A 64-year-old man is evaluated because of fatigue and shortness of breath on exertion. He has had three episodes of urinary tract infection in the past 7 months. On physical examination, he has pallor but is otherwise normal. He denies blood loss, and his stool is negative for occult blood on three measurements. He is anemic (hemoglobin 8.4 g/dL) with normochromic, normocytic indices, and his serum creatinine level is 2.9 mg/dL. The total serum protein level is elevated, and the serum albumin level is low normal. His serum calcium level is 11.8 mg/dL.What is the most likely cause of his symptoms?
A)Multiple myeloma
B)Chronic pyelonephritis
C)Iron deficiency anemia
D)Colon cancer
E)Small-cell lung cancer

Question

Quizplus · Accepted Answer

The patient's presentation of anemia, elevated total serum protein with low normal albumin, elevated serum calcium, and renal impairment (indicated by a serum creatinine level of 2.9 mg/dL) is suggestive of multiple myeloma. Multiple myeloma often presents with a constellation of symptoms known as CRAB: hyperCalcemia, Renal insufficiency, Anemia, and Bone lesions. The recurrent urinary tract infections could be related to the impaired kidney function secondary to multiple myeloma.

A 64-Year-Old Man Is Evaluated Because of Fatigue and Shortness