A 75-year-old farmer presents with pain in his right thigh and left upper arm.

Question Number 0642

Question:
A 75-year-old farmer presents with pain in his right thigh and left upper arm. The pain has been present for several months but has become worse. Examination reveals an enlarged and warm left humerus. His right leg is bowed Calcium: 2.34 mmol/l; PO43-: 0.9 mmol/l; ALP: 756 iu/L. Normal values for Calcium: 2.12-2.65mmol/l; Phosphate: 0.8-1.45mmol/l; ALP [Alkaline phosphatase] 30-300iu/L; Serum 25(OH) D: 20-105nmol/l; Urea: 2.5-6.7mmol/l; Creatinine: 70-120µmol/l

a) Osteomalacia
b) Multiple myeloma
c) Paget's disease of bone
d) Sarcoidosis
e) Hyperthyroidism


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