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NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 2/Question#39 (reveal difficulty score)
A 57-year-old woman with breast cancer comes ...
Spinal cord decompression and cervical stabilization ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: neuro marked

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submitted by โˆ—kingfriday(45)
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Lady with mets and increased ca2+ (hypercalcemia of malignancy) at risk for cervical spine compression. She also has neurological impairment which makes her a candidate for surgery - decompress spinal cord and cervical stabilization.

I think this lady needs way more than a soft tissue collar and PT - more conservative therapy.

Mithramycin is evidently an antitumor drug used in testicular cancer

Tamoxifen therapy - treat her immediate neurological issues

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lilmonkey  Shouldn't we stabilize her neck with a collar (maybe not too soft:)) to prevent further damage before taking her to the OR? +
machetebetty  Yes to a collar before she heads to urgent/emergent surgery- but a rigid collar. Tricksy buggars ;) +1



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submitted by โˆ—step_prep7(71)
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  • Patient has signs/symptoms concerning for cervical spinal cord compression (neck pain with tenderness upon palpation, diffuse hyperreflexia) secondary to spinal metastases
  • Key idea: Acute spinal cord compression is a neurological emergency and requires immediate surgical decompression
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