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MSCC — SCE Medical Oncology MCQ

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HardOncological EmergenciesMSCCSCE Medical Oncology

A patient with known metastatic cancer develops new paraplegia and urinary retention. MRI confirms metastatic spinal cord compression. Dexamethasone 16 mg was given immediately and definitive radiotherapy is planned for the next morning. What supportive prescription should accompany ongoing corticosteroid treatment while definitive therapy is awaited?

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Correct answer: B — Continue 16 mg dexamethasone daily, monitor blood glucose and provide proton-pump-inhibitor cover

For neurological symptoms or signs of MSCC, NG234 recommends 16 mg dexamethasone as soon as possible and continuation at 16 mg daily while surgery or radiotherapy is awaited. It also specifies blood-glucose monitoring and proton-pump-inhibitor acid suppression. Escalating to extreme doses adds toxicity, while early stopping or underdosing risks neurological deterioration.

Reference: NICE NG234 spinal metastases and metastatic spinal cord compression (Published September 2023): https://www.nice.org.uk/guidance/ng234/chapter/recommendations