A 72-year-old male smoker with a 42-pack-year history presents with anorexia, cough, and altered mental status. A chest radiograph shows a right-sided mass that, on bronchoscopy, is identifi ed as squamous cell carcinoma. On physical examination, the patient is thin, cachectic, dehydrated, and disoriented with no focal neurologic defi cits. Th e calcium level is elevated (15 mg/dL), creatinine is 2.5 mg/dL, and albumin is 2.2 g/dL. A bone scan shows only some degenerative changes. What is the most appropriate next step in the management of this patient? a. Cisplatin-based chemotherapy b. Radiotherapy to the brain c. Intravenous fl uids and bisphosphonates d. Dexamethasone 100 mg given as an intravenous push e. Emergent magnetic resonance imaging of the head

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