Review Question - QID 210565

A 45-year-old man presents to his primary care physician for lower extremity pain and unsteadiness. He describes the pain as severe and stabbing and affecting his lower extremities. These episodes of pain last for minutes at a time. He also reports knocking into furniture regularly. Medical history is significant for streptococcal pharyngitis, where he had a severe allergic reaction to appropriate treatment. He is currently sexually active with men and does not use condoms. His temperature is 98.6°F (37.0°C), blood pressure is 127/78 mmHg, pulse is 80/min, respirations are 10/min, and oxygen saturation is 98% on room air. On physical exam, his pupils are miotic in normal and low light. The pupils do not constrict further when exposed to the penlight, and there is no direct or consensual pupillary dilation when the penlight is removed. The pupils constrict further when exposed to a near object. He has decreased vibration and proprioception sense in his lower extremities, absent lower extremity deep tendon reflexes, and a positive Romberg test. Which of the following is the most appropriate next step in management?