MRCP2-2391

MRCP2-2391

A 65-year-old woman presents to her new primary care physician with complaints of fatigue and weakness. She has a history of high blood pressure managed with lisinopril and amlodipine and has been experiencing back pain for the past 6 months. On examination, her blood pressure is 130/70 mmHg, pulse is 80 bpm and regular, and there is mild bilateral ankle edema.
Lab results show:
– Hemoglobin (Hb): 105 g/L (normal range: 120-160 g/L)
– White blood cell count (WBC): 12.2 x 10^9/L (normal range: 4.0-11.0 x 10^9/L)
– Platelets (PLT): 180 x 10^9/L (normal range: 150-400 x 10^9/L)
– Sodium (Na+): 140 mmol/L (normal range: 135-145 mmol/L)
– Potassium (K+): 4.2 mmol/L (normal range: 3.5-5.0 mmol/L)
– Creatinine (Cr): 100 µmol/L (normal range: 50-120 µmol/L)
– Albumin: 30 g/L (normal range: 35-55 g/L)
– Total protein: 62 g/L (normal range: 60-83 g/L)

Which of the following findings would be most suggestive of symptomatic myeloma?