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Multiple Myeloma — UKMLA MCQ

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HardHaematologyMultiple MyelomaUKMLAMRCP Part 1

A patient with known multiple myeloma develops new leg weakness, a sensory level and urinary retention with severe thoracic back pain. What should be arranged immediately while the metastatic spinal cord compression service is contacted?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Dexamethasone 16 mg plus whole-spine MRI

The best answer is “Dexamethasone 16 mg plus whole-spine MRI”. Neurological signs make metastatic spinal cord compression an oncological emergency. NICE calls for dexamethasone 16 mg as soon as possible and MRI urgently, always within 24 hours, with immobilisation when instability is suspected. Plain radiography, bone scan and lumbar puncture cannot exclude compression, and mobilisation before stability assessment risks neurological deterioration.

Reference: NICE NG234, Spinal metastases and metastatic spinal cord compression: https://www.nice.org.uk/guidance/ng234/chapter/Recommendations