phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
75 y/o man with prostate carcinoma, presents to ER with worsening back pain for the past 3 days, PE: muscle power in the lower extremities is 4,5/5, brisk reflexes, rectal sphincter tone is weak, point tenderness over L5 S1
What is the next step ?
A. MRI of spine
B. Decompression surgery of spine
C. CT myeelogram
D. IV corticoids
E. Radiotherapy
|
| Dot
Forum Senior
Topics: 1
Posts: 168
|
I think option A is the correct one.This will give correct diagnosis ab the metastasis and level of involvement as well as help in planning decompression.
___________________
have fun
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
I'd go with Dot. A.
|
| ARJ
Forum Guru
Topics: 133
Posts: 792
|
Fisrt IV corticosteroid and then radiotherapy
___________________
"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
|
| phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
but the answer is IV corticoids
In case of suspected metastatic spinal compression, do the following order:
1. Give IV steroid
2. Do MRI for confirmation
3. Give radiotherapy
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
I'm new here and feel miles away from the target, but I must say you guys are good. These discussions tend to coax me into reading more. I'm not one of those who can spend hours at the study table, and for me, clearing the usmle will involve major attitudinal changes and a degree of hardwork I've never put in before, so it is intimidating. It's inspiring to see y'all move ahead with such dedication and direction.
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,463
|
yeah, thatīs correct, first D, because there are some neurologic changes in the patient.
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| Dot
Forum Senior
Topics: 1
Posts: 168
|
I read ab this n truly agree.But Harrison says that newer trial shows that mitoxantron is better drug than prdnisolone in management of pain though there is no survival advantage.Threpy lso depend wather symptom of metastasis is focal or diffuse.Focal symptoms can be best treated with external beam rediation but for diffuse symptoms mitoxantron or prednisoloe has to be used as aim is palliative treatmennt to reduce pain of pt.Hope it makes some meaning
___________________
have fun
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,463
|
wow, that new info is interesting. Mitoxantrone, ok. 
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| lucky
Forum Guru
Topics: 23
Posts: 505
|
hey frontal dont be intimidated at all. its all in kaplan notes and videos, its just the basics that u need to know , u dont have to go for the really complex stuff.
the ans is indee steroids first for the compression then xr and mri to confirm.
|
|
| |
| | | | | | | | | | |
