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  #1  
Old 04-19-2012
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Question Six Months of Bone Pain

68 yo man comes to your office with 6 months history of bone pain. He tried acetaminophen and ibuprofen but the pain is not relieved. He has history of HTN and Depression. He has smoked 3 packs of cigarettes for 40 years. Physical exam reveal BP: 130/98 mmhg, HR :80, RR :25. Auscultation:S4 gallop. Tenderness to palpation on the distal left femur and rt distal humerus. X rays of the femur and humerus reveal bilateral periostosis. What is the next step in management?

A- Joint aspiration
B- Chest xray
C- Bone marrow biopsy
D- Ca serum and PTH
E- Bone scan
F- 24 h urine calcium
G- PO4 serum
H- abdominal X ray
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  #2  
Old 04-20-2012
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I think, it should be > E-bone scan
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Old 04-20-2012
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I think its d ca and pth........
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Old 04-20-2012
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Ca and pth think mm. Ans?
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Old 04-20-2012
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this is a good question, at first i would pick Ca and PTH however the story of smoking makes me think of lung cancer, squamous, producing PTH like peptide and all that.. I would love for a CT scan of the chest tho, maybe chest xray? dunno! whats the answer?
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Old 04-20-2012
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- bilateral periostosis is radiological finding of hypertrophic osteioartheropathy,the syndrome of triad (clubbing, periostosis, artheritis), & has highly association with lung CA (squamous & adenocarcinoma).
the initial scan for lung ca is B. chest x ray. this my own answer.
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Old 04-21-2012
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Quote:
Originally Posted by um aala View Post
- bilateral periostosis is radiological finding of hypertrophic osteioartheropathy,the syndrome of triad (clubbing, periostosis, artheritis), & has highly association with lung CA (squamous & adenocarcinoma).
the initial scan for lung ca is B. chest x ray. this my own answer.
I think that would be the case if q asks most appropriate next step...if q asks What is the next step in management..then we are supposed to choose less invasive test right??
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Old 04-21-2012
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D

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Old 04-21-2012
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chest xray
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Old 04-26-2012
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Chest xray
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Old 04-26-2012
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Default Non invasive test 1st

Chest X-ray
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Old 04-26-2012
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B- Chest xray since the most likely cause is Ca Lung.

http://en.wikipedia.org/wiki/Hypertr...teoarthropathy
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