Pyogenic flexor tenosynovitis — RCPSC EM MCQ

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HardMusculoskeletalPyogenic flexor tenosynovitisRCPSC EM

A 54-year-old has severe back pain, new bilateral leg weakness, perineal numbness and urinary difficulty. Post-void residual is 140 mL. What is the most appropriate next step?

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Correct answer: A — Obtain urgent MRI and request immediate spine-specialist consultation

The best answer is “Obtain urgent MRI and request immediate spine-specialist consultation”. This is suspected cauda equina syndrome. A residual of 200 mL or less reduces probability but does not exclude the diagnosis when saddle sensory change, urinary dysfunction and bilateral weakness are present. Urgent MRI and neurosurgical or orthopedic consultation are required because delay can cause permanent neurological dysfunction.

Reference: Emergency Care BC: Cauda Equina and Conus Medullaris Syndromes: https://emergencycarebc.ca/clinical_resource/clinical-summary/cauda-equina-and-conus-medullaris-syndromes/