NMS Q&A Family Medicine

Hematology 323whereas in multiple myeloma plasma cells are only rarelyseen peripherally. One percent of all adults and three percentof people over the age of 70 years have monoclonalgammopathy of unknown significance, most commonlyan IgG spike with less than 2.5 g/dL. In 25% of cases, thisprogresses over a period of many years to overt malignancy.Nearly all patients with IgG spikes 3.5 g/dL proveto have multiple myeloma.17. The answer is A. Hodgkin disease presents as a painlessmass, often in the cervical lymph nodes or with constitutionalsymptoms suggesting low-grade fever. Nearlyspecific is pain in the lymphoid mass with alcohol ingestionand often intolerance to tobacco.ReferencesFamily Medicine Review . Kansas City , Missouri ; May 3–10;2009.Fitzpatrick TB , Eisen AZ , Wolff L , Freedbuerg IM , Austen KF ,eds. Dermatology in General Medicine, 3rd ed. New York/St. Louis/San Francisco: McGraw-Hill ; 1987 .Lee GR , Bithell TC , Foerstel J , Athens JW , Lukens JN , eds. ClinicalHematology . Philadelphia; London: Lea and Febiger ; 1993.McKnight JT , Eklund EA . Hematology . In: Rakel RE, ed. Textbookof Family Practice . 6th ed. Philadelphia: WB Saunders ;2002 .McPhee SJ , Papadakis MA , eds. Current Medical Diagnosis andTreatment , 49th ed . New York/Chicago : Lange, McGraw-Hill ;2010.Mengel MB , Schiebert LP , eds. Family Medicine Ambulatory Care& Prevention, 5th ed. New York : Lange, McGraw-Hill; 2009 .Blinker CA . Blood . In: Tierney LM , McPhee SJ , Papadakis MA ,eds. Current Medical Diagnosis and Treatment . 45th ed . NewYork/Chicago/San Francisco: Lange, McGraw-Hill ; 2006 .