American Board of Internal Medicine (ABIM) Certification Practice Exam

Metastatic spinal cord compression requires which of the following treatments?

1. Observation only

2. Low-dose glucocorticoids

3. High-dose glucocorticoids

4. Physical therapy

The correct answer is: High-dose glucocorticoids

Metastatic spinal cord compression is a serious condition that occurs when cancer spreads to the spinal column, leading to increased pressure on the spinal cord itself. This can result in significant neurological deficits and requires prompt treatment to prevent irreversible damage. High-dose glucocorticoids are the mainstay of treatment for metastatic spinal cord compression because they help reduce inflammation and edema around the spinal cord, alleviating pain and neurological symptoms. Dexamethasone is commonly used in these settings and is administered at high doses for rapid effect. The immediate goal is to decrease the swelling in the spinal cord tissue caused by the tumor, which can improve neurological functions and potentially avert the progression of paralysis. Observation alone would not be appropriate in this situation, as it would lead to worsening symptoms and potential permanent damage. Low-dose glucocorticoids could be inadequate in providing the rapid and substantial reduction in inflammation required. Physical therapy is essential for rehabilitation but is not a treatment for the underlying compression itself and should not be prioritized before addressing the immediate danger to the spinal cord. Thus, high-dose glucocorticoids constitute the critical intervention necessary for effectively managing the acute phase of metastatic spinal cord compression.