Hematology Oncology Question 48

A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months' duration and a 6.8-kg (15 lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker.

On physical examination, temperature is 37.3 °C (99.1 °F), blood pressure is 112/74 mm Hg, pulse rate is 98/min, and respiration rate is 18/min. BMI is 22. The cardiopulmonary examination is unremarkable. He has no lymphadenopathy or hepatosplenomegaly. Point tenderness to palpation is noted over the mid thoracic spine. No skin changes or peripheral edema are observed.

A chest radiograph shows no infiltrates and a normal cardiac silhouette. Radiographs of the thoracic spine reveal osteopenia with a compression fracture of T6.

Which of the following is the most appropriate diagnostic test to perform next?

A 1,25-Dihydroxyvitamin D (calcitriol) measurement

B Intact parathyroid hormone measurement

C Parathyroid hormone–related protein measurement

D Serum protein electrophoresis and free light chain test

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