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A 70-Year-Old Woman Comes to the Office Due to Back

question 928

Multiple Choice

A 70-year-old woman comes to the office due to back pain, fatigue, and inability to carry out her daily work. The pain began 6 months ago and has slowly intensified. The patient had a hip fracture 3 months ago but has no other medical conditions. She is a lifetime nonsmoker and drinks alcohol on social occasions. She currently takes no medications. The patient has no extremity weakness or paresthesia. She has mild constipation; urination is normal. Initial laboratory results are as follows: $A 70-year-old woman comes to the office due to back pain, fatigue, and inability to carry out her daily work. The pain began 6 months ago and has slowly intensified. The patient had a hip fracture 3 months ago but has no other medical conditions. She is a lifetime nonsmoker and drinks alcohol on social occasions. She currently takes no medications. The patient has no extremity weakness or paresthesia. She has mild constipation; urination is normal. Initial laboratory results are as follows: Dipstick urinalysis is normal. The patient undergoes a bone marrow biopsy, which shows 20% plasma cells. While discussing the options for further investigation and treatment, the patient says that, since her initial visit, she has had pain in her left shoulder and right flank after a minor fall. Which of the following is the best next step in management? A) Measurement of serum alkaline phosphatase B) Technetium-99m bone scan C) Whole-body low-dose CT scan D) X-ray skeletal survey$ Dipstick urinalysis is normal. The patient undergoes a bone marrow biopsy, which shows 20% plasma cells. While discussing the options for further investigation and treatment, the patient says that, since her initial visit, she has had pain in her left shoulder and right flank after a minor fall. Which of the following is the best next step in management?

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