08-10-2011, 12:08 PM
A 64-year-old woman presents to her primary care physician with fatigue, weakness, and a
weight loss of 4.5 kg (10 lb) in the past 4 months. Additionally, she notes that her vision
has deteriorated over that time, and has had several severe nosebleeds. Physical examination
demonstrates hepatosplenomegaly, and laboratory tests show an increased total protein
level. Serum protein electrophoresis reveals a large spike in the gamma region. A skeletal survey is negative. Which of the following is the most likely diagnosis?
(A) Chronic lymphocytic leukemia
(B) Diabetes mellitus
© Monoclonal gammopathy of undetermined
signifi cance
(D) Multiple myeloma
(E) Waldenström’s macroglobulinemia
weight loss of 4.5 kg (10 lb) in the past 4 months. Additionally, she notes that her vision
has deteriorated over that time, and has had several severe nosebleeds. Physical examination
demonstrates hepatosplenomegaly, and laboratory tests show an increased total protein
level. Serum protein electrophoresis reveals a large spike in the gamma region. A skeletal survey is negative. Which of the following is the most likely diagnosis?
(A) Chronic lymphocytic leukemia
(B) Diabetes mellitus
© Monoclonal gammopathy of undetermined
signifi cance
(D) Multiple myeloma
(E) Waldenström’s macroglobulinemia
