Oncology: malignant spinal cord compression: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Oncology: malignant spinal cord compression

Sample item

A 66-year-old man with known metastatic prostate cancer has three days of progressive back pain, and now has bilateral leg weakness, urinary retention and a sensory level at T10. What is the next best step?

APlain spine radiograph and clinic reviewBUrgent MRI of the whole spine with high-dose dexamethasoneCStart a bisphosphonate and review next weekDLumbar puncture

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Urgent MRI of the whole spine with high-dose dexamethasone

Back pain with motor, sensory and sphincter loss in a patient with metastatic cancer is spinal cord compression, an emergency in which outcome depends on pre-treatment function. High-dose dexamethasone is started and urgent MRI of the whole spine is done to find the level and any other sites. Radiotherapy or surgical decompression follows promptly.

Option by option

A. Plain spine radiograph and clinic review
A plain film is insensitive and delay risks permanent paraplegia.
B. Urgent MRI of the whole spine with high-dose dexamethasone (correct)
Correct. Steroids reduce oedema and MRI defines the compressive lesion for definitive treatment.
C. Start a bisphosphonate and review next week
A bisphosphonate does not relieve compression, and waiting a week would risk permanent deficit.
D. Lumbar puncture
Lumbar puncture can worsen neurological deficit with a spinal block and does not show the lesion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Urgent MRI of the whole spine with high-dose dexamethasone. Back pain with motor, sensory and sphincter loss in a patient with metastatic cancer is spinal cord compression, an emergency in which outcome depends on pre-treatment function.

Why is "Plain spine radiograph and clinic review" not the answer?

A plain film is insensitive and delay risks permanent paraplegia.

Why is "Start a bisphosphonate and review next week" not the answer?

A bisphosphonate does not relieve compression, and waiting a week would risk permanent deficit.

Why is "Lumbar puncture" not the answer?

Lumbar puncture can worsen neurological deficit with a spinal block and does not show the lesion.

What concept does this question test?

It tests Oncology: malignant spinal cord compression in General Medicine. High-dose dexamethasone is started and urgent MRI of the whole spine is done to find the level and any other sites. Radiotherapy or surgical decompression follows promptly.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Oncology: malignant spinal cord compression?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.