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Monoclonal gammopathy — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Monoclonal gammopathyUSMLE Step 3

A 68-year-old man has an incidental IgG kappa monoclonal spike of 0.8 g/dL. Hemoglobin, creatinine, calcium, and skeletal survey are normal. Bone marrow plasma cells are 4%. He has no bone pain, infections, or neuropathy. Which of the following is the most appropriate at this time?

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Correct answer: B — Monitor for progression as monoclonal gammopathy of undetermined significance

Low M-protein, fewer than 10% clonal plasma cells, and no end-organ damage indicate MGUS, requiring surveillance rather than chemotherapy.

Reference: International Myeloma Working Group Criteria