Instructions
You are a medical student on placement in the general medicine clinic. Margaret Ellery, 69, has months of low back pain and tiredness. Her GP started ibuprofen 400 mg three times a day a month ago. Her bloods and spine X-ray are printed for you.
Interpret the results provided
Outline to the examiner:
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
- You do not need to take a history or examine the patient
- The examiner will ask you questions at the end
Bloods
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 96 g/L | 115-165 g/L |
| MCV | 90 fL | 80-100 fL |
| White cells | 5.1 x10^9/L | 4.0-11.0 x10^9/L |
| Platelets | 182 x10^9/L | 150-400 x10^9/L |
| ESR | 110 mm/h | <30 mm/h |
| Sodium | 136 mmol/L | 135-145 mmol/L |
| Potassium | 4.6 mmol/L | 3.5-5.2 mmol/L |
| Urea | 12.4 mmol/L | 3.0-8.0 mmol/L |
| Creatinine | 170 umol/L (88 a year ago) | 45-90 umol/L |
| Corrected calcium | 2.95 mmol/L | 2.10-2.60 mmol/L |
| Total protein | 98 g/L | 60-80 g/L |
| Albumin | 30 g/L | 35-50 g/L |
| ALP | 82 U/L | 30-110 U/L |
Lumbar spine X-ray
| Item | Value | Reference range |
|---|---|---|
| L3 vertebral body | Well-defined lytic lesion; vertebral height preserved | - |
| Bones | Generalised osteopenia | - |