[Verified Answer]: A previously healthy 48-year-old…

A previously healthy 48-year-old accountant presents to his primary care office with severe low back pain that began the previous day after he helped his daughter move into her college dorm. He denies any trauma or previous back injury. He describes the pain as generally “achy,” and sometimes characterized as being “sharp” when he moves suddenly. The pain is located in his lower back and radiates down the back of both legs to the middle of his posterior thighs. He has been continent of both bowel and bladder and denies any weakness in his legs. He denies fever, chills, weight loss, or malaise. He finds it very difficult to stand for prolonged periods of time because he can’t find a comfortable position. he states that this is the worst back pain he has ever experienced, and it has not been relieved with acetaminophen or ibuprofen. His past medical history is significant for hypertension; his only medications are metoprolol and a baby aspirin daily. He does not smoke or use illicit drugs, and only drinks alcohol on occasion. On physical exam he is well-developed, overweight, and in moderate discomfort. On neuromuscular exam he has moderate tenderness bilaterally in his lumbar paraspinous muscles, and his lumbar flexion and extension are limited by pain. Strength and sensation are within normal limits and equal and symmetrical bilaterally, as are his deep tendon knee and ankle reflexes. Straight leg raise testing is negative bilaterally and gait is within normal limits What is the most likely primary diagnosis for this patient? What differential diagnoses would you need to consider? What workup is most appropriate at this time? What treatment(s) will you recommend today? If you choose prescription medications, be sure to include the generic name, dose, route, frequency, amount to dispense and number of refills. When will you want to see this patient back for a follow up visit? What management will be needed at that time?