A 78-year-old man presents to the surgery with pain in his left - TopicsExpress

A 78-year-old man presents to the surgery with pain in his left femur. He says this is a dull aching pain which seems to be there all day long, and it is driving him mad. He has lost about 4 kg in weight over the past few months and feels very lethargic, suffering from worsening bony aches and pains in other parts of his body as well. He reports the usual other complaints consistent with being elderly, including poor stream on passing urine. On examination his BP is 149/82, his pulse 72 and regular. His BMI is 21.5. You can demonstrate some bony tenderness on palpation of his lumbar spine. PR reveals an enlarged prostate. Investigations Haemoglobin 10.8 g/dl (13.5-18) White cell count 8.9 x 109/l (4-10) Platelets 170 x 109/l (150-400) Sodium 137 mmol/l (134-143) Potassium 4.9 mmol/l (3.5-5) Creatinine 135 μ/l (60-120) Alkaline phosphatase 450 U/l (39-117) Albumin 41 g/l 35-50() PSA 42 Ng/ml (

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