<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 78-year-old man presents to his primary care physician for persistent back pain. The patient states that he has had back pain for awhile; however, this past weekend he was helping his son move heavy furniture. Since the move, his symptoms have been more severe. The patient states that the pain is constant and occurs throughout the day. On review of systems, the patient endorses a recent 15 pound weight loss and constipation. His temperature is 99.5F 37.5C, blood pressure is 13779 mmHg, pulse is 90min, respirations are 15min, and oxygen saturation is 98 on room air. Cardiovascular exam is notable for a murmur at the right sternal border that radiates to the carotids. Pulmonary exam reveals mild bibasilar crackles. Musculoskeletal exam is notable for mild midline tenderness of the lower thoracic spine and the upper segment of the lumbar spine. No bruising or signs of external trauma are observable on the back. Symptoms are not exacerbated when the patient is lying down and his straight leg is lifted. Strength is 55 in the lower and upper extremities. The patients sensation is intact bilaterally in his lower and upper extremities. Laboratory values are ordered and return as seen below.Hemoglobin: 11 gdLHematocrit: 34Leukocyte count: 10,500mm3 with normal differentialPlatelet count: 288,000mm3Serum:Na: 139 mEqLCl-: 100 mEqLK: 4.3 mEqLHCO3-: 25 mEqLBUN: 20 mgdLGlucose: 99 mgdLCreatinine: 1.6 mgdLCa2: 11.8 mgdLAST: 12 ULALT: 12 ULWhich of the following is the most likely diagnosis?? A: Muscle strain, B: Herniated nucleus pulposus, C: Sciatic nerve irritation, D: Piriformis muscle inflammation, E: Plasma cell dyscrasia,  <response>: Based on the patients age, persistent back pain, recent weight loss, constipation, mild anemia, elevated creatinine, and normal ASTALT, the most likely diagnosis is plasma cell dyscrasia. The back pain and constitutional symptoms point towards a malignant process like multiple myeloma. The mild anemia, renal insufficiency, elevated calcium, and normal liver enzymes support this diagnosis. Muscle strain, herniated disc, sciatica, and piriformis inflammation would not explain the constitutional symptoms or lab abnormalities. E: Plasma cell dyscrasia 