bone mets

Question 1

Most common tumour causing bone metastases

Answer 1

prostate
breast
lung

Question 2

most common site of bone mets

Answer 2

spine
pelvis
ribs
skull
long bones

Question 3

features of patient with bone mets

Answer 3

bone pain
pathological fractures
hypercalcaemia
raised ALP

Question 4

neoplastic spinal cord compression cause, most common with

Answer 4

extradural compression due to vertebral body metastases
lung, breast, prostate

Question 5

features of neoplastic spinal cord compression

Answer 5

back pain - earliest and most common
- worse on lying down and coughing
lower limb weakness
sensory changes:
-sensory loss and numbness
Lesions above L1 - upper motor neuron signs in the legs and a sensory level.
Lesions below L1 - lower motor neuron signs in the legs and perianal numbness.
Tendon reflexes increased below lesion and absent at the level of the lesion

Question 6

neoplastic spinal cord compression investigations and management

Answer 6

urgent MRI
high dose oral dexamethasone
urgent oncological assessment for radiotherapy or surgery

Question 7

PET scan

Answer 7

uses glucose uptake as a marker for metabolic activity and combined with CT to see if lesions are metabolically active

Question 8

symptoms of spinal mets

Answer 8

Unrelenting lumbar back pain
Any thoracic or cervical back pain
Worse with sneezing, coughing or straining
Nocturnal
Associated with tenderness

Question 9

SVC obstruction features

Answer 9

associated with lung cancer
dyspnoea is the most common symptom
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension

Question 10

causes of SVC obstruction

Answer 10

common malignancies: small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis