Would want to see this tested that glucocorticoids are not given since it does have shelf tag. Real life and NBME tends to not always align. We can however add to extra this distinction if anything
“and may be treated with” in text and explanation in extra?
(Started a related thread about this topic under nid:1550409409106 for future reference.)
Came across this card again while on neuro.
#AMBOSS::f50kjg
AMBOSS question describes trauma patient with spinal cord injury at T3. Question asks next step in management. Answer is placement of foley catheter. IV steroids is an incorrect answer choice and the explanation says steroids are “not recommended for patients with acute nonpenetrating spinal cord injury.” Says recent studies show it does not improve outcomes. I don’t see any UW tags for this, though a somewhat related card (nid:1550409409106) says these tags. Not sure if they’re relevant.
#AK_Step2_v12::#UWorld::COMLEX::101156
#AK_Step2_v12::#UWorld::Step::4368
Also just took Form 6 for Neuro NBME which had steroids as a correct answer without any disclaimer. Submitted change request to add tag #AK_Step2_v12::#Resources_by_rotation::Neuro::nbme::Form_6. Though we don’t necessarily change cards based on NBMEs, especially if AMBOSS contradicts it.
I’m against this change as is. I remember seeing a question where you need to give high dose steroids prior to MRI. My acute back pain flowchart has that on there too because of that question and other cards.
Would like a UW check, but I also lean against this change for now
No tagged UW qid I’ll look at other cards and find some questions
NID:1512505698104
Initial management of acute spinal cord compression includes IV {{c1::glucocorticoids}} and emergency MRI
NID:1550409409106
{{c1::Dexamethasone}} should be given first in a patient with back pain and one of the following:
- History of cancer
- Urinary symptoms (incontinence or retention)
- Sexual dysfunction (ED or priapism)
- Bilateral lower extremity weakness
- Sensory deficits in a dermatome
- Fever
Traumatic spinal cord injury or metastasis causing spinal cord compression = high dose steroids before imaging.
Step 2 QID 3560
This patient has atraumatic back pain but from explanation “Immediate neurosurgical evaluation is warranted to avoid permanent neurologic dysfunction. Neuroimaging (ie, MRI of
the spine) is performed while awaiting surgical consultation. High-dose glucocorticoids are often used, especially in cases
of suspected malignant compression.”
Step 2 4368 and 4391 were not really helpful
if anyone finds other step 2 QID I can look them up, but still leaning towards rejecting
I looked back at the AMBOSS question, and it was more related to spinal shock than spinal cord compression. Initial CT didn’t show any stenosis or edema, just an isolated T3 burst fx. In the explanation why steroids was the wrong choice, AMBOSS says “Routine use of steroids (e.g., dexamethasone) is not recommended for patients with acute nonpenetrating spinal cord injury. Although intravenous methylprednisolone was previously indicated, recent studies have shown that it does not improve neurological recovery and increases the risk of gastrointestinal hemorrhage and respiratory infection.”
I still think that spinal cord injuries should only be treated by steroids IF they have neurological symptoms (c/w edema and compression) which is what the algorithm image says as well. So nid:1512505698104 would be correct to say IV steroids + emergency MRI in the context of compression. But no compression/edema = no steroids. This card just says trauma to the spinal cord without specifying if there is compression or edema. The Extra says “neck trauma + neuro deficits = give steroids” which is in accordance with AMBOSS and the algorithm image.
But I’m fine with rejecting this change. Thanks for your discussion!