Q122) A 75 year old man presents to your office with complaints of severe fatigue and constipation for the past one week. He has no significant past medical history except for benign prostatic hypertrophy for which he takes terazosin. Physical examination reveals mild tenderness in left mid thigh area. Rest of the exam is normal. An x-ray of the left lower extremity reveals a lytic lesion in the shaft of the femur. A subsequent bone scan reveals multiple lytic lesions in the ribs, right iliac bone, left and right femur shaft as well as in the left femur neck. The most important next step in managing this patient’s symptoms is :
A) Serum PSA level
B) Serum protein electrophoresis
C) Start IV Bisphosphonates
D) Check serum calcium level and start IV hydration
E) Skeletal surevey

Q123) The patient was admitted to the hospital and his symptoms were managed appropriately. However, during the second hospital day the patient complains of pain in his left thigh. Review of his previous x-ray reveals lytic lesion occupying the head and neck of femur.  The most important immediate next step in managing this condition
A) MRI of the Hip
B) CT scan of the Hip
C) Orthopedic consultation for internal fixation
D) Radiation therapy
E) Chemotherapy