A 62-year-old woman is encouraged to consult her general practitioner because her husband thinks she has become rather confused and irritable over the last 3–4 weeks. She admits to feeling rather irritable and has found it difficult to remember things. She also complains of some non-specific back pain, which has been present for 2 months and is maximal in the low thoracic area. She does not recall any trauma at the start of the problem and the pain is gradually increasing in severity. It is partially relieved by paracetamol and ibuprofen. She has noticed some abdominal discomfort and constipation which she has related to the medication for the back pain.
She takes no other medicines and does not drink or smoke. PMH : None Examination She looks a little pale. There is no abdominal tenderness. Bowel sounds are normal. She has tenderness locally over the lower thoracic spine. Hb : 9.9 g/dL…
