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Davidson and Harrison MCQs about Respiratory system.
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97. A 58-year-old woman with known stage IV breast cancer presents to the emergency department with inability to move her legs. She has had lower back pain for the past 4 days and has found it difficult to lie down. There is no radiating pain. Earlier today, the patient lost the ability to move either of her legs. In addition, she has been incontinent of urine recently. She was diagnosed previously with metastatic disease to the lung and pleura from her breast cancer but was not known to have spinal or brain metastases. Her physical examination confirms absence of movement in the bilateral lower extremities associated with decreased to absent sensation below the umbilicus. There is increased tone and 3+ deep tendon reflexes in the lower extremities with crossed adduction. Anal sphincter tone is decreased, and the anal wink reflex is absent. What is the most important first step to take in the management of this patient?
