Plasma cell disorders Quiz: Ace Your Exams

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A 72 year-old man comes to his outpatient provider’s office because of lower back pain and fatigue. The symptoms started two months ago and have progressively worsened. Past medical history is notable for hypertension, for which he is taking hydrochlorothiazide and carvedilol. Review of systems is significant for 5 kg (11 lb) unintentional weight loss. The patient’s temperature is 37.6°C (99.7°F), pulse is 75/min, and blood pressure is 136/85 mmHg. Cardiopulmonary and abdominal examination is noncontributory. There is tenderness to palpation of the lumbar spine at the L2 to L4 level. Laboratory results are as follows:  

 Laboratory value  Result  Reference Range 
 Hemoglobin  8.7 g/dL  13.5-17.5 g/dL 
 Mean corpuscular volume (MCV)  85 fL  80-100 fL 
 Leukocyte count  3400/mm3  4,500-11,000/mm3 
 Creatinine  2.4 mg/dL  0.6-1.2 mg/dL 
 Calcium  11.5 mg/dL  8.4-10.2 mg/dL 
 Total protein  9.2 g/dL  6-7.8 g/dL 
 Albumin  3.9 g/dL  3.5-5 g/dL 
   
Which of the following is the most likely explanation for the patient’s symptoms? 

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