Suspect metastatic malignancy in an elderly patient with progressive and constant back pain that is worse at night and unrelieved by rest + history of weight loss.

Blastic lesions : Prostate and Breast CA

Lytic lesions: Lung, renal, breast, thyroid, multiple myeloma

Dx

Best initial = Plain X-rays

Bone scan is most sensitive in early disease (however, it is not helpful in purely lytic lesion like MM)

MRI is the best

Spinal cord compression

involvement of the spine is

• thoracic spine 70%
• lumbosacral in 20%
• cervical in 10%
• level can be predicted by sensory level: upper limit being 1-2 vertebral bodies below the compression
• sensory changes typically precedes motor loss
• MRI is the gold standard for diagnosis
• Radiation therapy is TOC
• other options : steroids, laminectomy, combined chemo

Malignant pericardial and pleural effusion

Chest pain in pericardial effusion is usually relieved by leaning forward