CHIEF COMPLAINT: Abnormal protein.

HISTORY OF PRESENT ILLNESS: This is a 52-year-old female with a history of hypertension and was referred for evaluation for abnormal protein around January. This month the patient complained about back pain. The patient was seen by her primary physician. Serum protein electrophoresis was performed, which shows a faint band of IgG kappa. The patient subsequently noted discharge from the back area. No fever. No sweats. The patient denied any other bone pain except occasional joint pain. No family history of multiple myeloma.

PAST MEDICAL HISTORY: The patient had kidney surgery in November 1985, C section two times, heart murmur as a child, breast reduction surgery in 1985, and hysterectomy.

ALLERGIES: Sulfa, penicillin, and shellfish.

MEDICATIONS: Clonidine, Aciphex, albuterol and ciprofloxacin for UTI.

FAMILY HISTORY: Father died of high blood pressure. Grandmother and sister had cervical cancer. Mother had diabetes. Brother has high blood pressure.

SOCIAL HISTORY: The patient denies history of smoking and drinks socially once or twice a month. The patient is a sales manager. Denies history of exposure to any chemicals or asbestos.

REVIEW OF SYSTEMS: General: Weight loss. Eyes: Negative. ENT: Negative. Heart: Negative. Endocrine: Feels occasionally sluggish. Psychological: Negative. Blood & Lymphatics: Negative. Urination: Feels occasional frequency. Muscle & Bone: Some joint pain and cervical pain, which is improved with some muscle aches. Skin: Rash. Neurological: Negative. Lungs: Occasionally has cough and wheezing. GI: Negative except indigestion and heartburn. Allergy: Hay fever and food allergy.

PHYSICAL EXAMINATION: Physical examination shows a well-nourished, well-developed obese female in no apparent distress. Weight is 191 pounds. Blood pressure is 130/84 mm Hg. HEENT: EOMI, PERRLA, sclera is non-icteric. Neck is supple. Lungs are clear to auscultation and percussion. Cardiac exam shows normal sinus rhythm. Abdomen is soft. There is no organomegaly. Chest shows breasts with reduction scar bilaterally. Extremities show no cyanosis, clubbing or edema. Skin shows no petechiae and ecchymosis. There is also no peripheral lymphadenopathy.

LABORATORY DATA: CBC done today shows hemoglobin of 13.1, hematocrit 40.1, white cell count 6300, granulocytes 67.8%, lymphocytes 27.8%, monocytes 4.4%, and platelets 304,000. IgA 343, IgG 1324, and IgM 334.

IMPRESSION: Monoclonal gammopathy of unknown significance.

PLAN: My plan is to obtain results of the bone survey and also to see patient in three months with followup immunoglobulin levels.

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