Differential Diagnosis
- Single most likely diagnosis
- D) Herniated lumbar disc: The patient's symptoms of pain radiating down her right leg while walking, occasional moderate pain in her right hip while sitting, and a positive straight-leg raise test are highly suggestive of a herniated lumbar disc. The decreased sensation over the lateral aspect of the right lower extremity also supports this diagnosis.
- Other Likely diagnoses
- A) Avascular necrosis of the hip: The patient's long-term use of prednisone increases her risk of avascular necrosis, and her symptoms of hip pain could be consistent with this condition.
- B) Corticosteroid-induced myopathy: Although the patient's muscle strength is relatively preserved, her long-term use of prednisone puts her at risk for corticosteroid-induced myopathy, which could contribute to her symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C) Femoral vein occlusion: Although less likely, femoral vein occlusion is a potentially life-threatening condition that could present with leg pain and swelling. It is essential to consider this diagnosis to avoid missing a potentially fatal condition.
- E) Polymyositis flare: A flare of the patient's underlying polymyositis could potentially cause her symptoms, and it is crucial to consider this diagnosis to ensure that her treatment is adequate.
- Rare diagnoses
- Other rare conditions, such as spinal stenosis, spondylolisthesis, or a spinal tumor, could also be considered, but they are less likely given the patient's presentation and history.