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A 68-year-old male presents to his primary care physician with complaints of fatigue and pain in his upper arms and lower back for the past 2 months. Physical examination reveals pallor, hepatosplenomegaly, and focal bony tenderness to palpation over the lumbar vertebrae, bilateral humeri, and skull. Laboratory evaluation reveals hemoglobin 9.8 g/dL, serum calcium of 9.4 mg/dL, serum creatinine of 1.4 mg/dL, albumin of 3.7 g/dL, and rouleaux formation on peripheral blood smear. Serum protein electrophoresis reveals an elevated spike of a monoclonal IgG protein, with an M-protein serum concentration of 50 g/L. Which of the following radiographs would most likely be associated with this patient's condition?
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A 68-year-old man presents with a 6-month history of worsening fatigue and weight loss. He is especially concerned about a recent episode in which he noticed a blurring of his vision and headache; he also notes that his “memory is not as good as it used to be,” which his wife confirms. Physical exam is notable only for pallor and general weakness. Laboratory studies reveal anemia as well as an elevated erythrocyte sedimentation rate. Serum protein electrophoresis (SPEP) reveals a sharp, narrow spike of monoclonal IgM; serum IgM concentration is 6.3 g/dL. What is the most likely diagnosis in this case?
IgM monoclonal gammopathy of undetermined significance (MGUS)
Chronic lymphocytic leukemia
A 57-year-old woman with a history of hypertension presents to her physician with severe mid-back pain. She reports that the pain is sharp and began when she was reaching to retrieve a plate from a cabinet in her kitchen. She denies any major trauma to the back or any history of lifting heavy objects. On exam, she has spinal tenderness over the site, which is not warm or erythematous. On laboratory evaluation, she is found to have a creatinine of 5.6 mg/dL and a calcium of 16 mg/dL. Which of the following bone marrow biopsy findings is most likely to be found in this patient?