Soru

A 71-year-old man comes to the clinic reporting a 2-month history of worsening mid-to-lower back pain. The pain is constant, does not improve with rest, and occasionally awakens him at night. Over the same period, he has experienced progressive fatigue, constipation, and increased urinary frequency. His past medical history is notable only for mild osteoarthritis, for which he takes acetaminophen as needed. He does not use tobacco, alcohol, or illicit drugs. Vital signs are within normal limits. Physical examination reveals tenderness to palpation over the lumbar spine but no focal neurological deficits.

Laboratory results are as follows:

Hemoglobin: $9.2 \text{ g/dL}$
Leukocyte count: $6,500/\mu\text{L}$
Platelet count: $140,000/\mu\text{L}$
Calcium: $11.8 \text{ mg/dL}$
Creatinine: $2.1 \text{ mg/dL}$
Alkaline phosphatase: $95 \text{ U/L}$

Which of the following diagnostic tests should be ordered concurrently as the most appropriate next steps in this patient's initial workup? (Select all that apply)