<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 55-year-old man presents to the physician with tiredness, lethargy, bone pain, and colicky right abdominal pain for 1 month. He has no comorbidities. He does not have any significant past medical history. His height is 176 cm 5 ft 7 in, weight is 88 kg 194 lb, and his BMI is 28.47 kgm2. The physical examination is normal, except for mild right lumbar region tenderness. Laboratory studies show:Hemoglobin 13.5 gdLSerum TSH 2.2 mULSerum calcium 12.3 mgdLSerum phosphorus 1.1 mgdLSerum sodium 136 mEqLSerum potassium 3.5 mEqLSerum creatinine 1.1 mgdLUrine calcium ElevatedAn ultrasound of the abdomen reveals a single stone in the right ureter without hydroureteronephrosis. Clinically, no evidence of malignancy was observed. An X-ray of the long bones reveals diffuse osteopenia with subperiosteal bone resorption. The serum parathyroid hormone level is tested and it is grossly elevated. What is the most appropriate next step in his management?? A: 99mTc sestamibi scan with ultrasound of the neck, B: CT scan of the neck, C: Bone scan DEXA, D: Ultrasound of the neck only, E: Sestamibi scan only,  <response>: This is a clinical case scenario describing a 55-year-old man with symptoms of tiredness, lethargy, bone pain, abdominal pain, and kidney stones. Lab tests show elevated calcium, low phosphorus, elevated PTH, and bone X-ray shows osteopenia and bone resorption. This clinical presentation is most consistent with primary hyperparathyroidism caused by a parathyroid adenoma. The next step in management would be to localize the parathyroid adenoma. Sestamibi scan is the imaging test of choice for localizing parathyroid adenomas, and combining it with ultrasound of the neck increases the sensitivity. CT scan of the neck is not the preferred initial imaging test. Bone scan is not helpful for localizing the adenoma. Ultrasound of the neck alone has lower sensitivity than combined sestamibi and ultrasound.A: 99mTc sestamibi scan with ultrasound of the neck 