A 66-year-old man comes to the office due to increasing pain in his left arm. The patient works as a furniture transporter and initially attributed the pain to a muscular strain, but it has slowly worsened and stopped responding to over-the-counter pain medications. The pain started 3 months ago and is mainly near the left elbow. He also notes back pain. He has not had fever or chills. His other medical problems include hypertension and hypercholesterolemia. The patient has never smoked. Temperature is 36.8 C (98.2 F), blood pressure is 132/86 mm Hg, pulse is 88/min, and respirations are 14/min. He appears comfortable. His mucous membranes are pale. There is no lymphadenopathy. Cardiopulmonary examination is normal. The abdomen is soft without organomegaly. The prostate is smooth, nontender, and moderately enlarged. Neurologic examination is unremarkable. Laboratory results are as follows:

X-ray of the left arm is shown in the exhibit.

Which of the following tests would be the most useful next step in the management of this patient?
A)Blood cultures
B)Bone marrow biopsy
C)Bone scan
D)Prostate biopsy
E)Serum parathyroid hormone levels
F)Serum protein electrophoresis

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