American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is a common early symptom of cauda equina syndrome?

Severe urinary incontinence
Acute low back pain
Gait instability
Bowel incontinence

The correct answer is: Acute low back pain

Acute low back pain is a common early symptom of cauda equina syndrome. Cauda equina syndrome occurs when the nerves at the lower end of the spinal cord become compressed, often due to a herniated disc, tumor, or other mass. As these nerves are responsible for motor and sensory function in the lower body, the condition can present with various symptoms. Acute low back pain often precedes more definitive neurological signs and is an early warning sign of possible nerve compression. This pain can vary in intensity but is typically severe and localized. Recognizing acute low back pain in conjunction with other signs can be critical for early diagnosis and intervention, potentially preventing long-term complications such as permanent nerve damage. In cases of cauda equina syndrome, other symptoms may develop as the condition progresses, including urinary incontinence, gait instability, and bowel incontinence; however, these tend to present after the initial back pain. Awareness of acute low back pain helps clinicians evaluate the likelihood of cauda equina syndrome and take appropriate action swiftly.