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Q1: Recognition & definition (2 min)
- Define spinal cord compression. Why is it a neurological emergency? What does "time is cord" mean biologically (compression → venous congestion/vasogenic oedema → ischaemia → demyelination → infarction; early stages reversible, late irreversible)?
- Distinguish spinal cord compression from cauda equina syndrome anatomically and clinically (UMN vs LMN pattern; symmetric vs asymmetric). What about conus medullaris syndrome?
- Which five red flags in back pain mandate urgent imaging? (age over 50, known cancer, weight loss/night pain, fever, progressive neurological deficit, bladder/bowel dysfunction, saddle anaesthesia).
Q2: Investigation & diagnosis (3 min)
- Why is whole-spine MRI the gold standard? What does it show that CT cannot? When would you use CT myelography?
- Walk through the imaging pathway and timeframe for suspected MSCC (MRI within 24 hours; sooner if rapidly progressing) versus cauda equina (emergency, hours).
- What bedside test supports cauda equina? (post-void residual over 100 to 200 mL; palpable bladder; reduced anal sphincter tone and saddle anaesthesia).
- What blood tests help identify the cause? (FBC, CRP/ESR for abscess; calcium, SPEP, serum free light chains for myeloma; PSA for prostate).
Q3: Acute & definitive management (3 min)
- Give the immediate management of suspected MSCC before imaging: dexamethasone 16 mg IV loading, analgesia, catheterisation, DVT prophylaxis, pressure-area care.
- State the indications for surgery versus radiotherapy (Patchell trial; single level/unstable/unknown primary/radio-resistant → surgery; multiple levels/radiosensitive/unfit → radiotherapy), and the 24 to 48 hour decompression window.
- How does cauda equina from disc differ in management? (emergency microdiscectomy/decompression within 24 to 48 hours; no routine steroids).
- How do you manage a spinal epidural abscess? (surgical decompression plus 4 to 6 weeks IV antibiotics covering Staphylococcus aureus).
Q4: Prognosis, complications & pitfalls (2 min)
- What is the strongest predictor of outcome in MSCC, and why? (pre-treatment ambulatory status).
- What is the median survival after MSCC, and what determines it? (3 to 6 months; primary tumour).
- List the complications of immobility and of high-dose dexamethasone (pressure sores, DVT/PE, contractures; hyperglycaemia, infection, GI bleed, psychosis).
- Why must you never assume "non-organic" weakness without excluding cord compression, and what is your medicolegal duty? (document red flags; act urgently).