USMLE PRACTICE QUESTION OF THE WEEK

Question for February 27, 2026

A 35-year-old man is evaluated for fever, severe back pain, and difficulty walking for 2 weeks. He recently had a dental extraction. Medical history includes type 2 diabetes. Temperature is 38.5°C (101.3°F). Exam shows midline spinal tenderness in the thoracic region and weakness in both legs. Laboratory studies show WBC count 17,000/µL and ESR 112 mm/hr. MRI spine reveals a paravertebral fluid collection compressing the cord.

Which of the following is the most appropriate next step in management?

A. High-dose corticosteroids

B. IV antibiotics and urgent neurosurgical evaluation

C. Lumbar puncture with CSF cultures

D. Outpatient oral antibiotics

E. Spinal bracing and observation

Get Detailed Explanation

Correct Answer:

B. IV antibiotics and urgent neurosurgical evaluation

Correct Answer Explanation:

This patient has spinal epidural abscess, presenting with fever, back pain, neurologic deficits, and paraspinal fluid collection. The correct management is urgent neurosurgical evaluation and IV antibiotics. Corticosteroids do not treat the infection. Lumbar puncture is contraindicated due to risk of cord compression.

Further Insight:

Classic triad: fever, back pain, neurologic deficits.
Staphylococcus aureus is the most common cause.