1. A 73-year-old female with a past medical history of IDDM T2, hypertension, and hyperlipidemia presented to the hospital with 1 month of neck and shoulder pain with associated paresthesia and weakness in the fingertips. The pain radiates down both arms. There is no history of recent fall or trauma. Current medications include: lantus 20 units QD, lisinopril 20 mg QD, and atorvastatin 40mg QD. She was also taking ibuprofen 600 mg 3-4 times daily for 3 weeks for the pain with no significant relief. Initial laboratory tests show a serum creatinine 1.48 mg/dL, calcium 14.1 mg/dL, and elevated protein gap of 6.2. The remainder of her chemistry panel is normal. In the ED, CT of the cervical spine disclosed a pathologic C7 fracture. In this setting of renal insufficiency, hypercalcemia, elevated protein gap and pathologic fracture, which combination of screening tests for plasma cell dyscrasias is most sensitive?

2. The following screening tests were done. Serum IFE revealed a monoclonal IgG kappa protein, and serum FLC assay measured the kappa at 16.8, lambda at 1.56, and a kappa/lambda ratio of 10.77. Multiple IV boluses of normal saline were given and the serum calcium normalized. However, the serum Cr continued to worsen despite the improvement in calcium, and progressed to 2.5 mg/dL. The patient underwent anterior cervical corpectomy of C7 with arthrodesis fusion with structural allograft from iliac crest for C6-T1. Specimens were sent to pathology from the bone fragment which revealed plasmacytoma. If a kidney biopsy was to be performed in this patient what would be the most common expected finding?

3. Type I cryoglobulinemia is diagnosed by the presence of monoclonal immunoglobulins that precipitate at colder temperatures. The primary disease that is associated with type 1 cryoglobulins are plasma cell dyscrasias such as multiple myeloma, Waldenstroms macroglobulinemia, and lymophoplasmacytic lymphoma. As these proteins precipitate, they can damage surrounding tissues in the skin, nervous system, and kidney. Where does precipitation primarily occur in cryoglobulinemic kidney disease?

4. Which of the following is associated with improved mortality benefit in patients with AL amyloidosis?

5. Which of the following findings on electron microscopy best describes the pattern of light chain deposition disease?

6. Which of the following dysproteinemic kidney diseases is associated with low-grade proteinuria, metabolic acidosis, hypokalemia, hypophosphatemia, hypouricemia, and normoglycemic glycosuria?