🏥 USMLE Exam Prep

A 60-year-old male with a history of metastatic prostate cancer presents with a 3-day history of progressively worsening back pain, radiating down both legs, associated with new-onset bilateral lower extremity weakness and difficulty initiating urination. Physical examination reveals decreased anal sphincter tone and a sensory level at T10. What is the most appropriate immediate management step?

A Order an emergent MRI of the entire spine
B Administer high-dose intravenous dexamethasone
C Refer for urgent radiation therapy
D Perform surgical decompression

✓ Correct Answer: Option B

High-dose intravenous corticosteroids should be administered immediately upon suspicion of malignant spinal cord compression to reduce edema and prevent irreversible neurological damage, even before imaging confirms the diagnosis.

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