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Four-Drug CSCI Compatibility — SCE Palliative Medicine MCQ

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HardSyringe Driver & Drug CompatibilityFour-Drug CSCI CompatibilitySCE Palliative Medicine

A patient with metastatic prostate cancer develops new bilateral leg weakness, a sensory level and urinary difficulty. Metastatic spinal cord compression is suspected and urgent MRI is being arranged. Which corticosteroid regimen is indicated now?

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Correct answer: D — Give dexamethasone 16 mg now and continue 16 mg daily awaiting definitive treatment

Neurological symptoms and signs of suspected metastatic spinal cord compression require dexamethasone 16 mg as soon as possible, followed by 16 mg daily while surgery or radiotherapy is arranged. Imaging should be urgent but treatment is not deferred for confirmation. NICE also advises glucose monitoring and proton-pump-inhibitor acid suppression; the Scottish palliative guideline specifies prompt administration and later downward titration after radiotherapy.

Reference: NICE NG234: Spinal metastases and metastatic spinal cord compression. https://www.nice.org.uk/guidance/ng234/chapter/Recommendations Scottish Palliative Care Guidelines: Malignant spinal cord compression. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/scottish-palliative-care-guidelines/palliative-emergencies/malignant-spinal-cord-compression/