QuestionSBA
QuestionChoice
The patient has a past medical history of polymyalgia rheumatica which can explain the elevated ESR, however, does not explain the pancytopenia or his current symptoms. PMR would present with shoulder and pelvic girdle stiffness, not lumbar spine pain and weight loss.
10003628
c
Polymyalgia rheumatica (PMR)
QuestionChoice
This would explain the patient's lumbar spine pain, weight loss as well as the elevated ESR. However, this would not explain the pancytopenia which makes this an unlikely diagnosis.
10003630
e
Discitis
QuestionChoice
The symptoms of lumbar spine pain and unintentional weight loss suggest malignancy. There is also pancytopenia and raised ESR which is classically seen in multiple myeloma. Patients are also likely to have raised calcium and signs of renal impairment.
10003626
a
Multiple myeloma
QuestionChoice
This is a haematological cancer which can cause pancytopenia and unintentional weight loss. However, Hodgkin's lymphoma is less likely in patients of this age group than multiple myeloma.
10003629
d
Hodgkin's lymphoma
QuestionChoice
This patient does have a past medical history of osteoarthritis, but this would not explain the presence of pancytopenia or red-flag symptoms like weight loss.
10003627
b
Osteoarthritis of the spine
Concept
Chapter
2693
3923
myeloma
Topic
157
Haematology
13272
An 82-year-old man has been admitted to the acute medical unit because he has lumbar spine pain and he is worried that he has lost 5kg in the past month. He has a past medical history of osteoarthritis and polymyalgia rheumatica. Physical examination is unremarkable.


Blood tests show:

||||
|--------------|:-------:|---------------|
|Haemoglobin|115 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|2x10<sup>9</sup>/L|3.0 - 10.0|
|Platelets|100x10<sup>9</sup>/L|150 - 400|
|Erythrocyte Sedimentation Rate (ESR)|115 mm/hr|< 20|


What is the most likely diagnosis?
a