question: Q:A 69-year-old male presents to the emergency room with back pain. He has a history of personality disorder and metastatic prostate cancer and was not a candidate for surgical resection. He began chemotherapy but discontinued due to unremitting nausea. He denies any bowel or bladder incontinence. He has never had pain like this before and is demanding morphine. The nurse administers IV morphine and he feels more comfortable. Vital signs are stable. On physical examination you note tenderness to palpation along the lower spine, weakness in the bilateral lower extremities, left greater than right. Neurological examination is also notable for hyporeflexia in the knee and ankle jerks bilaterally. You conduct a rectal examination, which reveals saddle anesthesia. Regarding this patient, what is the most likely diagnosis and the appropriate next step in management?? 
  {'A': 'The most likely diagnosis is cauda equina syndrome and steroids should be started prior to MRI', 'B': 'The most likely diagnosis is cauda equina syndrome and steroids should be started after to MRI', 'C': 'The most likely diagnosis is cauda equina syndrome and the patient should be rushed to radiation', 'D': 'The most likely diagnosis is conus medullaris syndrome and steroids should be started prior to MRI', 'E': 'The most likely diagnosis is conus medullaris syndrome and steroids should be started after to MRI'},