01-18-2014, 08:57 PM
A 57-year-old African-American man presents
to his physician with gradual onset of pain in
the right leg over 3 months, and acute onset of
back pain. He reports that the pain is right on
the bone and becomes worse with walking. He
does not recall any inciting trauma to the leg.
He has no chronic illnesses but reports two episodes
of pyelonephritis over the last 18 months.
Review of systems is signifi cant for mild fatigue.
Physical examination shows tenderness
along the right femur with no pain on straight
leg raise. The legs are warm to the touch with
good pulses and no sensory or motor defi cit.
No abdominal bruit is heard. Laboratory results
are signifi cant for hypercalcemia, elevated
creatinine, and a low hemoglobin level. X-ray
of the spine reveals compression fractures.
Which of the following additional tests would
confi rm the most likely diagnosis?
(A) Abdominal ultrasound showing stenosis of
the right iliac artery
(B) Bone densitometry with diminished
T-score
© Bone marrow biopsy showing plasmacytosis
(D) Decreased serum vitamin D level
(E) Nerve conduction studies
to his physician with gradual onset of pain in
the right leg over 3 months, and acute onset of
back pain. He reports that the pain is right on
the bone and becomes worse with walking. He
does not recall any inciting trauma to the leg.
He has no chronic illnesses but reports two episodes
of pyelonephritis over the last 18 months.
Review of systems is signifi cant for mild fatigue.
Physical examination shows tenderness
along the right femur with no pain on straight
leg raise. The legs are warm to the touch with
good pulses and no sensory or motor defi cit.
No abdominal bruit is heard. Laboratory results
are signifi cant for hypercalcemia, elevated
creatinine, and a low hemoglobin level. X-ray
of the spine reveals compression fractures.
Which of the following additional tests would
confi rm the most likely diagnosis?
(A) Abdominal ultrasound showing stenosis of
the right iliac artery
(B) Bone densitometry with diminished
T-score
© Bone marrow biopsy showing plasmacytosis
(D) Decreased serum vitamin D level
(E) Nerve conduction studies
