American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial treatment for compressive spinal cord lesions due to plasmacytoma?

1. Surgical decompression

2. Chemotherapy

3. Radiation therapy

4. Physical therapy

The correct answer is: Radiation therapy

The initial treatment for compressive spinal cord lesions due to plasmacytoma typically involves radiation therapy. Plasmacytoma is a type of tumor that arises from plasma cells, and when it occurs in the spine, it can lead to significant morbidity due to spinal cord compression. Radiation therapy is favored as it is a non-invasive treatment that can quickly reduce tumor size, alleviate pressure on the spinal cord, and control symptoms such as pain and weakness. The rapid action of radiation can prevent further neurological compromise and is often effective in providing palliation and improving quality of life for patients. While surgical decompression might be needed in certain scenarios, especially if there is a need for immediate surgical intervention to relieve acute neurological symptoms, initial management often leans towards radiation for its practicality. Chemotherapy might play a role in the overall treatment plan, particularly if the plasmacytoma is part of a more extensive systemic condition like multiple myeloma, but it is not the first-line treatment for controlling acute spinal cord compression. Physical therapy is important for rehabilitation after treatment, but it does not address the immediate compressive issue. Thus, radiation therapy is considered the most appropriate initial approach for addressing the compressive spinal cord lesions associated with plasmacytoma.