MSCC

Question 1

detailed HPC

Answer 1

s - (thoracic/lower) back pain

o - gradual, preceeds neurology by weeks, no trauma

c - localised spinal tenderness/shooting pain in nerve distribution

r - radicular

a - motor weakness (difficulty walking) // bowel/bladder dysfunction // sensory changes (saddle anaesthesia) // recent weight loss

t - severe, unremitting

e - coughing, movement, lying supine, night time

s - v severe

Question 2

PMH Qs

Answer 2

known cancer - type, date DDx, stage, treatment

(1/5th cases are first presentation cancer)

Hx arthritis/osteoporosis

mood

Question 3

investigations

Answer 3

LL PNS - upgoing plantars

DRE - loss of anal tone

Question 4

management

Answer 4

dexamethasone 16mg stat orally (+PPI cover + glucose monitoring)

discuss with colleagues re radiotherapy (multiple sites) or neurosurgery (localised)

provide optimal analgesia