Case-based Internal Medicine: Elderly patient with fatigue, weight loss, and back pain (ER case)

Flashcards covering key concepts from an ER case of an elderly patient with fatigue, weight loss, and back pain, including differential, initial workup, and important exam/documentation considerations.

Why is it important to state that the patient is a reliable source in the HPI during an ER case discussion?

Declaring the patient as a reliable source ensures the information comes from a trustworthy source and helps prevent point deductions for documentation of source reliability.

What were the primary presenting complaints and their timeline in the 75-year-old male patient?

About four months of fatigue, new mid-back pain, and unintended weight loss (~10 pounds) over five months.

What red flags in this case would prompt you to consider cancer or anemia in an elderly patient presenting with back pain?

Unexplained weight loss, new fatigue, persistent back pain, and overall weakness.

What physical exam finding in an elderly patient with back pain should raise concern for fracture?

Tenderness to palpation over a bony prominence; treat as fracture until proven otherwise.

What are the initial laboratory and imaging studies recommended for this patient?

CBC with differential, CMP, and lumbar spine X-ray.

Which additional tests are suggested after initial labs to evaluate for anemia or bone marrow/plasma cell disorders?

Serum PTH, ECG, and urine protein electrophoresis or serum/urine monoclonal gammopathy testing.

Why might a clinician consider urinary symptoms in a 75-year-old man with this presentation?

Urinary symptoms can indicate prostate issues (e.g., BPH or cancer) that could contribute to fatigue or systemic symptoms.

What systemic signs should be asked about in the ROS to assess for malignancy in this patient?

Fever, chills, night sweats, and appetite changes; the presence or absence of these guides the differential alongside weight loss.

What is a common differential diagnosis for back pain with anemia and weight loss in an older patient?

Malignancy with possible bone involvement (e.g., metastatic cancer or multiple myeloma) or osteoporosis with fracture.

What role does the neurological examination play in this case?

A largely normal neuro exam does not rule out spinal pathology; focal back tenderness still warrants imaging and further workup.

What imaging modality is specifically mentioned for evaluating back pain in this scenario?

Lumbar X-ray to assess vertebral integrity and potential fracture.

What broader condition is being considered when the workup includes urine electrophoresis and monoclonal gammopathy testing?

Plasma cell disorders such as multiple myeloma and MGUS.