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Question
Answered step-by-step
Asked by PresidentJackal1616

What to do:
What differential diagnoses would you consider?
What would you want to discuss with the pt and family initially?
Who should be consulted?
Cancer
52 y/o female, K, presents to ER with intractable back pain and bilat leg weakness x 1 week. She 
has not seen a doctor in over 10 years and has no known PMH, surgical history, nor does she 
take any medicine. She states 3 months ago she was flipping a mattress and felt something “pop” 
in her back. Since then, she has had intermittent low back pain that she applied heat to. Last 
week, however, her back pain became severe and she got to the point that she could not get out 
of bed due to the pain. She then noticed a progressive weakness in her legs bilateral. She initially 
refused to be taken to the ER but eventually relented to the requests of her husband and two 
grown sons. She was seen in ER, given 4 mg morphine IV, labs and CT were ordered. Results 
are below.
CBC significant for Hgb 7.2, Hct 25.2, WBC 18.1

 

 

CMP significant for Alkaline phosphatase 259 (34-104)
Sed rate 78 (0-30)
CRP normal
PCT 0.098 (0-0.065)
D-Dimer > 5,000
CT Chest, abd, pelvis, cervical, thoracic, and lumbar spine: Diffuse osseous metastatic disease 
through cervical, thoracic and lumbar spine. Pathologic fractures of C3, C5, T9 and possibly L4. 
Multiple enlarged lymph nodes in the pelvic area, a significantly enlarged uterus and bilateral 
hydronephrosis. Also noted a dominant metastatic lesion of the left femoral neck worrisome for 
impending pathologic fracture.
Differential diagnoses:
Who would you consult?
Discussion points with family?
What further diagnostics?

 

 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 6501

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