Best of Five 2.143

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BOF: 2.143

An 80-year-old male presents in a state of confusion. His carers say he has been complaining of backache and he had been constipated for some time. He has also been increasingly thirsty.

On examination he is confused and disoriented. He appears dehydrated.

Investigations reveal

Hb 8.0 g/dL

ESR 90 mm in 1^st hour

Urea 12.7 mmol/L

Creatinine 130 mmol/L

Blood glucose 6.0 mmol/L

Chest X-ray shows multiple rib fractures

Spinal X-ray shows wedge fractures

In this patient which one of the following investigations is essential in initial management of this patient?

a)      Plasma protein electrophoreses

b)      Bone marrow examination

c)      Urine for Bence-Jones protein

d)      Renal ultrasound

e)      Serum calcium

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