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ngaybinhyen
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Topics: 23
Posts: 657
10/08/08 - 12:57 PM       #1

A 67-year-old woman comes to the clinic for an annual visit. She says she has been in good health other than her back pain which started 2 months ago right after she moved into her new house. The pain is constantly there but she says she can tolerate the pain very well. She denies any bladder or bowel incontinence. She has a past medical history of hypertension, hypercholesterolemia. and coronary heart disease. She underwent an angiogram with a stent placement 2 years ago. Physical examination shows a pulse of 80/min. respiratory rate of 16/min. blood pressure of 130/90 mm Hg. and temperature of 36.9 °C (98 °F). HEENT examination is normal. Cardiovascular examination shows normal S1 and S2 with no rubs or gallops. Lungs are clear to auscultation. Examination of the spine shows focal areas of tenderness on palpation of the lower spine. Straight leg raise test is negative. Neurologic examination is normal. Laboratory workup shows:
Hgb: 10.2 g/dL
WBC:8 OOO
Platelets:110,000/mm3
Sodium: 132mEq/L
Potassium: 4.7 mEq/L
Chloride: 101 mEq/L
Bicarbonate: 27 mEq/L
BUN: 46 mg/dL
Creatinine: .9 mg/dL
Glucose: 80mg/dl
Calcium: 11.2 mg/dL
Total protein: 8.2 g/dL
Albumin 2.0 g/dL
LFTs. PT. and INR are all within normal limits.

Which of the following is most likely to confirm the suspected diagnosis?
O A. Abdominal sonogram
O B. Bone marrow biopsy
O C. MRI of the spine
O D. Serum protein electrophoresis
O E. Urinalysis
O F. X-ray of the spine

What is the Dx?


docnit
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Topics: 8
Posts: 193
10/08/08 - 01:03 PM       #2

Multiple myeloma

Serum protein electrophoresis.

Anemia, hypercalcemia, back pain in elderly.

sucralfate
Forum Senior

Topics: 14
Posts: 79
10/09/08 - 12:07 PM       #3

D

Multiple myeloma


ngaybinhyen
Forum Guru

Topics: 23
Posts: 657
10/09/08 - 10:09 PM       #4

Yeap, it's multiple myeloma

But the answer is BM biopsy (higher priority than protein electrophoresis)
to confirm the Dx



sucralfate
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Topics: 14
Posts: 79
10/10/08 - 12:02 AM       #5

of course! that tricky thing about first, best or confirmatory test!

mad


drfax
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Topics: 23
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10/10/08 - 12:40 PM       #6

the major criteria for diagnosis of multiple myeloma (among choices) is Bone marrow biopsy to see plasmacytosis which must be greater than 30%

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ngaybinhyen
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Topics: 23
Posts: 657
10/10/08 - 01:14 PM       #7

I think 10% is enough to confirm MM, and < 5% is confirming for Monoclonal Gammopathy of Uncertain Significance (MGUS)



lampard
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10/10/08 - 10:36 PM       #8

yup > 10% fpr MM

<5 MGUS plus no other symptoms

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drfax
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10/11/08 - 04:05 AM       #9

ngaybinhyen wrote:
I think 10% is enough to confirm MM, and < 5% is confirming for Monoclonal Gammopathy of Uncertain Significance (MGUS)



10% is a minor criteria and three minor criteria must be preset to confirm MM
while 30% is a major criteria and one major and one criteria is necessary for Diagnosis of MM

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