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Your opinion needed

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8 Posts

doyoudig
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Topics: 144
Posts: 613

08/02/07 - 02:05 PM

39. A 57-year-old woman with breast cancer comes to the physician because of increasing neck pain over the past 3 days. She has fallen frequently because of muscle weakness. Vital signs are within normal limits. Examination shows hyperreflexia of all extremities. There is tenderness over the cervical spine. Serum calcium level is 11 mg/dL. X-ray films show metastases to the cervical spine. Which of the following is the most appropriate next step in management?

A
) Application of a soft cervical collar

B
) Physical therapy

C
) Mithramycin therapy

D
) Tamoxifen therapy

E
) Spinal cord decompression and cervical stabilization

would you do A 1st before doing spinal decompression or go for E ???

kpmle2
Forum Elite

Topics: 29
Posts: 290

08/02/07 - 02:30 PM

E ) Spinal cord decompression and cervical stabilization

muscle weakness. hyperreflexia of all extremities. so will go with E.

veroni14
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Topics: 5
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08/03/07 - 08:08 AM

Cervical stabilization= soft cervical collar

Drtweetie
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08/03/07 - 02:51 PM

agree w/ E nod

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khorshid
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08/03/07 - 04:54 PM

cirus
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08/04/07 - 03:48 AM

Examination shows hyperreflexia of all extremities ---> Decompress 1st..

if one of the ans was IV biphosphonates, i would have chose it as the next best step over surical decompression, always lower Ca prior to surgery, right??

khorshid
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08/04/07 - 08:24 AM

yes but bisphosphonates take a while to lower Ca, don't they?

cirus
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08/05/07 - 07:35 AM

well the first step should be IV steroids + morphine (for pain), then IV Biphosphonates(for increased Ca) & then surgery or radiation ( if not that severe as it is the preferred ttt)

so following this algorithm, it should be surgery

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