American Board of Internal Medicine (ABIM) Certification Practice Exam

What symptom is associated with spinal stenosis?

1. Pain relieved by standing

2. Severe leg pain absent when seated, relieved by leaning forward

3. Constant back pain with minimal relief

4. Intermittent claudication

The correct answer is: Severe leg pain absent when seated, relieved by leaning forward

Spinal stenosis is a condition characterized by the narrowing of the spinal canal, which can lead to pressure on the spinal cord and nerve roots. One of the hallmark symptoms of spinal stenosis is the presence of severe leg pain that is typically triggered by activities such as walking or standing for extended periods. However, this pain often decreases significantly when the patient sits down or leans forward. The symptom of having severe leg pain that is relieved by leaning forward aligns with the classic presentation of spinal stenosis. Patients often find that flexing at the hips or bending forward helps to alleviate their discomfort. This mechanism is thought to reduce the pressure on the nerves that are affected by the narrowed pathways. In contrast, other symptoms and answers presented do not accurately reflect the typical experience of patients with spinal stenosis. For instance, constant back pain with minimal relief may indicate other conditions but does not specifically capture the unique pattern of pain associated with spinal stenosis. Intermittent claudication, while related to vascular insufficiency, presents quite differently from the symptomatology of spinal stenosis. Pain relieved by standing is also misleading, as patients with spinal stenosis usually find that standing exacerbates their symptoms rather than alleviating them.