09-30-2007, 11:29 AM
A 75-year-old white female presents with back pain of several months™ duration, which is
worsened by movement. Her examination is unremarkable except for mild pallor. She takes
furosemide (Lasix) for hypertension.
Laboratory Findings
Hemoglobin . . . . . . . . . . . . . . . . . 10.0 g/dL (N 12.0“16.0)
Serum creatinine . . . . . . . . . . . . . . 2.0 mg/dL (N 0.6“1.5)
BUN . . . . . . . . . . . . . . . . . . . . . . . 40 mg/dL (N 8“25)
Serum uric acid . . . . . . . . . . . . . . . 8.0 mg/dL (N 3.0“7.0)
Serum calcium . . . . . . . . . . . . . . . 12.0 mg/dL (N 8.5“10.5)
Total serum protein . . . . . . . . . . . 9.8 g/dL (N 6.0“8.4)
Globulin . . . . . . . . . . . . . . . . . . 6.1 g/dL (N 2.3“3.5)
Albumin . . . . . . . . . . . . . . . . . . 3.7 g/dL (N 3.5“5.0)
Serum IgG . . . . . . . . . . . . . . . . . . . 3700 mg/dL (N 639“1349)
Urine . . . . . . . . . . . . . . . . . . . . . . . positive for Bence-Jones protein
Which one of the following would be most appropriate at this point?
A) Repeat the physical examination and laboratory evaluation every 6 months
B) Take the patient off the diuretic and repeat the laboratory evaluation in 1 month
C) Obtain a bone scan
D) Obtain a bone marrow examination
E) Begin therapy with tamoxifen (Nolvadex), 20 mg daily
worsened by movement. Her examination is unremarkable except for mild pallor. She takes
furosemide (Lasix) for hypertension.
Laboratory Findings
Hemoglobin . . . . . . . . . . . . . . . . . 10.0 g/dL (N 12.0“16.0)
Serum creatinine . . . . . . . . . . . . . . 2.0 mg/dL (N 0.6“1.5)
BUN . . . . . . . . . . . . . . . . . . . . . . . 40 mg/dL (N 8“25)
Serum uric acid . . . . . . . . . . . . . . . 8.0 mg/dL (N 3.0“7.0)
Serum calcium . . . . . . . . . . . . . . . 12.0 mg/dL (N 8.5“10.5)
Total serum protein . . . . . . . . . . . 9.8 g/dL (N 6.0“8.4)
Globulin . . . . . . . . . . . . . . . . . . 6.1 g/dL (N 2.3“3.5)
Albumin . . . . . . . . . . . . . . . . . . 3.7 g/dL (N 3.5“5.0)
Serum IgG . . . . . . . . . . . . . . . . . . . 3700 mg/dL (N 639“1349)
Urine . . . . . . . . . . . . . . . . . . . . . . . positive for Bence-Jones protein
Which one of the following would be most appropriate at this point?
A) Repeat the physical examination and laboratory evaluation every 6 months
B) Take the patient off the diuretic and repeat the laboratory evaluation in 1 month
C) Obtain a bone scan
D) Obtain a bone marrow examination
E) Begin therapy with tamoxifen (Nolvadex), 20 mg daily
