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A 66-Year-Old Man Comes to the Office Due to Several

Question 45

Multiple Choice

A 66-year-old man comes to the office due to several weeks of back and lower extremity pain.  The pain feels dull and achy and is worsened by movement, causing him to have difficulty bearing weight and ambulating.  He has had no bladder or bowel dysfunction, extremity weakness, or numbness.  The patient takes metformin for type 2 diabetes mellitus.  He drinks 2 alcoholic beverages daily.  Physical examination shows no gross abnormality or deformity of the back or extremities.  There is no swelling or redness of the legs, and neurological examination is normal.  A radiograph of the right lower extremity is shown in the exhibit.  A 66-year-old man comes to the office due to several weeks of back and lower extremity pain.  The pain feels dull and achy and is worsened by movement, causing him to have difficulty bearing weight and ambulating.  He has had no bladder or bowel dysfunction, extremity weakness, or numbness.  The patient takes metformin for type 2 diabetes mellitus.  He drinks 2 alcoholic beverages daily.  Physical examination shows no gross abnormality or deformity of the back or extremities.  There is no swelling or redness of the legs, and neurological examination is normal.  A radiograph of the right lower extremity is shown in the exhibit.  Laboratory results are as follows: Which of the following is the most likely explanation for this patient's bone changes? A) Decreased urinary calcium excretion B) Increased 1,25-dihydroxyvitamin D production C) Increased secretion of parathyroid hormone D) Local tumor cell-mediated activation of osteoblasts E) Local tumor cell-mediated activation of osteoclastsLaboratory results are as follows: A 66-year-old man comes to the office due to several weeks of back and lower extremity pain.  The pain feels dull and achy and is worsened by movement, causing him to have difficulty bearing weight and ambulating.  He has had no bladder or bowel dysfunction, extremity weakness, or numbness.  The patient takes metformin for type 2 diabetes mellitus.  He drinks 2 alcoholic beverages daily.  Physical examination shows no gross abnormality or deformity of the back or extremities.  There is no swelling or redness of the legs, and neurological examination is normal.  A radiograph of the right lower extremity is shown in the exhibit.  Laboratory results are as follows: Which of the following is the most likely explanation for this patient's bone changes? A) Decreased urinary calcium excretion B) Increased 1,25-dihydroxyvitamin D production C) Increased secretion of parathyroid hormone D) Local tumor cell-mediated activation of osteoblasts E) Local tumor cell-mediated activation of osteoclasts Which of the following is the most likely explanation for this patient's bone changes?


A) Decreased urinary calcium excretion
B) Increased 1,25-dihydroxyvitamin D production
C) Increased secretion of parathyroid hormone
D) Local tumor cell-mediated activation of osteoblasts
E) Local tumor cell-mediated activation of osteoclasts

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