MLA Domain 5 · Presentation
Back pain
20 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.
classic presentation · 4
Urinary retention/incontinence, saddle anaesthesia, bilateral leg symptoms or reduced anal tone → IMMEDIATE MRI and emer
Do not miss genuine illness; document objectively; avoid premature labelling
Hypercalcaemia, acute kidney injury, or metastatic spinal cord compression → emergencies
Metastatic spinal cord compression (back pain + neurology) → emergency MRI + dexamethasone + oncology
recognised feature · 11
Suspected rupture (pain + collapse + pulsatile mass) → immediate vascular surgery; do NOT delay a haemodynamically unsta
Acute anterior uveitis (painful red eye, photophobia) → same-day ophthalmology
Vertebral osteomyelitis with neurology (epidural abscess) → emergency MRI + surgical decompression
New vertebral fracture / hip fracture → high imminent re-fracture risk; consider underlying malignancy in atypical fract
Vertebral fracture with neurology, or hip fracture → acute orthopaedic/surgical pathway (cross-ref acute_care)
Painless obstructive jaundice + weight loss → urgent imaging/2-week-wait (pancreatic cancer)
Pain starting years after menarche, deep dyspareunia, menorrhagia, or an abnormal examination → suspect a SECONDARY caus
New back pain in a cancer patient, progressive weakness, sensory level, sphincter involvement → MSCC emergency
Bladder/bowel dysfunction or saddle anaesthesia → exclude cauda equina (emergency MRI)
STOP the transfusion immediately for any significant reaction and reassess (ABCDE); recheck the patient/unit identity
Lyme carditis (heart block) or neuroborreliosis → specialist treatment (IV ceftriaxone)
differential of the above · 5
Acute urinary retention (painful, palpable bladder) → catheterise; high-pressure chronic retention with AKI → catheter +
Must exclude organic neurological disease; new "functional" symptoms in the elderly warrant caution
Fabricated or induced illness in a child = safeguarding emergency; self-harm/induced-illness risk
Rapidly progressive/ascending weakness (GBS), autonomic involvement, foot ulceration (diabetic insensate foot)
Do not miss genuine organic disease — somatic symptom disorder can coexist