Question

a 73 - year - old female patient presents with low back pain, weight loss, and fatigue. the pain came on a couple months ago and it is waking her up a night. her peripheral blood smear indicates a rouleaux formation. what else would you expect to find on her lab results?
a) salt and pepper skull x - ray
b) decreased phosphorus
c) m - spike on electrophoresis
d) decreased alp
e) increased albumin levels

Explanation:

The patient's symptoms (low back pain, weight loss, fatigue, night - waking pain) and rouleaux formation (associated with increased immunoglobulin levels) suggest multiple myeloma. In multiple myeloma, there is an M - spike (monoclonal spike) on serum protein electrophoresis due to the overproduction of a single type of immunoglobulin (usually IgG or IgA) by plasma cells.

• Salt and pepper skull x - ray is more characteristic of conditions like hyperparathyroidism - related bone changes rather than multiple myeloma.
• In multiple myeloma, phosphorus levels are usually normal or increased (not decreased) due to bone breakdown.
• Alkaline phosphatase (ALP) is usually normal in multiple myeloma (unless there is liver or bone involvement in a non - typical way, but it is not a key finding).
• Albumin levels are often decreased in multiple myeloma as the production of normal proteins (like albumin) is suppressed in favor of the monoclonal immunoglobulin.

Answer:

C. M - spike on electrophoresis