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Metastatic spinal cord compression — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsMetastatic spinal cord compressionSCE Acute Medicine

A 42-year-old man presents with acute neurological symptoms. Relevant history includes vascular, infectious or neuromuscular risk factors. On assessment, neurological examination shows focal or global dysfunction. Investigations show known cancer with sensory level, urinary retention and cord compression on MRI. What is the most appropriate next step in management?

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

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Correct answer: D — Give dexamethasone and arrange urgent oncology and spinal surgical assessment

The key discriminator is that known cancer with sensory level, urinary retention and cord compression on MRI, which makes Give dexamethasone and arrange urgent oncology and spinal surgical assessment the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Give analgesia and antiemetic therapy would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Call critical care for escalation are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG234