Spinal Cord Compression Quiz
Created by Chris Galbraith and Connor Bohlken
Edited by Dr. Paris Ingledew
You are doing a radiation oncology elective, and have just finished seeing a patient with suspected spinal cord compression. You report the case to your attending, and they ask you which of the following is the LEAST likely type of cancer to result in spinal cord compression. You answer:
You are working with Dr. Spinalis, the esteemed neurosurgeon. She is known to be a fantastic teacher and loves ensuring her students have a solid understanding of the foundations of medicine. One of your patients has a lumbar puncture scheduled for today. She asks you, at what level does the adult spinal cord end?
You are a third year medical working with Dr. Squished, a Radiation Oncologist. You are reviewing your patient list today and you notice that one of your patients is an emergency case for impending cord compression. Dr. Squished asks you, do you know what the leading cause of Spinal Cord Compression is in those with cancer? You answer:
Expansion of Paraspinal Masses
Primary Spinal Cord Tumors
Spinal Epidural Abscess
Metastatic Tumors in the Vertebral Bodies
You are working an emergency shift from 2300 - 0700, when in walks Mr. Owmybach. He is a 72 year old male with known prostate cancer who sadly was lost to follow up. On history you learn that Mr. Owmybach has had severe back pain for several weeks time. It is worse at night and in recumbent positions. On further questioning he endorses some new onset numbness, urinary retention and constipation. His wife is present with him and indicates she thinks he has had some recent gait changes. Which of his signs or symptoms is NOT indicative of SCC?
You are a 3rd year medical student who is working with Dr. Tomes, a Radiation oncologist. You are seeing Mr. Oddline, a 67 year old male with metastatic prostate cancer. He has had vertebral bone metastasis treated with external beam radiation therapy in the past. Today he is in for regular follow up and on review of systems, you ask about skin changes. He mentions a strange phenomenon that he recently noticed. He states: It’s strange doc, I have this band of numbness that goes all the way across my chest right at my nipple line, and across my back at roughly the same level, everywhere else feels normal isn’t that the strangest thing eh? You and your attending excuse yourselves briefly, Dr. Tomes asks you: If Mr. Oddline had metastasis that was compressing on his spinal cord, based on his description, what level of the spinal cord would it be at?
It is 0200 and all the following patients are in the emergency room for query back pain. Which of the following should you be most suspicious of a malignant cause of back pain?
Kurt, 31 year old male who just twisted his back catching a frisbee
Ilene, 63 year old female who just got hit by a truck
Paul, 58 year old male who now can’t feel when he wipes his bum
Joe, 32 year old male IVDU who has been feverish for two days
George, 82 year old chain smoker with colicky low back pain
You are a R1 Family Medicine resident working in a clinic with Dr. Takeapic. You are seeing Mrs. Massinther, a 72 year old female with metastatic breast cancer. Her known metastasis are to the T6, T7, and L4 vertebrae as well as the left Iliac. Dr. Takeapic asks you, if you had a patient who you suspected had spinal cord compression, what imaging modality is the gold standard for you to order to have this evaluated?
You are a first year family medicine resident working in the emergency department. Your next patient is a Mrs Inca Tinence. She is a 74 year old female with known breast cancer. She is presenting to the emergency department today with a 3 week history of progressive back pain, and now she is noticing urinary retention and stool incontinence. On a physical exam she has saddle anesthesia. Given her history and presentation you correctly suspect spinal cord compression. What should be her initial therapy?
You are a R4 Radiation Oncologist on call. You have been asked to see Mrs. Inca Tinence urgently as a referral from Emergency. She is suspected to have spinal cord compression.She has just had an urgent MRI done and while you are waiting you gather the following additional information. Her medical history is significant for Breast Cancer, chemoresistant, Hemophilia B, COPD; FEV-1 < 30% predicted on 2L O2 at home, and a Stroke 4 years ago. Her current medications include: Formoterol + Budesonide 12 / 400 mcg inhaled BID and ASA 81 mg. You get the results of the MRI back and see diffuse disease involving multiple vertebrae with obvious SCC at the level of T6. What is a reasonable approach to definitive treatment of her SCC?
External Beam Radiation Therapy (EBRT)
What is NOT a good prognostic factor for spinal cord compression?
Tumor is Responsive to Radiotherapy
Acute Onset of Symptoms
Stable Vertebral Column
Able to Ambulate
Normal Bladder Function
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