4-Year-Old's Understanding of Death — SCE Palliative Medicine MCQ

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HardBereavement4-Year-Old's Understanding of DeathSCE Palliative Medicine

A patient with metastatic prostate cancer develops new thoracic pain, leg weakness and urinary hesitancy overnight. What is the most important immediate action?

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Correct answer: B — MSCC activation, dexamethasone and urgent spinal MRI

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

E is correct. New focal spinal pain with weakness and bladder symptoms is metastatic spinal cord compression until proved otherwise. NICE requires immediate pathway activation, urgent MRI and prompt dexamethasone for neurological signs while definitive radiotherapy or surgery is coordinated. A risks irreversible paralysis by treating pain alone. B uses an insensitive test and delays escalation. C interprets a neurological emergency as deconditioning. D addresses skeletal complications but not cord compression. Steroid contraindications and haematological malignancy nuances are considered, but they do not justify routine outpatient review in this presentation.

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