Buy Oncological Management Of Patients

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1. Which one of the following statements
regarding the management of pain related to spinal metastasis is most accurate?
a. Bisphosphonates have shown utility inmanagement of pain resistant to conventional
analgesia and/but not in reducing the risk
of malignant spinal cord compression
b. Intrathecal morphine pump insertion is
inappropriate in patients with intractable
pain from spinal metastases
c. NSAIDs are inappropriate for management of pain related to spinal metastases
due to their platelet inhibiting effect
d. Single fraction palliative radiotherapy for
spinal metastases causing non-mechanical
pain is not appropriate in those with complete paralysis
e. Vertebroplasty has been shown to be effective in the setting of pain from metastatic
spinal cord compression in non-surgical
candidates
 
2. A 57-year-old with who recently underwent
right upper lobectomy for small cell lung cancer presents due to worsening back pain over
the last 3 days. It initially started at night over
thelast 2 weeks or so, butis now exacerbated by
physical movement.He denies any trauma. On
examination he is tender to palpation in the
mid thoracic spine. Neurological examination
reveals mild weakness of both lower limbs
bilaterally, brisk knee and ankle reflexes, and
extensor plantars. Sensory examination reveals
a sensory level at the umbilicus. Which one of
the following would you do next?
a. Standing spine X-ray
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b. MRI whole spine MRI and CT whole
spine
c. ensure they are Nurse flat with neutral
spine alignment
d. CT lumbar spine
e. Dexamethasone
 
3. Which one of the following statements
regarding definitive oncological management of patients presenting with MSCC is
LEAST accurate?
a. In patients who present with MSCC without a known diagnosis of malignancy
radiotherapy can usually start sooner than
chemotherapy
b. Preoperative radiotherapy should not be
carried out on patients with MSCC if surgery is planned
c. Radiotherapy can be given as soon as
there is suspected MSCC on imaging
d. Spinal instability is a relative contraindication to radiotherapy
e. Teratoma is one of the rare causes of spinal cord compression where chemotherapy is more effective than radiotherapy
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4. Which one of the following statements
regarding surgery in patients with metastatic
disease of the spine is LEAST accurate?
a. Indicated in those with metastatic spinal
cord compression who are ambulant and
without significant neurological deficit if
they are expected to survive greater than
3 months
b. Indicated in those with metastatic spinal
cord compression with less than 24 h of
complete paralysis who otherwise have a
good prognosis
c. Indicated in those with spinal instability
and evidence of structural spine failure
to prevent malignant spinal cord compression, even if their pain is controlled
d. Indicated in those with spinal instability
related mechanical back pain resistant to
analgesia
e. Indicated only in those patients expected
to survive at least 12 month
 
5. Which one of the following statements
regarding the 2005 RCT (Patchell et al.,
Lancet 366:643-648) comparing decompressive resection plus adjuvant radiotherapy versus radiotherapy alone for metastatic spinal
cord compression is LEAST accurate?
a. The surgical arm and radiotherapy only
arm both received 30 Gy of externalbeam radiation delivered in 10 fractions
b. The surgical arm did not haveincreased survival time compared to radiotherapy alone
c. The surgical arm had greater return of
ambulation after treatment compared to
radiotherapy alone
d. The surgical arm remained ambulatory for
longer compared to radiotherapy alone
e. The surgical plus radiotherapy, and radiotherapy alone groups both excluded those
with radio-sensitive tumors
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